Optum Idaho Behavioral Health Plan - Resources & Tools

Click here to view the handbook, which is presented by Optum Idaho. For the Member Handbook in Spanish, click here. We manage outpatient behavioral health services. That means if you have Medicaid, we can help you find a mental health or substance use provider. 

A Person-Centered Service Plan (PCSP) is required for participants to access Medicaid home and community-based services (HCBS). If your child does not qualify for Medicaid under traditional income limits, and was eligible for Medicaid only after meeting with the independent assessor, or you access respite, you will need a PCSP.

The PCSP includes information about the child, including preferences, goals and strengths/needs, as identified in the CANS. It also includes a list of all formal and informal services and supports needed to achieve the identified goals. All supports are included regardless of whether they are reimbursable by Medicaid. Click here to view completed PCSPs via the portal. PCSPs are available for portal viewing once the member/family has signed consent for your access, the targeted care coordinator has added you as an approved contact within Optum Supports and Services Manager (OSSM) and the plan has met Code of Federal Regulations (CFR) requirements.

The Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) benefit allows a child under 21 years of age to receive medically necessary services that are not covered in the Idaho Behavioral Health Plan (IBHP). The EPSDT Service request form is used to request prior authorization for outpatient behavioral health services deemed medically necessary and are not covered by the IBHP. EPSDT prior authorization requests may be submitted by the child’s physician specialist or primary care provider. The request form must be signed by the parents/guardians or authorized representative. Please click on the link below to access the form and additional instructions on how to request EPSDT services.
EPSDT Form

Targeted Care Coordination (TCC) is the service provided by someone trained to help you access services, coordinate care between various providers and agencies, and monitor the progress of a member. Click here to view the latest listing of Targeted Care Coordination agencies.

Information about Medical Transportation Management, Inc. (MTM)

Medical Transportation Management, Inc. is the transportation broker responsible for coordinating Non-Emergency Medical Transportation (NEMT) for Idaho Medicaid eligible participants in the State of Idaho.

Medicaid Non-Emergency Medical Transportation is a phrase typically used to describe a transportation benefit for Medicaid members that ensures:

• Eligible patients can get to and from scheduled medical appointments, scheduled surgeries, urgent care or the hospital
• Trips are non-emergency in nature, meaning there is no immediate threat to the health or life of the participant
• Oxygen can be transported with the member as long as the member or their attendant can handle the equipment on their own.  Equipment being transported must be addressed at the time your ride is scheduled
• MTM does not transport to or from the Emergency Room

Patients may require NEMT for a variety of reasons, including: lack of a valid driver’s license, lack of a working vehicle, geographic isolation, or the inability to take traditional transportation for physical, mental, or developmental reasons.  Non-Emergency Medical Transportation exists to ensure that participants have access to routine and preventative care to increase overall health outcomes and avoid costly ambulance bills or emergency room visits.

Link to the MTM website is accessible here: http://www.mtm-inc.net/idaho/  

MTM telephone number: 1-877-503-1261  TTY: Dial 711

This online support group offers support with others who have gone through a similar situation you or a family member might be going through. These online forums are available to learn and to connect with others.

Dig deeper into mental health topics that are important to you. In these short videos from PsychHub, you’ll hear personal stories, find out about common symptoms and learn how treatment can help restore health and well-being.

A statewide community information and referral source to programs that offer free or low cost health and human services or social services and the details on how to obtain these resources is available.

To learn more about Medicaid benefits and eligibility, details are available. If you are a Medicaid member inquiring about behavioral health services, please also visit our contact us page.