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September/October 2026 Top of Mind

Prior auth no longer required for PHP & IOP admission days 1 and 2

Mass General Brigham Health Plan (MGBHP) Medicaid ACO has removed behavioral health prior authorization requirements for Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) admission days 1 and 2.

This change applies service(s) delivered on or after Jan. 1, 2026.

What does this mean for providers?

Network providers must request authorization for PHP or IOP services for admission day 3 and beyond. Reimbursement for services delivered without authorization may be delayed or denied.

Questions?

A full list of services that require authorization or notification can be found in the MGBHP manual addendum and in the Massachusetts Medicaid prior authorization list.

If you have additional questions, please call the dedicated Massachusetts Provider Services Team at 1-866-860-7308, 8 am – 8 pm ET, Monday – Friday. 


 

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