Behavioral Health Changes Nationwide

What changed. CARF has opened a public field review of new Problem Gambling Specialty Designation standards for Behavioral Health and Opioid Treatment Programs, and the review closes on Monday, October 26, 2026. CARF's field review form, linked from that page, says the draft holds a description and 13 standards for programs that treat gambling disorder and gambling-related harms, to be published in the 2027 Behavioral Health and 2027 Opioid Treatment Program standards manuals. A program seeking the designation would also have to meet its manual's business practice and general program sections and at least one of its treatment program sections.

What it means. If you treat gambling disorder or plan to add it, read the 13 draft standards and send comments through CARF's field review by October 26, because the adopted wording is slated for the 2027 manuals. A program that would seek the designation still has to meet its manual's business practice, general program and treatment program standards, so weigh it when you set the scope of a future CARF survey.

What changed. OHA filed DMAP 43-2026 on October 14, 2026, suspending the temporary version of OAR 410-141-3545 adopted under DMAP 26-2026, effective October 14 through December 25, 2026. The suspended text had let outpatient behavioral health provider organizations outside Oregon qualify if they were licensed and in good standing in their own state and located no more than 75 miles from the Oregon border. OHA said the temporary language did not have the intended effect, so the rule reverts to its permanent text, which requires outpatient provider organizations to be certified by OHA under OAR 309-008-0250 and to follow OAR chapter 309 and the CCO contract.

What it means. If you run an outpatient behavioral health program outside Oregon and serve CCO members under the temporary rule, confirm with each CCO whether your contract and claims continue and whether you now need OHA certification under OAR 309-008-0250. CCO network staff should recheck any out-of-state outpatient providers added under the temporary rule and calendar December 25, 2026, the end date listed for the suspension.

What changed. Temporary OAR 410-141-3850, effective October 1, 2026 through March 29, 2027, sets a 90 day transition of care period for all physical, oral and behavioral health services when OHP members move between CCOs or from a CCO to OHP Open Card, ahead of about 100,000 Healthier Oregon members moving to Open Card on January 1, 2027. Members moving to Open Card can keep seeing a previous provider only if that provider is enrolled as a fee-for-service provider, and behavioral health services continue with the previous provider until an equivalent level of care can be established. In transitions of 500 or more members where OHA is the receiving entity, OHA will honor the prior CCO's prior authorizations for six months after the transition date or until it reviews them and decides a change in coverage is necessary.

What it means. Behavioral health programs that serve Healthier Oregon members through a CCO should confirm they are enrolled as OHP Open Card (fee-for-service) providers before January 1, 2027, so those clients can stay in care. Pull a list of affected clients with their active prior authorizations and care plans so billing and authorizations carry over after the move.

What changed. OHA issued a Request for Grant Proposals on September 30, 2026 for culturally specific suicide prevention programs and services for youth ages 24 and younger in Communities of Focus, supporting Oregon's Youth Suicide Intervention and Prevention Plan, with up to 20 grants totaling about $900,000 and individual awards not anticipated to exceed $80,000 for a grant period through June 30, 2027. Proposers must have a host organization located in Oregon, strong ties to and a focus on diverse communities and a background in culturally specific work, and activities currently funded by Medicaid are not allowable. Proposals are due in OregonBuys by 3:00 p.m. Pacific on October 30, 2026.

What it means. If your organization runs culturally specific youth mental health or suicide prevention work in Oregon, note that OHA's posted answers apply the 12 page limit to the Attachment B implementation plan, and the budget proposal must be a separate file alongside the reference check and responsibility forms. Grantees must attend learning communities, complete the Be Sensitive, Be Brave trainings and build an evaluation plan with the Oregon Healing Collective, so budget staff time for those requirements.

What changed. Coordinated Care's current clinical policy list now carries CP.BH.500, Behavioral Health Treatment Documentation Requirements, with a date of last revision of 04/26 and an effective date of 10/01/2026; the policy says billed units not fully supported by documentation may be subject to payment denial or recoupment. The April 2026 revision added requirements that the mental health diagnosis be certified by a qualified practitioner under state guidelines, that the type of service be recorded with its code, that documentation justify the duration as well as the frequency and intensity of services based on current clinical presentation, that treatment plans be completed by a qualified practitioner and reviewed with the member within required timeframes, that interventions be evidence based, and that everyone who took part in a session be identified. It also requires addenda to reference the original note and carry the completion date and the provider's name, signature and credentials, and requires a clinical rationale for continuing services when progress is not shown.

