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        • What are my basic covered services?
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      • Other Apple Health programs
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      • Learn about my coverage
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      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
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        • What is recovery support?
        • Peer support & counseling
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      • Prevention
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    • I help others apply for & access Apple Health
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
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      • Apply for or renew Apple Health coverage
      • Apple Health for you
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      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
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      • ​Program standard for income & resources
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      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
    • I need medical, dental, or vision care
      • Find Apple Health benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
      • Other Apple Health programs
        • Noncitizens
        • Apple Health Medicare Connect
        • Apple Health for Workers with Disabilities (HWD)
        • Family Planning Only (FPO)
        • Medically Intensive Children's Program (MICP)
        • Medicare Savings Program
        • Veterans & family members
      • Am I eligible?
        • Eligibility overview
        • Individual adults
        • Parents & caretakers
        • Pregnant individuals
        • Children
        • Age 65 & older, or Medicare eligible
        • Aged, blind, or disabled
        • Long-term care & hospice
        • Foster care
      • Learn about my coverage
        • Coverage with managed care
        • Coverage without managed care
        • American Indians & Alaska Natives
        • Coordination of benefits
        • Premium payment program
        • Patient review & coordination
        • Client rights
      • Use my coverage
        • How do I use my coverage?
        • Enrollment next steps
        • Make my first appointment
        • Transportation services (nonemergency)
        • Apple Health client booklets
      • Manage my coverage
        • Update my income or address
        • Log into my Apple Health accounts
        • Replace my services card
        • Change my health plan
        • Pay my Apple Health premium
        • Cancel my coverage
      Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Find Apple Health benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
      • Other Apple Health programs
        • Noncitizens
        • Apple Health Medicare Connect
        • Apple Health for Workers with Disabilities (HWD)
        • Family Planning Only (FPO)
        • Medically Intensive Children's Program (MICP)
        • Medicare Savings Program
        • Veterans & family members
      • Am I eligible?
        • Eligibility overview
        • Individual adults
        • Parents & caretakers
        • Pregnant individuals
        • Children
        • Age 65 & older, or Medicare eligible
        • Aged, blind, or disabled
        • Long-term care & hospice
        • Foster care
      • Learn about my coverage
        • Coverage with managed care
        • Coverage without managed care
        • American Indians & Alaska Natives
        • Coordination of benefits
        • Premium payment program
        • Patient review & coordination
        • Client rights
      • Use my coverage
        • How do I use my coverage?
        • Enrollment next steps
        • Make my first appointment
        • Transportation services (nonemergency)
        • Apple Health client booklets
      • Manage my coverage
        • Update my income or address
        • Log into my Apple Health accounts
        • Replace my services card
        • Change my health plan
        • Pay my Apple Health premium
        • Cancel my coverage
    • I need behavioral health support
      • Mental health
        • Mental health crisis lines
        • Mental health services
        • Acute mental health care
        • Problem gambling
        • Mental health advance directives
      • Substance use
        • Substance use treatment
        • Alcohol use treatment
        • Opioid use treatment
      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
        • Housing for transitioning youth
      • American Indians & Alaska Natives
        • Behavioral health services for American Indians & Alaska Natives (AI/AN)
      • Recovery support services
        • What is recovery support?
        • Peer support & counseling
        • Recovery housing
      • Prevention
        • Substance use disorder prevention & mental health promotion
      Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Mental health
        • Mental health crisis lines
        • Mental health services
        • Acute mental health care
        • Problem gambling
        • Mental health advance directives
      • Substance use
        • Substance use treatment
        • Alcohol use treatment
        • Opioid use treatment
      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
        • Housing for transitioning youth
      • American Indians & Alaska Natives
        • Behavioral health services for American Indians & Alaska Natives (AI/AN)
      • Recovery support services
        • What is recovery support?
        • Peer support & counseling
        • Recovery housing
      • Prevention
        • Substance use disorder prevention & mental health promotion
    • I help others apply for & access Apple Health
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
      Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
  • Employee & retiree benefits
    • Public employees
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
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        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, FSA, & DCAP benefits
        • PEBB wellness programs
        • Medicare & PEBB benefits while employed
      • Explore costs
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        • Change my coverage
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        • Accessing SmartHealth
      Quick links
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      • Log into PEBB My Account
