Prior Authorization Requirements and Service Limitations – Behavioral Health Services Medicaid State Plan Amendment

Agency Action: Amendments to the Title XIX Medicaid State Plan and, by Association, the Alternative Benefit PlanPursuant to 42 CFR §§ 440.386 and 447.205, notice is hereby given that the Department of Health (the department) intends to seek approval from the Centers for Medicare and Medicaid Services (CMS) for amendments to the Alternative Benefit Plan (ABP) authorized under § 1937 of the Social Security Act for individuals 19 to 64 years of age who are eligible pursuant to § 1902(a) (10)(A)((i)(VIII) of the Social Security Act – the expansion population – and the Title XIX Medicaid State Plan (the state plan).Subject of Amendments: The department proposes submitting a SPA to modify some prior authorization requirements and service limitations for community behavioral health services and mental health physician clinic providers. The proposed SPA amends state plan sections Attached Sheet to Attachment 3.1-A (pages 3, 3.1, 4c, 6, 7, and 9), Supplement 2 to Attachment 3.1-A (page 5), and

Attachment 4.19-B (page 1.2).Proposed amendments are as follows - Community Behavioral Health Services Provider Removal of prior authorizations requirements and service limitations for screening and brief intervention services; medical evaluations of a recipient in an opioid use disorder treatment program; methadone or Antabuse administration for medication assisted treatment; behavioral health screening; behavioral health screening services; more than one mental health, substance use, and integrated mental health and substance use assessment; and pharmacological management services – SUD medication assisted treatment. Update medication administration services limitation to one billable service per day. Community Behavioral Health Providers and Mental Health Physician Clinics Removal of prior authorization and service limitations for any combination individual, group, and family therapy; psychiatric assessments; psychological testing; pharmacologic management services; and integrated mental health and substance use intake assessments, and combinations of mental health intake assessment and substance use intake assessment. Update service limitations of short-term crisis intervention services, without prior authorization, to 22 consecutive hours in a single encounter.Fee Schedule Effective Date Update the effective date of the licensed behavior analyst provider fee schedule.EPSDT and ARRA/Tribal Consultation:The proposed amendments will not affect how Alaska Medicaid provides or reimburses Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. The department follows the tribal consultation process established under the American Recovery and Reinvestment Act (ARRA) of 2009 and set forth in its approved state plan.Public Comments:The department is holding a public comment period relative to this amendment until 5 PM on April 30, 2024. Individuals may submit written comments via email to emily.beaulieu@alaska.gov. Please submit electronic comments as an attached word document or text within the email body with the phrase “Licensed Behavior Analyst Fee Schedule Effective Date” in the subject line. All submissions must include the sender’s full name and email address.If you are a person with a disability needing special accommodation(s) to participate in this process, please contact Emily Beaulieu at emily.beaulieu@alaska.gov or (907)538-7665 not later than September 29, 2023, to ensure the provision of these accommodations.Individuals unable to submit comments by email should submit written comments by the close of the comment period to:Emily Beaulieuc/o DOH – Commissioner’s Office3601 C Street, Suite 902Anchorage, AK 99503