What it means. Washington behavioral health agencies billing Coordinated Care should check note templates and a sample of charts from October 1 on against all 18 elements of CP.BH.500, including exact start and stop times, session participants and treatment plan review dates. Train clinicians on the addenda rules and on documenting why services continue when a client is not progressing, since unsupported units can be denied or recouped.

What changed. The Washington State Board of Nursing filed proposed amendments to WAC 246-840-010 and 246-840-300 through 246-840-4990 that would integrate prescriptive authority into initial ARNP licensure, set 250 and 500 hour supervised advanced clinical practice tiers for initial and internationally educated applicants based on time since graduation or advanced clinical practice, cut the maximum supervised practice requirement from 1,000 to 500 hours, and extend from one year to two years the period in which an initial applicant may qualify without supervised practice. The proposal also adds an optional one year interim permit for returning an expired ARNP license to active status and updates opioid prescribing and pain management standards. Written comments are due by October 23, 2026 at 11:59 p.m., and the hearing is November 13, 2026 at 1:15 p.m. in Tumwater or by Zoom, with adoption intended the same day.

What it means. If you employ or plan to hire ARNPs, including psychiatric nurse practitioners, check how the supervised practice tiers and the two year window would apply to recent graduates and to candidates with lapsed licenses, and send any comments to WABONRules@doh.wa.gov by October 23. Have your prescribers review the revised opioid prescribing and pain management sections before the November 13 hearing.

What changed. DHCS posted a draft Behavioral Health Information Notice dated October 15, 2026 that would end the requirement for county behavioral health plans to administer the Pediatric Symptom Checklist (PSC-35) and submit its data to DHCS in the Functional Assessment Screening Tool (FAST) platform. Under the draft, the Early Childhood module of the IP-CANS replaces the PSC-35 as the sole required tool for children ages zero through five, and plans or their providers may still use the PSC-35 at their discretion. The draft leaves the effective date blank, and DHCS asks for feedback to BH-CONNECT@dhcs.ca.gov by November 3, 2026.

What it means. Children's mental health programs that administer the PSC-35 under a county plan contract should read the draft and send any comments to DHCS by November 3. Plan the change to your intake and outcome workflows, but keep administering the PSC-35 until DHCS issues the final notice with an effective date.

What changed. The October 20, 2026 Louisiana Register publishes the final rule adopting LAC 48:I.5737 through 5755, a new Subchapter P that adds certified community behavioral health clinic requirements to the behavioral health service provider licensing standards, adopted on the day of promulgation. A CCBHC must hold an LDH behavioral health service provider license, obtain written confirmation from the Office of Behavioral Health that it completed CCBHC orientation and training before seeking CCBHC licensure, and have an MOU or designated collaborating organization agreement with the state-sanctioned crisis hub. The rule sets access standards (urgent needs served within one business day, routine needs within 10 business days, a comprehensive evaluation within 60 calendar days), requires 24/7 mobile crisis response, a governing board at least 51 percent people with lived experience and families or an alternate arrangement such as an advisory committee, and named staff including a full-time CEO, a full-time medical director and at least one authorized prescriber on site during regular hours.

What it means. If you operate or plan a CCBHC in Louisiana, compare your license, staffing plan, governance structure and access timelines against Subchapter P now, since the rule took effect on publication. Request the OBH orientation and training confirmation and put your crisis hub MOU or DCO agreement in writing before you apply for CCBHC licensure.

What changed. HHSC proposed amendments to 26 TAC §562.24, Standards for Private Practice, in the September 25, 2026 Texas Register (TRD-202603932, Proposed Rule 26R015) to carry out HB 1700 (89th Legislature) telehealth consent and records standards for licensed chemical dependency counselors in private practice. The proposal allows outpatient individual and group counseling by synchronous audiovisual technology with an existing clinical relationship and verbal consent before each session, and by audio-only technology only with an existing clinical relationship (an in-person or audiovisual service from the same provider within the prior six months), verbal consent before each session and a documented reason. It limits electronic services to qualified credentialed counselors and to counselor interns with more than 2,000 supervised hours (or a waiver) who passed the licensing exam, requires counselors to be equipped to see a client in person on request, and replaces the requirement that counselors reside in and work from Texas with a requirement to be licensed in Texas or meet a listed exemption.