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      MM - Footer
      • Contact us
      • PEBB news
      • Find benefits
        • Medical plans & benefits (including vision)
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        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, FSA, & DCAP benefits
        • PEBB wellness programs
        • Medicare & PEBB benefits while employed
      • Explore costs
        • Medical plan premiums
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        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Defer as a survivor
        • Enroll as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • School employees
      • Find benefits
        • Medical plans & benefits
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        • Vision plans & benefits
        • Benefits while traveling
        • Find a SEBB plan provider
        • Life, LTD, FSA, & DCAP benefits
        • SEBB wellness programs
        • Medicare & SEBB benefits while employed
      • Explore costs
        • Medical plan premiums
        • Life insurance premiums
        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • School employees
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
      • For groups joining SEBB
      MM - Footer
      • Contact us
      • SEBB news
      • Find benefits
        • Medical plans & benefits
        • Dental plans & benefits
        • Vision plans & benefits
        • Benefits while traveling
        • Find a SEBB plan provider
        • Life, LTD, FSA, & DCAP benefits
        • SEBB wellness programs
        • Medicare & SEBB benefits while employed
      • Explore costs
        • Medical plan premiums
        • Life insurance premiums
        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • Retirees
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home & auto benefits
        • PEBB wellness programs
        • Medicare & turning age 65
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
        • Denied coverage? You may still be eligible.
      • Learn how to enroll
        • How do I enroll?
        • Attend a retirement webinar
        • Verify & enroll my dependents
      • Learn how & why to defer
        • What is deferring & why would I?
        • How do I defer?
        • How do I enroll after deferring?
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • School employees
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
      • For groups joining SEBB
      MM - Footer
      • Contact us
      • PEBB news
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home & auto benefits
        • PEBB wellness programs
        • Medicare & turning age 65
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
        • Denied coverage? You may still be eligible.
      • Learn how to enroll
        • How do I enroll?
        • Attend a retirement webinar
        • Verify & enroll my dependents
      • Learn how & why to defer
        • What is deferring & why would I?
        • How do I defer?
        • How do I enroll after deferring?
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • PEBB Continuation Coverage
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, & FSA benefits
        • PEBB wellness programs
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Long term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • School employees
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
      • For groups joining SEBB
      MM - Footer
      • Contact us
      • PEBB news
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, & FSA benefits
        • PEBB wellness programs
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Long term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • SEBB Continuation Coverage
      • Find benefits
        • Medical plans & benefits
        • Dental plans & benefits
        • Vision plans & benefits
        • Benefits while traveling
        • Find a SEBB plan provider
        • Life & FSA benefits
        • SEBB wellness programs
      • Explore costs
        • Medical, dental & vision plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
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        • Denied coverage? You may still be eligible.
      • Learn how to enroll
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      • For survivors
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        • Enroll as a survivor
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      • Learn how to enroll
        • For newly eligible members
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      • Manage benefits
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      Quick links
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      • Log into PEBB My Account
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      • Learn how to enroll
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  • Billers, providers & partners
    • Prior authorization, claims & billing
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        • For new providers
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      • Submit prior authorization (PA)
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      Quick links
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        • Audit & program integrity
      • Submit prior authorization (PA)
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    • Program information for providers
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      • Programs: A-E
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        • Child & youth behavioral health services
        • Community behavioral support services
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        • Durable medical equipment
        • Early, Periodic Screening, Diagnosis, and Treatment
        • 340B Drug Pricing Program
        • 90- & 180-day civil commitment beds
        • Applied Behavior Analysis therapy
        • Child & youth behavioral health services
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      • Programs: F-H
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        • Family Planning Only
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        • Health Home
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      • Programs: I-N
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        • Managed care
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        • Immunization services
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        • Kidney Disease Program
        • Managed care
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      • Programs: O-P
