Employment Law Report

The Cabinet for Health and Family Services Department of Medicaid Services (DMS) is reinstating the ability of Medicaid Managed Care Organizations (MCOs) and Medicaid Fee-for-Service (FFS) to require prior authorization (PA)  for inpatient medical and surgical services, effective June 1, 2021.  DMS is also reinstating the ability to conduct concurrent review.  In response to the pandemic, DMS had prohibited MCOs and FFS from requiring prior authorizations for inpatient services.

The prior authorization requirement will remain in place for outpatient medical and surgical services and procedures, as well as pharmacy benefits. MCOs and FFS will not require prior authorization for all covered Behavioral Health and Substance Use Disorder (SUD) services until further notice.  At least 30 days’ notice will be given prior to any change in the above guidance.