Idaho Admin. Code r. 16.03.09.711, Outpatient Behavioral Health Services: Procedural Requirements

Requires providers that wish to provide outpatient behavioral health services to Medicaid participants to enroll with the contractor that administers the Idaho Behavioral Health Plan (IBHP) and to meet the IBHP contractor’s credentialing and quality assurance guidelines.  Grants the contractor responsibility to authorize covered behavioral health services that would otherwise require prior authorization. Subjects complaints, grievances, and appeals to a process administered by the contractor and the Department of Health and Welfare. Requires participants to exhaust the contractor’s appeals process prior to seeking an appeal with the Department.