P-13.1.1.2. Optional MCO Clinical Prior Authorizations

Implementation of all other board-approved clinical prior authorization is optional and will vary between VDP and the MCOs at the discretion of each MCO. An MCO may use any or all of the board-recommended clinical prior authorizations criteria but is not permitted to implement more stringent prior authorization criteria than the board approved.

Refer to the VDP website Managed Care Clinical Prior Authorization page (txvendordrug.com/formulary/prior-authorization/mco-clinical-pa) for the list of clinical prior authorizations MCOs have the option to perform for people enrolled in Medicaid.

Refer to the VDP website MCO Resources page (txvendordrug.com/resources/managed-care/mco-resources) for a link to the clinical prior authorization page on each MCO's website.