What it means. If your LCDCs or counselor interns see private practice clients by video or phone, review consent scripts, records that note how each session was delivered, audio-only justifications and intern eligibility against the proposal. Comments are due 31 days after the September 25 issue, which is October 26, 2026, by email to HHSRulesCoordinationOffice@hhs.texas.gov with Comments on Proposed Rule 26R015 in the subject line.

What changed. The Office of Licensing filed a repeal and readopt of Rule R501-8, Outdoor Youth Programs (Filing ID 58220), in the October 1, 2026 Utah State Bulletin to carry out the congregate care requirements of SB 297 (2025). The proposal limits programs to clients 13 through 17, defines a child in crisis as a reportable critical incident with parent or guardian notice within five hours, and requires an Office of Licensing approved admissions review process plus a tailored disruption plan and a suicide prevention plan for each client at admission. It also caps backpack weight at 15 percent of a client's body weight, requires at least one staff to every four clients with field groups of no more than 16 people, requires 80 hours of initial staff training, and requires programs to post and hand out the congregate care ombudsman notice.

What it means. If you operate or refer youth to a Utah outdoor youth program, compare your admissions review, disruption plans, suicide prevention plans and crisis notification steps with the proposed text and send any comments to the Office of Licensing by November 2, 2026. Calendar November 9, 2026, the date the agency anticipates making the rule effective, and schedule staff training and field equipment changes around it.

What changed. Beginning October 1, 2026, ForwardHealth replaced the substance abuse day treatment benefit with a behavioral health day treatment benefit covering SUD, mental health and co-occurring day treatment for members of all ages from providers certified under DHS 75.52, and current substance abuse day treatment providers move from specialty 802 to 803 without re-enrolling. Prior authorization is required for all treatment services on and after October 1, 2026 (assessments are exempt for the first eight hours in a rolling 12 months) using the new PA/BHDTA form F-03454, and requests missing required documentation are denied without clinical review. Claims use H2012 with modifier HE for mental health, HF for substance use or the new HH for co-occurring services, and family member sessions and recreation-oriented activities tied to treatment goals may now be covered.

What it means. Add the HE, HF and HH modifiers to your H2012 billing rules and switch to the PA/BHDTA form with the full supporting documentation set before you submit requests. If you serve youth, keep youth, transitional-age youth and adult services separate as DHS 75.22(6) requires, and confirm your managed care plans have implemented the new benefit.

What changed. The Bureau for Medical Services gave notice of State Plan Amendment 26-0004, filed to carry out Senate Bill 231 from the 2026 Regular Session, which attests that BMS will use outcome-based performance measures of individual recovery outcomes and provider performance and will require its managed care organizations to use value-based payment strategies for SUD provider reimbursement rather than paying for volume. The change, drafted in Attachment 4.19-B page 11.2, has an effective date of July 1, 2027 pending CMS approval and is projected to be cost neutral. Written comments are accepted September 25 through October 25, 2026 at SPAComments@wv.gov.

What it means. If you are a SUD provider in West Virginia Medicaid managed care, ask your MCOs how they plan to tie payment to outcomes and which measures they will use, and check that your systems can report recovery outcomes. Submit any comments to BMS by October 25, 2026.

What changed. DHCS and CDSS issued joint ACL 26-74/BHIN 26-032 on October 13, 2026, setting Phase II CANS alignment policies effective January 1, 2027. County behavioral health plans must use the Integrated Practice CANS (IP-CANS) for all children and youth ages zero through 20, including the Early Childhood module for ages zero through five, and by December 31, 2028 every IP-CANS administrator must complete The IP-CANS: Overview and Preparation for Certification training from an approved provider and hold Praed Foundation IP-CANS certification, renewed annually. Plans must send DHCS annual compliance reports by March 15 of 2027, 2028 and 2029, and IP-CANS data will move to a forthcoming shared Opeeka P-CIS data exchange.

What it means. Children's specialty mental health providers that complete the CANS for a county plan should ask the county which approved trainer to use and schedule every assessor to finish IP-CANS training and certification by December 31, 2028, noting that staff new to the CANS must certify before they administer it. Update assessment forms and EHR templates for the IP-CANS and its Early Childhood module before January 1, 2027.

