OSP News

Medicaid Health Plans Provide Coverage for Inpatient Stays in Non-psychiatric Hospitals

Posted: 03/11/2024

Effective with admissions on or after October 1, 2023, Medicaid Health Plans will provide coverage for inpatient stays in non-psychiatric hospitals where the member has a primary or admitting behavioral health diagnosis and is waiting placement for a psychiatric bed.

This update is due to recent contract changes with the Michigan Department of Health and Human Services. Prior authorization requirements include:

  • Prior to requesting health plan authorization for these services, the hospital must obtain Community Mental Health/Pre-Paid Inpatient Health Plan authorization for the psychiatric inpatient stay when both the admitting and primary diagnosis are a behavioral diagnosis.
  • When submitting the PA request to Blue Cross Complete for inpatient stays requiring CMH/PIHP authorization, documentation of the CMH/PIHP authorization for the psychiatric inpatient stay must be submitted with the request.
  • Authorization requests which require prior approval by the CMH/PIHP that do not have this documentation will not be approved. Providers may appeal the denial through the appeal process. The provider must include the CMH/PIHP authorization with the appeal request.

Click here to read the full announcement released by Blue Cross Complete.

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