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House Bill 517: Uniform Prior Authorization Implementation

The passage of House Bill 517 (HB517), the budget trailer bill, places new responsibilities on the Department to oversee the Medicaid managed care organizations’ (MCOs) prior authorization (PA) requirements for behavioral health drugs. The bill amends RSA 126-A:5,XIX by requiring the Commissioner to develop a universal online PA form for drugs used to treat mental illness by July 15, 2017 and requires community mental health centers (CMHC) and managed care organizations to use the universal PA form by September 1, 2017.

See FINAL NH Medicaid MCO Behavioral Health Drug PA Form Adobe Acrobat Reader Symbol

The bill also places stringent turnaround times on both prior authorization decisions and requested peer-to-peer reviews following denials of prior authorization requests. To quote: “A reasonably completed prior authorization request submitted using the online form shall be approved or denied by the close of the next business day.”

See FINAL Uniform PA Rx Approach Document Adobe Acrobat Reader Symbol

“Failure to meet this time frame shall be deemed automatic approval. If the prior authorization is denied, the prescribing provider may request a peer‐to‐peer review with a licensed psychiatric specialist with prescribing privileges, with the MCO, by the close of the next business day.”

“Failure by the managed care organization to provide such review by the close of the next business day shall be deemed an automatic approval unless the prescribing provider fails to participate in the peer‐to‐peer review within that time period.”

Prior authorization for drugs prescribed by community mental health centers for treatment of severe mental illness shall be suspended if the deadlines are not met, or if the Commissioner determines there is a pattern of missed deadlines for peer-to-peer reviews following denials, or if at any time the Commissioner determines such suspension is necessary to promote the behavioral health and well‐being of New Hampshire's citizens being served under Medicaid managed care.

See FINAL Patient Rights CMHC PA Rx Implementation Adobe Acrobat Reader Symbol

The Commissioner is also required to monitor compliance with the law and report quarterly to the fiscal committee of the general court relative to adherence to all such requirements including the rate of denial. The Department will outline the reporting specifications necessary for the commissioner to effectively monitor compliance, as required above.

See FINAL BHDRUG01 Reporting Document Microsoft Excel Symbol

For further information, please contact:
Deb Scheetz, Medicaid Deputy Director
(603) 271-9459
deborah.scheetz@dhhs.nh.gov

 

BHDRUG01 Uniform Prior Authorization Reporting
(documents are in Adobe PDF Format Adobe Acrobat Reader Symbol)

NH Healthy Families   Well Sense
2019 2018 2017 2019 2018 2017
December December 12/24-12/30/2017 December December 12/24-12/30/2017
November November 12/17-12/23/2017 November November 12/17-12/23/2017
October October 12/10-12/16/2017 October October 12/10-12/16/2017
September September 12/03-12/09/2017 September September 12/03-12/09/2017
August August 11/26-12/02/2017 August August 11/26-12/02/2017
July July 11/19-11/25/2017 July July 11/19-11/25/2017
June June 11/12-11/18/2017 June June 11/12-11/18/2017
May May 11/05-11/11/2017 May May 11/05-11/11/2017
April April 10/29-11/04/2017 April April 10/29-11/04/2017
March March 10/22-10/28/2017 March March 10/22-10/28/2017
February February * 10/15-10/21/2017 February February * 10/15-10/21/2017
January 02/11-02/17/2018 10/08-10/14/2017 January 02/11-02/17/2018 10/08-10/14/2017
  02/04-02/10/2018 10/01-10/07/2017   02/04-02/10/2018 10/01-10/07/2017
  01/28-02/03/2018 09/24-09/30/2017   01/28-02/03/2018 09/24-09/30/2017
  01/21-01/27/2018 09/17-09/23/2017   01/21-01/27/2018 09/17-09/23/2017
  01/14-01/20/2018 09/10-09/17/2017   01/14-01/20/2018 09/10-09/16/2017
  01/07-01/13/2018 09/03-09/10/2017   01/07-01/13/2018 09/03-09/10/2017
  12/31/2017-01/06/2018       12/31/2017-01/06/2018  
* Reporting frequency change from weekly to monthly


Frequently Asked Questions
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Additional Documentation

MCO Authorized Representative Forms for Standard Appeals

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

Microsoft Excel Symbol Microsoft Excel format. You can download a free reader from Microsoft.

 
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