MedicaidAdministrativeMedium impact
MSA 18-44
Michigan Medicaid - MDHHS·MI · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
Michigan requires all providers to use a new standard consent form (MDHHS-5515) for releasing behavioral health and substance use disorder information. This form must be accepted and honored across all Fee for Service, Managed Care, and PIHP beneficiaries for care coordination purposes.
Action Required
Before January 1, 2019: All Michigan providers must obtain and implement the MDHHS-5515 standard consent form from www.michigan.gov/bhconsent for any behavioral health or substance use disorder information releases. Train staff on proper use, signature requirements, and witness procedures. Ensure form is accepted from other providers and used for all Medicaid program beneficiaries. Note: Providers receiving VOCA, Violence Against Women Act, or Family Violence Prevention Services Act funding should NOT use this form.