Medical and Behavioral Health Coverage Policy

The Medical and Behavioral Health Coverage Section is made up of the Primary and Preventative Care Policy, Behavioral Health and Facilities, and Specialized Health Services units.  These units develop policy, procedures and programs focused on physician’s services, organ transplant services, inpatient and outpatient hospital services, durable medical equipment, hearing, vision and dental services, chiropractic and podiatric services, independent laboratory services, transportation services and services aimed at improving children’s health.

Primary and Preventive Care Policy

The Primary & Preventive Care Policy unit develops policy for procedures and programs focused on services furnished by the following professional practitioners and facilities:  physicians, advanced registered nurse practitioners, physician assistants, registered nurse first assistant; anesthesiology assistants, radiologists, midwives, birth centers, podiatrists, chiropractors, opticians, optometrists, hearing services provider, independent labs, portable x-ray, County Health Department, Federally Qualified Health Centers, Rural Health Clinic, Regional Perinatal Intensive Care Centers, and organ and tissue transplants.  

Health Care Policy Research

Responsible for the development of informed coverage decisions based on sources of reliable evidence by researching new or emerging health services.

Specialized Health Services Policy

The Specialized Health Services Unit is responsible for developing policy and administering the following programs: therapy services, home health, hospice, durable medical equipment and supplies, transportation, and dialysis services. In addition, the Specialized Health Services Unit is oversees prescribed pediatric extended care, medical foster care, early intervention services. Other services include Medicaid certified school match, school district administrative claiming, and county health department certified match policy.

Behavioral Health and Health Facilities

The Behavioral Health and Health Facilities unit develops policy, procedures, and programs for community behavioral health services (CBHS); specialized therapeutic services (STS); behavioral health overlay services (BHOS); substance abuse county match services; statewide inpatient psychiatric program services for children (SIPP);  state mental health hospital services; targeted case management services; nursing facility services; intermediate care facility services for the developmentally disabled (ICF/DD); assistive care services; inpatient and outpatient hospital services; and ambulatory surgical centers.