        • Partnership Access Lines
        • Peer support
        • Pharmacy services
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        • Prescription drug discount card
        • Program of Assertive Community Treatment
        • Partnership Access Lines
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        • Program of Assertive Community Treatment
      • Programs: Q-Z
        • Resources for behavioral health providers
        • School-based health care services
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        • Transhealth program
        • Transportation services (nonemergency)
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
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        • Transhealth program
        • Transportation services (nonemergency)
      Quick links
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      • News
      • Getting started
        • Program benefit packages & scope of services
        • Patient review & coordination
        • Program benefit packages & scope of services
        • Patient review & coordination
      • Programs: A-E
        • 340B Drug Pricing Program
        • 90- & 180-day civil commitment beds
        • Applied Behavior Analysis therapy
        • Child & youth behavioral health services
        • Community behavioral support services
        • Dental services
        • Designated crisis responders
        • Durable medical equipment
        • Early, Periodic Screening, Diagnosis, and Treatment
        • 340B Drug Pricing Program
        • 90- & 180-day civil commitment beds
        • Applied Behavior Analysis therapy
        • Child & youth behavioral health services
        • Community behavioral support services
        • Dental services
        • Designated crisis responders
        • Durable medical equipment
        • Early, Periodic Screening, Diagnosis, and Treatment
      • Programs: F-H
        • Family Planning Only
        • First Steps (maternity support & infant care)
        • Foster care & adoption support
        • Ground emergency medical transportation
        • Health Home
        • Home health care services: electronic visit verification
        • Family Planning Only
        • First Steps (maternity support & infant care)
        • Foster care & adoption support
        • Ground emergency medical transportation
        • Health Home
        • Home health care services: electronic visit verification
      • Programs: I-N
        • Immunization services
        • Indian health programs
        • Intensive behavioral health treatment facilities
        • Intensive residential treatment teams
        • Interpreter services
        • Kidney Disease Program
        • Managed care
        • Medicaid Administrative Claiming
        • Immunization services
        • Indian health programs
        • Intensive behavioral health treatment facilities
        • Intensive residential treatment teams
        • Interpreter services
        • Kidney Disease Program
        • Managed care
        • Medicaid Administrative Claiming
      • Programs: O-P
        • Partnership Access Lines
        • Peer support
        • Pharmacy services
        • Preadmission screening and resident review
        • Prescription drug discount card
        • Program of Assertive Community Treatment
        • Partnership Access Lines
        • Peer support
        • Pharmacy services
        • Preadmission screening and resident review
        • Prescription drug discount card
        • Program of Assertive Community Treatment
      • Programs: Q-Z
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
        • Suicide prevention resources
        • Transhealth program
        • Transportation services (nonemergency)
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
        • Suicide prevention resources
        • Transhealth program
        • Transportation services (nonemergency)
    • Become an Apple Health provider
      • Learn how to enroll
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      • What's next
        • Track my application
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      • For existing medicaid providers
        • Update my provider information
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        • Revalidation
      Quick links
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      • Learn how to enroll
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        • Enroll as a nonbilling provider
        • Enroll as a billing agent or clearinghouse
        • Enrollment overview
        • Eligible provider types & requirements
        • Become a behavioral health provider
        • Enroll as a billing provider
        • Enroll as a health care professional practicing under a group or facility
        • Enroll as a nonbilling provider
        • Enroll as a billing agent or clearinghouse
      • What's next
        • Track my application
        • Find next steps for new Medicaid providers
        • Track my application
        • Find next steps for new Medicaid providers
      • For existing medicaid providers
        • Update my provider information
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    • Learn ProviderOne
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        • Fact sheets
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    • Prior authorization, claims & billing
      • Getting started
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
      • Submit prior authorization (PA)
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
      • Submit claims
        • Provider billing guides & fee schedules
        • Hospital rates & reimbursement
        • Provider billing guides & fee schedules
        • Hospital rates & reimbursement
      Quick links
      • Log into ProviderOne
      • Find billing guides & fee schedules
      • Find forms & publications
      • Sign up for Provider Alerts
      • ProviderOne Billing & Resource Guide
      • ProviderOne Discovery Log
      • ProviderOne maintenance
      • Termination & exclusion list
      MM - Footer
      • Contact us
      • News
      • Getting started
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
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        • Request a Zoom license
        • Audit & program integrity
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
      • Submit prior authorization (PA)
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
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  6. Mental health assessment for young children

