Behavioral Health Changes Nationwide

What changed. Transmittal 14000 (CR 14591), issued October 8, 2026, replaces Transmittal 13920 to clarify how an inpatient psychiatric facility's FTE resident cap is calculated when slots were awarded under section 4122 of the Consolidated Appropriations Act, 2023, and carries the FY 2027 IPF PPS rates for discharges from October 1, 2026 through September 30, 2027. CMS applied an adjusted market basket update of 2.3 percent (a 3.2 percent 2021-based IPF market basket update less a 0.9 percentage point productivity adjustment) and a wage index budget neutrality factor of 0.9986 to the FY 2026 federal per diem base rate of $892.87, yielding $912.13, and to the ECT payment per treatment of $673.85, yielding $688.38. IPFs that did not meet IPF Quality Reporting Program requirements receive a 0.3 percent update instead, for a per diem of $894.29 and an ECT payment of $674.93, the fixed dollar loss threshold for outliers is $40,750, and the labor-related share is 78.9 percent.

What it means. If you run a psychiatric hospital or a distinct part psychiatric unit, confirm that your Medicare contractor's pricer and your own expected reimbursement tables use the $912.13 per diem (or $894.29 if you missed IPFQR submission) for discharges on or after October 1, 2026. Reconcile the first October remittances against the new rates and check whether your facility is affected by the five percent wage index cap or the phase-out of the rural adjustment for IPFs that became urban in FY 2025.

What changed. The Bureau of Justice Assistance released its FY 2026 Veterans Treatment Court Program solicitation on September 21, 2026, with approximately $20,732,429 available: Category 1 (5 awards of up to $950,000) and Category 2 (11 awards of up to $1,000,000) are open to state, county, city or township and special district governments, federally recognized and other tribal governments and other units of local government, and Category 3 (2 awards of up to $2,500,000) is open to state agencies, including state substance use agencies and administrative offices of the courts. No cost sharing or match is required, awards run 48 months starting January 1, 2027, and Category 1 and 2 applicants must document their court partnerships with memoranda of understanding or letters of intent. The SF-424 is due in Grants.gov by 11:59 p.m. ET on October 29, 2026 and the full application in JustGrants by 8:59 p.m. ET on November 5, 2026.

What it means. Treatment providers cannot apply directly, so if you serve or want to serve a veterans treatment court, contact the court or county now about being named as a treatment partner or subrecipient and supplying a letter of intent before the October 29 Grants.gov step. Ask the applicant which category it is pursuing so your proposed services and budget fit the award ceiling.

What changed. An October 9, 2026 OHA memo to 1915(i) HCBS providers and Community Mental Health Programs says that effective October 27, 2026, 1915(i) Community Based Integrated Supports (CBIS) billed under H0046 through MMIS move from a prior authorization to a plan of care. All current MMIS prior authorizations end October 26, 2026, remaining approved services transfer to an MMIS plan of care starting October 27, and for new referrals the Independent Qualified Agent, Comagine Health, enters the approval in MMIS as a plan of care after finding the member eligible. OHA pays for services rendered on or after the plan of care approval date, and the IQA will contact providers 60 days before a plan of care ends to start the annual reassessment.

What it means. Oregon 1915(i) CBIS providers should bill against the MMIS prior authorization through October 26 and against the plan of care from October 27. Register for the Comagine Health Provider Portal, submit referrals through it, and review OAR 410-173-0010 and 410-173-0050.

What changed. A provider update posted October 6, 2026 says CareOregon is experiencing a claims inventory backlog affecting both initial claims and claim adjustments and that it is working to restore normal turnaround times as quickly as possible. No timeline is given. Providers are asked to monitor claim status in the Connect portal, not to resubmit claims already sent, and to contact Provider Customer Service or their Provider Relations team with questions; contacts are listed for the Columbia Pacific, Jackson Care Connect and Health Share of Oregon (Metro) CCOs.

What it means. Oregon behavioral health programs paid through CareOregon plans should expect slower payments and should track aging claims in the Connect portal rather than resubmitting, since duplicates add to the backlog. Flag the cash flow effect to leadership now and keep records of submission dates.

