Covered and Non-Covered Services

We pay for the substance use disorder services listed below. Your provider needs to follow the appropriate Community Care authorization and billing procedures to be paid for services.

Covered Services:

  • Admission to a hospital for 24-hour care for mental or emotional illness
  • 24-hour care and rehabilitation for substance use disorders in a hospital or non-hospital setting
  • Partial hospital day programs for mental illness
  • Outpatient services for mental health or substance use disorder treatment
  • Withdrawal Management (formerly known as “detox”) from substances

  • Methadone maintenance (for treating people with opioid use disorder)
  • Laboratory services (if ordered by a psychiatrist in our network)
  • Case management services
  • Crisis services

Services Specific to Children and Adolescents:

  • Behavioral Health Rehabilitation Services (BHRS) for children and adolescents
  • Residential Treatment Facilities (RTF)
  • Community and home-based care
  • Family-based treatment

Anything not listed above is not covered by Community Care. Experimental services are not covered. Community Care does not manage your physical (medical) health care. Your physical health plan or Physical Health Managed Care Organization takes care of this. This includes pharmacy, durable medical equipment, and physical health needs. If you have questions about physical health, please contact your physical health plan.