Provider Alert! MCO Compliance with H.B. 2822 provisions related to PA for Antipsychotic Drugs Required by May 20

Date: April 21, 2022

Attention: Behavioral Health Providers

Effective Date: May 20, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Managed care contracts require MCOs to comply with Texas Government Code § 531.073 under the section titled “Compliance with State and Federal Prior Authorization Requirements” (UMCC 8.1.8.1, etc.). H.B. 2822 (87th Legislature, Regular Session) amends Texas Government Code § 531.073, adding subsections related to the availability of antipsychotic prescription drugs. This notice describes HHSC’s expectations for MCO compliance with this statute as amended.

How this impacts providers: MCOs must comply with the provisions under subsection (a-5) by updating pharmacy claims systems to:

1. Fully automate clinical prior authorization processes for drugs in the antipsychotic class.
2. Ensure prior authorization denial messaging for drugs in the antipsychotic class include:
3. specific contact information necessary for the pharmacist to submit a prior authorization request for the prescription, and
4. instructions to the pharmacist to dispense a 72-hour supply of the prescription if clinically appropriate under federal or state law.

Next steps for providers: Prescribers should share this update with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.