Your Benefits and Services (continued)
Horizon NJ Health covers a number of behavioral health benefits for you. Behavioral Health (BH)
services address the emotions and behaviors that affect a person’s overall well-being. Services
include those provided to members living with mental health and/or Substance Use Disorder (SUD)
needs. Some services are covered for you by Horizon NJ Health, while others are paid for directly by
Medicaid Fee-for-Service (FFS). The chart below explains which services are covered by Horizon NJ
Health and which services are covered by FFS.
When requesting prior authorization or making arrangements to receive a behavioral health service,
members and providers should call:
• Horizon NJ Health at 1-800-682-9090 (TTY 711), weekdays, 8 a.m. to 8 p.m., ET. (“Covered”)
• ReachNJ at 1-844-276-2777 (TTY 711), 24 hours a day, seven days a week. (“Covered by FFS”)
Autism services are detailed in the main Covered Benefits chart
Members in DDD, NJ FamilyCare NJ FamilyCare NJ FamilyCare NJ FamilyCare
Benefit MLTSS, or FIDE SNP Plan A/ABP Plan B Plan C Plan D
Mental Health (MH) Services:
Mental health services include, but are not limited to, comprehensive intake evaluation; off-site crisis intervention; family
therapy; family conference; case management; programs of assertive community treatment, inpatient treatment and
medication management.
Adult Mental Health Covered Covered by FFS Not covered
Rehabilitation
(Supervised Group
Homes and Apartments)
Inpatient Psychiatric Covered
Coverage includes services in an acute care hospital.
Independent Covered
Practitioner
Network or IPN
(Licensed Clinical
Social Worker,
Licensed Marriage
and Family Therapist,
Licensed Professional
Counselor,
Psychiatrist,
Psychologist, or
Advanced Practice
Nurse)
“Covered”: 1-800-682-9090 (TTY 711)
“Covered by FFS”: 1-844-276-2777
Member Services: 1-800-682-9090 horizonNJhealth.com
Your Benefits and Services (continued)
Outpatient Covered
Mental Health Coverage includes services received in an Independent Clinic and Outpatient Hospital Setting.
Services in these settings are covered for members of all ages.
Mental Health Covered
Partial Care Limited to 25 hours per week (5 hours per day, 5 days per week).
Prior authorization required.
Mental Health Covered
Acute Partial Admission is only through a psychiatric emergency screening center or post psychiatric
inpatient discharge.
Hospitalization Prior authorization required for Acute Partial Hospitalization.
Psychiatric Partial Covered
Hospitalization Prior authorization required.
Psychiatric Covered by FFS for all members.
Emergency Services
(PES)/Affiliated
Emergency Services
(AES)
Substance Use Disorder (SUD) Services:
Substance use disorder services include, but are not limited to, inpatient medical detoxification; outpatient (non-medical)
detoxification, partial care; intensive outpatient (IOP); opioid treatment services; and short-term rehabilitation.
The American Society of Addiction Medicine (ASAM) provides guidelines that are used to help determine what kind of
substance use disorder (SUD) treatment is appropriate for a person who needs SUD services.
Ambulatory Covered
Withdrawal
Management/
Detoxification with
On-Site Monitoring
Inpatient Covered
Withdrawal
Management/
Detoxification
(Hospital-Based)
“Covered”: 1-800-682-9090 (TTY 711)
“Covered by FFS”: 1-844-276-2777
Member Services: 1-800-682-9090 horizonNJhealth.com
Your Benefits and Services (continued)
Office-Based Covered
Addiction Treatment Covers coordination of patient services on an as-needed basis to create and maintain a comprehensive and
(OBAT) individualized SUD plan of care and to make referrals to community support programs as needed.
Non Hospital- Covered Covered by FFS
Based Withdrawal
Management/
Detoxification (SUD
Residential Setting)
Opioid Treatment Covered Covered by FFS
Services Includes coverage for Methadone Medication Assisted Treatment
(MAT) and
Non-Methadone Medication Assisted Treatment.
Coverage for Non-Methadone Medication Assisted Treatment
includes (but is not limited to) FDA-approved opioid agonist and antagonist
treatment medications and the dispensing and administration of such medications;
substance use disorder counseling; individual and group therapy; and toxicology
testing.
Substance Use Covered
Disorder Intensive Prior authorization required.
Outpatient (IOP)
Substance Use Covered
Disorder Outpatient
(OP)
Substance Use Covered
Disorder Partial Care Prior authorization required.
(PC)
Substance Use Covered Covered by FFS
Disorder Short Term
Residential (STR)
Substance Use Covered Covered by FFS
Disorder Long Term
Residential (LTR)
“Covered”: 1-800-682-9090 (TTY 711)
“Covered by FFS”: 1-844-276-2777
Member Services: 1-800-682-9090 horizonNJhealth.com