Apple Health public health emergency (PHE)

Important: Stay covered! Are you enrolled in Apple Health (Medicaid) coverage? It may be time to complete your renewal. Make sure your address and phone number are up to date so you can stay enrolled. Report a change.

Mental health assessment for young children

Developmentally appropriate assessment and diagnosis is a key component of providing effective infant-early childhood mental health services. In 2021, the Washington State Legislature passed legislation (2021 c 126 § 2) to align Apple Health policies with best clinical practices for mental health assessments for young children (birth through age five). This page helps providers, billers, and partners stay informed about these efforts.

Want to connect with HCA's IECMH team?

Visit out IECMH Statewide Tour webpage to find out with HCA is coming to visit you!

On this page

  • Background
  • How do I bill?
  • Using the DC:0-5™
  • Other resources
  • Project updates 

Stay informed! Want to stay updated on work related to the DC:0-5™ and mental health assessment for young children?

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Background

Approximately 1 in 5 young children has a diagnosed mental, behavioral, or developmental disorder (Vasileva et al., 2021). These disorders, if properly identified using diagnostic criteria relevant to infant and early childhood development, can be effectively treated. Appropriate assessment leads to more effective treatment and reduces behavioral, school, and physical health risk factors over the long term.

The infant-early childhood mental health (IECMH) community in Washington state worked for several years to advance policies supporting developmentally appropriate assessment for young children, especially those enrolled in Apple Health (Medicaid). As the result of these efforts, the Washington State Legislature passed legislation in 2021 (2021 c 126 § 2) to align Apple Health policies with best clinical practices for mental health assessments for young children (birth through age five). The policy changes included:

  • Allowing reimbursement for multi-session assessments
  • Allowing reimbursement for provider travel costs for sessions in home/community settings
  • Requiring providers to use the DC:0-5

HCA began work to implement the mental health assessment for young children (MHAYC) policies in July of 2021, and these changes went into effect in January 2022. A survey conducted in the Fall of 2022 found that implementation of these policies was underway, with positive impacts on providers, families, and children. Read more under Project updates.

How do I bill?

HCA provides regular webinars to review guidance on billing related to Mental Health Assessment for Young Children (MHAYC). These webinars are designed for mental health clinicians, billing and coding staff, and agency leadership.

  • View past webinar slides
  • View past webinar recordings

HCA also provides quarterly virtual opportunities to support providers and agencies in implementing infant-early childhood mental health services, including MHAYC policies, through our IECMH Office Hours. Learn more on our Infant-Early Childhood Mental Health (IECMH) webpage, under IECMH office hours.

For multi session assessments

Providers conducting a mental health assessment (i.e., Psychiatric Diagnostic Evaluation or Intake Evaluation) with children from birth through age five can be reimbursed for up to five sessions per billing provider, per client, per calendar year without a prior authorization. Providers submit claims using the appropriate Psychiatric Diagnostic Evaluation CPT®/HCPCS codes for each of the sessions conducted with the child and/or child's family for the purpose of the assessment.

For guidance on billing these sessions, please see the Mental Health Billing Guide and Service Encounter Reporting Instructions (SERI).

