RCPA - Rehabilitation and Community Providers Association


OMAP Bulletin Revises BHRS Authorizations for Children With Autism and Developmental Disabilities
June 22, 2005

In response to recommendations from the Autism Task Force, the following changes will become effective for evaluations performed and requests for Behavioral Health Rehabilitation Services (BHRS) submitted on and after August 1 in both the fee-for-service and managed care delivery systems.

Frequency of Comprehensive Evaluations and Authorizations
A comprehensive evaluation or re-evaluation will be required at the initiation of treatment. Subsequent comprehensive re-evaluation and reauthorization are required once every 12 months unless a family member or a treating professional believes that a re-evaluation is necessary sooner. If the need for Summer Therapeutic Activities Program is identified during the authorization period, an addendum, rather than a complete evaluation, may be used to request the service.

Who May Prescribe
The child’s treating physician, such as a pediatric neurologist or developmental pediatrician, in addition to psychiatrists or licensed psychologists, have the ability to recommend the services.

Limitation on Service Reductions and Terminations
If a behavioral health managed care organization (BHMCO) or the Office of Medical Assistance Programs (OMAP) conducts a concurrent review of BHR Services during the authorization period, it may not propose a reduction or termination of services on the basis that the child’s condition is improving or the child’s condition is not yet improving. The BHMCO or OMAP may reduce or terminate authorized services only if it can clearly demonstrate, on the basis of clinical evidence, that a substantial change in circumstances renders the authorized services no longer medically necessary.

A copy of the bulletin is available from the link below.

OMAP Bulletin #07-05-01: Psychological/Psychiatric/Clinical Re-Evaluations and Re-Authorizations for Behavioral Health Rehabilitation (BHR) Services for Children and Adolescents with Behavioral Health Needs Compounded by Developmental Disorders

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