A guide for independent practices

Kentucky Medicaid Behavioral Health Prior Authorization

Kentucky Medicaid reinstated behavioral health prior authorization in 2025. See what changed, how plan rules differ, and what to track before each visit.

By Minds Unraveled · Sources reviewed October 21, 2026

What changed in 2025

Many Kentucky Medicaid behavioral health prior authorization requirements were lifted during the COVID-19 public health emergency. In 2025, House Bill 695 directed the Department for Medicaid Services to reinstate all behavioral health prior authorization requirements that were in place on January 1, 2020. The department set June 25, 2025 as the effective date and reported the reinstatement complete that month.

The department left the details to each managed care organization. Its April 2025 letter said each plan would notify providers of its own behavioral health requirements at least 30 days in advance. Start dates differed: UnitedHealthcare Community Plan of Kentucky required authorization for some services on or after June 25, 2025, and Humana Healthy Horizons in Kentucky reinstated its requirements effective July 1, 2025.

Sources: Kentucky General Assembly: 2025 Acts Chapter 110 (House Bill 695) · Kentucky Medicaid: Prior Authorization for Behavioral Health Services, April 8, 2025 provider letter · Kentucky Medicaid: HB 695 update to the Budget Review Subcommittee, June 4, 2025 · Optum Provider Express: Medicaid prior authorizations are back (UnitedHealthcare Community Plan of Kentucky) · Humana Healthy Horizons in Kentucky: Behavioral health authorization reinstatement

Each plan sets its own list

Requirements are not uniform across plans. Humana’s list covers inpatient and residential care, partial hospitalization, intensive outpatient programs, therapeutic behavioral health services and day treatment, applied behavior analysis, and targeted case management, plus non-emergency services from non-participating providers. UnitedHealthcare says most routine outpatient behavioral health services do not require prior authorization or notification.

Do not assume routine therapy is exempt everywhere. The agenda for the state’s Behavioral Health Technical Advisory Committee meeting on March 12, 2026 listed concerns about prior authorizations for extended therapy services. Check each plan’s current list for the services, codes, and visit counts your practice bills.

Sources: Humana Healthy Horizons in Kentucky: Behavioral health authorization reinstatement · Optum Provider Express: Medicaid prior authorizations are back (UnitedHealthcare Community Plan of Kentucky) · Kentucky Medicaid: Behavioral Health Technical Advisory Committee agenda, March 12, 2026

Federal decision timelines in 2026

Beginning in 2026, a federal rule requires Medicaid managed care plans to decide standard prior authorization requests within seven calendar days and expedited requests within 72 hours. Plans must give a specific reason when they deny a request, and must publish prior authorization metrics on their websites each year, with the first report due March 31, 2026. Those reports show how a plan handles requests before your practice depends on it.

Sources: CMS: Interoperability and Prior Authorization Final Rule (CMS-0057-F)

Build a routine before the first visit

Authorization gaps usually surface as denied claims weeks after the visit. A short routine at intake, and again before each approval ends, keeps the request ahead of the care.

Confirm the client’s Medicaid eligibility and assigned managed care plan before the first visit and whenever coverage could change
Check that plan’s current list for the specific service and code, including any visit or unit limits
Submit requests early enough for the plan’s decision timeline, through a channel the plan accepts
Record the authorization number, approved codes, units, and dates where the billing team will see them
Track remaining units and end dates so continuing care is requested again before the approval runs out
Match each claim to the approved code, dates, and provider before submission

When a request or claim is denied

Start with the stated reason. It shows whether the issue is missing information, a code or date mismatch, or medical necessity. Follow the plan’s reconsideration and appeal steps and deadlines in your provider agreement and manual, and keep copies of everything you submit.

Clinical documentation and medical-necessity judgments belong to the treating clinician. Administrative support can track requests, deadlines, and claim follow-up, but it cannot substitute for the clinical record.

Sources: CMS: Interoperability and Prior Authorization Final Rule (CMS-0057-F)

Expect more change in 2027

House Bill 695 also requires new Medicaid managed care contracts with an effective date no later than January 1, 2027. New contracts could change which plans serve Kentucky Medicaid members and what each requires. When notices arrive, update your plan list and authorization routine before the effective date.

Sources: Kentucky General Assembly: 2025 Acts Chapter 110 (House Bill 695)

Sources and further reading

Requirements can change. Use the payer or program’s current instructions for your provider type and location.

All practice resources