Issued: March 15, 2023
What is happening?
In the Provider Alert issued on February 16, 2023, Partners announced changes to the benefit limit for Psychosocial Rehabilitation (PSR). These changes were effective on Feb. 22, 2023 and apply to initial or concurrent requests for PSR. You can access the full article at https://providers.partnersbhm.org/provider-alert-utilization-management-prior-authorization-for-medicaid-and-state-funded-psychosocial-rehabilitation/
What do providers need to do?
Providers may request up to 555 units per month of concurrent PSR services.
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 = 555 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 = 555 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. |
What does this mean for providers?
Changes to the Psychosocial Rehabilitation benefit limit include:
- Providers may request up to 555 units per month for concurrent PSR services.
- Pass-through of 32 hours or less for up to one year for both Medicaid and State-funded 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.
What if providers have other questions?
If you have additional questions regarding prior authorization submissions, please contact the MHSU Utilization Management Workgroup by calling 704-842-6436 or email UMquestions@partnersbhm.org.