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5.2.1.2 Subsequent Prior Authorization Request for Encounters/Visits after the Initial Prior Authorized Encounters
5.2.1.2.1 Client Condition Requirements
The following documentation requirements indicating the client conditions must be submitted when requesting prior authorization for subsequent encounters/visits.
All of the requirements for the initial authorized treatment sessions must be met in addition to an assessment of the client's response to treatment, which indicates one of the following:
• The client has not achieved the discharge goal necessary to conclude treatment, but the description of the client's progress indicated that treatment can be concluded within a short period of time.
•The client's psychiatric condition has not responded to a trial of short term outpatient therapy and there is potential for serious regression or admission to a more intensive setting without ongoing outpatient management (requiring several months or longer of outpatient therapy).
•The client's condition is one that includes long-standing, pervasive symptoms and/or patterns of maladaptive behavior.
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