Substance Use Disorder (SUD) Benefit for Medicaid Recipients
SUD Benefit Categories, Provider Types, Billable Services, and fee schedules for NH Managed Care Organizations
Medicaid Recipients
Medicaid recipients are eligible for a comprehensive SUD benefit, including:
- assessment
- outpatient services
- residential treatment
- opioid treatment programs
- recovery support services
- recovery monitoring
There are eight Substance Use Disorder (SUD) provider types and four existing Medicaid provider types that are able to provide SUD Services.
- Individual MLADCs
- Group MLADCs
- Individual LADCs
- Group LADCs
- Certified Recovery Support Worker (CRSW)
- Outpatient Substance Use Disorders Programs
- Comprehensive Substance Use Disorders Programs
- Recovery Community Organizations (RCOs)
The NH He-W 500 rules govern the Medicaid program with the He-W 513 series being specific to SUD services under Medicaid.
Checking Eligibility for Medicaid Recipients
It is important that providers check and confirm eligibility and health plan enrollment via the Medicaid Management Information System (MMIS) portal prior to providing services to Medicaid recipients. MMIS is the software system that maintains eligibility information for all NH Medicaid recipients. If providers have questions after checking the MMIS portal, please contact the state’s Medicaid Provider Service Center at 1-866-291-1674.