Medicaid Behavioral Health Services: ASAM Level 3.3 - Clinicially Managed Population-Specific High Intensity Residential Services

2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 27; No - 18; NR - 6	Yes - 1	Yes - 11
Alabama	Yes	Yes - not specified	No
Alaska	Yes	No	NR
Arizona	Yes	NR	Prior authorization and concurrent review
Arkansas	NR	NR	NR
California	Yes	No	Prior authorization required (non-quantitative treatment limitation (NQTL))
Colorado	Yes	No	No
Connecticut	Yes	No	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	Authorization is required
Florida	No
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	No
Illinois	No
Indiana	No
Iowa	Yes	No	No
Kansas	No
Kentucky	No
Louisiana	Yes	No	NR
Maine	Yes	No	Limit of 270 days annually with no limits on number of admissions; any combined stays in excess of 270 days requires documented need
Maryland	Yes	No	Global average length of stay must not exceed 30 days
Massachusetts	No
Michigan	Yes	No	No
Minnesota	NR	NR	NR
Mississippi	No
Missouri	Yes	No	No
Montana	No
Nebraska	Yes	No	No
Nevada	No
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	Prior authorization is required 5 days from admission and prior to moving to a different level of care
New York	Yes	No	No
North Carolina	No
North Dakota	No
Ohio	Yes	No	Prior authorization is required after utilization thresholds
Oklahoma	Yes	No	NR
Oregon	Yes	No	No
Pennsylvania	No
Rhode Island	Yes	No	Yes - not specified
South Carolina	No
South Dakota	No
Tennessee	Yes	No	No
Texas	Yes	No	Limit of up to 35 days per episode of care, with a maximum of 2 episodes of care per rolling 6 month period and 4 episodes of care per rolling year; prior authorization is required
Utah	NR	NR	NR
Vermont	No
Virginia	Yes	No	Service authorization is required
Washington	Yes	No	No
West Virginia	Yes	No	Based on medical necessity
Wisconsin	No
Wyoming	No

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Medicaid Behavioral Health Services: ASAM Level 3.3 – Clinicially Managed Population-Specific High Intensity Residential Services

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Medicaid Behavioral Health Services: ASAM Level 3.3 – Clinicially Managed Population-Specific High Intensity Residential Services

2022

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