BEHAVIORAL HEALTH SERVICES PROVIDER IN MASSACHUSETTS

Fatumata Kaba
Aug 8
3 min read

DELIVERING INDIVIDUALIZED MENTAL HEALTH AND SUBSTANCE USE SUPPORT ACROSS HOME, COMMUNITY, AND OUTPATIENT SETTINGS

Behavioral Health Services in Massachusetts are essential to promoting mental wellness, recovery, and independence for individuals with mental illness, emotional disturbances, or substance use disorders. These services may be delivered through Medicaid’s MassHealth Behavioral Health Initiative, managed care plans, or Home and Community-Based Services (HCBS) programs under specific waivers.

1. GOVERNING AGENCIES

Agency: Massachusetts Executive Office of Health and Human Services (EOHHS)

Role: Oversees MassHealth and behavioral health policy across the state

Agency: Massachusetts Behavioral Health Partnership (MBHP) and other MCOs like Tufts Health Together, BMC HealthNet Plan, etc.

Role: Administer behavioral health services for Medicaid-eligible members

Agency: Department of Mental Health (DMH)

Role: Provides licensing, oversight, and service coordination for individuals with serious mental illness

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Approves and oversees 1915(c) waiver programs and Medicaid funding

2. BEHAVIORAL HEALTH SERVICE OVERVIEW

Behavioral Health Services support individuals across a spectrum of needs, from short-term counseling to long-term clinical and community-based interventions.

Common service types include:

Outpatient therapy (individual, group, or family counseling)
In-home therapy and therapeutic mentoring (especially for youth)
Peer support and recovery coaching
Mobile crisis intervention
Intensive Care Coordination (ICC)
Psychiatric consultation and medication management
Community Support Programs (CSP) for complex needs

Services must be authorized through a member’s treatment plan and must align with MassHealth or waiver eligibility criteria.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth
Obtain an IRS EIN and Type 2 NPI
Secure professional liability insurance
Obtain DMH, DCF, or Department of Public Health (DPH) licensure for clinical services, depending on the scope
Comply with local zoning and safety codes (if operating a facility)
Develop HIPAA-compliant Policies & Procedures

Clinical Practice Requirements:

Supervising clinician must hold an active MA license (e.g., LICSW, LMHC, LMFT, Psychologist, or Psychiatrist)
Maintain active clinical documentation and treatment plans
Adhere to DMH guidelines and MassHealth billing protocols

4. PROVIDER ENROLLMENT PROCESS

Step 1: Register with MassHealthApply via the Provider Online Service Center (POSC):https://massgov.account.gov

Step 2: Complete Credentialing with Managed Care PlansSubmit documentation and clinician rosters to MBHP or participating MCOs for network participation

Step 3: Obtain Licensing (If Applicable)

If providing outpatient clinic services, apply for a DMH site license or DPH clinic license (Substance Use)

Step 4: Execute Provider Agreements & Prepare DocumentationEnsure contracts, compliance manuals, and supervisory structures are in place

5. REQUIRED DOCUMENTATION

Articles of Incorporation or DBA filings
IRS EIN and NPI confirmation letters
Proof of insurance and licensure
Behavioral Health Policy & Procedure Manual, including:
- Treatment plan templates
- Intake, screening, and referral forms
- Progress notes and discharge summaries
- Medication administration (if applicable)
- Incident reporting protocols
- Staff training logs and supervision schedules
- Client rights and consent documentation
- Billing and compliance audit forms

6. STAFFING REQUIREMENTS

Role: Licensed Clinician (LICSW, LMHC, etc.)

Requirements: Valid Massachusetts license, clinical experience, liability coverage

Role: Unlicensed Mental Health Counselor / Behavioral Health Worker

Requirements: Bachelor’s degree in related field, supervision from licensed clinician, background checks

Role: Peer Support or Recovery Coach

Requirements: Peer certification or relevant lived experience, training in harm reduction and motivational interviewing

Mandatory Trainings:

HIPAA & confidentiality
Trauma-informed care
Emergency protocols & crisis response
Cultural competency & language access
Ethics and professional boundaries

7. MASSHEALTH & HCBS BEHAVIORAL HEALTH PROGRAMS

Behavioral health services may be delivered and reimbursed through:

MassHealth Standard and CommonHealth (general Medicaid plans)
Children’s Behavioral Health Initiative (CBHI) — ICC, Family Support, In-Home Therapy
Community Support Program (CSP) — adults with complex needs
Program of Assertive Community Treatment (PACT) — intensive, multidisciplinary outreach
Behavioral Health for Dually Eligible (One Care & SCO)
Money Follows the Person (MFP) Waiver — transition support with BH wraparound services