1. GOVERNING AGENCIES

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Behavioral Health
Role: Oversees behavioral health services statewide, including Medicaid-funded programs, licensing, and quality monitoring

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid
Role: Manages Medicaid provider enrollment, service authorization, and reimbursement for Behavioral Health Services

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Behavioral Health Services meet Medicaid quality standards for access, integration, and participant-centered care

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2. BEHAVIORAL HEALTH SERVICE OVERVIEW

Behavioral Health Services support individuals across a range of needs, from outpatient therapy to intensive community-based crisis supports, based on clinical assessments and person-centered goals.

Approved providers may deliver:

• Individual, group, and family therapy (mental health counseling)
• Psychiatric evaluations, medication management, and psychiatric nursing
• Crisis intervention services and mobile crisis response
• Skills training in emotional regulation, coping strategies, and daily living
• Peer support and recovery coaching
• Psychosocial rehabilitation (PSR) and community integration support
• Substance use disorder treatment services (with additional certification)

Services must be outlined in an individualized Treatment Plan, focus on recovery and functional improvements, and be coordinated with other service systems when needed.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Idaho Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Obtain licensure through IDHW as a Behavioral Health Agency (if providing facility-based services) or ensure employed clinicians hold appropriate independent licenses ( LCSW, LCPC, LMFT, Psychologist, Psychiatrist)
• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment
• Maintain general liability, professional liability, and malpractice insurance
• Develop clinical policies for intake, treatment planning, participant rights, crisis response, and documentation

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4. IDHW PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Behavioral Health Services through Idaho’s Medicaid Management Information System (MMIS)
• Submit Behavioral Health Agency application (if facility-based) through IDHW Behavioral Health licensing unit

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, professional licensure documentation, insurance certificates, operational policies, and service delivery models
• Provide clinical documentation templates (intake forms, treatment plans, crisis plans)

Program Readiness Review:

• IDHW reviews provider readiness including clinical compliance, documentation systems, participant protections, and Medicaid billing practices

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for therapy sessions, psychiatric services, psychosocial rehabilitation, peer support, and other authorized services

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business Registration (Idaho Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Behavioral Health Agency license (if applicable) or clinician licenses
• Proof of general, professional, and malpractice insurance

HCBS-Compliant Policy & Procedure Manual including:

• Participant intake, assessment, treatment planning, and discharge procedures
• Mental health, crisis intervention, and recovery support protocols
• HIPAA confidentiality, participant rights, and grievance handling policies
• Emergency preparedness and critical incident reporting procedures
• Staff credentialing, background screening, and clinical supervision documentation
• Medicaid billing, service authorization tracking, and audit readiness documentation

6. STAFFING REQUIREMENTS

Role: Clinical Director / Program Manager
Requirements: Master’s degree or higher in behavioral health; active Idaho licensure (LCSW, LCPC, LMFT, or equivalent), experience supervising clinical services, background screening clearance

Role: Licensed Therapists (LCSWs, LCPCs, LMFTs, Psychologists, Psychiatrists)
Requirements: Active Idaho licensure, experience in outpatient and/or community mental health, background screening clearance

Role: Peer Support Specialists / Recovery Coaches (where applicable)
Requirements: Idaho Peer Support Certification (IPSC) required, lived experience preferred, background screening clearance

All staff must complete:

• HIPAA confidentiality and participant rights training
• Crisis intervention, suicide prevention, and abuse prevention training
• Annual competency evaluations and continuing clinical education

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7. MEDICAID WAIVER PROGRAMS

The following Idaho Medicaid programs and waivers authorize Behavioral Health Services:

• Medicaid State Plan Behavioral Health Services (outpatient mental health and substance use treatment)
• Aged and Disabled (A&D) Waiver (mental health support coordination)
• Developmental Disabilities (DD) Waiver (behavioral supports tied to habilitation and community integration)

Approved providers may deliver:

• Therapy, psychiatric services, and medication management
• Psychosocial rehabilitation and skills training
• Crisis stabilization and mobile response services

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8. TIMELINE TO LAUNCH

Phase: Business Formation and Credentialing Setup
Timeline: 1–2 weeks

Phase: Staff Hiring, Credentialing, and Clinical Program Development
Timeline: 2–3 months

Phase: IDHW Behavioral Health Agency Licensing (if applicable) and Medicaid Enrollment
Timeline: 3–6 months

Phase: Medicaid Billing System Configuration and Claims Readiness
Timeline: 30–45 days

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9. CONTACT INFORMATION

Idaho Department of Health and Welfare (IDHW) — Division of Behavioral Health
Website: https://healthandwelfare.idaho.gov/behavioral-health

Idaho Department of Health and Welfare (IDHW) — Medicaid Division
Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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Waiver Consulting Group supports behavioral health clinics, therapy practices, and community-based mental health providers in launching Medicaid-compliant Behavioral Health Services under Idaho’s Medicaid programs and HCBS waivers.