What changed. HCA filed proposed rules on September 23, 2026 creating chapter 182-566 WAC, Certified community behavioral health clinics. The rules implement a statewide CCBHC model directed by ESSB 5167, section 214(43), and establish cost based prospective payment system rates and standards for CCBHC certification, including a certification questionnaire, a community needs assessment, cost reports and designated collaborating organizations. A virtual public hearing is set for October 27, 2026 at 10:00 a.m., written comments are due by October 27, 2026 at 11:59 p.m., and adoption is intended no sooner than October 28, 2026.

What it means. Outpatient mental health and SUD clinics that hold or want CCBHC certification in Washington should read the proposed certification standards and PPS rate provisions and send comments to arc@hca.wa.gov by October 27. Finance leads should look at the cost report definitions now, since the PPS rate will be set and rebased from them.

What changed. HCA filed proposed amendments to WAC 182-501-0160 (exception to rule) and 182-501-0165 (fee for service prior authorization determinations) on September 18, 2026 to comply with the federal CMS-0057-F prior authorization rule at 42 CFR 440.230(e)(4). Standard prior authorization decisions would be due no later than seven calendar days after the request instead of 15 business days, expedited requests within 72 hours, providers would have seven calendar days to return additional information before a denial, and denial notices would go out within seven calendar days. The virtual hearing is October 27, 2026 at 10:00 a.m. and written comments are due by October 27, 2026 at 11:59 p.m.

What it means. Behavioral health providers that bill Apple Health fee for service should note the shorter window to answer HCA requests for more information, since a late response becomes a denial. Utilization review staff who want different timelines should comment to arc@hca.wa.gov before October 27.

What changed. The October 7, 2026 Idaho Administrative Bulletin carries a proposed rule updating IDAPA 16.05.06, Criminal History and Background Checks, to implement H.B. 494, which took effect July 1, 2026 and is codified at Chapter 27, Title 56, Idaho Code. The bill put FBI required provisions into statute, including the fingerprint background check requirement, the list of individuals who must be checked, and who may access confidential information, so the chapter is streamlined to remove those items while keeping the list of disqualifying crimes in rule. There are no fee changes. A public hearing was set for October 15, 2026 at 1:00 p.m. Mountain time and written comments are due October 28, 2026.

What it means. Idaho agencies whose staff must clear a DHW background check, including Medicaid behavioral health providers, should check the rewritten chapter against their hiring and clearance procedures. Comments go to DHWRules@dhw.idaho.gov by October 28.

What changed. The October 7, 2026 Idaho Administrative Bulletin (Vol. 26-10) carries a proposed rule amending IDAPA 16.03.26, Medicaid Plan Benefits. The Department says the changes align with session laws and respond to CMS and provider network feedback, do not create new services, in some cases relieve provider burden or clarify ambiguous language, and involve no fee increase. Amended sections include background check requirements, definitions (adding the Idaho Behavioral Health Plan), provider agreements, records, case management and school based services provider qualifications, and nursing facility behavioral care unit qualifications and eligible days. Public hearings are October 16, 2026 at 3:00 p.m. and October 21, 2026 at 2:00 p.m. Mountain time in Boise and online, and written comments are due October 28, 2026.

What it means. Idaho Medicaid behavioral health providers should pull the docket text from the bulletin and compare the amended background check, records and provider qualification sections against current practice. Send written comments to DHWRules@dhw.idaho.gov by October 28 or attend one of the two hearings.

What changed. Magellan's October 1, 2026 provider e-blast states that the updated Child and Adolescent Needs and Strengths (CANS) assessment Levels of Care were implemented on Monday, October 5, 2026. Magellan says the enhancements are intended to support consistent clinical decision making while continuing to reinforce clinical judgment and individualized treatment planning, and refers providers to its August 21, 2026 CANS Levels of Care communication for details. Questions go to bhtcom@dhw.idaho.gov.

What it means. Idaho children's behavioral health providers should confirm their clinicians are using the updated Levels of Care in the CANS Decision Support Application for assessments on or after October 5. Review the August 21 communication for how level of care recommendations map to services.

What changed. Magellan's September 25, 2026 provider e-blast says claims submitted to Magellan may be denied when a provider's enrollment with Gainwell Technologies is in maintenance status or the provider is not enrolled, because the provider record is not reflected as active. Providers should contact Gainwell first to complete or reinstate enrollment, should not file claim disputes for these denials because they will not be overturned through the dispute process, and should notify their Magellan provider specialist once Gainwell backdates eligibility so affected claims can be reviewed and adjusted.

