Ohio Medicaid Standardizes Behavioral Health Prior Authorization Requirements Across Managed Care Plans

The Ohio Department of Medicaid (ODM) announced new prior authorization (PA) requirements for community behavioral health, mental health, and substance use disorder services. The new requirements establish a standardized framework that all Medicaid managed care plans (MCPs) must implement statewide.

ODM cited a significant increase in behavioral health service utilization across the Medicaid program as a factor behind the new requirements. According to ODM, while much of the growth reflects expanded access to care, it also revealed instances of duplicative services, unnecessary layering of services, and insufficient clinical coordination.

ODM said the initiative is intended to create more consistent utilization . . .