Missouri Care Mental Health Benefits
The table below shows the basic mental health benefits available to Missouri Care members. The table is not an exhaustive list. The specific services to be delivered to Missouri Care Members are described in detail in the MO HealthNet Managed Care Policy Statement. If you have questions as to whether a service is covered, contact the Missouri Care Behavioral Health Department at (800-889-4073).
| Covered Mental Health Service Overview |
| Covered Service |
Service Description |
| Outpatient Counseling |
Counseling with member, family members and/or group members; includes physician services as medically necessary; provided in an office setting from 60 to 90 minutes |
| Inpatient Treatment |
Acute inpatient, 24-hour, medically-based mental health treatment in either a specialty or general hospital setting. Includes detoxification. |
| Detoxification Services |
Detoxification from acute phase of alcohol and drug abuse. |
| Court-Ordered Services |
Services in the Comprehensive Benefit Package that are court-ordered for involuntary care and meet medical necessity criteria. |
| Emergency and Crisis Intervention |
Crisis/emergency face-to-face contact available 24 hours, seven days per week. |
| Medication Monitoring |
Medication monitoring and management. Individualized case management is provided and reported, but is not counted against the basic mental health benefit limit. |
Mental Health Provider Manual
Case Management
Case management assists participating providers in the care of members with special needs or complex mental health problems. Case management is available plan-wide. The following types of cases are most commonly referred to mental health case management:
- Pregnant and substance abusing members with treatment compliance and relapse problems
- Two or more readmissions within three months
- Chronic lethality risk with history of suicide attempts
- Chaotic family contributing to high use of service/cost of service
- Dual-diagnosed (substance abuse and mental health) members with more than two admissions in a three-month period and treatment compliance problems
- Children and adolescents at risk of out-of-home placement or loss of parental custody as indicated by either prior, current, or record of considerations of out of home placement or removal of parental custody
Behavioral Health Services Limitations
All members who are not covered under MO HealthNet within Category of Aid 4 (foster children) shall be eligible to receive all medically necessary mental health services included in the comprehensive benefit package. For children under the MO HealthNet Category of Aid 4, mental health services shall be provided by MO HealthNet on a fee-for-service basis.