{"id":8806,"date":"2020-04-28T14:43:14","date_gmt":"2020-04-28T20:43:14","guid":{"rendered":"https:\/\/93fd47b736.nxcli.net\/corporate\/?p=8806"},"modified":"2020-04-28T14:53:55","modified_gmt":"2020-04-28T20:53:55","slug":"medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs","status":"publish","type":"post","link":"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/","title":{"rendered":"Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs"},"content":{"rendered":"<p><strong>Effective April 23, 2020<\/strong><\/p>\n<p>Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs<\/p>\n<p>Montana Healthcare Programs is continually working to improve safe access to Medicaid services throughout the public health emergency. <a href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/wp-content\/uploads\/2020\/04\/ProviderNotice_Suspension_of_PA_or_ContinuedStayReviews_and_ClinicreqforsomeMedicaidprograms04222020.pdf\" target=\"_blank\" rel=\"noopener\"><strong>This provider notice<\/strong><\/a> is to suspend the prior authorization or continued stay reviews and clinical requirements for some Medicaid programs during the statewide emergency declared in Executive Orders 2-2020 and 3-2020.<\/p>\n<p><a href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/wp-content\/uploads\/2020\/04\/ProviderNotice_Suspension_of_PA_or_ContinuedStayReviews_and_ClinicreqforsomeMedicaidprograms04222020.pdf\" target=\"_blank\" rel=\"noopener\"><strong>This provider notice<\/strong><\/a> will remain in effect through the remainder of the COVID-19 epidemic. Future provider notices will specify individual program resumption dates and specific steps to follow for resuming prior authorization, continued stay and clinical requirements.<\/p>\n<p>For most Montana Medicaid programs, prior authorization and continued stay reviews are lifted for the duration of the epidemic but clinical criteria in rule will remain in place. It is the responsibility of the provider to document the clinical criteria. The following exceptions apply:<\/p>\n<p>1. Prior authorization and continued stay reviews are still required for the following programs:<\/p>\n<p><strong>Addictive and Mental Disorders Division<\/strong><\/p>\n<ul>\n<li>Inpatient Hospital (Montana State Hospital) (under 18 and over 64 years of age)<\/li>\n<li>Medically Monitored Intensive Inpatient Substance Use Disorder (SUD) Treatment (ASAM 3.7)<\/li>\n<li>Substance Use Disorder Intensive Outpatient Services (IOP) (ASAM 2.1)<\/li>\n<\/ul>\n<p><strong>Developmental Services Division\/Children\u2019s Mental Health Bureau<\/strong><\/p>\n<ul>\n<li>Children\u2019s Mental Health Bureau Early Periodic Screening, Diagnostic, and Treatment (EPSDT)Reviews<\/li>\n<li>Intermediate Care Facility \u2013 Individual with Intellectual Disability (ICF-IID)(out-of-state)<\/li>\n<li>Psychiatric Residential Treatment Facility (in-state, out-of-state, and assessment)<\/li>\n<li>Youth Mental Health Genetic Testing<\/li>\n<\/ul>\n<p><strong>Health Resources Division<\/strong><\/p>\n<ul>\n<li>Audiology and Hearing Aid Services<\/li>\n<li>DME items reimbursed over $5,000 (formally $1,000 as found on <a href=\"https:\/\/medicaidprovider.mt.gov\/manuals\/durablemedicalequipmentprostheticsorthoticsandmedicalsuppliesmanual#607587032-prior-authorization\" target=\"_blank\" rel=\"noopener\">Prior Authorization Chapter ofthe DME Manual<\/a><\/li>\n<li>Early, Periodic Screening, Diagnostic, and Treatment (EPSDT) Reviews<\/li>\n<li>Eyeglasses and Contact Lenses<\/li>\n<li>Home Infusion Therapy<\/li>\n<li>Interim Hospital Claims<\/li>\n<li>Personal and Non-Emergency Medical Transportation<\/li>\n<li>Physician Administered Drugs<\/li>\n<li>Orthodontia<\/li>\n<li>Outpatient Pharmacy<\/li>\n<\/ul>\n<p>For out-of-state hospitals with patients admitted prior to April 23, 2020 continued stay reviews are\u00a0still required until discharge.<\/p>\n<p>2.\u00a0Montana Medicaid has temporarily lifted clinical criteria in addition to prior authorization and continued\u00a0stay reviews requirements for the following Medicaid programs to allow for flexibility in intake and\u00a0discharge that may be required as a result of the COVID-19 epidemic:<\/p>\n<p><strong>Addictive and Mental Disorders Division<\/strong><\/p>\n<ul>\n<li>Adult Group Home (AGH)<\/li>\n<li>Clinically Managed Low-Intensity Residential SUD Treatment (ASAM 3.1)<\/li>\n<li>Crisis Stabilization Program (Crisis Intervention Facility)<\/li>\n<\/ul>\n<p><strong>Developmental Services Division\/Children\u2019s Mental Health Bureau<\/strong><\/p>\n<ul>\n<li>Partial Hospital Services<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Claim Submission Instructions<\/p>\n<p>Many Medicaid services allow providers to span bill for multiple days. In order to avoid denied claims for\u00a0services that are span billed, providers will need to submit separate claims as follows:<\/p>\n<ol>\n<li>For services up to and including April 22, 2020, providers will be required to submit claims with the\u00a0prior authorization number as normal.