Behavioral Health and ARTS
Medallion and CCC+ Plans
Behavioral health services offer a wide range of treatment options for individuals with a mental health or substance use disorder. Many individuals struggle with mental health conditions such as depression, anxiety, or other mental health issues. Substance use may also be a factor.
These behavioral health services aim to help people live in their community and maintain the most independent and satisfying lifestyle possible. Services range from outpatient counseling to hospital care, including day treatment and crisis services. These services can be provided in your home or in the community, over a short or long time frame. All services are performed by qualified individuals and organizations.
Optima Health provides most of the Medicaid EPSDT covered services, including Applied Behavioral Analysis (ABA) services. Behavioral therapy services must be designed to enhance communication skills and decrease maladaptive patterns of behavior before there is a need for a more restrictive level of care.
- Are available to members under 21 years of age
- Include assessments (up to 5 hours per child, per provider)
- Should ensure the member’s family or caregiver is trained to support the member in the home and community using the skills learned while actively participating in behavioral therapy
- Are only allowed after the service provider documents that lesser services such as Community Mental Health Services (CMHS) services are not the best option
For assistance, please reach out to Behavioral Health Member Services at 1-757-552-7174 for Optima Family Care members, 1-757-552-7580 for Optima Health Community Care members, or call the toll free number at 1-888-946-1168 for both Optima Family Care and Optima Health Community Care members.
How to Access Medicaid Behavioral Health Services
To access behavioral health services, you can call Optima Health Member Services at 1-800-881-2166 TTY/TDD 711 for Optima Family Care members, or 1-888-512-3171 TTY 1-844-552-8148 for Optima Health Community Care members, Monday through Friday, 8:00 a.m. to 8:00 p.m.
The call is free and you can also be connected to your Care Coordinator during the call. You can also contact your Care Coordinator directly.
How to Access Non-Emergency Transportation Services Covered by Optima Health
Rides may be provided if you have no other means of transportation and need to go to an appointment for a covered service. Call SOUTHEASTRANS at 1-877-892-3986 (TTY: 711) for Optima Family Care members, Monday through Friday, 6:00 a.m. to 6:00 p.m., and 1-855-325-7558 for Optima Health Community Care members, Monday through Friday, 8:00 a.m. to 5:00 p.m. to set up a ride. Trips need to be scheduled at least five business days beforehand. Weekends and holidays do not count toward these days.
Behavioral Health Services Administrator (BHSA)
Some behavioral health services, such children’s residential treatment and therapeutic foster care case management, are covered for you through Magellan of Virginia. Magellan of Virginia is the behavioral health services administrator (BHSA) for the Department of Medical Assistance Services (DMAS). Optima Health’s Member Services Department can help coordinate the services you need, including those that are provided through the BHSA.
Community Mental Health Services (CMHS) and Trauma Informed Care
Optima Health provides coverage for traditional inpatient and partial psychiatric hospitalization. We also cover Community Mental Health Services (CMHS) for Medicaid members. CMHS services are also available for members who have experienced potentially traumatic events in their lifetime.
Trauma refers to intense and overwhelming experiences that involve serious loss, threat or harm to a person’s physical and/or emotional well-being. These experiences may occur at any time in a person’s life. They may involve a single traumatic event or may be repeated over many years. People often find a way of coping that may work in the short run, but can cause serious harm in the long run.
Optima Health’s in-network providers deliver services to members through a trauma-informed care framework.
Addiction and Recovery Treatment Services (ARTS)
Optima Health offers a variety of services that help individuals who are struggling with substance use. This includes alcohol and drug use. Addiction is a medical illness, just like diabetes. Many people face addiction, and can benefit from treatment. If you need treatment for addiction, we cover services that can help you.
Optima Health covers the following ARTS services:
- Inpatient acute detoxification hospitalization;
- Partial hospitalization;
- Group home / halfway house;
- Residential treatment facility services;
- Substance abuse intensive outpatient treatment;
- Outpatient (individual, family, and group) substance abuse treatment;
- Opioid treatment services (includes individual, group counseling; family therapy and medication administration); and
- Substance abuse peer specialist services.
Medication-assisted treatment options are also available for addiction involving prescription or non-prescription drugs. Peer services are provided by someone who has experienced similar issues and in recovery. Case management services are also available.
How to Access Addiction and Recovery Treatment Services (ARTS)
Talk to your Primary Care Provider (PCP) or call an Optima Health Care Coordinator to determine the best option for you and how to get help in addiction and recovery treatment services.
To find an ARTS provider, you can do any of the following:
- look in the Provider and Pharmacy Directory
- visit our website
- call your Optima Health Care Coordinator
- contact Member Services at 1-800-881-2166 TTY/TDD 711 for Optima Family Care members, or 1-888-512-3171 TTY 1-844-552-8148 for Optima Health Community Care members, Monday through Friday, 8:00 a.m. to 8:00 p.m.
If you have any questions or if you are interested in finding out more about ARTS, please do not hesitate to reach out to us. We hope you will take advantage of these services that are a benefit and are available at no cost to you.
Prior Authorizations for Behavioral Health and ARTS
Optima Health requires a prior service authorization for:
- all inpatient behavioral health and substance abuse admissions to hospitals
- partial hospitalization
- residential treatment
- substance abuse group home / halfway house treatment
- intensive outpatient substance abuse services
We also require a prior service authorization for the following Community Mental Health and Rehabilitation services (CMHRS) services:
- mental health case management
- therapeutic day treatment (TDT) for children
- Mental Health Partial Hospitalization Program (MH-PHP)
- crisis intervention and stabilization
- assertive community treatment (ACT)
- mental health intensive outpatient services (MH-IOP)
- mental health skill-building services (MHSS)
- intensive in-home
- psychosocial rehab
- mental health peer support services (individual)
- mental health peer support services (group)
- To find out more about how to request approval for these treatments or services, contact Member Services at 1-800-881-2166 TTY/TDD 711 for Optima Family Care members, or 1-888-512-3171 TTY 1-844-552-8148 for Optima Health Community Care members, Monday through Friday, 8:00 a.m. to 8:00 p.m., or call your Care Coordinator.
Any person or child admitted to a Therapeutic Group Home (TGH) will not be excluded from the Medallion 4.0 or CCC Plus Program; however, the TGH per diem service is “carved out” of the Medallion 4.0 and CCC Plus contracts and will be administered through Magellan of Virginia. Any professional medical services rendered to individuals in the TGH will be administered by Optima Health.