Mental Health Residential Treatment Coverage

Due to the Mental Health Parity provision of the Affordable Care Act, residential treatment is now eligible for coverage as a behavioral health services benefit under the Quality Care Health Plan (QCHP) effective July 1, 2014.  This means residential treatment benefits may be eligible for coverage retroactive to July 1, 2014, as long as the stay meets the medical-necessity requirements.  The plan administrator for the QCHP health plan is Magellan Behavioral Health.  If a behavioral health provider is recommending residential treatment for you or a covered dependent, have the provider contact Magellan at 1-800-513-2611 for further information and determination of medical necessity.  If you or a dependent had residential treatment denied for services on or after July 1, 2014, contact Magellan for further information or to resubmit a denied claim.  Residential treatment is not eligible for coverage for dates of service prior to July 1, 2014, or for services deemed not to be medically necessary.  You may also contact the CMS Group Insurance Division for assistance at 1-800-442-1300.



Updated 04/30/2015