Coverage of Mobile Crisis Benefit in Essential Plans
Impacted Plans: Essential Plans (EP 1-4, and EP 200-250)
Effective as of January 1st, 2026, MetroPlus Health Plan will cover mobile crisis services for Essential Plans to provide immediate support and offer alternatives to hospitalization when appropriate.
Mobile crisis services are provided by a mobile crisis team licensed, certified, or authorized by the Office of Mental Health and the Office of Addiction Services and supports to provide community-based mental health or substance use disorder interventions for individuals who are experiencing a mental health or substance use disorder crisis. Members of a mobile crisis team may include, but not be limited to: behavioral health professionals, certified peer specialists, certified recovery peer advocates, credentialed family peer advocates, and credentialed youth peer advocates.
Mobile Crisis services are available 24 hours a day, 7 days a week, and 365 days a year. Mobile Crisis services are delivered telephonically, in person, or via telehealth to individuals at risk of or experiencing a Behavioral Health (BH) crisis and their collaterals for the direct benefit of the individual in crisis.
Claims can be billed using the same procedure codes, rate codes and modifier combinations established in the Medicaid line of business. Please refer to the following NYS published Guidance documents:
Resources:
NOTE: Mobile crisis services shall not be subject to prior authorization requirements.
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected].