MedicaidCoverageMedium impact
American Society of Addiction Medicine (ASAM) 4th Edition, Level of Care 4
Missouri Medicaid (MO HealthNet)·MO · Psychiatry·Provider Notice
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Effective December 1, 2025, psychiatric hospitals classified as Institutions for Mental Disease (IMD) under Missouri's 1115 waiver must comply with ASAM 4th Edition Level of Care 4 criteria for medically managed intensive inpatient services. This change specifically affects Missouri Medicaid (MO HealthNet) coverage requirements for intensive psychiatric inpatient treatment.
Action Required
Before December 1, 2025: Billing teams at psychiatric hospitals designated as IMDs must review ASAM 4th Edition Level of Care 4 criteria and update documentation requirements for intensive inpatient psychiatric services. Review Section 2.32 of the Hospital Manual and ASAM 4th Edition presentation on the MHD Behavioral Health Provider Page. Ensure all intensive inpatient psychiatric admissions meet ASAM Level 4 criteria to maintain MO HealthNet coverage eligibility.