[New York] Spravato prior authorization requirement

By April 1, 2026: Billing team and clinical staff must implement prior authorization requirement for Spravato administration via Buy and Bill process for all New York Medicaid Managed Care members. (1) Update billing system to automatically flag Spravato claims for Medicaid Managed Care requiring prior auth before claim submission. (2) Provide providers with the Esketamine (Spravato) Request Form and establish workflow to submit requests before treatment initiation. (3) Train clinical and billing staff on the new requirement and InterQual 2025 Esketamine criteria. (4) Update patient education materials to explain prior authorization requirement to members. Claims submitted without prior authorization will be denied.