Substance Use Disorder


For the treatment of substance use disorder, The Health Plan has adopted "Guidelines for the Treatment of Patients with Substance Use Disorders" published by The American Psychiatric Association.


Substance Abuse Disorder (SUD) Waiver Form

A universal SUD waiver form has been developed and accepted by all West Virginia managed care organizations requesting SUD services for Medicaid members. Completion of this form in its entirety may reduce the amount of requests for additional clinical information to support SUD services for our members.

The new SUD form is available in fillable format here.

Use of the new universal form is not mandatory. We will continue to accept the THP specific version of the SUD service request form still in use for other lines of business if Medicaid providers fill it out in error.

For assistance or questions, please contact the Clinical Services Department at 1.800.624.6961, ext. 7644.


SUD Medicaid Services Transitioned to Managed Care

All residential services, peer-to-peer recovery and naloxone administration by ambulance transport services transitioned to managed care. Methadone continues to remain under the fee-for-service program. In order to participate in the WV Medicaid Program and receive payment from The Health Plan, providers of SUD waiver services must meet all enrollment criteria which is described in Chapters 300 and 504 of the BMS Provider Manual. 

The Health Plan follows ASAM® criteria. This information is included in Chapter 504 of the BMS Provider Manual. You can also read more under Introduction to ASAM Criteria.

Providers will follow The Health Plan’s behavioral health prior authorization requirements, located under Prior Authorization and Referrals.


Questions?

Behavioral Health Specialist 304.720.4957
Utilization Review 740.699.6254
Referrals & Prior Authorizations 1.877.221.9295