Regulation .08 Authorization Requirements.

The ASO shall establish a process, through a utilization review system, for authorization of specialty mental health services.

The ASO shall authorize services that are:

(1)

Medically necessary;

(2)

Of a type, frequency, and duration that are consistent with expected results and cost-effective; and

(3)

Delivered in a manner consistent with this chapter.

Preauthorization is not required before a provider renders services in an emergency department.

Except as provided in Regulation .08C of this chapter, no payment shall be rendered for services that have not been authorized.