Provider guide to behavioral health
Find resources to support delivery of quality behavioral health care while meeting current requirements.
Access resources for behavioral health care
Molina uses an integrated, collaborative approach to behavioral health care. Molina encourages participation from primary care providers, behavioral health providers, and specialty providers to support whole-person care.
Provider resources
Behavioral health providers
Behavioral Health Residential Facility, BHRF
Molina requires all provider practices to align with secured BHRF requirements and follow provider requirements defined in AMPM 320 V. Services delivered to Molina members must meet all expectations outlined in AMPM 320 V for fee-for-service members.
Adult Behavioral Health Therapeutic Homes, ABHTH
Molina requires all providers to follow AMPM 320 X and procedure requirements defined in A.A.C. R9-10-1801 et. seq. and the Arizona State Plan for Medicaid.
Utilization management and prior authorization
Certain behavioral health services require prior authorization. Requests for behavioral health inpatient services, substance use disorder residential services, psychiatric residential treatment, and select outpatient treatments are submitted using the Prior Authorization form or by contacting Molina prior authorization services. Visit the Contact Us page to locate a state-specific phone number. Molina recommends use of the Availity provider portal for submission of all prior authorization requests.
Emergency psychiatric services do not require prior authorization. All behavioral health service requests must include the current Diagnostic and Statistical Manual of Mental Disorders classification and current clinical information supporting the request. Molina applies standard, generally accepted medical necessity criteria during prior authorization review.
Access to behavioral health providers and PCPs
Members receive referrals to in-network behavioral health providers through a primary care provider, medical specialist, or self-referral. Primary care providers screen and assess members for known or suspected behavioral health conditions and provide clinically appropriate behavioral health services within scope of practice and regulatory requirements. A formal referral or prior authorization is not required for member self-referral or referral to a primary care provider, specialist, or behavioral health provider. Prior authorization is required for services delivered by non-network behavioral health providers.
Behavioral health providers refer members to in-network primary care providers, or members self-refer. Behavioral health providers refer members for primary care or specialty services when physical or other health concerns are identified.
Care coordination and continuity of care
Discharge planning
Discharge planning begins at admission to an inpatient or residential behavioral health facility. Members admitted to inpatient or residential behavioral health settings must have an outpatient follow-up appointment scheduled prior to discharge. The appointment must occur within seven days of discharge.
Interdisciplinary care coordination
Molina emphasizes collaboration across the member treatment team to support whole-person care. Behavioral health, primary care, and specialty providers coordinate care to support communication, improve service delivery, and support improved health outcomes. Molina care management supports coordination and communication across the treatment team.
Care management
Molina care management includes licensed nurses and clinicians with behavioral health experience who support members with mental health or substance use disorder needs. Members with high-risk psychiatric, medical, or psychosocial needs are referred by a behavioral health provider or primary care provider.
Referrals to care management are made by phone. Visit the Contact Us page to locate a state-specific phone number.
Behavioral health care management
Molina works with providers to address care coordination and care management needs. All providers, including substance use disorder and behavioral health providers, must cooperate with Molina and provide relevant member records and information when requested. When consent or authorization is required by law, providers must make best efforts to obtain required consent or authorization from the member.
Molina and providers follow HIPAA and all applicable federal and state privacy laws, including HIPAA Privacy Rule at 45 C.F.R. Part 164 Subpart E, HIPAA Security Rule at 45 C.F.R. Part 164 Subpart C, 42 C.F.R. Part 2 governing confidentiality of substance use disorder patient records, and applicable state privacy laws.
Responsibilities of behavioral health providers
Molina supports collaboration and integration of physical and behavioral health services. Behavioral health providers deliver evidence-based mental health and substance use disorder services within scope of practice. Physical health services are delivered only when appropriate licensure is held.
Providers follow access and quality standards. Molina oversees provider compliance to support timely member access to services.
Members receiving inpatient psychiatric services must have an outpatient psychiatric appointment scheduled prior to discharge. The appointment must include date, time, location, and provider name and must occur within seven days of discharge. When a member misses an appointment, the behavioral health provider contacts the member within 24 hours to reschedule.
Molina monitors referral and intake processes to support timely access to behavioral health services. Referrals are accepted 24 hours per day, seven days per week. Referral processing is not delayed due to missing or incomplete information.
Behavioral health providers complete intake assessments with accurate data collection and provide appropriate accommodations for members with disabilities or language needs. Providers use a strength-based approach and determine urgency to schedule assessments within required timeframes with appropriate providers.
When emergency services are needed, services begin immediately. A financial screening must be initiated within five days of service.
Outreach, engagement, and re-engagement for behavioral health
Outreach
Molina participates in community events and educational activities related to health and plan information. Providers are encouraged to participate in outreach activities when possible.
Engagement
Providers participate in active treatment planning with involvement from:
Re-engagement
Behavioral health provider re-engagement efforts are documented in the medical record and include:
When outreach is successful and the member presents risk to self, others, or meets criteria for grave disability, the provider determines whether voluntary inpatient admission is appropriate. When voluntary admission is declined, the provider initiates the pre-petition screening or petition for treatment process defined in AMPM Policy 320-U.
Molina care management follows an outreach and unable-to-contact protocol and collaborates with providers to support re-engagement in treatment.
Behavioral health crisis line
Molina offers a Behavioral Health Crisis Line available 24 hours per day, seven days per week. Licensed behavioral health clinicians provide crisis intervention, referrals, and triage to appropriate supports and emergency response teams. Visit the Contact Us page to locate a state-specific phone number.
National Suicide Lifeline
The National Suicide Lifeline is available by dialing 988. Free, confidential support is available 24 hours per day, seven days per week, year-round, for individuals experiencing suicide or mental health crises or for those concerned about others.
Behavioral health toolkit
Molina provides an online toolkit to support screening, assessment, and diagnosis of common behavioral health conditions. The toolkit includes Behavioral Health HEDIS tip sheets, evidence-based guidance, provider training resources, and care coordination recommendations. Toolkit resources apply to both primary care and behavioral health settings.