What it means. Idaho Behavioral Health Plan providers seeing enrollment related denials should check their Gainwell record status before appealing anything. Keep a list of the denied claims so they can be reprocessed once Magellan verifies the enrollment update.

What changed. A public notice dated September 29, 2026 says the Department of Mental Health is submitting State Plan Amendment 26-0008 for the Comprehensive Substance Treatment and Rehabilitation (CSTAR) program, effective for dates of service beginning October 1, 2026. The amendment adds addictive disorders (gambling) as a qualifying diagnosis for CSTAR services, removes Day Treatment as a standalone service because it is now part of ASAM levels 2.1 and 2.5, and updates existing service descriptions; the estimated fiscal impact is $73,310 in federal fiscal year 2027. Comments must be received within 30 calendar days of the notice, and no public hearing will be held.

What it means. Missouri CSTAR providers should compare their service array and billing against the draft state plan pages, especially any program that billed day treatment as its own service. Send comments to Ask.MHD@dss.mo.gov with the subject line Public Comment for CSTAR SPA before the 30 day window closes on October 29, 2026.

What changed. An October 12, 2026 bulletin for NC Medicaid Direct and NC Medicaid Managed Care says concurrent billing under Clinical Coverage Policy 8F, Research-Based Behavioral Health Treatment, is permitted only in the exceptions in Attachment A, Section C, and all other concurrent billing is prohibited until further notice. CPT 97153 or 97154 may be billed with 97155 when a paraprofessional delivers treatment while observed by an eligible licensed provider, a single rendering provider may not bill both for the same time period, and non beneficiary facing work such as caregiver training under 97156 without the beneficiary present or treatment planning under 97151 is not counted as concurrent. Service notes for 97151 and 97156 must show in and out times that separate beneficiary facing time from other time.

What it means. ABA and other research based behavioral health treatment providers billing NC Medicaid should audit claims where two clinicians billed the same beneficiary for the same minutes and make sure each fits an Attachment A exception. Update service note templates so 97151 and 97156 entries show in and out times for beneficiary facing and non beneficiary facing work.

What changed. AHCCCS posted a final rates notice on September 30, 2026 finalizing fee for service rate changes effective October 1, 2026, with an estimated $6,337,038 increase in FFS payments through September 30, 2027. On the Behavioral Outpatient Fee schedule the S5145 rate was updated, doctoral level HP modifier rates were added to the diagnostic evaluation codes, ABA codes 97156 and 97157 received set rates in place of By Report and 97154 with the TJ modifier was set at $16.95, FQHC and RHC rates rise about 3.44 percent, and the Behavioral Health Inpatient fee schedule is unchanged.

What it means. Arizona behavioral health providers billing AHCCCS fee for service should load the October 1 fee schedules and check that diagnostic evaluations by doctoral level clinicians carry the HP modifier. Programs paid under a managed care contract should ask their plan whether its rates follow the fee for service schedule.

What changed. SB 993 was approved by the Governor on September 27, 2026 and chaptered the same day as Chapter 668. Board of Behavioral Sciences licensees and registrants must still give clients the written notice about the Board's complaint process, but in an acute psychiatric hospital, a correctional treatment center, or any setting serving incarcerated individuals they may now choose, for individual safety reasons, whether to include their full name, license number, license type and expiration date. The employer must authorize that discretion, the setting must have a disclosed process through which a client can obtain enough identifying information to file a complaint, and a copy of the notice must be kept in the client record.

What it means. Psychiatric hospitals and correctional behavioral health contractors in California that want to allow this should write the authorization and the client request process into policy and update their notice templates and record retention. Outpatient and residential programs are not covered and should keep using the full notice.

What changed. The Division's rulemaking page lists docket 24-1501-2601 for IDAPA 24.15.01 with a notice of intent on May 6, 2026, a proposed rule on August 5, 2026, a public hearing on August 13, 2026, a pending rule vote on August 14, 2026 and a record of public comments posted September 15, 2026. The Division describes the change as decreasing the direct supervisory hour requirements for marriage and family therapists. The pending text cuts the supervision required within the 2,000 hour postgraduate experience from 200 hours to 100 hours, with 50 rather than 100 of those hours individual, and requires all supervised hours to be provided by a licensed marriage and family therapist who meets the supervisor qualifications.

