1.      The prescriber must complete either the Medicaid “Informed Consent for Psychotherapeutic Medication” attestation form; the Department of Children and Families CF1630 form; or provide the court order for the medication.

2.      The completed form must be presented to the pharmacy with every new prescription for a psychotherapeutic medication.  Prescription refills where the original prescription was filled prior to September 1st  will not be denied.   However, pharmacies may not add refills to old prescriptions to circumvent the need for an updated informed consent form.

3.      In order for a prescription claim for a psychotherapeutic medication to pay, the pharmacy must enter the medical certification code “2” to certify that the consent form has been filed with the prescription.  This process is similar to the pre-existing family planning “6” and dialysis “8” code requirements.

4.      The completed form must be filed with the prescription (hardcopy or imaged)  in the pharmacy and held for audit purposes, for a minimum of five years.

5.      Every new prescription will require a new informed consent form.

6.      Prescriptions may be phoned in or emailed for these medications, when the child is less than 13.  However, the pharmacist will need to obtain a completed consent form from the prescriber via fax, mail or from the guardian, prior to dispensing.

7.      The informed consent forms do not replace prior authorization requirements for non-PDL medications or prior authorized antipsychotics for children and adolescents from 0 through 17 years of age.

8.      Medicaid HMOs have been directed to implement the policy, but may chose to operationalize it in a different manner from Medicaid fee-for-service.  They may require something other than a medical certification code.

You may access the Medicaid “Informed Consent for Psychotherapeutic Medication” attestation form here.