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Upcoming Service Authorization Requirements for Designated Behavioral Health and Substance Use Disorder Services
Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 21, 2026
Summary
Beginning July 1, 2025, Alaska Medicaid will require prior authorization through HMS Gainwell for behavioral health and substance use disorder residential services that exceed fiscal year limits (ranging from 7 to 180 days depending on service type). Providers must submit service authorization requests demonstrating medical necessity for continued treatment beyond these limits.
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What to do
by Jul 1, 2025 · 4 steps
01Billing and clinical staff must implement tracking system to monitor fiscal year limits for Alaska Medicaid BH/SUD residential services.
02Update billing workflows to submit prior authorization requests to HMS Gainwell when services approach limits (7 days for crisis residential, 90 days for most residential treatment, 180 days for Adult Level 2, 14 days for withdrawal management).
03Ensure medical necessity documentation is prepared for authorization requests.
04Services exceeding limits without authorization will be denied.
Original notice
Upcoming Service Authorization Requirements for Designated Behavioral Health and Substance Use Disorder Services
extranet-sp.dhss.alaska.gov · Always check the source before changing claims.