<\/li>\n<li>For those services identified in this provider notice as NOT needing a prior authorization, a separate\u00a0claim will need to be submitted for services starting April 23, 2020.<\/li>\n<\/ol>\n<p><a href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/wp-content\/uploads\/2020\/04\/ProviderNotice_Suspension_of_PA_or_ContinuedStayReviews_and_ClinicreqforsomeMedicaidprograms04222020.pdf\" target=\"_blank\" rel=\"noopener\"><strong>See provider notice for contact information<\/strong><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Effective April 23, 2020<br \/>\nSuspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs<br \/>\nMontana Healthcare Programs is continually working to improve safe access to Medicaid services throughout the public health emergency. <a href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/wp-content\/uploads\/2020\/04\/ProviderNotice_Suspension_of_PA_or_ContinuedStayReviews_and_ClinicreqforsomeMedicaidprograms04222020.pdf\" target=\"_blank\" rel=\"noopener\">This provider notice<\/a> is to suspend the prior authorization or continued stay reviews and clinical requirements for some Medicaid programs during the statewide emergency declared in Executive Orders 2-2020 and 3-2020.<br \/>\n<a href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/wp-content\/uploads\/2020\/04\/ProviderNotice_Suspension_of_PA_or_ContinuedStayReviews_and_ClinicreqforsomeMedicaidprograms04222020.pdf\" target=\"_blank\" rel=\"noopener\">This provider notice<\/a> will remain in effect through the remainder of the COVID-19 epidemic. Future provider notices will specify individual program resumption dates and specific steps to follow for resuming prior authorization, continued stay and clinical requirements.<br \/>\nFor most Montana Medicaid programs, prior authorization and continued stay reviews are lifted for the duration of the epidemic but clinical criteria in rule will remain in place. It is the responsibility of the provider to document the clinical criteria. The following exceptions apply:<br \/>\n1. Prior authorization and continued stay reviews are still required for the following programs:<br \/>\nAddictive and Mental Disorders Division<\/p>\n<p>Inpatient Hospital (Montana State Hospital) (under 18 and over 64 years of age)<br \/>\nMedically Monitored Intensive Inpatient Substance Use Disorder (SUD) Treatment (ASAM 3.7)<br \/>\nSubstance Use Disorder Intensive Outpatient Services (IOP) (ASAM 2.1)<\/p>\n<p>Developmental Services Division\/Children\u2019s Mental Health Bureau<\/p>\n<p>Children\u2019s Mental Health Bureau Early Periodic Screening, Diagnostic, and Treatment (EPSDT)Reviews<br \/>\nIntermediate Care Facility \u2013 Individual with Intellectual Disability (ICF-IID)(out-of-state)<br \/>\nPsychiatric Residential Treatment Facility (in-state, out-of-state, and assessment)<br \/>\nYouth Mental Health Genetic Testing<\/p>\n<p>Health Resources Division<\/p>\n<p>Audiology and Hearing Aid Services<br \/>\nDME items reimbursed over $5,000 (formally $1,000 as found on <a href=\"https:\/\/medicaidprovider.mt.gov\/manuals\/durablemedicalequipmentprostheticsorthoticsandmedicalsuppliesmanual#607587032-prior-authorization\" target=\"_blank\" rel=\"noopener\">Prior Authorization Chapter ofthe DME Manual<\/a><br \/>\nEarly, Periodic Screening, Diagnostic, and Treatment (EPSDT) Reviews<br \/>\nEyeglasses and Contact Lenses<br \/>\nHome Infusion Therapy<br \/>\nInterim Hospital Claims<br \/>\nPersonal and Non-Emergency Medical Transportation<br \/>\nPhysician Administered Drugs<br \/>\nOrthodontia<br \/>\nOutpatient Pharmacy<\/p>\n<p>For out-of-state hospitals with patients admitted prior to April 23, 2020 continued stay reviews are\u00a0still required until discharge.<br \/>\n2.\u00a0Montana Medicaid has temporarily lifted clinical criteria in addition to prior authorization and continued\u00a0stay reviews requirements for the following Medicaid programs to allow for flexibility in intake and\u00a0discharge that may be required as a result of the COVID-19 epidemic:<br \/>\nAddictive and Mental Disorders Division<\/p>\n<p>Adult Group Home (AGH)<br \/>\nClinically Managed Low-Intensity Residential SUD Treatment (ASAM 3.1)<br \/>\nCrisis Stabilization Program (Crisis Intervention Facility)<\/p>\n<p>Developmental Services Division\/Children\u2019s Mental Health Bureau<\/p>\n<p>Partial Hospital Services<\/p>\n<p>&nbsp;<br \/>\nClaim Submission Instructions<br \/>\nMany Medicaid services allow providers to span bill for multiple days. In order to avoid denied claims for\u00a0services that are span billed, providers will need to submit separate claims as follows:<\/p>\n<p>For services up to and including April 22, 2020, providers will be required to submit claims with the\u00a0prior authorization number as normal.