MedicaidPrior AuthHigh impact
PA Reinstatement for SUD Residential and Inpatient Services letter
Kentucky Medicaid·KY · Psychiatry·Provider Letter
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Kentucky Medicaid is reinstating prior authorization requirements for substance use disorder (SUD) residential and inpatient treatment services, including ASAM Levels 3.1, 3.5, 3.7 and 4.0, effective July 1, 2022. This reverses the suspension of prior auth requirements that was in place during the COVID-19 Public Health Emergency.
Action Required
By July 1, 2022: Billing team must reinstate prior authorization processes for all SUD residential and inpatient services (ASAM Levels 3.1, 3.5, 3.7, and 4.0). Contact credentialed Managed Care Organizations to confirm specific prior auth requirements and processes. Ensure patients meet ASAM Dimensional Admission criteria assessment before admission. Update billing system to require prior auth verification before submitting claims for these services. Claims without proper prior authorization will be denied.