What it means. Idaho programs that employ MFT interns should note the lower supervision load but also that the LMFT only supervision rule would remove the option of a second experienced supervisor. The change is not yet in effect; watch the Idaho Administrative Bulletin for the pending rule and its effective date before changing supervision contracts.

What changed. IHCP Bulletin BT2026161, dated September 29, 2026, announces that beginning November 1, 2026, peer to peer reviews will no longer be offered for fee for service (Traditional Medicaid) prior authorization requests, and peer to peer review scheduling ends October 31, 2026. All authorization determinations will be completed through the existing administrative review and appeal processes, which are not changing, and the member appeal process is not affected.

What it means. Programs that request prior authorization from Indiana Traditional Medicaid should remove peer to peer review from their denial workflow and route disputes through the administrative review and appeal steps in the Prior Authorization provider reference module. Check whether your managed care entity contracts still offer peer to peer review, since this bulletin covers only fee for service requests.

What changed. House Bill 1249, Certified Recovery Residences, Refusing Services to Individuals Receiving Medication-Assisted Treatment, Prohibition, was approved by the Governor as Chapter 793 of 2026 with an effective date of October 1, 2026. It requires that the certification requirements set by a credentialing entity prohibit a certified recovery residence from refusing services to a person receiving medication assisted treatment for opioid use disorder, or from requiring a person to stop or change how they receive that treatment as a condition of services.

What it means. Maryland recovery residences that hold or want certification should remove any admission or house rule that excludes residents on buprenorphine, methadone or naltrexone or that requires tapering, and train house managers on medication storage rather than exclusion. Expect the credentialing entity to fold the prohibition into its certification standards and inspections.

What changed. Proposed policy 2622-BH, open for comment until October 30, 2026 with a proposed effective date of January 1, 2027, sets out how MDHHS will certify and oversee Medicaid funded behavioral health programs that require special approval under Prepaid Inpatient Health Plans and Certified Community Behavioral Health Clinics. Programs must be certified before claiming Medicaid reimbursement, recertification is required every three years or as MDHHS identifies, and certification may be granted with a Technical Assistance Plan for unmet requirements that are correctable within six months, or 12 months for new clubhouse programs. The listed services include Assertive Community Treatment, Clubhouse Psychosocial Rehabilitation, crisis residential programs for children and adults, drop in programs, home based services, Intensive Care Coordination with Wraparound and Intensive Crisis Stabilization Services, and a CCBHC that does not contract with its PIHP must apply directly to MDHHS.

What it means. Michigan CMHSPs, PIHP network providers and CCBHCs that run any listed program should check their certification dates against the proposed three year cycle and the off cycle review language. Send comments to PiglowskiM@michigan.gov by October 30, 2026.

What changed. A federal jury in St. Paul convicted Sharmaine Meadows of Lake Elmo, Minnesota on three counts of health care fraud for billing the now-defunct Minnesota Medicaid Housing Stabilization Services program more than $3.6 million between 2020 and 2025 for services that were not provided. The program allowed up to 150 hours of transitional and 150 hours of sustaining services per beneficiary, and evidence showed Meadows told employees to maximize billing to that cap whether or not the hours were delivered, billed in-person hours for staff located in other states and in the Philippines, billed while beneficiaries were in the hospital, and billed as if employees worked more than 20 hours a day for weeks. Beneficiaries testified they received little or no service and were told they had used up their hours.

What it means. Run a claims analysis for impossible days, meaning any staff member billed for more hours than a day allows or for in-person services while out of the area, and compare billed units against the program's unit caps to make sure your team is not steering toward the maximum. Check that every unit billed for case management, housing support or other hourly Medicaid services ties to a dated progress note and that your staff know never to tell a client their hours are exhausted unless the record shows the service was delivered.

What changed. The Division of Behavioral Health posted a draft amendment to 9 CSR 30-3.130 Outpatient Treatment for comment on October 8, 2026 and will hold a public hearing by Webex on November 16, 2026 from 11:00 a.m. to 12:00 p.m. The hearing notice says the amendment updates outdated language, clarifies treatment requirements, and clarifies language on service transition and discharge planning. The draft replaces substance abuse with substance use disorder, renames intensive outpatient rehabilitation as intensive outpatient treatment, removes the requirement to serve a light meal after four consecutive hours of services, and bases the duration of treatment on the individual's needs and response to treatment rather than fixed time limits.

