Montana Medicaid State Plan Amendment: Remove ENA prior authorization & make IOP permanent
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Removes prior authorization for EPSDT Extraordinary Needs Aides (ENA) and adds Intensive Outpatient (IOP) mental health services as a permanent Medicaid benefit effective Jan 1, 2023; applies to Montana Medicaid administration, providers, and beneficiaries.
Prior authorization requirements for EPSDT Extraordinary Needs Aides (ENA) will be removed.
Mental health Intensive Outpatient (IOP) services will be made a permanent Medicaid benefit (previously approved only during the COVID-19 PHE).
Proposed Coverage Changes
Proposed coverage changes
Changes proposed in the SPA affecting coverage and authorization:
ALL of the following
ONE of
- Removal of prior authorization for EPSDT Extraordinary Needs Aides (ENA).
Operational change affecting authorization workflow for ENA services under EPSDT.
- Addition of Intensive Outpatient (IOP) mental health services as a permanent Medicaid benefit (previously approved only during the COVID-19 PHE).
Creates ongoing coverage and fiscal impact for IOP beyond the Public Health Emergency SPA.
ALL of the following
- SFY 2023: $100,946.
- SFY 2024: $211,978.
Coding and Fiscal Information
Provider Actions and Requirements
Remove ENA prior authorization
Remove prior authorization requirements for EPSDT Extraordinary Needs Aides (ENA) as described in the SPA; ENA services will no longer require prior authorization under Montana Medicaid effective January 1, 2023.
IOP services made permanent
Make Intensive Outpatient (IOP) mental health services a permanent Medicaid benefit; IOP was previously authorized only under a COVID-19 PHE SPA that will end with the PHE.
- Estimated IOP expenditures: $100,946 (SFY2023) and $211,978 (SFY2024).
Key Definitions
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