For provider travel

Provider travel is eligible for reimbursement when providers are conducting a mental health assessment for children birth through age five in the home or in a community setting. The following information must be present on any submitted claims to qualify the claims for provider travel reimbursement.

  • CPT®/HCPCS Code (90791, 90792, H0031)
  • Client age (0 years up until 6th birthday)
  • Place of Service Code (03: School, 04: Homeless Shelter, 12: Home, 99: Other Place of Service)

Provider travel will be reimbursed by mileage. Current mileage reimbursement rates can be found on the Office of Financial Management's accounting resource page regarding travel.

Claims not eligible for reimbursement

Claims with a U8 modifier, which identify services provided to Wraparound Intensive Services (WISe) participants by qualified WISe practitioners, are NOT eligible for MHAYC provider travel reimbursement.

Provider travel resources for clients enrolled in Apple Health

With a managed care plan

Providers serving children enrolled in managed care should follow guidance from the managed care organization regarding provider travel reimbursement.

Without a manage care plan (or fee-for-service)

Providers serving children enrolled in Apple Health without a managed care plan (sometimes knows as fee-for-service or FFS) should use the Mental Health Assessment for Young Children (MHAYC) FFS A-19 template, following guidance including in the instructions. Guidance regarding MHAYC provider travel is also included in the Mental Health Billing Guide.

  • MHAYC FFS A-19 form
  • MHAYC FFS A-19 instructions

Additional questions can be directed to the HCA mental health fee-for-service team.

Using the DC:0-5™

The DC:0-5™ is the internationally-accepted system for developmentally appropriate assessment of young children's mental health and is recommended as a best practice by both CMS and SAMHSA. It uses developmentally specific diagnostic criteria that reflects mental health disorders that are typically diagnosed in infancy and early childhood. Washington is among many other states who are working to integrate use of the DC:0-5 into state policies and systems.

The state legislation creating the MHAYC policies (2021 c 126 § 2) did not include an explicit implementation date for required use of the DC:0-5™. HCA interprets that the intent of this legislation is to support the field in moving toward standard and expected use of the DC: 0-5™ for children birth through age five. Current efforts are focused on building workforce knowledge and capacity through the resources described below.

Apple Health DC:0-5™ Crosswalk

The Apple Health DC:0-5™ Crosswalk is a reference tool that helps Apple Health providers ‘crosswalk’ DC:0-5™ diagnoses to associated ICD-10 diagnostic codes, which are required for Apple Health billing purposes.

HCA’s Apple Health DC:0-5™ Crosswalk is informed by community feedback and grounded in infant-early childhood mental health research. The initial community-informed Apple Health DC:0-5™ Crosswalk was developed over the course of nine months in 2022, in partnership with a dedicated workgroup of infant-early childhood mental health (IECMH) providers and advocates. Learn more about the inaugural community review process.

2024 Apple Health DC:0-5 Crosswalk – community review process

The annual community review process for the Apple Health DC:0-5 Crosswalk will take place from October 5 until November 5, 2023. Feedback received through this review process will inform updates for the 2024 Apple Health DC:0-5™ Crosswalk, which is slated for publication on January 1, 2024.

The review process began with a Community Review Kick-off event, where HCA staff shared proposed crosswalk updates, areas of additional feedback, and the process to submit feedback.

  • Slides from the Crosswalk Review Kick-off

As a reminder, IECMH community members are always welcome to submit feedback through the Apple Health DC:0-5™ Crosswalk feedback form. A link to this form is also embedded on page 2 of the current Apple Health DC:0-5™ Crosswalk.

Why is a DC:0-5™ crosswalk needed?

Though the DC:0-5™ is recognized as the clinically appropriate manual for diagnosing infants and young children, other diagnostic manuals are often still necessary in the current behavioral health system. For Apple Health providers, federal guidance requires all claims be submitted with an ICD (International Classification of Disease) diagnostic code. Additionally, some electronic health record systems may require a DSM (Diagnostic and Statistical Manual) diagnosis in the documentation of services.

