Issued: April 7, 2026
Partners Health Management’s (Partners) will begin reviewing medical necessity criteria for Substance Abuse Intensive Outpatient Program (SAIOP) and ambulatory withdrawal management services as outlined in the appropriate clinical coverage policy.
Partners Utilization Management (UM) Department has been administratively approving the following Medicaid services impacted by the Mental Health Parity and Addiction Equity Act (MHPAEA) from Dec. 1, 2025, to April 30, 2026:
- SAIOP (CCP 8A-12) – H0015, H0015 AD, H0015 GT
- Ambulatory Withdrawal Management without Extended On-Site Monitoring (CCP 8A-7) – H0014
- Ambulatory Withdrawal Management with Extended On-Site Monitoring (CCP 8A-8) – H0014 HF
Partners addressed the impacted services in an Oct. 8, 2025, Provider Alert titled CMS-Approved NQTLs: Staggered Implementation Plan and Provider Guidance. Click here to read that provider alert.
What is changing?
Effective May 1, 2026, Partners UM will begin reviewing medical necessity criteria for SAIOP and ambulatory withdrawal management services as outlined in the appropriate clinical coverage policy.
What do providers need to know?
Providers should become familiar with authorization requirements and guidelines by consulting the Behavioral Health Medicaid Benefit Grid.
What do providers need to do?
- Continue to submit a Notification Service Authorization Request (SAR) for the pass-through period.
- After the pass-through period, providers should submit a SAR with all required documentation for a medical necessity review for SAIOP and ambulatory withdrawal management services.
Who can providers contact with questions?
If providers have questions, they can contact: