MedicaidCoverageHigh impact
Substance Abuse Residential Treatment Provided in an Inpatient Hospital Setting
Arkansas Medicaid·AR · Psychiatry, Pediatrics·Provider Notice
Effective date
Jul 1, 2026
We identified it
Sep 2, 2026
Summary
Arkansas Medicaid is now covering substance abuse residential treatment services for individuals under 21 years of age in inpatient hospital settings, effective July 1, 2026. Hospitals must enroll under a new Provider Type 05, Specialty SU, obtain prior authorization for all admissions using PA Process Type 135, and bill using Revenue Code 156 at $850/day. Provider Portal functionality to support enrollment and prior authorization submissions becomes available September 1, 2026, with retroactive authorization allowed for services provided July 1–August 31, 2026.
Action Required
By September 1, 2026: (1) Billing team must enroll hospital under Provider Type 05, Specialty SU through the Arkansas Medicaid Provider Portal (https://portal.mmis.arkansas.gov/armedicaid/provider/Home), obtaining a unique NPI and separate Medicaid Provider ID for this specialty. (2) Update billing system and encounter forms to require prior authorization using PA Process Type 135 (Substance Abuse Acute Care) for all admissions of patients under 21 years of age. (3) Configure billing software to use Revenue Code 156 with reimbursement rate of $850.00 per day and ensure all claims are linked to an approved prior authorization. (4) Train billing and clinical staff that Revenue Code 156 claims do not count toward the 24-day inpatient State Fiscal Year limit and MUMP criteria does not apply. (5) For services provided July 1–August 31, 2026, submit retroactive prior authorization requests and claims beginning September 1, 2026. Contact Arkansas Foundation for Medical Care (AFMC) at 1-800-426-2234 (toll-free inpatient) or 1-877-650-2362 for prior authorization submission. Failure to obtain prior authorization will result in claim denial.