The Michigan Department of Health and Human Services (MDHHS) recently completed the April 2025 update to the MDHHS Medicaid Provider Manual, which will be available online April 1, 2025. This update aims to clarify coverage responsibilities among Medicaid Health Plans (MHPs), Prepaid Inpatient Health Plans (PIHPs) and Medicaid Fee-for-Service (FFS) to improve service delivery and reduce confusion among providers and beneficiaries.
The update specifically addresses coverage responsibilities for psychological and neuropsychological evaluations, including:
- MHPs will remain responsible for evaluations related to mild to moderate conditions, particularly when driven by medical necessity.
- PIHPs will handle evaluations and treatment if a severe condition is suspected.
- Medicaid FFS will cover behavioral health screenings, including psychological and neuropsychological evaluations, when performed by primary care providers or other qualified professionals for FFS beneficiaries. If a service is not included under the PIHP benefit or is provided by a non-PIHP enrolled provider, Medicaid FFS will assume coverage. However, if the beneficiary qualifies for PIHP services, the PIHP will take over coverage.
These clarifications will also be incorporated into the Beneficiary Eligibility subsection within the Behavioral Health and Intellectual and Developmental Disability Supports and Services section of the Medicaid Provider Manual. This update ensures that providers better understand their roles in delivering psychological and neuropsychological evaluations and that beneficiaries receive appropriate services based on their needs.
Members with questions may contact Lauren LaPine at the MHA.