Used to see if your youth has a substance use concern. It helps providers know the best way to help them. Results will not impact your youth’s eligibility for services.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Tests to see if your youth’s hair, urine, or saliva shows that there is alcohol or drugs in their body.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless your youth has already had 24 units/tests in the calendar year

BMC teaches your youth skills to manage their behavior in social and school settings. Your youth’s provider will evaluate them to see what behaviors may need to change. They will work with your youth and family on a plan for your youth to learn skills to improve their behavior. Your youth can get BMC services at home, in school and in the community.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

Case management is a collaborative process with a trained behavioral health professional. A case manager helps facilitate and advocate for options and services to meet your youth’s needs. They can help your youth access and coordinate care for their physical and mental health. They can also help your youth with community-living needs and connect your family to services.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless your youth has already had 240 units of case management in the calendar year

The CANS is a functional assessment tool for youth under 18 years old. All IBHP members under 18, both Medicaid members and other eligible members, must have a CANS assessment. The CANS is required to be updated at least every 90 days to track the child’s/youth’s progress.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

A CFT is a group of people your youth and family choose to help and support you while your youth gets treatment. At a minimum, the team includes the youth, family, and their primary mental health provider. It can also include friends, neighbors, coaches, instructors, religious leaders, and other community members and professionals.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

A CDA helps providers understand your youth’s mental health and substance use concerns and is used to develop a care plan. It includes a review of your youth’s health history and any family-related issues. A CDA needs to be completed every twelve (12) months. It can be updated more often if needed.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If your youth is having a behavioral health crisis*, you or they can call 988 or text 988 24 hours a day, 7 days a week to talk to a live person at the Idaho Crisis and Suicide Hotline. You/they can also call your youth’s treatment provider if the provider has after-hours services. This service gives you/your youth immediate help from trained professionals. Staff listen and connect callers to the right levels of care. 

• Medicaid: Available to all Idahoans
• Other State Funds: Available to all Idahoans
• Pre-Authorization Required: No

*A crisis is when you or someone you know is having sudden and severe mental health/substance use concerns, and you are unsure of what to do. See the How to Get Care section for more information.

Youth Crisis Centers (YCC) are safe places for youth, ages 12-17, to go to by choice if they are having emotional distress, psychiatric symptoms, substance use challenges, or other life stressors. Each YCC is expanding to include youth ages 5-17; call your local YCC for details. Your youth may stay at a Crisis Center for up to 23 hours and 59 minutes. A list of youth crisis centers can be found at this link.

• Medicaid: Available to all Idahoans
• Other State Funds: Available to all Idahoans
• Pre-Authorization Required: No

*A crisis is when you or someone you know is having sudden and severe mental health/substance use concerns, and you are unsure of what to do. See the How to Get Care section for more information.

With crisis* intervention services, you or your youth can talk to a behavioral health expert 24 hours a day, 7 days a week. The person will work with you or your youth to manage the crisis and make a plan to improve your youth’s situation.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

*A crisis is when you or someone you know is having sudden and severe mental health/substance use concerns, and you are unsure of what to do. See the How to Get Care section for more information.

Crisis* psychotherapy is available when your youth has a behavioral health crisis but is not at risk of hurting themselves or others. They talk with a trained therapist to explore and address the issues that led to their crisis. The goal is to help your youth get stabilized quickly.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

*A crisis is when you or someone you know is having sudden and severe mental health/substance use concerns, and you are unsure of what to do. See the How to Get Care section for more information.

This is an assessment a clinician does for children under age 6 to see if they show signs of mental health concerns.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If your youth starts to have signs of serious mental illness that interferes with their life, they may have ESMI.* The STAR program is for people who:

• Are between 15 and 30 years old
• Have experienced ESMI within the past two (2) years
• Have not received treatment
• Meet the criteria in the most recent version of The Diagnostic and Statistical Manual of Mental Disorders 

Services include:

• Assessments
• Treatment plans
• Psychoeducation
• Crisis intervention
• Case management and coordination
• Psychotherapy (individual and group)
• Peer support
• Medication management
• Education and career help

*ESMI is a condition that affects an individual, regardless of their age, and that is a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the current version of The Diagnostic and Statistical Manual of Mental Disorders as published by the American Psychiatric Association (APA). For a significant portion of the time since the onset of the disturbance, the individual has not achieved or is at risk for not achieving the expected level of interpersonal, academic, or occupational functioning. This definition is not intended to include conditions that are attributable to the psychologic effects of a substance, substance use disorder, are attributable to an intellectual developmental disorder or another medical condition. The term ESMI is intended for the initial period of onset of the symptoms.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

ECT is a medical treatment used for severe major depression or bipolar disorder that has not responded to other treatments. ECT involves a brief electrical stimulation of the brain while your youth is under anesthesia in a hospital.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

If your youth has serious emotional disturbance (SED), a mental health diagnosis, or a mental health and substance use diagnosis, you can get help from a Certified Family Support Partner (CFSP). CFSPs have experience parenting youth with mental health and substance use concerns. They know what your youth and family are going through, so you feel less alone. CFSPs encourage and empower families to identify and use strengths through the recovery process.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless your family has already had 416 units of family peer support in the calendar year.

