2018-27: Revised and Streamlined MHR Authorization Renewal Process

Date: 05/04/18

Louisiana Healthcare Connections is dedicated to improving member health outcomes while streamlining the healthcare delivery system and protecting state resources against fraud, waste and abuse. In light of these responsibilities, we are revising our process for authorizing and renewing mental health rehabilitation (MHR) services.

Effective June 4, 2018, the standard authorization period for MHR services will be 60 days. To minimize the administrative burden to providers, only an abbreviated treatment renewal request will be required to renew services every 60 days thereafter, for up to six months. At six months, a full reauthorization will be required and the cycle will begin again.

Responsive to Provider Input and Feedback

We appreciate the several dozen providers who have contributed thoughtful input on this process or served as beta-testers for the process and forms. This revised process reflects their input in significant ways:

The standard renewal period is doubled, from 30 to 60 days
The process allows flexibility to account for special circumstances
The OTR form is simplified and shortened to less than half of the previous length

Continuity of Authorizations for a Smooth Transition

Continuity of services is important to both our members and providers, and the transition to this process will not disrupt services. All existing authorizations will continue until their established end date. At that time, subsequent MHR requests will begin using this process.

If the patient is due for a LOCUS/CALOCUS assessment, the request should use the initial MHR outpatient treatment request form.
If the patient is not yet due for a LOCUS/CALOCUS assessment (completed every 6 months), then the request should use the renewal MHR outpatient treatment request form.

Minimizing Administrative Burden

We recognize that administrative burden is a constant concern to all healthcare providers, and have redesigned the process and the MHR outpatient treatment request form to:

Increase the standard renewal period from 30 to 60 days
Reduce the length of the form to less than half of the previous length
Use principles of user-experience design to make it simple and intuitive to complete
Integrated “just-in-time” tips to proactively answer questions and help avoid issues

Download the New MHR OTR Forms

Resources for Providers

Based on early feedback, we have published an MHR Authorization Resource Kit to support providers and make this process as simple and quick as possible. The Resource Kit include a process overview, checklists, and annotated forms for frequently asked questions. A brief, on-demand webinar training is also available.

If you have any questions, please contact your dedicated Provider Relations Consultant, call Provider Services at 1-866-595-8133 or email feedback@LouisianaHealthConnect.com.

Partners in Improving Health – and Health Care

We are committed to open communication and active partnership with our network providers to improve health and healthcare in Louisiana. If you have feedback or questions about this process, these resources, or other matters, please let us know: feedback@LouisianaHealthConnect.com.

Frequently Asked Questions

What is the new MHR re-authorization process?

Starting June 4, 2018, mental health rehabilitation (MHR) services will need to be re-authorized every 60 days. Providers may use the Renewal MHR Outpatient Treatment Request (OTR) form to communicate member progress updates and request re-authorization. This process aligns with best practices in level-of-care decision-making for Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) services.

To what services will the 60-day re-authorization process apply?

Only CPST and PSR are covered by this process. The authorization timeframes remain unchanged for all other behavioral health services.

Will all Louisiana Healthcare Connections members currently receiving MHR services require a new OTR on June 4?

No. All existing MHR authorizations will continue until their expiration date. There is no need to submit an OTR form unless the patient’s authorization is about to expire.

Is the LOCUS/CALOCUS required every 60 days?

No. The LOCUS/CALOCUS timelines are not changing. The LOCUS/CALOCUS must accompany only the initial OTR request, and then be submitted every 180 days thereafter.

Is a new treatment plan required every 60 days?

No. Only an OTR is necessary for re-authorization every 60 days.

Is a face-to-face assessment by an LMHP required every 60 days?

No. A Licensed Mental Health Professional (LMHP) familiar with a patient’s case can complete the OTR form in a matter of minutes using the progress documentation by the unlicensed practitioner who is providing services. The MHR re-authorization process is designed to ensure that the patient’s care is being appropriately supervised by an LMHP.

Why is the oversight of a LMHP required for the OTR?

Per the Louisiana Department of Health (LDH) Behavioral Health Provider Manual (Ch. 2, Sec. 2.2):

“The medical necessity for these rehabilitative services must be determined by and services recommended by a licensed mental health professional or physician, or under the direction of a licensed practitioner, to promote the maximum reduction of symptoms and restoration to his/her best age appropriate functional level.”

