Behavioral Health Expedited Prior Authorization Sample Clauses

Behavioral Health Expedited Prior Authorization. Assertive community treatment (ACT), intensive home-based treatment (IHBT), and substance use disorder (SUD) residential treatment (beginning with the third stay in a calendar year) shall be prior authorized as expeditiously as the member’s health condition requires but no later than 48 hours after receipt of the request in accordance with OAC rule 5160-26-03.1.
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Behavioral Health Expedited Prior Authorization. Assertive community treatment (ACT), intensive home-based treatment (IHBT) and substance use disorder (SUD) residential treatment (beginning with the third stay in a calendar year) shall be prior authorized as expeditiously as the member’s health condition requires but no later than 48 hours after receipt of the request in accordance with OAC rule 5160-26-03.1. The sanctions for noncompliance with requirements in this appendix are listed in Appendix N of this Agreement. APPENDIX D ODM RESPONSIBILITIES The following are the Ohio Department of Medicaid (ODM) responsibilities not otherwise specifically stated in Ohio Administrative Code (OAC) Chapter 5160-26 or elsewhere in this Agreement.
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Related to Behavioral Health Expedited Prior Authorization

  • Behavioral Health Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services, are a covered benefit under the Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). This includes, but is not limited to:  Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits.  Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work.  Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request.  Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members.  Providing out-of-network coverage for mental health or substance use disorder benefits when made available for medical and surgical benefits. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to:  Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health;  Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and  Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

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