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AmbetterExchange · Documentation · Provider Bulletin · KY · Psychiatry, PediatricsMedium impact

ASAM Criteria Changes for Adolescent and Transition-Aged Youth Substance Use Disorder Services: Effective December 1, 2026

Effective date
Dec 1, 2026
Identified
Oct 15, 2026

Summary

Ambetter from WellCare of Kentucky is implementing ASAM 4th Edition Criteria for adolescent and transition-aged youth (TAY) substance use disorder services effective December 1, 2026. Changes include new admission and continued stay criteria, revised Levels of Care with new youth-specific levels, updated Six Dimensions assessment with a new Person-Centered Considerations dimension, and updated guidance for members aged 18-25. Providers must review and align internal assessments, documentation, and treatment-planning processes before the effective date.

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What to do

Action · 5 steps
01Before December 1, 2026: Providers and clinical staff should review internal assessments, documentation templates, and treatment-planning processes to ensure alignment with ASAM 4th Edition Criteria for adolescents and TAY.
02Billing and clinical teams should verify understanding of new admission/continued stay criteria, revised Levels of Care assignments (including new youth-specific levels and removed levels), and updated Six Dimensions assessment structure.
03Update clinical documentation systems and assessment tools to reflect the renamed, reordered, and new Person-Centered Considerations dimension.
04Clarify internal protocols for members aged 18-25 regarding eligibility for either TAY or Adult programming based on clinical presentation.
05Contact Provider Relations representative with questions before implementation.

Original notice

ASAM Criteria Changes for Adolescent and Transition-Aged Youth Substance Use Disorder Services: Effective December 1, 2026
ambetterhealth.com · Always check the source before changing claims.
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