Florida Medicaid Behavioral Health Services Overview
Florida Medicaid offers a comprehensive behavioral health benefit package that includes community and inpatient services, therapeutic foster care, and specialized treatment services for members under 21. The Statewide Medicaid Managed Care program ensures access to critical behavioral health services through provider networks that meet set standards. Monitoring is conducted to uphold network requirements, including provider ratios, time, distance, and appointment wait times. A review of Calendar Year 2021 Quarter 2 shows overall compliance with network ratios and appointment wait times, with some challenges in meeting time and distance requirements for certain provider types.
- Florida Medicaid
- Behavioral Health Services
- Provider Networks
- Medicaid Managed Care
- Access Monitoring
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Commission on Mental Health and Substance Abuse Simone Marstiller, Secretary October 20, 2021
Behavioral Health Services Florida Medicaid provides a comprehensive behavioral health benefit package that includes an array of community and inpatient services. Specialized therapeutic foster care services Members under 21 years old are entitled to an additional array of prevention, diagnostic, and treatment services such as: Statewide Inpatient Psychiatric Program services Therapeutic behavioral on-site services Most members receive services through the Statewide Medicaid Managed Care (SMMC) program, and from providers who participate in their SMMC plan network.
Ensuring Access Additional specialized behavioral health provider network monitoring is conducted to ensure enrollees have access to critical behavioral health services. SMMC plans must maintain sufficient provider networks to meet standards established by the Agency. The Agency conducts systematic and continuous monitoring of each plan s provider network. Plans must meet provider network requirements or be fined or sanctioned.
Ensuring Access Behavioral Health Provider Network Ratio, Time and Distance Requirements: Provider Type Ration Board Certified or Board Eligible Adult Psychiatrists members Board Certified or Board Eligible Child Psychiatrists members Licensed Practitioners of the Healing Arts members Time and Distance 1 per 1,500 Urban Max Time: 30 minutes; Max miles: 20 1 per 7,100 Rural Max Time: 60 minutes; Max miles: 45 1 per 1,500 Appointment Wait Time Requirements: Urgent Services Within 48 hours for services not requiring authorization Non-Urgent Services 7 days post discharge from inpatient behavioral health admission for follow-up behavioral health treatment 14 days for initial outpatient behavioral health treatment Within 96 hours for services requiring authorization
Ensuring Access Calendar Year 2021 Quarter 2 Behavioral Health Provider Network Ratio, Time and Distance Review: All of the plans met the ratio requirements where licensed providers were available 12 plans had some difficulty meeting Time and Distance for Child Psychiatrists and Adult Psychiatrists Calendar Year 2021 Quarter 2 Appointment Wait Time Review: 98% average compliance for post discharge follow up appointments 99% average compliance for initial outpatient treatment
Accessing Behavioral Health Services Once enrolled in an SMMC plan, members are provided contact information for their plan to receive assistance in locating providers. Member Handbook ID Card Plans are required to help members find a provider. If a member wishes to see a specific provider, they may be subject to a wait if that provider has no immediate appointments available. The Medicaid Helpline (1-877-254-1055) is available to provide assistance.
Increasing Access Behavioral Health Workforce: Need has increased: Pandemic Increased acceptance Initiatives like First Lady DeSantis Hope for Healing Florida Campaign Like all states, Florida is experiencing workforce challenges across the healthcare sector. Team approach to build improved provider networks.