Your youth and family can get information that can help understand your youth’s and family’s needs and strengths. This service is to help you learn about and understand your youth’s concerns, so you all can manage and make decisions in an informed way. Depending on what your youth or family needs help with, your youth can come to sessions with just your family or a group of families that share the same experiences.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Your youth and family can talk with a behavioral health expert about concerns you all have. Your all will learn coping skills to help manage them. You can meet with a provider with expertise with your youth’s concerns.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Functional assessments measure your youth’s ability to do things needed for daily living. It measures your youth’s strengths and needs.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Your youth can meet with a group of three or more people with similar concerns. Your youth and the other group members will talk and support each other. They may practice coping skills to learn how to manage concerns. The group is led by a behavioral health expert who makes sure youth are safe. 

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

HBAI takes place in clinics that provide medical services. Your youth may get mental health, substance use, and physical assessments and tests to determine what care they need.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless your youth has already had 60 units of HBAI in the calendar year

Idaho WInS is a family-driven program for youth with serious emotional problems. It also helps youth who are returning home from or at risk of needing out-of-home placement. It is a structured, evidence-based, high-fidelity form of Intensive Care Coordination delivered by providers. Idaho WInS allows your youth to get services at home and in the community. The services are "wrapped around" your family to keep your youth at home and your family intact. Idaho WInS is part of the YES system of care and is the Idaho model of Wraparound.

Youth on Medicaid can get this benefit through the month of their 21st birthday with the Early and Periodic Screening, Diagnostic, and Testing (EPSDT) benefit.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless youth gets service through EPSDT

Your youth can talk with a trained therapist to explore and address emotional, mental, and behavioral concerns. Therapy provides a safe space for your youth to understand feelings and develop coping strategies to improve overall wellbeing. They can meet with a provider with expertise with their concerns.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

A trained clinician and a skills builder work with your youth and family to create a personalized treatment plan. The approach focuses on your youth’s strengths and helps them meet goals.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If your youth has mental health concerns (with or without a co-occurring substance use concerns), and their thoughts, mood, perception, or behavior is substantially impaired, they may need to be admitted to the hospital for inpatient services. Your youth will get covered services in a hospital and stay there overnight.

If your youth does not have Medicaid, other state funds will cover inpatient care only if your youth is involuntarily admitted.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

If your youth has substance use concerns and needs medically managed withdrawal treatment and related care, they may need to be admitted to the hospital for inpatient services. Your youth will get covered services in a hospital and stay there overnight for at least one day.

• Medicaid: Covered
• Other State Funds: Not Covered
• Pre-Authorization Required: Yes

Your youth may get IHCBS if they:

• Are at risk of out-of-home placement
• Are transitioning back to live with their families
• Have significant behavioral health needs

Services can include therapy, behavior modification, and parent education and training.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

This is a structured program for your youth if they have mental health or substance use symptoms that can be managed in a level of care that is less intensive than partial hospitalization but higher than regular outpatient treatment. Services include:

• Assessment and treatment planning
• Psychotherapy and/or psychoeducation
• Skill-building activities
• 24-hour crisis services
• Psychiatric evaluation
• Medication management
• Substance use screening and monitoring, and drug testing (as appropriate)
• Physical exam completed within the first week of treatment
• Care coordination/transition management/discharge planning
• For eating disorders:
  • Health assessment and monitoring
  • Dietary and nutrition services

Your youth can get these services outside the program:

• Separate case management
• Respite
• Peer support 
• Recovery coaching
• Psychological/neuropsychological testing

Coverage:

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If English is not your youth’s or your primary language, or they/you are hearing impaired, they/you can get free oral translation or American Sign Language services when they/you are speaking to Magellan or providers. To get services, please call Magellan at 1-855-202-0973 (TTY 711).

Members who are hearing impaired can also use Idaho Relay Services at TTY 711 or: 

• Voice: 1-800-377-1363 
• Speech-to-Speech: 1-888-791-3004
• Visually Assisted Speech-to-Speech (VA STS): 1-800-855-9400
• Spanish: 1-866-252-0684

Written materials can be translated to another language and provided in alternate formats such as audio, large print, or Braille. For help with written materials, please call Magellan at 1-855-202-0973 (TTY 711).

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

A doctor or nurse meets with your youth to discuss the medicines they take and order new ones they might need.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Mobile response is a brief face-to-face community-based intervention to help your youth wherever they are if they are in crisis. Teams identify your youth’s stressors and focus on their strengths and natural supports to de-escalate the crisis and prevent future crises. Mobile response is delivered in the community. Teams are dispatched by calling 988 or texting 988 - the Idaho Crisis and Suicide Hotline. This is available for all Idahoans.

