Reevaluation of Consent Securing Process

SUMMARY OF OPTIONS:

“Priority Members”
i. Outpatient opioid treatment
ii. Ambulatory detoxification
iii. Non-hospital medical detoxification
iv. Medically supervised or alcohol drug g abuse treatment center (ADATC) detoxification crisis stabilization

Option 1, Current Process:

Before July 1, 2021 (before Managed Care Launch):
- Provider submits new PAs for member to LME-MCO.
- LME-MCOs work with providers to identify those members anticipated to fall into the Priority Member Category.
- Starting with PA submissions 1 month prior to Managed Care Launch, provider will also secure member consent that is specific to the member’s new PHP (as selected or auto assigned) using the DHHS-sponsored consent form and provide to the LME-MCO.
- Consent provides authorization necessary for the member’s LME-MCO to transfer the PA for services covered under 42 CFR Part 2 and to engage in pre-transition communication with the PHP.
On or After July 1, 2021:
- Managed Care Launch: member is now enrolled in PHP
- PHPs are required to honor open PAs for up to 90 days post Managed Care Launch.
- If a consent is not secured within established timeframe after Managed Care Launch, the provider will need to submit a new Prior Authorization for services to the member’s PHP.

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Option 2, Alternative Process:

Before July 1, 2021 (pre Managed Care Launch):
- Provider submits PA to LME-MCOs to authorize services needed prior to July 1, 2021.
- LME-MCOs work with providers to identify those members anticipated to fall into the Priority Member Category.
- State sets expectation that authorized PAs are covered under State requirement that PHPs honor identified PAs for at least 90 days (or current end date, whichever occurs first).
On or after July 1, 2021:
- Managed Care Launch: member is now enrolled in the PHP.
- At Managed Care Launch, provider submits new PA to client’s PHP.
- Managed Care Launch requirement of honoring for duration of PA, up to 90 days, is in effect.

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SURVEY:

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* 1. Provider Agency (optional)

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* 2. Which option, in your opinion, is the least likely, to disrupt member care at the time of transition?

Option 1 - Current Process

Option 2 - Alternative Process

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* 3. Which option, in your opinion, best ensures uninterrupted authorization to provider?

Option 1 - Current Process

Option 2 - Alternative Process

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* 4. The requirements in these options have been reviewed to ensure compliance with 42 CFR Part 2. Is there another option that is not being considered?

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* 5. Additional Feedback?

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