<br \/>\nFor those services identified in this provider notice as NOT needing a prior authorization, a separate\u00a0claim will need to be submitted for services starting April 23, 2020.<\/p>\n<p><a href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/wp-content\/uploads\/2020\/04\/ProviderNotice_Suspension_of_PA_or_ContinuedStayReviews_and_ClinicreqforsomeMedicaidprograms04222020.pdf\" target=\"_blank\" rel=\"noopener\">See provider notice for contact information<\/a>.<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[25],"tags":[],"class_list":{"0":"post-8806","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-in-the-news","7":"entry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs - Mountain Pacific<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs - Mountain Pacific\" \/>\n<meta property=\"og:description\" content=\"Effective April 23, 2020 Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs Montana Healthcare Programs is continually working to improve safe access to Medicaid services throughout the public health emergency. This provider notice is to suspend the prior authorization or continued stay reviews and clinical requirements for some Medicaid programs during the statewide emergency declared in Executive Orders 2-2020 and 3-2020. This provider notice will remain in effect through the remainder of the COVID-19 epidemic. Future provider notices will specify individual program resumption dates and specific steps to follow for resuming prior authorization, continued stay and clinical requirements. For most Montana Medicaid programs, prior authorization and continued stay reviews are lifted for the duration of the epidemic but clinical criteria in rule will remain in place. It is the responsibility of the provider to document the clinical criteria. The following exceptions apply: 1. Prior authorization and continued stay reviews are still required for the following programs: Addictive and Mental Disorders Division Inpatient Hospital (Montana State Hospital) (under 18 and over 64 years of age) Medically Monitored Intensive Inpatient Substance Use Disorder (SUD) Treatment (ASAM 3.7) Substance Use Disorder Intensive Outpatient Services (IOP) (ASAM 2.1) Developmental Services Division\/Children\u2019s Mental Health Bureau Children\u2019s Mental Health Bureau Early Periodic Screening, Diagnostic, and Treatment (EPSDT)Reviews Intermediate Care Facility \u2013 Individual with Intellectual Disability (ICF-IID)(out-of-state) Psychiatric Residential Treatment Facility (in-state, out-of-state, and assessment) Youth Mental Health Genetic Testing Health Resources Division Audiology and Hearing Aid Services DME items reimbursed over $5,000 (formally $1,000 as found on Prior Authorization Chapter ofthe DME Manual Early, Periodic Screening, Diagnostic, and Treatment (EPSDT) Reviews Eyeglasses and Contact Lenses Home Infusion Therapy Interim Hospital Claims Personal and Non-Emergency Medical Transportation Physician Administered Drugs Orthodontia Outpatient Pharmacy For out-of-state hospitals with patients admitted prior to April 23, 2020 continued stay reviews are\u00a0still required until discharge. 2.\u00a0Montana Medicaid has temporarily lifted clinical criteria in addition to prior authorization and continued\u00a0stay reviews requirements for the following Medicaid programs to allow for flexibility in intake and\u00a0discharge that may be required as a result of the COVID-19 epidemic: Addictive and Mental Disorders Division Adult Group Home (AGH) Clinically Managed Low-Intensity Residential SUD Treatment (ASAM 3.1) Crisis Stabilization Program (Crisis Intervention Facility) Developmental Services Division\/Children\u2019s Mental Health Bureau Partial Hospital Services &nbsp; Claim Submission Instructions Many Medicaid services allow providers to span bill for multiple days. In order to avoid denied claims for\u00a0services that are span billed, providers will need to submit separate claims as follows: For services up to and including April 22, 2020, providers will be required to submit claims with the\u00a0prior authorization number as normal. For those services identified in this provider notice as NOT needing a prior authorization, a separate\u00a0claim will need to be submitted for services starting April 23, 2020. See provider notice for contact information.