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TAC votes to ask DMS to review prior-authorization requirements for individual, family and group therapy
Summary
The Behavioral Health TAC voted to recommend that the Department for Medicaid Services review the necessity and implementation of prior-authorizations for individual, family and group therapy and to reconsider the one-business-day retroactive requirement; the motion was made by Steve Shannon and seconded by Valerie Mudd and approved by vocal assent.
During the meeting's discussion of widespread provider concerns about prior authorizations, Steve Shannon moved that the TAC recommend DMS review whether prior-authorization requirements for individual, family and group psychotherapy are necessary and, if appropriate, reconsider their approval. Valerie Mudd seconded the motion.
The chair called for discussion and members reiterated clinical and administrative concerns: that one-business-day retroactive request windows are impractical for crisis-driven care, that provider notice via website alone was insufficient, and that inconsistent MCO implementation and audits have created a heavy administrative burden. After discussion the voting members indicated assent by vocal "aye," and the chair confirmed the motion would be transmitted to the MAC with supporting materials and that a TAC member should attend the next MAC meeting to present background and rationale.
The TAC asked staff to complete the new TAC recommendation form per the updated process and to provide background materials so the MAC can consider the recommendation. Danny Davis (DMS liaison) summarized the submission process and asked that a TAC member be present at the next MAC to explain the request.
Next steps: TAC staff will submit the recommendation form, DMS will receive the form and the TAC-appointed member will present at the MAC; the item will remain on the BHTAC agenda for follow-up.
