Medicaid performance specifications page
Optum Provider Network Performance Specifications
Performance Specifications are a component of the Optum Provider Manual, which is an extension of your Provider Agreement with Optum. If you have questions or need help with these performance specifications, or any other information in the Provider Manual, contact Optum Provider Relations at (877) 614-0484.
The general performance specification applies to all Optum network providers at all levels of care. Additionally, providers are held accountable to the service-specific performance specifications for each level of care for which they are contracted.
General Performance Specifications
Children's Behavioral Health Initiative (CBHI)
The Children's Behavioral Health Initiative (CBHI) is an interagency effort of the Commonwealth's Executive Office of Health and Human Services (EOHHS). Its mission is to strengthen, expand, and integrate Massachusetts state services into a comprehensive, community-based system of care to ensure that families and their children with significant behavioral, emotional, and mental health needs obtain the services necessary for success in home, school, and community.
Intensive Hospital Diversion Program
Diversionary Services
Diversionary services are mental health and substance use disorder services that provide intensive support upon returning to the community after an Enrollee has been in a hospital. These services can be provided in a 24-hour facility or in a non-24-hour setting.
24-Hour Diversionary Services
Acute Treatment Services for SUD
Acute Treatment Services for Pregnant Women
Acute Treatment Services for SUD - Co-Occurring Enhanced
Clinical Stabilization Services for SUD
Community-Based Acute Treatment
Community Crisis Stabilization
Family Residential Rehabilitation Services
Intensive Community-Based Acute Treatment
Residential Rehabilitation Services for SUD
Residential Rehabilitation Services for SUD - Co-Occurring Enhanced
Residential Rehabilitation Services for Pregnant and Post-Partum Women
Residential Rehabilitation Services for Transitional Age Youth or Young Adults
Residential Rehabilitation Services for Youth
Non-24-Hour Diversionary Services
Community Support Program for Chronically Homeless Individuals
Community Support Program for Individuals with Justice Involvement
Intensive Outpatient Program for Deaf and Hard of Hearing
Partial Hospitalization Program
Partial Hospitalization Program - Eating Disorders
Program of Assertive Community Treatment
Psychiatric Day Treatment - Enhanced
Structured Outpatient Addiction Program
Structured Outpatient Addiction Program - Adolescent Enhanced
Structured Outpatient Addiction Program - Homeless Enhanced
Structured Outpatient Addiction Program - Motivational Interviewing
Inpatient Mental Health Services
Inpatient services are provided in a 24-hour hospital setting and offer evaluation and treatment of acute mental health or substance use disorders.
Inpatient Eating Disorder Services
Inpatient Mental Health Services
Inpatient Mental Health Services for Children or Adolescents with ID/ASD
Inpatient Mental Health Services for Individuals with ID
Inpatient SUD Services - Withdrawal Management Services
Outpatient Services
Outpatient mental health services are provided in places like clinics, community health centers, hospital outpatient departments, the individual's home, school, or other places in the community. These services, which include individual therapy, group therapy, and family/couples therapy, help with a variety of mental health issues such as trauma, depression, anxiety, eating disorders, and adjustment disorders. Outpatient substance use disorder services help with withdrawal from substances. These services also support recovery from addiction.
Ambulatory Withdrawl Management
Assessment for Safe and Appropriate Placement
Dialectical Behavioral Therapy
Outpatient Services - Home-Based and Non-Facility Based
Outpatient Services - School Based
Psychiatric Consultation on an Inpatient Medical Unit