While the DC:0-5™ manual includes a crosswalk, it is not regularly updated; therefore, many states and regions, including Washington, publish their own crosswalks to align with current ICD coding guidance.

DC:0-5™ training

Because providers may not receive training in the DC:0-5™ manual as part of their education, additional professional development is needed to support implementation. In 2021, the legislature allocated funds to provide free DC:0-5™ training for Apple Health mental health and allied professionals.

Apple Health DC:0-5™ training is provided through the Infant-Early Childhood Mental Health Workforce Collaborative (IECMH-WC). Register for trainings and find additional resources on the Washington Association for Infant Mental Health (WA-AIMH) website, or contact the WA-AIMH training team.

DC:0-5™ in clinical records

Maintaining accurate clinical records is an important component of high-quality mental health services, including mental health assessments. Following a policy statement effective September 1, 2022 (CHS-07-20-22) and WAC amendment effective May 1, 2023, the Department of Health allows providers working in licensed behavioral health agencies to use either the DSM-5 or the DC:0-5, when completing a diagnostic assessment statement, as required in WAC 246-341-0640(c)(iv). This aligns with Apple Health guidance for mental health professionals to utilize the DC:0-5™ when completing a mental health assessment for children younger than six.

Providers serving young children may still experience other challenges translating clinical record guidance for adults, youth, and older children into developmentally relevant criteria. In the future, HCA intends to develop additional resources to support these needs. Providers or partners who may be interested in collaborating on this work should reach out to Christine Cole.

Other resources

Conducting developmentally appropriate mental health assessments for young children may be a new practice for some providers. HCA is providing additional resources to support best practices within the field.

MHAYC multi-disciplinary referral guide

A thorough mental health assessment includes gathering information about child functioning across settings and caregivers which often requires partnership from other professionals and disciplines. Further, an assessment may identify needs beyond mental health treatment necessitating referral to other services. To support providers in navigating the complex early childhood system, HCA has developed a tool to help providers identify referral partners for non-mental health specific needs related to a child's functioning and well-being. The multi-disciplinary referral guide provides examples of potential multidisciplinary partners, though it is not a comprehensive list.

Project updates

Mental health assessment for young children is an evolving project. Please check in regularly for new updates.

MHAYC implementation survey

In the Fall of 2022, twenty different providers from across the state completed the MHAYC implementation survey, sharing their experience in adopting the various components of the MHAYC policy. While this survey only represents a small number of providers, the results indicated a moderate uptake of the mental health assessment for young children (MHAYC) policies. Providers also reported that MHAYC policies have made billing for IECMH services easier, increased provider competence in serving young children, and improved access to developmentally appropriate services. To learn more about implementation strategies and challenges, as well as what HCA is doing next, read the report.

MHAYC community presentations

HCA has hosted community presentations about the past two years of implementation of MHAYC. The presentations outlined the shared progress, lessons learned, and details on what is coming up next.

  • 2023 MHAYC community presentation slides
  • 2022 MHAYC community presentation slides

Bulletin updates

HCA also sends periodic bulletin updates on implementation progress. Sign up for the Prenatal through Age 25 behavioral health mailing list to stay informed. Recent bulletins are now available on our IECMH webpage, under IECMH updates.

Contact

Email: Christine Cole, LCSW, IMH-E®
Infant and early childhood mental health program manager

Email: Kimberly “Kiki” Fabian, M. Ed
Infant and early childhood mental health systems analyst

Related forms and publications

  • MHAYC FAQ and resources
  • Mental Health Assessment for Young Children (MHAYC) fact sheet 2023
  • Cost Analysis for behavioral health assessment and diagnosis in infants and children (2020)

Related links

  • IECMH-WC: DC:0-5 Training information
  • Infant early childhood mental health services provider page
  • Infant early childhood mental health statewide tour page

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