Nebraska Medicaid Program

Behavioral Health Managed Care (BHMC)

(Mental Health/Substance Use Disorder)

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Effective September 1, 2013, Nebraska Medicaid moved to Full-Risk Managed Care for all Mental Health and Substance Use Disorder Services.  Magellan of Nebraska is the contracted Managed Care Plan for services provided to Nebraska Behavioral Health Managed Care Clients. The goal of this new delivery system is to provide services consistent with best practices that will decrease reliance on emergency and inpatient levels of care, increase evidence-based treatment, increase outcome-driven community-based programming and support, increase coordination between service providers, promote a Recovery Oriented System of Care, and increase access to high quality services to meet the needs of our diverse clients. 

The Behavioral Health plan is allowed to provide medically necessary services to the clients, in addition to those covered under Medicaid. The Behavioral Health Managed Care Plan covers the  following:

  • Inpatient Mental Health services
  • Residential Mental Health services
  • Outpatient Mental Health services
  • Substance Use Disorder Services
  • Psych RN Nursing Services
  • Behavioral Health Injectibles

The Behavioral Health plan is also allowed to provide “substitute health services” when the Behavioral Health plan has determined that it is more cost effective than the covered service and the health status of the client is expected to improve or stabilize. If additional or substitute health services are provided, the total payment to the Behavioral Health plan will not be adjusted but will remain within the certified rates agreed upon in any resulting contract and approved by Centers for Medicaid and Medicare Services.

All eligible members for Managed Care must be eligible for Medicaid services in the State of Nebraska.   To learn more about how to apply for Medicaid see ACCESS Nebraska. Certain Medicaid clients are automatically enrolled in Behavioral Health Managed Care. Enrollment in this plan takes effect the first day of the month that the client is determined to be Medicaid eligible, and in a mandatory enrollment group.   Clients who are eligible for BHMC may not opt out of managed care.    For a complete listing of eligible categories for enrollment please click on the Frequently Asked Questions link below.

Magellan will send a letter to members as they become eligible for enrollment.  Each member will also receive a Magellan Member Handbook with 30 days of enrollment.

All providers of services for Behavioral Health Managed Care members must be Nebraska Medicaid providers. For more information about provider enrollment see:   Nebraska Medicaid Provider Enrollment.

Additional Resources

Rules and Regulations for Behavioral Health Managed Care:

http://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-482/Chapter-5.pdf

Frequently Asked Questions

Provider Bulletin 13-19

Provider Bulletin 13-32

Provider Bulletin 13-55

Provider Bulletin 13-61

Magellan Contract 55286


 

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