Idaho Medicaid members have many benefits available to them under Optum’s outpatient services including:
Adult Partial Care, Skills Training and Development: Your behavioral health care professional teaches you skills to support your recovery and reach your goals in a group setting.
Behavior Modification and Consultation (requires prior authorization): Your provider works with you to develop strategies to improve skills for identified behaviors. Behavior Modification and Consultation can be provided at any time and in any setting to meet your needs. These settings include home, school and other locations.
Case Management: A behavioral health care professional helps you learn how to coordinate and access your medical, mental health and community-living needs.
Crisis Intervention (a crisis is when you or someone you know is having sudden and severe mental health problems, and you are unsure of what to do): Crisis Intervention services allow you to talk to a behavioral health professional in a face-to-face setting, and are available 24-hours a day, seven days a week. The behavioral health specialist will work with you to manage the crisis and will help you develop a plan that includes the steps needed to reduce the crisis.
Crisis Response (a crisis is when you or someone you know is having sudden and severe mental health problems, and you are unsure of what to do): Crisis Response services allow you to speak with a mental health professional over the phone while you are in crisis and are available 24-hours a day, seven days a week. They will help you find resources to figure out your next steps. Some choices for follow-up might include calling your provider or even going to the emergency room. If your provider does not offer this service, you can call the Member Crisis Line for immediate help at 1-855-202-0973 TDD/TTY:711.
Comprehensive Diagnostic Assessment (CDA): A CDA is a process where a behavioral health care professional reviews past and present medical and behavioral information that you report and then makes a written summary and identifies a diagnosis, if needed.
Day Treatment (requires prior authorization): This service provides therapeutic outpatient care for when you have severe needs that require more care than intensive or routine outpatient care. This service may include skills building or group, individual and family therapy. Managing medication may also be included. You will be in therapy at least 3 hours per day and can be up to 5 hours per day. Treatment is 4 to 5 days a week. Day Treatment providers coordinate and communicate with other agencies, including coordination with schools.
Drug/Alcohol Testing: A test to see if you have been using chemical substances or alcohol.
Family Psychoeducation: You and your family are given information that can help you understand your mental health needs and strengths. This service is to help you make decisions in an informed way. Depending on what you need help with, you can attend sessions with just your family or a group of families that share the same experiences.
Family Psychotherapy: Your family can talk with a behavioral healthcare professional about emotional problems you and your family may be having and learn coping skills to help you and your family manage them.
Family Support: Family Support helps your family learn how to help you manage your treatment. This service is provided by a parent who also has lived experience of caring for a child with behavioral health issues and specific specialist training.
Group Psychotherapy: You will meet with a group of people with similar emotional issues and a behavioral healthcare professional. Group members share experiences and practice coping skills to learn how to manage issues as independently as possible.
Individual Psychotherapy: You can talk with a behavioral healthcare professional about emotional issues you may be having and learn coping skills to help you manage them.
Individualized Treatment Plan: A written plan you create with your behavioral health provider. The plan describes your behavioral health wellness goals and the steps you want to take to achieve your goals.
Intensive Outpatient Program (IOP): This service gives you outpatient therapy to help you manage your behavioral health or substance use disorder needs and met your treatment goals. This service also allows you to receive more intensive treatment when you need it. Adults participate at least three hours per day, three times a week. Adolescents participate at least two hours per day three times a week.
Peer Support - Adult Service: Peer Support Specialists use their lived recovery experience from a mental health diagnosis and specific specialist training to help you define your goals for recovery and develop a recovery plan. This service helps you learn to manage difficulties in your life.
Peer Support - Youth Support: Youth support helps you learn how to manage your treatment, makes sure that you know your rights and helps you speak for yourself. This service is provided by someone who also has lived experience of mental health issues as a child or youth, and specific specialist training to teach them how to work with youth. This can be done individually or in groups.
Pharmacologic Management (Medication Management): A doctor or nurse meets with you to discuss the medicines you are taking and order new prescriptions you might need.
Psychological Neuropsychological Testing: Written, visual or verbal tests that are given by a psychologist to measure your thinking and emotional abilities.
Respite: Respite is available to families with children who are in the Youth Empowerment Services (YES) Program. For more information, see page 23 of the Member handbook. Respite care is a short-term or temporary care so you and your primary caregiver can have a break. This service is designed to help reduce a stressful situation. This service is provided to give relief to the person who usually takes care of the youth. The combined (individual and group) limit if you or your family is receiving Respite services is 300 hours per calendar year.
Skills Building/Community Based Rehabilitative Services (requires pre-authorization): Services provided to you by a behavioral health professional in your home or community to help you gain skills for successful living. You will also practice skills you need to support your overall wellness and independent living abilities.
Optum Idaho is providing clarification on appeal rights for Peer Support Services and Family Support Services. If Peer Support or Family Support Services requested by a member’s provider are not authorized (or partially authorized) members will have the right to appeal this decision and/or file a State Fair Hearing request. You can find information on how to file an appeal or and you can 
find information on how to file a State Fair Hearing in the Member Handbook.
