MedicaidPrior AuthMedium impact
MAB2023111302
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Neurology +1 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for antipsychotic medications, with new clinical guidelines for children under 18 and clarified requirements for non-preferred antipsychotics. The policy adds specific monitoring requirements and specialist consultation mandates for pediatric cases.
Action Required
By January 8, 2024: Billing teams must update prior authorization workflows for antipsychotic prescriptions for Pennsylvania Medicaid patients. Ensure providers document comprehensive evaluations, baseline monitoring (weight/BMI, blood pressure, fasting glucose/A1c, lipid panels, AIMS scores), and specialist consultations for patients under 18. Update encounter forms to include required monitoring documentation fields. Claims may be denied without proper prior authorization and documentation.