Attention Medicaid Members: Outpatient Mental Health and Substance Use Disorder (SUD) Services Available
Date: 11/01/24
Superior HealthPlan understands there may be times when inpatient hospital admission is needed for members experiencing mental health or substance use disorder (SUD) issues. When these services are needed, they are ordered by your doctor. For some members, outpatient services are an option to an inpatient hospital admission. These outpatient services include either outpatient Partial Hospitalization Program (PHP) services or Intensive Outpatient (IOP) services. PHP and IOP are available to Superior adult members, aged 21 and older for outpatient care “In Lieu Of” an inpatient admission. PHP and IOP are also available for Medicaid members under the age of 21 as Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services, known in Texas as Texas Health Steps services.
- PHP services provide a structured day program of outpatient behavioral health services. PHP may provide services for mental health, SUD, or both. These services are similar to short-term hospital inpatient programs. The treatment level is more intense than outpatient day treatment or psychosocial rehabilitation.
- IOP services are used to treat issues that do not require SUD detoxification or 24-hour supervision. IOP services are generally less intense than PHP services. IOP may be delivered for mental health, SUD, or both. Intensive outpatient services are organized non-residential services providing structured group and individual therapy, educational services, and life skills training which consists of at least 10 hours per week for 4-12 weeks, but less than 24 hours per day.
Members must get an order from their doctor to get PHP or IOP services from one of Superior’s network providers. Superior requires prior authorization for both PHP and IOP services. If the member’s doctor believes that the best treatment is PHP or IOP instead of being admitted to an inpatient hospital, the doctor will discuss this option with the member, and confirm the member’s agreement with, or refusal of the proposed IOP or PHP treatment, instead of an inpatient admission. Members can refer to Rights and Responsibilities section of their member handbook by visiting Superior's Member Handbook webpage. This section will explain the member’s right to agree to or refuse treatment, and the right to actively participate in treatment decisions.
The member’s doctor will issue an order for the proposed IOP or PHP treatment and a prior authorization request will be sent to Superior to have the services authorized for approval by or before treatment. Superior will review the prior authorization request to confirm if the PHP or IOP service requested is medically necessary and appropriate for the member.
The member’s doctor may also determine that PHP or IOP may be an appropriate ‘step down’ level of care for a member who is discharging from an inpatient psychiatric hospital, when appropriate. In addition, neither the doctor nor Superior will require that IOP or PHP services are received before an inpatient admission is ordered or approved, when a member’s treatment is required in an inpatient hospital.
Members can access a listing of providers available in Superior’s network to provide PHP and IOP services through Superior's Find a Provider webpage by clicking Search Medicaid or CHIP Providers or Search STAR Health Providers. For assistance with locating an IOP or PHP provider in the member’s area or to get a paper copy of a provider directory at no cost, call Superior Member Services using one of the phone numbers listed below:
- STAR: 1-800-783-5386
- STAR+PLUS: 1-877-277-9772
- STAR Kids: 1-844-590-4883
- STAR Health: 1-866-912-6283