Prior Authorization Required for Partial Hospitalization Programs Starting October 9

LifeWise Health Plan of Washington is expanding its Psychiatric and Other Specified Evaluations in Inpatient, Residential, and Partial Hospital Program Behavioral Health Treatment 3.01.521 policy to include new criteria that apply to partial hospitalization programs (PHPs). The expanded policy takes effect on October 9, 2026.

Why it Matters

Clearer evaluation and assessment requirements support consistent, compliant decisions for PHP treatment of mental health conditions, substance use disorders, and eating disorders.

Depending on the type of care provided, requirements may include the following:

• Psychiatric medication evaluations
• Substance use evaluations
• Nutritional assessments
• Other InterQual^® criteria that may apply to treatment

The policy outlines provider qualifications, documentation requirements, and timeframes for completing applicable evaluations and assessments. This includes ongoing requirements that must be completed every 7 to 10 days.

Next Steps

To prepare for these changes, review the updated policies for individual and group plans to understand the requirements for PHP services. Reference prior authorization request.