Top Forms and Resources for Behavioral Health Providers
Prior Authorization Requirements when Prescribing Psychotropic Medications for Children and Adolescents
New York state requires CDPHP, as a Medicaid Managed Care plan, to implement a Children’s Behavioral Health Pharmacy Program that includes the monitoring and oversight of key medications for children. Effective February 1, 2020, prior authorization will be required for:
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All antipsychotics, benzodiazepines, hypnotics, anxiolytics, and lithium prescribed for members younger than 18 years of age.
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Formulary stimulant and non-stimulant medications prescribed to treat attention deficit hyperactivity disorder (ADHD) in members younger than six years of age.
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Antidepressants prescribed for members younger than the FDA-approved age.
When receiving prior authorization requests for these medications, CDPHP will be looking for documentation of any non-pharmacologic interventions that have been tried, as well as evidence of ongoing medication monitoring. Additionally, we encourage providers to use age-appropriate, FDA-approved medications whenever clinically appropriate.
Patients who are stabilized on their current medication regimen will be grandfathered to prevent any disruption in treatment. The CDPHP behavioral health team is available by phone (518-641-3600) to answer any questions about these requirements or behavioral health services in general.
Important Forms and Checklists
Participating providers are also urged to register for secure access to the provider portal to view the Provider Office Administration Manual and full list of CDPHP policies. If you have not already done so, please click on “Register” in the login box to sign up.
Registration Form for Trading Partner Testing
Medicaid Behavioral Health (BH) testing with our trading partners began April 15, 2016. Please register with CDPHP when you are ready to begin testing and indicate if you are testing with a paper claim submission or using a trading partner. Please make sure you have submitted an operating certificate to your network contracting representative at least five business days prior to registering for testing.
E&M Coding Tips
CDPHP hosted a workshop entitled “E&M Coding for Behavioral Health Providers: Avoiding Common Documentation Mistakes.” The presentation and related handouts are provided here, by express permission of presenter Derek Jansen-Jones, PhD, cofounder of health care compliance consulting firm Diligence.pro.