• Medicaid: Available to all Idahoans
• Other State Funds: Available to all Idahoans
• Pre-Authorization Required: No

If your youth has mental health concerns, your youth and family can meet with other families who face similar challenges. In a group setting with a trained professional, your family discusses and works on emotional concerns with other families. The goal is to help your youth and family grow, handle your emotions better, and improve daily life skills.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Formal sets of tests that help detect brain damage, injuries or other issues. They can reveal challenges in how the brain functions. These tests are given by a psychologist.

Maximum of 14 units of neuropsychological testing per member per calendar year

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If your youth is aged 10 through 17* and has a serious emotional disturbance or substance use disorder diagnosis, this program can help your family. PLL helps parents re-establish adult authority with consistent limits. It helps families reclaim loving relationships. It combines individual and group therapy and lets families meet other families with the same needs. 

Youth who have Medicaid can get PLL services through the EPSDT program through the end of the month of their 21st birthday. 

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless either:
  • Your youth gets the service through EPSDT, or
  • Your family has already had 12 weeks of PLL in the calendar year

If your youth has mental health or substance use concerns that can be managed in a level of care that is less intensive than inpatient hospitalization but higher than intensive outpatient, they may be able to attend a PHP for 20 or more hours a week. Your youth’s provider will determine if your youth’s age and concerns are appropriate for PHP. Your youth will not spend the night in the hospital. Services include:

• Assessment and treatment planning
• Psychotherapy and/or psychoeducation
• Skill-building activities
• 24-hour crisis services
• Psychiatric evaluation
• Medication management
• Substance use screening and monitoring, and drug testing (as appropriate)
• Physical exam
• Care coordination/transition management/discharge planning
• For eating disorders:
  • Health assessment and monitoring
  • Dietary and nutrition services

Coverage:

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

Formal sets of written, visual or verbal tests that are given by a psychologist. They help providers understand how your youth thinks, feels and behaves. They can also help determine your youth’s strengths, challenges, personality and how they handle situations.

Maximum of four (4) hours of psychological testing per member per calendar year

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If your youth has a mental health concern and their psychiatric, behavioral, or cognitive problems so severe that they need 24-hour care, they could go to a residential treatment center. A residential treatment center is not a hospital. Services include:

• Psychiatric care
• Psychological care
• Therapeutic and behavior modification
• Psychotherapy 
• Nursing care
• Family visits
• Psychoeducation

Coverage:

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

Respite is only available to families with youth who have been evaluated through the independent assessment process, diagnosed with Serious Emotional Disturbance and enrolled in the Medicaid YES Program. Respite care is short-term or temporary care for your youth so you can take a break from caregiving. It can last up to 72 consecutive hours when not delivered in a community setting. It can last up to 10 consecutive hours when delivered in a community setting. Respite is not to be used in place of childcare. Only IBHP network providers who have completed Magellan's Respite training can provide this service. 

Youth get a maximum of 300 hours per year of respite.

Respite may be available to youth who are not enrolled in the YES Program via the vouchered respite program. Information about the program can be found at bpahealth.com/respite-care.

• Medicaid: Covered
• Other State Funds: Not Covered
• Pre-Authorization Required: No

If your youth has mental health concerns that make it hard for them to do everyday tasks, this service can help. Your youth will work in a group to learn important daily living skills.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

If your youth has mental health concerns, they might be able to get CBRS at home or in the community. Providers use special techniques to help your youth improve behavior, social skills, communication, and daily living skills. It can help boost your youth’s abilities and confidence and reduce mental health symptoms.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless youth has already had 308 units of CBRS in a calendar year

TASSP is a range of therapeutic, recreational, and social activities for youth. TASSP helps them with social, communication, behavior, and basic living skills. Youth also get help with psychosocial and problem-solving skills. TASSP helps youth improve functioning at home, school, and in their community. Services are provided after school, on school breaks, and in the summer and can include you and your youth’s family. 

Youth who have Medicaid can get TASSP services through the EPSDT program through the end of the month of their 21st birthday.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless youth gets service through EPSDT

A doctor or nurse may give your youth medicine they need in a shot form. Injections may help people with long-term mental health conditions. They can lead to better results and consistent use. Sometimes injections are the best way to get certain medicines.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No

Day treatment is a program where youth with serious emotional disturbance get one-on-one or group treatment. Services can include assessments, therapy, medication management and skill building. Youth spend three (3) to five (5) hours per day, four (4) to five (5) days a week in day treatment.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: Yes

If your youth has serious emotional disturbance (SED), a mental health diagnosis, or a mental health and substance use diagnosis, they can get youth peer support. It is provided by a Certified Peer Support Specialist (CPSS) who has had Youth Peer Support Training. Specialists have personal experience with recovery from mental health and/or substance use concerns. Your youth can get one-on-one support or meet with a group. Youth support helps your youth:

• Know they are not alone
• Get involved in their treatment
• Set recovery goals
• Amplify their voice in decision making

If your youth is under age 12, see the Family Peer Support benefit.

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Authorization Required: No, unless youth has already had 416 units of peer support in the calendar year