Prior Authorization Metrics

In accordance with federal reporting requirements under 42 CFR 438.210(f) and DHCS Behavioral Health Information Notice (BHIN) 26-008, the Los Angeles County Department of Mental Health is required to publicly report annual prior authorization metrics. These metrics reflect our commitment to transparency, accountability, and timely access to care for Medi-Cal beneficiaries.

Data Points Responses
1. A list of all items and services that require prior authorization Intensive Home Based Services (IHBS)
Day Treatment Intensive (DT)
Day Rehabilitation (DR)
Therapeutic Behavioral Services (TBS)
Therapeutic Foster Care Services (TFCS)
2. Total standard prior authorization requests received 7533
3. The percentage of standard prior authorization requests that were approved, aggregated for all items and services 99.3%
4. The percentage of standard prior authorization requests that were denied, aggregated for all items and services 0.7%
5. The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services 46.3%
6. The percentage of prior authorization requests where the timeframe for review was extended, and the request was approved, aggregated for all items and services N/A
7. Total expedited prior authorization requests received 0
8. The percentage of expedited prior authorization requests that were approved, aggregated for all items and services N/A
9. The percentage of expedited prior authorization requests that were denied, aggregated for all items and services N/A
10. Total standard and expedited prior authorization requests received (Combined total volume) 7533
11. The average and median time between submission and determination for standard prior authorizations Average: 2 days; Median: 0 days
12. The average and median time between submission and determination for expedited prior authorizations N/A