What it means. Missouri certified outpatient SUD programs should read the draft against their current policies on levels of care, transfers and discharge planning. Send comments to Tiana.Stephenson@dmh.mo.gov and calendar the November 16 Webex hearing if you want to speak.

What changed. For dates of service on or after September 1, 2026, MO HealthNet no longer requires precertification for psychotherapy CPT codes 90832, 90834, 90837, 90846, 90847, 90849 and 90853, or for psychological testing and family therapy for participants under age three. Daily and monthly limits (one unit per day and five units per month for the individual therapy codes) are now counted per participant rather than per participant per performing provider, active precertifications closed the day after implementation, and providers must still request a clinical exception before exceeding a daily, monthly or annual limit. Monthly limits and daily group limits do not apply in the listed inpatient and residential places of service, including residential substance abuse treatment facilities and psychiatric residential treatment centers.

What it means. Missouri outpatient programs billing MO HealthNet fee for service should stop submitting psychotherapy precertification requests and build the per participant monthly limit into scheduling, since another provider's sessions now count against the same five unit cap. Managed care plans may still add prior authorization, so confirm each plan's rules before dropping the step for managed care members.

What changed. Provider Bulletin 26-15, dated September 18, 2026, says coverage of short term medically necessary residential and inpatient stays in Institutions for Mental Diseases for adults with serious mental illness and children with serious emotional disturbance will be implemented January 1, 2027 under an amendment to Nebraska's Substance Use Disorder Program Section 1115 demonstration that CMS approved on August 14, 2026. Only stays of 60 consecutive days or less are covered, the state must show an average length of stay of no more than 30 days, and interim or monthly claims are not allowed. The bulletin lists the rates, including H0019 HE at $157.93 per diem, H2018 HK at $478.97, H2020 at $225.87 and tiered acute inpatient psychiatric rates from $994.30 for days one and two down to $835.60 from day seven.

What it means. Nebraska residential and inpatient psychiatric providers that meet the IMD definition should work out which fee schedule and claim form apply to them and set up admission, treatment planning and discharge processes that keep average stays under 30 days. Watch for the pre recorded training and the length of stay tracking rules DHHS says it will publish closer to January 1, 2027.

What changed. House Bill 1104, An Act to Improve the Involuntary Commitment Process and Increase Public Safety and to Implement an Inpatient Capacity Restoration Program, was signed by the Governor on July 6, 2026 and chaptered as Session Law 2026-38 on July 7, 2026. Section 11 rewrites the outpatient commitment provisions of Chapter 122C, replacing the outpatient treatment physician or center with an outpatient treatment provider and extending the outpatient commitment a court may order when moving a respondent from inpatient to outpatient commitment from 90 to 180 days, effective December 1, 2026 for proceedings on or after that date. Section 13 adds capacity restoration services to Chapter 15A and limits compelled medication for capacity restoration to defendants charged with serious offenses under written court findings by clear and convincing evidence, effective December 1, 2026 for capacity hearings on or after that date; the rest of the act took effect when it became law.

What it means. Outpatient providers, hospitals and LME/MCO contracted programs in North Carolina should read Sections 11 and 13 and update involuntary commitment, outpatient commitment and capacity restoration procedures before December 1, 2026. Ask your LME/MCO how outpatient commitment referrals and notices will reach your program under the new outpatient treatment provider language.

What changed. NC Medicaid, with the Division of Juvenile Justice and Delinquency Prevention, is implementing Section 5121 of the Consolidated Appropriations Act of 2023 and on November 1, 2026 will launch the first phase at the five state operated Youth Development Centers. Eligible Medicaid enrolled youth under 21, or 18 to 26 in the former foster care group, who are incarcerated post adjudication will receive screening and diagnostic services within 30 days before release, or no later than one week after, and Reentry Care Management as targeted case management beginning within 30 days before release and planned for up to one year after. State prisons, county jails and tribal jails may be added in later phases.

What it means. Behavioral health providers near a Youth Development Center or serving youth returning from one should ask NC Medicaid or their health plan how reentry care management referrals will flow and whether their agency can enroll to provide it. Programs that already serve justice involved youth should plan for new care management contacts starting November 1, 2026.

