MedicaidPrior AuthMedium impact
Change in Level of Service Determinations and Prior Authorizations for ACT
Healthfirst·NY · Psychiatry·Prior Authorization
Effective date
Jun 20, 2023
We identified it
Jun 20, 2026
Summary
Effective June 20, 2023, Healthfirst will no longer require Level of Service Determinations (LOSD) or prior authorization for Assertive Community Treatment (ACT) services in accordance with New York State guidelines. Concurrent authorizations are also eliminated but may still be done based on utilization management criteria.
Action Required
Effective June 20, 2023: Billing team must update Healthfirst prior authorization requirements to remove LOSD and prior auth requirements for all Assertive Community Treatment (ACT) services. Update billing system settings and staff workflows to reflect that ACT claims can now be submitted directly without prior authorization. Review utilization management guidelines referenced in policy for any ongoing requirements.