Reinstatement of Prior Authorization Requirements
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This document announces reinstatement of Medicaid prior authorization (PA) requirements in Rhode Island: non-behavioral health PAs resume October 1, 2021 and behavioral health PAs resume January 1, 2022, and it directs MCOs and providers to follow EOHHS PA rules.
Prior authorization requirements for all services except behavioral health will be reinstated effective October 1, 2021.
Prior authorization requirements for behavioral health services will be reinstated effective January 1, 2022.
Providers must proactively ensure services are authorized prior to providing them for services that require prior authorization.
Prior Authorization Reinstatement Timeline
Prior authorization reinstatement timeline
Reinstatement schedule and provider action required:
For services that require PA, providers must proactively ensure members' services are authorized prior to providing them.
For services that require PA, providers must proactively ensure members' services are authorized prior to providing them.
What Providers and MCOs Must Do
Reinstatement of prior authorization requirements (effective dates)
Prior authorization requirements for all services except behavioral health are reinstated effective October 1, 2021. Behavioral health prior authorizations are reinstated effective January 1, 2022. For services that require prior authorization, providers must proactively ensure members’ services are authorized prior to providing them. See the EOHHS prior authorization guidance link for details.
- Non‑behavioral health PAs resume October 1, 2021.
- Behavioral health PAs resume January 1, 2022.
- Providers must obtain authorization before delivering services that require prior authorization.
MCO responsibility to notify and cooperate with providers
Managed Care Organizations must inform providers of the reinstatement and cooperate with providers to ensure continuity of services.
- Notify network providers of PA reinstatement dates and requirements.
- Cooperate with providers to minimize disruptions and ensure continuity of member services.
Key Terms
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