MGBHP Medicaid: prior authorization for PHP and IOP admission is no longer required 

Mass General Brigham Health Plan (MGBHP) Medicaid has removed prior authorization requirements for behavioral health Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) admission (days 1 and 2 of services) retroactively to Jan. 1, 2026.

This change applies to any claim submission by network providers with dates of service on or after Jan. 1, 2026, for admission to PHP or IOP.

What you need to do

Providers will need to request authorization for continuation of services prior to day 3 of PHP or IOP treatment when utilization management begins.

The MGBHP manual and addendums are available on the Provider Express Massachusetts page for the full list of services with prior authorization requirements.

Questions?

For assistance, please call the dedicated Massachusetts provider line at 1-866-860-7308 to speak with a Provider Relations Advocate.