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Prior Authorization Requirements
Links to Ohio Medicaid prior authorization requirements for fee-for-service and managed care programs.
Prior Authorization Requirements

Pursuant to Ohio Revised Code 5160.34, the Ohio Department of Medicaid (ODM) has consolidated links to Medicaid prior authorization requirements.  All changes to prior authorization requirements for ODM-administered services and Managed Care Organization-administered services can be accessed via links on this web page.

Home and Community-Based Waiver Programs

Fee for Service

Instructions to Access Behavioral Health Prior Authorization Requirements:
In the behavioral health (BH) benefit package, there are services and/or levels of care that are subject to prior authorization. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below.

  1. Access the BH Provider Manuals, Rates and Resources webpage here.
  2. Under the “Manuals” heading, click on the blue “Behavioral Health Provider Manual” text.
  3. Scroll down to the table of contents. Referencing the table of contents, find the entry for “Table 1-5: Prior Authorization”.
  4. Click the text: Table 1-5: Prior Authorization.
  5. Table 1-5 summarizes the BH services/levels of care and their associated prior authorization policy. 

Non-Institutional

Pharmacy