What changed. On October 14, 2026 OHA gave notice that it will submit Medicaid State Plan Amendments to comply with the federal Working Families Tax Cut legislation effective January 1, 2027: community engagement (work) requirements for the ACA adult expansion population (section 71119), eligibility redeterminations every six months for ACA adults (section 71107), a shorter retroactive eligibility period for applications on or after January 1, 2027 (section 71112), and a process to reduce duplicate enrollment. OHA says the SPAs do not change coverage, benefits or EPSDT. Written comments are due by 5 p.m. November 13, 2026 to jesse.anderson@oha.oregon.gov.

What it means. Oregon providers serving OHP adults should plan for more frequent coverage loss and shorter retroactive coverage starting in 2027 and build eligibility checks into intake and renewal reminders. Read the proposed community engagement language attached to the notice and comment by November 13 if the exemption and verification rules matter to your clients.

What changed. Six permanent filings (BLSW 1-2026 through 6-2026) were filed September 22, 2026 and took effect September 23, 2026. OAR 877-001-0020, which the Board lists as a renewal fee increase, now sets active renewal fees of $343 for LCSWs, $264 for LMSWs, $132 for RBSWs and $79 for CSWAs. OAR 877-025-0011 adds 2 hours of suicide risk, assessment, treatment and management to the continuing education required of LCSWs, LMSWs and RBSWs, which the Board's continuing education page says applies to renewals beginning January 1, 2027. OAR 877-020-0012 lets the Board authorize Oregon licensed marriage and family therapists and professional counselors as alternative plan supervisors, and OAR 877-020-0010 sets the terms for a temporary reduction in supervision of no more than 100 days in a 12 month period.

What it means. Budget for the higher renewal fees and add a 2 hour suicide risk course to the CE plan of every social worker renewing in 2027. Clinical social work associates whose supervisor is an LMFT or LPC should confirm the Board has authorized that supervisor under the amended rule.

What changed. EOHHS says the FY2027 Budget as Enacted directs it to raise Medicaid rates to the final Office of the Health Insurance Commissioner recommendations effective October 1, 2026, and its FY2027 Medicaid Budget Initiatives page, updated October 7, 2026, links a draft request to CMS to increase rates for behavioral health services under the Section 1115 waiver effective that date. The draft lists BH Link (S9485) rising from $701.66 to $762.93 per diem and peer recovery (H0038 U2 and U3) rising from $16.23 to $17.65 per 15 minutes, each an 8.7 percent inflation adjustment from the last change on October 1, 2024. The page says waiver service rates need federal approval first and that increases will be applied retroactively to October 1, 2026 where implementation is delayed.

What it means. Rhode Island behavioral health providers should pull the draft rate sheet for each code they bill and note that the new amounts are pending CMS approval and MCO contract amendments. Track claims from October 1, 2026 so retroactive adjustments can be reconciled when the fee schedules and the MCO minimum fee schedule take effect.

What changed. The Examining Board of Psychology filed a preproposal statement of inquiry (CR-101) on September 16, 2026 to amend chapter 246-924 WAC, Psychologists. Topics listed include the role of ancillary staff, upcoming changes to the examination of professional practice of psychology, the role of the jurisprudence examination in sanctions, licensure of applicants with out of country education and experience, the rules of ethical conduct in WAC 246-924-353 through 246-924-475, supervision requirements for alternative internships, retired active status, removing the jurisprudence examination for probationary license candidates, and temporary permits.

What it means. Programs that employ or supervise psychologists in Washington can take part in the rules workshops by contacting psychology@doh.wa.gov or joining the board's email list. Watch for the CR-102 proposed rule, which will carry the hearing date and comment deadline.

What changed. HCA adopted permanent rules on September 8, 2026, effective January 1, 2027, amending 11 sections of Title 182 WAC to comply with federal law (42 U.S.C. 1396a(e)(14)(L) and P.L. 119-21, sections 71107 and 71112). Eligibility redeterminations for certain federally funded medical assistance move to every six months, and the retroactive certification period shrinks from three months to one month for apple health for adults under WAC 182-505-0250 and two months for all other Apple Health programs.

