Medicaid Providers
Effective 5/12/2024, the Division of Behavioral Health has continued the suspension of the fiscal year limits and Service Authorization (SA) requirements for Behavioral Health Medicaid State Plan services processed through Optum. The suspension will continue until the effective date of the proposed regulation adoption that permanently removes these SA requirements.
Note: The 1115 Substance Use Disorder and 1115 Behavioral Health services Service Authorizations as described in the February 2, 2024, revised regulations package, will continue to be required.
Optum is updating provider express, their websites and claims system as soon as possible to reflect this change.
Additional guidance:
Suspension of State Plan Service Limits and Service Authorizations, Effective May 12, 2024.
Background
The Division of Behavioral Health (DBH) gained approval from the Centers for Medicare and Medicaid Services (CMS) to leverage the 1135 flexibilities granted under Alaska disaster State Plan Amendment (dSPA) to fully suspend 1115 BH, 1115 SUD and State Plan state fiscal year limits and Service Authorization (SA) requirements throughout the Covid-19 Public Health Emergency, with a termination date of May 11, 2024.
Guidance
Effective May 12, 2024: 1115 SUD and 1115 BH services are subject to the fiscal year limitations and SA requirements described in the February 2, 2024, revised regulations and billing manuals. State fiscal year 2024 utilization of limited services will accrue prospectively from date of service May 12, 2024, through June 30, 2024. Service limits will “reset” on July 1, 2024 for state fiscal year 2025. For continuation of services beyond the described state fiscal year limits, a SA demonstrating medical necessity will be required, submitted to the DBH ASO, Optum.
Effective May 12, 2024: State Plan services processed through the DBH ASO, Optum, for the following provider types will remain paused indefinitely while the State pursues permanent removal of the associated limitations and SA requirements in regulation:
- Autism Services
- Community Behavioral Health Providers
- Mental Health Physician Clinics
Providers must ensure that services rendered are medically necessary and align to the requirements outlined in 7 AAC 135.100 – 7 AAC 135.350. Medical necessity must be documented in all assessments, treatment plans and progress notes as indicated.
Any questions regarding this guidance may be directed to mpassunit@alaska.gov; in the Subject Line please note: Amended DSPA Suspended SA Guidance.
Thank you,
Andrea Mueca
Deputy Director
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