Behavioral Health Prior Authorizations
AmeriHealth Caritas Ohio providers may need to receive prior authorization before administering some behavioral health services to members.
Submit a prior authorization request for behavioral health services.
Per guidance from Ohio Department of Medicaid, AmeriHealth Caritas Ohio providers are expected to submit prior authorization requests and associated attachments through the Ohio Department of Medicaid Provider Network Management (PNM) system.
Additional information regarding this process will be available closer in the fourth quarter of 2022.
Behavioral health services requiring prior authorization
Behavioral health services requiring prior authorization (SUD pending ODM clarification)
- Adult (21 and over) inpatient hospitalizations (mental health and/or substance use disorder)
- Psychological and neuropsychological testing
- Electroconvulsive therapy
- Therapeutic behavioral services (TBS)
- Therapeutic group services (day treatment)
- Assertive community treatment
- Behavioral analysis therapy for autism spectrum disorder
- Psychosocial rehabilitation services
- Community psychiatric supportive treatment (individual and group)
- Substance use disorder intensive outpatient program (SUD IOP)
- Substance use disorder partial hospitalization program (SUD PHP)
- Withdrawal management ASAM 2-WM
- Clinically managed low-intensity residential treatment ASAM 3.1
- Clinically managed residential withdrawal management ASAM 3.2-WM
- Clinically managed population-specific high-intensity residential treatment ASAM 3.3 (adults)
- Clinically managed high-intensity residential treatment ASAM 3.5
- Medically monitored intensive inpatient treatment (adults) and medically monitored high-intensity inpatient services (adolescent) ASAM 3.7
- Medically monitored inpatient withdrawal management ASAM 3.7-WM
- Unlisted psychiatric services
Services covered by OhioRISE ONLY:
- Child and Adolescent Inpatient Hospitalization (mental health and/or substance use disorder)
- Intensive Home Based Treatment (IHBT)
- Intensive and Moderate Care Coordination
- Psychiatric Residential Treatment Facility
- OhioRISE 1915(b) and 1915(c) services
Services requiring notification (Pending clarification with ODM – SUD may require notification only)
Behavioral health services that do not require authorization
- Psychotherapy for Mental Health and Substance Use Disorder: Individual, Family, Multiple-family, Group
- Psychotherapy for Crisis for Mental Health and Substance Use Disorder
- Behavioral Health Counseling
- Substance Use Disorder Assessment
- Substance Use Disorder Individual and Group Counseling
- Substance Use Disorder Case Management
- Substance Use Disorder Urine Drug Screen
- Evaluation and Management Visits for Mental Health and Substance Use Disorder including home and prolonged visits
- Psychiatric Diagnostic Evaluation
- Smoking and Tobacco Cessation Counseling
- Screening, Brief Intervention and Referral to Treatment (SBIRT)
- Substance Use Disorder Peer Support Services (up to four hours per day)
- A Child and Adolescent Needs and Strengths (CANS) assessment; and
- Up to 72 hours of Mobile Response Stabilization Services (MRSS), except in accordance with OAC rule 5160-27-13.
- Depression Screening and Cognitive Behavioral Health Therapies provided in coordination with the Help Me Grow program including services performed in the home. The AmeriHealth Caritas Ohio Population Health team will assist with the member with arranging for depression screening and cognitive behavioral health therapies for members enrolled in the Help Me Grow program who are either pregnant or the birth mother of an infant or toddler under 3 years of age.