Program Information

Note: Effective for dates of service on or after January 1, 2021, Tufts Health Plan does not require notification for behavioral health outpatient psychotherapy. Prior authorization for certain outpatient procedures are still required as indicated in Outpatient Services Requiring Prior Authorization for Commercial and Senior Products.

Coverage is provided for benefits related to children and adolescents up to age 19 with behavioral health disorders that substantially interfere with or substantially limit their functioning and social interactions.

Medical Necessity Guidelines

• NEW Effective 1/1/2021 Therapeutic Mentoring (TM): Massachusetts Products
• NEW Effective 1/1/2021 Family Support & Training (FS&T): Massachusetts Products
• In-Home Behavioral Services (IHBS): Massachusetts Products
• In-Home Therapy Services (IHTS): Massachusetts Products
• Mobile Crisis Intervention (MCI): Massachusetts Products
• Targeted Case Management Services: Intensive Care Coordination (ICC): Massachusetts Products
• Behavioral Health Level of Care Determinations

Payment Policies

• Inpatient and Intermediate Behavioral Health/Substance Use Disorder Facility Payment Policy

Authorization Requirements

• Behavioral Health Authorization Requirements

• Medical Necessity Guidelines: Psychological Testing and Assessment
• Medical Necessity Guidelines: Neuropsychological Testing and Assessment
• Psychological and Neuropsychological Assessment Supplemental Form

• Designated Facilities Information
• Instructions for Reporting a Discharge
• Transition to Home Referral Request Information
• MA Substance Use Disorder Mandate - FAQs for DF Providers
• MA Substance Use Disorder Mandate - FAQs for FFS Facilities

• Applied Behavioral Analysis (ABA) Therapy and Habilitative Services for Autism Spectrum Disorders: Massachusetts Products
• Applied Behavioral Analysis (ABA) Therapy for Autism Spectrum Disorders: Rhode Island Products
• Autism Professional Payment Policy
• ABA Initial Services Request—Assessment and Treatment Planning (H0031) only
• ABA Autism Service Request (Initial and Continued)
• Early Intervention ABA Service Request (H2019 only)

• Payment Policies
• Provider Manuals
• Provider Education
• Designated Facilities Manual: Developed by the Behavioral Health Department to supply designated facilities and staff with details on the designated facility operating guidelines of Tufts Health Plan.
• Behavioral Health Provider Credentialing Forms

Please e-mail us your availability at mh_providers@tufts-health.com.