2.8.2

Prior Authorization and Documentation Requirements

Prior authorization is not required for HBAI services.

Documentation is required for HBAI services to support the medical necessity of the initial assessment, reassessment, and intervention.

For the initial assessment, documentation must support the medical necessity of the assessment and must include the following information:

•	The date of initial diagnosis of physical illness

•	A clear rationale for assessment

•	Outcome of assessment, which includes mental status and the client’s or caregiver’s ability to understand and respond meaningfully

•	Goals and expected duration of specifically recommended psychological intervention(s).

For reassessment, documentation must support the reassessment is necessary and include the following information:

•	The date of change in mental or physical status

•	Rationale for re-assessment with a clear indication of precipitating events.

For the intervention, documentation must support the necessity of the intervention and include the following information:

•	Evidence that the client or caregiver has the capacity to understand and respond meaningfully,

•	Clear outline of planned psychological intervention

•	Goals of the psychological intervention identifying expected improvement in compliance with the medical treatment plan

•	The client’s response to the intervention

•	Rationale for frequency and duration of acute care services

All documentation must include the amount of time spent in the HBAI assessment or intervention and must be documented in the client’s medical record.

All services are subject to retrospective review to ensure that the documentation in the client’s medical record supports the medical necessity of the services provided.