Issued: February 17, 2023
Utilization Management: Prior Authorization for Medicaid and State-funded Psychosocial Rehabilitation
Effective February 22, 2023, the following changes will be made to the benefit limit for Psychosocial Rehabilitation (PSR). This applies to both initial and concurrent requests for PSR. Changes have been made to facilitate claims with the new system, TruCare. Partners Utilization Management (UM) will allow a transition period for retroactive Service Authorization Requests (SAR) submission through March, 22, 2023.
Partners Medicaid Adult MH/SU Services Benefit Plan:
| Service Description | Benefit Limit | Level of Care | Source | Documentation Required for Authorization |
| Psychosocial
Rehabilitation:
H2017 H2017 (DJ) |
Pass-through of 32 hours or less for up to one year.
Initial: For over 32 hours, initial authorization is up to one year.
Concurrent: For over 32 hours, concurrent authorization is up to one year.
32 hours = 128 units per week = 512 units per month |
LOCUS/CALOCUS: 2-5; optional
ASAM: 1-2.5 |
8A | Notification of Prior Authorization (PA) is Required for Pass-through. Please submit within 7 days of beginning the service.
If exceeding 32 hours per week: Initial: CCA, PCP, CCP, Service Order. Service Order is valid for one year.
Concurrent: Updated PCP or new annual PCP, signature page, and Service Order. |
Partners State Adult MH/SU Services Benefit Plan:
| Service Description | Benefit Limit | Level of Care | Source | Documentation Required for Authorization |
| Psychosocial
Rehabilitation:
H2017 H2017 (DJ) H2017 (OT) |
Pass-through of 32 hours or less for up to one year.
Initial: For over 32 hours, initial authorization is up to one year.
Concurrent: For over 32 hours, concurrent authorization is up to one year.
32 hours = 128 units per week = 512 units per month |
LOCUS/CALOCUS: 2-5; optional
ASAM: 1-2.5 |
8A | Notification of Prior Authorization (PA) is Required for Pass-through. Please submit within 7 days of beginning the service.
If exceeding 32 hours per week: Initial: CCA, PCP, CCP, Service Order. Service Order is valid for one year.
Concurrent: Updated PCP or new annual PCP, signature page, and Service Order. |
Changes to the Psychosocial Rehabilitation benefit limit include:
- Pass-through of 32 hours or less for up to one year for both Medicaid and State-funded Psychosocial Rehabilitation (PSR).
- Notification of Prior Authorization (PA) is required for pass-through. Notification PAs do not require clinical documentation or justification of medical necessity criteria; however, Notification PAs are required for claims payment. Please remember to complete the necessary and required fields to submit a PA in TruCare and indicate that you are submitting a Notification PA for pass-through in the notes section.
- For concurrent authorizations, please remember to submit an updated Person-Centered Plan (PCP) or a new annual PCP, Signature Page, and Service Order.
For additional clinical information, please refer to Clinical Coverage Policy 8A:
https://providers.partnersbhm.org/service-definitions/
If you have additional questions regarding prior authorization submissions, please contact the MH/SU Utilization Management Workgroup by calling 704-842-6436 or email UMquestions@partnersbhm.org.