MedicaidPrior AuthMedium impact
Behavioral Health Prior Authorization Resumption
Kentucky Medicaid·KY · Psychiatry·Prior Authorization
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Kentucky Medicaid will resume prior authorization requirements for specific behavioral health services starting May 1, 2025. Services like inpatient psychiatric stays over 3 days, intensive outpatient programs beyond 30 days, and several other behavioral health services will require PA, with MCOs required to develop consistent notification protocols.
Action Required
By May 1, 2025: Billing team must update systems to require prior authorization for behavioral health services including Applied Behavioral Analysis beyond 30 days, inpatient psychiatric stays over 3 consecutive days, Intensive Outpatient Programs beyond 30 days, Peer Support Services (H0038) exceeding 800 units per year, Psychoeducation (H2027) exceeding 500 units per year, and Targeted Case Management beyond 3 months. Implement MCO notification protocols for inpatient admissions and service initiations. Update encounter forms to remind providers of PA requirements. Note that PA is not allowed for children's behavioral health services or crisis/emergency services.