Service Authorization Requirements for Select Behavioral Health Services Effective July 1, 2025
Greetings Behavioral Health Providers,
In 2024, the Center for Medicaid/Medicare Services (CMS) approved the continued suspension of Alaska Medicaid state fiscal year limits and service authorization (SA) requirements for 1115 Behavioral Health Reform (1115) and State Plan Behavioral Health services through June 30, 2025. This allowed the Division the time needed to revise regulations to permanently remove most outpatient service limits. On May 29, 2025, the proposed regulation changes under 7 AAC 135 were approved for adoption with an effective date of July 1, 2025.
Beginning July 1, 2025, state fiscal year limits will resume for select 1115 behavioral health (BH) and substance use disorder (SUD) residential services. Medicaid beneficiaries may receive these services up to the fiscal year limit without prior authorization. SA requests will need to be submitted to HMS Gainwell for these 1115 services that will exceed the fiscal year limits and must demonstrate medical necessity. This is part of the Division’s continued effort to align services with client need, ensure quality of care, and support service utilization management. 1115 services requiring SA’s can be found in the following Provider Service Manuals:
Please Note: Comagine Health will continue to provide authorizations for the following behavioral health services:
- Residential Psychiatric Treatment Center (RPTC) admissions and continued stay reviews.
- All inpatient psychiatric admissions and continued stays exceeding three (3) days.
Do not submit service authorization requests for these services to HMS Gainwell.
What to Expect
Training
HMS Gainwell has been developing training for providers with a detailed overview of the Behavioral Health SA process, the services subject to these requirements, and tips and tricks for reviewing and monitoring SA submissions. To attend a future training session, please sign up here:
https://extranet-sp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/AKMedicaidTraining.htm
Forms
To request a SA, providers will need to submit the appropriate form to HMS Gainwell, along with the client’s current treatment plan.
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1115 Behavioral Health Service Authorization Request_BH Services (link coming soon)
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1115 Behavioral Health Service Authorization Request_SUD Services (link coming soon)
Completed forms can be submitted to HMS Gainwell via DSM or FAX after July 1, 2025. Dedicated Behavioral Health contacts are under development and will be published soon.
High Level Authorization Process
- Providers will send the Behavioral Health and SUD Service Authorization Form with the client’s current treatment plan to HMS Gainwell.
- HMS Gainwell’s dedicated behavioral health staff will process the request and make medical necessity determinations.
- The expected turnaround time is 5 business days, unless outreach to the provider is necessary.
- Providers can view service authorization requests for their patients in the Health Enterprise provider portal. Details of how to view requests will be covered in the trainings.
- Providers will receive a SA number with approval, that must be used when billing for the correlating service(s). The SA number is submitted in box 23 of the CMS-1500.
SA approval does not guarantee payment for services. Providers must still verify client eligibility for services, bill the services correctly to Alaska Medicaid, and ensure that treatment documentation meets regulatory requirements. If a claim submitted with a SA number is denied, please review the remittance advice statement for denial explanation.
For more details about the SA process, providers are encouraged to attend the upcoming HMS Gainwell training.
Reminder of Dedicated Behavioral Health Provider Assistance Phone Number
To help the Division track Behavioral Health specific issues, providers are encouraged to use the dedicated phone line for HMS Gainwell.
The Behavioral Health Provider Assistance phone number is 855-293-3568, and office hours are Monday through Friday 8:00 am – 5:00 pm AKST.
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