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/\" \/>\n<meta property=\"og:site_name\" content=\"Mountain Pacific\" \/>\n<meta property=\"article:published_time\" content=\"2020-04-28T20:43:14+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-04-28T20:53:55+00:00\" \/>\n<meta name=\"author\" content=\"Beth Brown\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Beth Brown\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/\",\"url\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/\",\"name\":\"Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs - Mountain Pacific\",\"isPartOf\":{\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/#website\"},\"datePublished\":\"2020-04-28T20:43:14+00:00\",\"dateModified\":\"2020-04-28T20:53:55+00:00\",\"author\":{\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/#\/schema\/person\/376103ffa21df7d6ae493779714178e1\"},\"breadcrumb\":{\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/#website\",\"url\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/\",\"name\":\"Mountain Pacific\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/#\/schema\/person\/376103ffa21df7d6ae493779714178e1\",\"name\":\"Beth Brown\",\"url\":\"https:\/\/dsiohn098w.mpqhf.org\/corporate\/author\/beth_admin\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs - Mountain Pacific","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/dsiohn098w.mpqhf.org\/corporate\/medicaid-provider-notice-suspension-pas-continued-stay-reviews-clinical-requirements-medicaid-programs\/","og_locale":"en_US","og_type":"article","og_title":"Medicaid Provider Notice: Suspension of PAs or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs - Mountain Pacific","og_description":"Effective April 23, 2020 Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs Montana Healthcare Programs is continually working to improve safe access to Medicaid services throughout the public health emergency. This provider notice is to suspend the prior authorization or continued stay reviews and clinical requirements for some Medicaid programs during the statewide emergency declared in Executive Orders 2-2020 and 3-2020. This provider notice will remain in effect through the remainder of the COVID-19 epidemic. Future provider notices will specify individual program resumption dates and specific steps to follow for resuming prior authorization, continued stay and clinical requirements. For most Montana Medicaid programs, prior authorization and continued stay reviews are lifted for the duration of the epidemic but clinical criteria in rule will remain in place. It is the responsibility of the provider to document the clinical criteria. The following exceptions apply: 1. Prior authorization and continued stay reviews are still required for the following programs: Addictive and Mental Disorders Division Inpatient Hospital (Montana State Hospital) (under 18 and over 64 years of age) Medically Monitored Intensive Inpatient Substance Use Disorder (SUD) Treatment (ASAM 3.7) Substance Use Disorder Intensive Outpatient Services (IOP) (ASAM 2.1) Developmental Services Division\/Children\u2019s Mental Health Bureau Children\u2019s Mental Health Bureau Early Periodic Screening, Diagnostic, and Treatment (EPSDT)Reviews Intermediate Care Facility \u2013 Individual with Intellectual Disability (ICF-IID)(out-of-state) Psychiatric Residential Treatment Facility (in-state, out-of-state, and assessment) Youth Mental Health Genetic Testing Health Resources Division Audiology and Hearing Aid Services DME items reimbursed over $5,000 (formally $1,000 as found on Prior Authorization Chapter ofthe DME Manual Early, Periodic Screening, Diagnostic, and Treatment (EPSDT) Reviews Eyeglasses and Contact Lenses Home Infusion Therapy Interim Hospital Claims Personal and Non-Emergency Medical Transportation Physician Administered Drugs Orthodontia Outpatient Pharmacy For out-of-state hospitals with patients admitted prior to April 23, 2020 continued stay reviews are\u00a0still required until discharge. 2.\u00a0Montana Medicaid has temporarily lifted clinical criteria in addition to prior authorization and continued\u00a0stay reviews requirements for the following Medicaid programs to allow for flexibility in intake and\u00a0discharge that may be required as a result of the COVID-19 epidemic: Addictive and Mental Disorders Division Adult Group Home (AGH) Clinically Managed Low-Intensity Residential SUD Treatment (ASAM 3.1) Crisis Stabilization Program (Crisis Intervention Facility) Developmental Services Division\/Children\u2019s Mental Health Bureau Partial Hospital Services &nbsp; Claim Submission Instructions Many Medicaid services allow providers to span bill for multiple days. In order to avoid denied claims for\u00a0services that are span billed, providers will need to submit separate claims as follows: For services up to and including April 22, 2020, providers will be required to submit claims with the\u00a0prior authorization number as normal. For those services identified in this provider notice as NOT needing a prior authorization, a separate\u00a0claim will need to be submitted for services starting April 23, 2020. 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