Primary mental health services
We cover primary mental health services required by enrollees, including clinical evaluation and assessment, provision of primary mental health services, and/or referral for additional services, as appropriate.
The PCP of an enrollee requiring mental health services may elect to treat the enrollee if the treatment falls within the scope of the PCP’s practice, training and expertise. Neither the PCP nor Maryland Physicians Care may bill the Public Mental Health System (PMHS) for the provision of such services because these services are included in the HealthChoice capitation rates.
If a PCP believes an enrollee’s need for mental health treatment cannot be adequately addressed by primary mental health services provided by the PCP, the PCP should, after determining the enrollee’s eligibility (based on probable diagnosis), refer the enrollee to the PMHS for specialty mental health services.