MedicaidAdministrativeMedium impact
May 2026 Medicaid Information Bulletin
Utah Medicaid·UT · Psychiatry, Family Medicine, Internal Medicine +1 more·Government Programs
Effective date
May 1, 2026
We identified it
Jun 21, 2026
Summary
Utah Medicaid is implementing new CMS interoperability requirements including Patient Access, Prior Authorization, Provider Access, and Payer-to-Payer APIs by January 1, 2027. Additionally, effective July 1, 2026, outpatient substance use disorder services in Box Elder, Cache, and Rich counties will transition from fee-for-service billing to Bear River Mental Health Services (now Bear River Behavioral Health Services) managed care.
Action Required
By July 1, 2026: Providers serving outpatient SUD services to Medicaid members in Box Elder, Cache, or Rich counties must contact Bear River Mental Health Services at 435-752-0750 or 1-800-620-0049 to discuss service provision and billing arrangements. Stop billing Medicaid FFS for these services after July 1, 2026. By January 1, 2027: Prepare for new API requirements for prior authorization processes - monitor https://medicaid.utah.gov/interoperability/ for implementation instructions available by September 30, 2026.