Behavioral health rule changes implemented with Executive Order 2020-23D
In accordance with Governor DeWine’s Executive Order 2020-23D, the Ohio Department of Medicaid (ODM) and the Ohio Department of Mental Health and Addiction Services (OhioMHAS) are implementing emergency changes to Ohio Administrative Code (OAC) that will:
The full text of these Ohio Administrative Code changes can be found at the embedded links below.
Fee-for-Service Prior Authorization
For the services in Table 1-5 of the BH Provider Manual (found at https://bh.medicaid.ohio.gov/manuals), administrative authorizations will be offered in lieu of typical prior authorizations that require submission and review of clinical documentation. The following behavioral health rules have been amended on an emergency basis to allow for the temporary administrative authorization option through June 30:
Providers shall request an administrative authorization using the MITS portal. An administrative authorization gives the provider an authorization number for claim submission but does not require submission of clinical documentation or a medical necessity review. Medical documentation can be submitted, but it will not be reviewed by ODM or its prior authorization vendors.
Providers should enter administrative authorization requests in the same manner and include the same information they provide for prior authorization, except that in lieu of attaching clinical documentation, the provider must attach a Word document stating only “COVID-19.” Additionally, enter a comment in the provider notes field indicating “COVID-19.” No clinical practitioner signatures are necessary for an administrative authorization request.
The administrative authorization number must be submitted on claims for services that required prior authorization before the COVID-19 pandemic; otherwise, claims may be denied. The administrative authorization number should be entered in the same field on the claim that the prior authorization number would be submitted.
All services authorized during the COVID-19 emergency remain subject to Medicaid requirements for medical necessity and medical record documentation.
Effective July 1, 2020, prior authorization requests will be reviewed for medical necessity, so clinical documentation will be required for any request submitted on or after July 1, 2020.
Telehealth-related Emergency Rule Changes
In March 2020, ODM adopted OAC rule 5160-1-21 on an emergency basis to expand and enhance telehealth options for Ohioans and their providers, including for behavioral health services. Through Executive Order 2020-23D, ODM is incorporating telehealth provisions previously implemented in OAC rule 5160-1-21 to specific Medicaid behavioral health services rules in Chapters 5160-8 and 5160-27 of the OAC as follows:
Annual Fidelity Reviews for ACT and IHBT
ODM has modified requirements related to annual fidelity to accommodate remote reviews in the following rules:
OhioMHAS Emergency Rule Updates
OhioMHAS updated two of its rules as part of Executive Order 2020-23D:
Additional Telehealth Procedure Codes
SUD withdrawal management services can be rendered via telehealth
The following procedure codes have been updated in MITS to allow services to be rendered via telehealth effective March 9, 2020. Claims submitted to MITS after May 12, 2020, should include the GT modifier to reflect telehealth delivery:
MITS and the managed care plan claims payment systems have been updated to reflect these substance use disorder withdrawal management services being rendered via telehealth. Claims should include the GT modifier to reflect delivery via telehealth.
COVID Resources
The ODM website has a COVID-19 webpage with health-related information.
OhioMHAS COVID resources are on the OhioMHAS website.
For more information on Behavioral Health Medicaid Redesign, visit http://bh.medicaid.ohio.gov.