It is important to the health outcomes of our members that licensed providers remain proactive in developing, monitoring and measuring their treatment plans and goals of care.

How many LOCUS/CALOCUS assessments are covered each year?

Louisiana Healthcare Connections covers two LOCUS/CALOCUS assessments per year. The MHR re-authorization process requires only two LOCUS/CALOCUS assessments per year – one every 180 days.

How does the OTR re-authorization process affect members?

The process itself does not directly affect the member, as no additional face-to-face visits with an LMHP are required. The OTR re-authorization process supports providers in improving outcomes for their patients – our members. Members who need and benefit from MHR services will have continued access to those services.

Are Louisiana Healthcare Connections’ OTR reviewers licensed clinicians?

Yes. Our behavioral health care managers and utilization management reviewers are all licensed clinicians who receive additional specialized training for case management and utilization review. This team and the OTR review process was developed specifically to improve member outcomes, and includes a provision that any authorization request that does not meet medical necessity criteria must be reviewed by a physician before being denied.

Will you still accept the old OTR for any authorization requests?

No old OTRs will be accepted beginning June 4, 2018. The new MHR OTR form will be required for all MHR authorization requests.

Will the abbreviated renewal OTRs be a substitute for the "progress summary" as defined in the Behavioral Health Service Provider manual (Record Keeping Section)?

The progress summaries referenced in the record keeping section of the Behavioral Health Service Provider manual has a list of all documentation requirements that must be included in the clinical record of the member (those progress summaries stay in your clinical record and do not need to be submitted to us). The abbreviated OTR contains some of those required elements but does not include the entirety of the documentation necessary for complete record keeping in the medical records of the member.

On page 1 of both the initial and renewal OTR, there are blanks for Clinician and Credentials. Are these blanks to be completed with the name of the LMHP or the individual non-licensed clinician who is delivering CPST and PSR to the member? The last page of the OTR is clearly where the LMHP information and signature is obtained - just not sure which clinician information you want on the first page.

The clinician responsible for overseeing the care or the licensed person who would be able to answer additional questions related to the member’s care is who should be indicated on the first page. That could also be the same as the clinician who is attesting to the accuracy of the OTR information on the last page, but they are not required to be the same clinician.

On page 3 of the OTR forms, under requested authorization there is no check box for H2017 Individual Office or Community. The only checkboxes are by group PSR or Permanent Supportive Housing. We typically deliver PSR individually. Can this checkbox be added?

Thanks for this question. After looking at these checkboxes closely, we are going to modify the form to remove the place of service information that’s currently there. It is not necessary for the authorizations, so this will simplify the form and hopefully avoid this potential confusion. We’ll add a small note that reminds people that the place of service code should be included when they submit the claim for payment.

In the instructions and on the OTR forms, it states that the Healthy Louisiana Behavioral Health Assessment (for adults) only needs to be completed annually; however, in previous communications it was stated that information from the LBH Assessment is needed to be able to complete the LOCUS. So, it has been our understanding that means the LBH Assessment should be completed along with the LOCUS to obtain current scores. This new process states it should be completed only annually. Can you clarify for me which is the required frequency for the Louisiana Behavioral Health Assessment: annually or every 180 days? Or is it optional to complete it every 6 months?

The Healthy Louisiana Behavioral Health Assessment (for adults) only needs to be completed annually. That assessment is separate from the LOCUS, which is required every 180 days. They do not have to be completed at the same time.

When services are being initiated for a member for the first time, both will be needed in order to submit the first Outpatient Treatment Request. So in practice, it may be common to complete both the LBH assessment and LOCUS at the same time. Then 180 days later, the LOCUS will be completed without the LDH assessment. And then 180 days after that (approximately a year after the initial request) both the LOCUS and LBH assessment will be completed again.

For those people who are currently authorized, let say, until August; will they need a concurrent auth completed or will everyone get an initial auth under the new process, even if they are established clients?

Since the majority of the current authorizations are for a 180 day timespan, it is most likely that once the current authorization expires they will be due for a new 180 day CA/LOCUS, and therefore should use the initial OTR. If, for some reason, the member is not due for a new CA/LOCUS when the current auth expires, then the renewal OTR can be used.

What resources are available if I have other questions?

If you have any questions, please contact your dedicated Provider Relations Consultant, call Provider Services at 1-866-595-8133 or email feedback@LouisianaHealthConnect.com.