Ohio Medicaid Announces New Prior Authorization Standards To Strengthen Oversight Of Behavioral Health Services

The Ohio Department of Medicaid (ODM) announced new prior authorization (PA) requirements for community behavioral health, mental health, and substance use disorder (SUD) services as part of a statewide effort to improve oversight and reduce fraud, waste, and abuse.

ODM attributed the change in part to a significant rise in behavioral health service utilization across the Medicaid program. While some of that growth reflects broader access to care, the agency identified cases of duplicated, layered, or poorly coordinated services. Developed in coordination with behavioral health provider organizations and managed care plans, the new framework aims to standardize oversight while reducing . . .