COVID-19 State of Emergency: Behavioral Health Service Requirements
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Mandates managed care plans to waive prior authorization and service limits for all behavioral health services under the 2018-2023 SMMC contract benefits (MMA and MMA Specialty), effective during the COVID-19 state of emergency and until further notice; applies to Simply Healthcare Plans' SMMC lines indicated.
Managed care plans must waive prior authorization requirements and service limits (frequency, duration, and scope) for all behavioral health services (including targeted case management) until further notice.
The waiver applies to all behavioral health services, explicitly including targeted case management.
Builds on prior transmittal 2020-15 by communicating additional flexibilities enacted by the Governor related to behavioral health services.
Behavioral Health Coverage Flexibilities
Behavioral health coverage flexibilities
Covered when ALL of the following are met:
ALL of the following
- Effective May 5, 2020: the managed care plan must waive prior authorization requirements for all behavioral health services (including targeted case management) until further notice.
- Effective May 5, 2020: the managed care plan must remove/waive service limits (frequency, duration, and scope) for all behavioral health services until further notice.
- The plan must implement these provisions in plan systems by May 8, 2020.
Affected Services and Service Limits
| No codes listed |
What Providers Must Do / Watch For
Prior authorization waiver for behavioral health
Waive prior authorization requirements for all behavioral health services (including targeted case management) until further notice.
Service limits waived for behavioral health
Remove service limits — frequency, duration, and scope — for all behavioral health services until further notice.
- Applies to all behavioral health services, explicitly including targeted case management.
- Must be implemented in the managed care plan's system by May 8, 2020.
Key Definitions
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