Integrated Managed Care (IMC)/Behavioral Health Services Only (BHSO)

As a member of the Association of Washington Healthcare Plans (wahealthcareplans.org), Molina Healthcare covers behavioral health (BH) services for IMC and BHSO members statewide. This includes outpatient and inpatient mental health and substance use disorder (SUD) services.

While Molina members may self-refer and access services at any time, Molina recommends members be connected to a primary care provider (PCP) who can assess members for mental health or substance use concerns and refer as needed. PCPs should support and encourage members toward recovery and educate them on the benefits of treating these conditions as well as the risks of not treating them.

Under IMC/BHSO Molina covers the following types of services:

Mental health treatment services may include:

• Initial evaluation and specialty follow-up evaluations as needed
• Individual, group and/or family treatment services
• Other outpatient services such as:
• • Medication management/monitoring
  • Peer support
  • Psychological assessment
  • Program of Assertive Community Treatment (PACT)
  • Wraparound with Intensive Services (WISe)
  • • Visit the Washington State Health Care Authority (HCA) (hca.wa.gov) for more information on WISe services.
• Day Support (typically provided in community mental health agencies, clubhouses or community centers. Intensive rehabilitative program which provides a range of integrated and varied life skills training).
• Crisis stabilization in outpatient or inpatient settings
• Mental health intensive residential treatment
• Acute psychiatric inpatient admissions to community hospitals, free standing behavioral health facilities or Evaluation and Treatment (E&T) facilities

Substance use disorder treatment services may include:

• Initial evaluation and specialty follow-up evaluation as needed
• Individual, group and/or family treatment services
• Other outpatient services such as: peer support, case management
• Intensive outpatient programs (IOP)
• Opiate use disorder treatment program services that includes medications and/or therapy services
• Withdrawal management (detoxification)
• Substance use disorder intensive residential treatment, long term residential treatment and recovery house residential treatment

View the Apple Health IMC and BHSO Benefit Index found on the home page under Provider Manualsfor more information on Molina’s IMC/BHSO covered BH services.

View the BH Provider Prior Authorization Reference Guide to see which BH services require a prior authorization.

Use the Behavioral Health Admission Notification/Authorization Request Form to request a BH prior authorization.

Also see member-facing information on behavioral health and crisis services.

To find in-network behavioral health agencies and community health centers by region, click on the links below:

• Molina's Provider Online Directory.

If you need additional benefit information, assistance in arranging consults, or referrals for MH, SUD treatment or care for those with disabilities call (800) 869-7175 or log in at Availity Essentials Availity Provider Portal.