Prevent Behavioral Health Readmissions

Prevent Behavioral Health Readmissions Poor access to prescribed medications after discharge is one of the most common reasons for behavioral health readmissions. One effective way to help ensure access to medications post-discharge is to obtain and verify prior authorization for the medications before discharge. Texas Children’s Health Plan follows the state of Texas Medicaid Guidelines for the use and approval of antipsychotics in children. Criteria for approval can be accessed here. If a patient does not meet criteria and the prior authorization is denied, a medical director at Texas Children’s Health Plan can review submitted appeal requests to approve based on medical necessity. Another effective way to ensure access is to fill the prescription at discharge which can be done by hospital pharmacies or outside retail pharmacy delivery. The Texas Children’s Health Plan Case Management staff is available at 832-828-1430 to work with you and your patients to help break down barriers that may be impacting their care. Contact your Provider Relations representative at 832-828-1008 if you need guidance on the prior authorization and appeal process or for more information on participating retail pharmacies that can deliver your patient’s medications prior to discharge. By: Dr. Lia C. Rodriguez, MD FAAP Medical Director, Texas Children’s Health Plan