Beacon eliminates prior authorization requirement
On August 6, 2014, then-Gov. Deval Patrick signed into law Senate Bill 2341 to “establish a continuing program of investigation and study of mental health and substance use disorders in the Commonwealth.”
In response to a section of that bill, Massachusetts Chapter 258, “An Act to Increase Opportunities for Long-Term Substance Abuse Recovery,” insurers no longer require prior authorization for substance use treatment services for Medicaid, Medicare and commercial insurers as of Oct. 1, 2015.
Chapter 258 also mandates that the largest insurance carriers in Massachusetts provide coverage for abuse-deterrent opioid products; additionally, under the mental health parity law, the statute expanded providers to include licensed alcohol and drug counselors (LADC-I).
Beacon Health Options is one of those insurers and manages the behavioral health benefits for Boston Medical Center Health Net Plan, Fallon Health, Neighborhood Health Plan, Senior Whole Health and the Group Insurance Commission for Tufts Health Plan and UniCare State Indemnity Plan.
Previously, private insurers required prior authorization and provided preliminary approval for a certain number
of days; the insurer had the right to conduct a utilization review if a provider deemed it necessary to extend treatment beyond the initially approved days.
“Chapter 258 shifts the balance of decision-making about admission to substance abuse services from the insurer to the provider,” according to a report from the Center for Health Information and Analysis, which reviewed and evaluated the law for its potential fiscal impact.
Beacon has removed the prior authorization requirement for in-network providers for patients who are medically managed/level 4 detox. However, within 48 hours, providers must notify Beacon that a patient has been admitted.
Once notification is complete, authorization for a seven-day period will be issued.
Although prior authorization will be waived, in-network providers whose patients enter dual diagnosis acute treatment must request authorization on day three of treatment.
Clinical stabilization services may begin without prior authorization, but in-network providers are required to notify Beacon of the admission within 48 hours, at which time authorization for 10 units will be generated automatically.
Similarly, intensive outpatient programs no longer require prior authorization for the first six treatment units within 14 days. But if additional treatment is required, in-network providers should contact Beacon. Family stabilization team services, as long as they pertain to a primary diagnosis of a substance use disorder, require no prior authorization for in-network providers. The same policy applies to outpatient therapy services.
In all situations, discharges and discharge reviews may be submitted electronically.
Beacon has made no process changes to acute treatment services/level 3.7 detox; structured outpatient addictions programs; and medication-assisted treatment.
Providers who have questions about the process changes should contact Beacon via its Web site (www.beaconhs.com) and select Provider Tools to access its e-services manual.