Behavioral Health

Primary Mental Health Services for MPC Members

MPC covers primary mental health services required by enrollees, including clinical evaluation and assessment, provision of primary mental health services, and/or referral for additional services, as appropriate.

The PCP of an enrollee requiring mental health services may elect to treat the enrollee if the treatment falls within the scope of the PCP’s practice, training, and expertise. Neither the PCP nor Maryland Physicians Care may bill Maryland’s Public Mental Health System (PMHS) for the provision of such services because these services are included in the HealthChoice capitation rates.

If a PCP believes an enrollee’s need for mental health treatment cannot be adequately addressed by primary mental health services provided by the PCP, the PCP should, after determining the enrollee’s eligibility (based on probable diagnosis), refer the enrollee to the PMHS for specialty mental health services.

Primary Substance Use Services for MPC Members

MPC covers primary substance use services required by enrollees, including screening, provision of early intervention, and/or referral for additional services, as appropriate.

The SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence-based approach used to identify and address risky substance use behaviors in healthcare settings. The SBIRT should be used during well child visits to:

• Identify patients at risk for substance use disorders (SUDs);
• Provide early intervention to prevent or reduce substance use-related problems; and
• Connect patients with appropriate treatment and support services.

Best practice is also to obtain a release of information to the State’s behavioral health/substance use vendor following the ROI process under 42 CFR, Part 2.