|
Prior Authorization Resources
Required Documents for Utilization Management Prior Authorization:
- Mental/Behavioral Health Assessment signed by QMHP within 1 year of service start date.
- Mental Health treatment plan (ISSP) signed by QMHP or higher for new provider, signed by Licensed Medical Provider for yearly updates. Must be within 1 year of service start date.
- Mental/Behavioral Health Assessment signed by QMHP within 1 year of service start date.
- LOCUS signed by QMHA or higher qualification. Within 1 year (used to be 6 months) of service start date.
- LSI must be completed by within 1 year (used to be 1 month) of service start date (before or after) by a QMHA or higher.
- Residential care plan (not MH treatment plan). Must be within 1 year of service start date.
Checklist for Applied Behavioral Analysis (ABA) Requests:
The Following Five Items are Required:
- A diagnosis of autism spectrum disorder or stereotypy with self-harming behavior from a physician.
- An order for ABA treatment from a physician (or appropriately qualified Clinical Psychologist).
- An Assessment and Treatment Plan formulated by a licensed ABA therapist
- Form KF-004
- Form KF-005
Note: The first two bullets are usually the same document.
(An assessment that refers to a doctor that gave a child a diagnosis of autism is not enough. There must be a documented diagnosis and order from the physician.)
