Provider Alert! MCO Compliance with H.B. 2822 provisions related to PA for Antipsychotic Drugs Required by May 20Texas Children's Health Plan
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 18.104.22.168, 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:
- Fully automate clinical prior authorization processes for drugs in the antipsychotic class.
- Ensure prior authorization denial messaging for drugs in the antipsychotic class include:
- specific contact information necessary for the pharmacist to submit a prior authorization request for the prescription, and
- 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: email@example.com.