Mental Health Day Treatment - MEDICAID - OHIO (New)

By June 24, 2026: Billing and authorization teams must implement the following changes for Ohio Medicaid mental health day treatment claims: (1) Update billing system to flag all mental health day treatment service requests for prior authorization review; (2) Establish submission protocol to ensure authorization requests are received at least 7 days before service date for standard requests or 2 days for expedited requests; (3) Train providers and billing staff to submit authorization requests using ODM-approved forms available on the Ohio Department of Medicaid website; (4) Ensure medical necessity documentation and clinical rationale accompany all authorization submissions; (5) Configure system to exclude services billed with KX crisis modifier from prior authorization requirements; (6) Update internal processes to reference MCG (Milliman Care Guidelines), ASAM Level of Care Guidelines, and Ohio Administrative Code Chapter 5160 for medical necessity determinations. Failure to obtain proper prior authorization before service delivery may result in claim denials and financial penalties to the practice and reduced benefits for members.