Ohio Department of Medicaid · May 28, 2026 · Primary source
Ohio Medicaid Announces New Prior Authorization Standards to Behavioral Health Services COLUMBUS, Ohio –The Ohio Department of Medicaid (ODM) today announced new prior authorization requirements for community behavioral health, mental health, and substance use disorder services. May 28, 2026
Summary
The Ohio Department of Medicaid issued new prior authorization requirements on May 28, 2026, covering community behavioral health, mental health, and SUD services across all Ohio Medicaid managed care plans. The framework establishes standardized prior authorization forms to be used uniformly by all managed care plans, replaces plan-by-plan variation with threshold-based review, and requires managed care plans to identify high-value behavioral health providers for value-based payment partnerships. ODM stated that no services will be reduced or denied without individualized clinical review, and that members already receiving ongoing care are protected from abrupt transitions.
What this may mean
All Ohio Medicaid managed care plans are now required to use standardized prior authorization forms for BH and SUD services, eliminating the prior patchwork of plan-specific forms. Providers in Ohio billing Medicaid for community behavioral health, mental health, or SUD services face new utilization management thresholds and enhanced documentation requirements tied to medical necessity. Managed care plans must also engage in value-based payment initiatives with high-performing behavioral health providers, which may include streamlined authorization processes or financial incentives.
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