BHA Systems Overview
The Behavioral Health Administration (BHA) is the agency within the Department of Health and Mental Hygiene responsible for the delivery of public behavioral health services. BHA operates five inpatient psychiatric facilities and two residential treatment centers for children and adolescents, and funds community behavioral health services for Medicaid eligible individuals. In addition, BHA funds services to individuals who, because of the severity of their illness and their financial need, are qualified to receive state subsidized services. For the most part, these services are provided and funded through a fee-for-service system.
In the community setting, BHA funds community behavioral health services for individuals who are eligible for Medicaid. Services are also provided to those, who because of the severity of their illness and their financial need, qualify to receive state-subsidized services.
These services are provided by 19 Core Service Agencies (CSA) located across Maryland. The CSAs contract for services that include peer support programs, training and others not reimbursed through the fee-for-service system.
BHA and the Core Service Agencies are assisted in their responsibility to manage the Public Behavioral Health Services by an administrative service organization (ASO), which operates under a contract with BHA. The ASO, Beacon Health Options, authorizes services, provides utilization management, management information, claims processing, and evaluation services.
The ASO provides the following services:
- 24-hour access for clinically related calls
- Referring individuals to qualified service providers
- Preauthorization of non-emergency care
- Review of Authorization Plans to assist in determining whether an individual meets Medical Necessity Criteria and is part of the Public Behavioral Health System
- Conducting utilization reviews of services
- Collecting data
- Processing claims
- Remitting payments
- Assisting with the evaluation of the PBHS
Any practitioner who is authorized under the Health Occupations Article according to Maryland state law (COMAR) to provide behavioral health services, or a provider who is licensed under the Maryland Department of Health and Mental Hygiene Regulations, may be a provider in the PBHS.