What it means. Admissions and billing teams should expect more coverage gaps from six month renewals and less retroactive coverage for clients who apply after admission. Check Apple Health eligibility at intake and at each renewal date, and help clients apply before services start when possible.

What changed. Premera's September 3, 2026 payment policy update says the policy formerly titled Group Psychotherapy Services (90853) is now Group Visits. Premera added details for group preventive counseling, group education and shared (group) medical appointments to the policy section, clarified the group psychotherapy details, added CPT codes with descriptors to the codes and coding guidelines section, and added definitions of group psychotherapy and shared medical appointments. The update states no effective date for the revision.

What it means. Washington and Alaska programs that bill Premera for group therapy should pull the Group Visits policy and check the expanded code list and group psychotherapy language against their billing setup. Confirm whether the one unit per day limit on 90853 from Premera's 2022 notice still applies in the revised policy before changing group billing.

What changed. Coordinated Care's provider policy notifications page lists a new clinical policy, WA.CP.BH.528 Intensive Behavioral Supportive Supervision, with a last revision date of 08/26 and an effective date of January 1, 2027. The policy sets authorization guidelines for IBSS, a Health Related Social Needs service provided in lieu of a covered service under 42 CFR 438.3, for Integrated Managed Care, Integrated Foster Care and BHSO members. Among the criteria, the member must be 18 or older, have had a medically necessary hospital admission within the 12 months before the initial authorization, and have documentation of severe cognitive impairment such as traumatic brain injury, autism spectrum disorder, developmental delay, dementia, encephalopathy or substance use disorder chronically affecting cognition. Authorization periods are set by care needs at 3, 6 or 12 months and may not exceed 12 months.

What it means. Washington agencies that deliver IBSS or behavior support to Coordinated Care members should read the full criteria and compare them with HCA's HRSN and ILOS policy guide before January 1, 2027. Build the hospital admission history and cognitive impairment documentation into IBSS referral packets so authorizations are not delayed.

What changed. In an October 8, 2026 Federal Register notice SAMHSA proposes revisions to the National Substance Use and Mental Health Services Survey (N-SUMHSS), the annual census of substance use and mental health treatment facilities that also feeds FindTreatment.gov. Three existing crisis questions (B12 to B14) would be removed and replaced with two screening questions for every facility, on whether it offers mobile crisis or community outreach services and whether it offers behavioral health emergency or crisis stabilization services, with follow-up questions on service models and client counts for facilities that answer yes, plus a new question on whether the facility identifies as a faith-based organization and targeted wording clarifications. SAMHSA estimates 25,000 facilities answering either the substance use or mental health questionnaire at 0.90 hours each and 11,000 answering both at 1.22 hours, and written comments are due by December 7, 2026.

What it means. If your program offers mobile crisis, outreach, crisis stabilization or emergency behavioral health services, expect the next N-SUMHSS cycle to ask for service model detail and client counts, so decide now who owns that data. Send comments on the burden or wording to the SAMHSA Reports Clearance Officer before December 7 if the new questions do not fit how your crisis services are organized.

What changed. CMS posted a revised Telehealth FAQ (dated October 8, 2026 and listed on its telehealth page as updated October 9, 2026) stating that through December 31, 2027 beneficiaries can receive Medicare telehealth services anywhere in the United States, including audio-only services at home, and that from January 1, 2028 the rural and medical facility requirements return for everything except behavioral health. The FAQ says the in-person visit requirement for mental health telehealth furnished to a patient at home applies after December 31, 2027, that a beneficiary who began mental health telehealth at home on or before that date is treated as established and needs one in-person visit every 12 months afterward, and that audio-only remains allowed for behavioral health at home when the practitioner can use video and the patient cannot or does not consent. It also states that since October 1, 2026 RHCs and FQHCs bill non-behavioral health telehealth with the individual CPT or HCPCS code and a telehealth modifier instead of G2025, and that telehealth modifiers BB (service furnished through a contracted virtual platform) and BC (telehealth furnished incident to a professional service) are required beginning January 1, 2027 with no payment implications.

What it means. Keep your Medicare telehealth program running under the current rules through 2027, but calendar January 1, 2027 to add modifiers BB and BC where they apply and brief your billing team on when each one is used. Start tracking which Medicare patients receive mental health telehealth at home before December 31, 2027 so you can schedule the in-person visits that will be required every 12 months once 2028 begins.