What changed. DHCS's Medi-Cal Fee-for-Service Provider Toolkit (Version 1.0, October 14, 2026) says that starting January 1, 2027, federal rules require Medi-Cal members with Unsatisfactory Immigration Status to get care through fee for service instead of a managed care plan, so providers bill DHCS directly and request authorizations through Treatment Authorization Requests. Providers not already enrolled in Medi-Cal fee for service must submit an enrollment application by January 1, 2027 to bill for these members, and DHCS will accept TARs for them starting November 1, 2026 for dates of service on or after January 1, 2027. The toolkit says county behavioral health plans will continue to cover Specialty Mental Health Targeted Case Management for members who are QNC, PRUCOL or whose citizenship status is not known, lists Psychiatric Collaborative Care Management and Dyadic Services among care management services that remain available, and says members lose access to Enhanced Care Management and Community Supports in fee for service.

What it means. Outpatient mental health practices that see these members through a Medi-Cal managed care plan should check their fee for service enrollment in PAVE now and apply before January 1, 2027 if they are not enrolled. Billing teams should set up fee for service claim and TAR workflows for these members and keep the accepting new patients status current in the DHCS Provider Portal, which DHCS now requires each quarter.

What changed. AB 2562 was approved by the Governor on September 27, 2026 and chaptered as Chapter 620, Statutes of 2026. It adds a suicide prevention plan to the policies and procedures every certified alcohol or other drug program must keep in its operation manual under Health and Safety Code Section 11832.8, and requires every licensed residential facility to develop a suicide prevention plan under Section 11834.26. DHCS may implement the licensed facility requirement by bulletin or all-county or all-provider letter, after stakeholder input, until it adopts regulations, which are due no later than January 1, 2031.

What it means. California SUD programs licensed or certified by DHCS should draft a written suicide prevention plan, and certified programs should add it to the operation manual alongside the admission and discharge, client rights, services, medications and code of conduct policies. Watch for a DHCS bulletin or all-county or all-provider letter implementing the licensed facility requirement, which DHCS may issue after stakeholder input until regulations are adopted.

What changed. AB 96 was approved by the Governor on September 27, 2026 and chaptered as Chapter 497, Statutes of 2026. It amends Welfare and Institutions Code Section 14045.15 to remove the requirement that an applicant for Medi-Cal peer support specialist certification possess a high school diploma or equivalent degree. Applicants must still be at least 18 years of age, self-identify as having experience with recovery from mental illness or substance use disorder as a consumer or as a parent or family member of a consumer, agree in writing to a code of ethics, complete the required curriculum and training, and pass a certification examination approved by DHCS.

What it means. California programs that bill Medi-Cal for peer support services should update job descriptions and hiring screens that list a diploma as a minimum qualification for certified peer support specialists. Ask your county's certifying entity when its application process will reflect the change before recruiting candidates who do not hold a diploma.

What changed. The State Board of Human Services adopted the Fall 2026 packet of the BHA Aligned Provider Rules (2 CCR 502-1) on October 9, 2026, and the adopted rules take effect July 1, 2027; BHA says the Secretary of State will take several months to publish them and encourages providers to review the adopted text now for transition planning. The adopted packet adds new versions, effective July 1, 2027, of the chapters on rule authority and definitions, behavioral health entity licensing, outpatient and high intensity outpatient treatment, residential services, emergency and crisis services, and emergency and involuntary SUD commitment. Outpatient and intensive outpatient sub-endorsements are organized by ASAM level, from long-term remission monitoring (Level 1.0), outpatient treatment (Level 1.5-type) and medically managed outpatient (Level 1.7) to intensive outpatient (Level 2.1-type), high-intensity outpatient and partial hospitalization (Level 2.5-type) and medically managed intensive outpatient (Level 2.7).

What it means. If you hold or plan to apply for a Colorado behavioral health entity license, map each program to the new endorsements and ASAM-based sub-endorsements in the adopted text and budget the policy, staffing and EHR changes needed by July 1, 2027. Watch for the Secretary of State publication and the separate Spring 2027 provider rules packet BHA lists on the same page.

What changed. The updated 2026-2027 Magellan Care Guidelines for the Idaho Behavioral Health Plan take effect November 14, 2026, combining Magellan's IBHP guidelines, the MCG Behavioral Health Care Guidelines and the ASAM Criteria, with the ASAM Criteria, 3rd Edition staying in use until the 4th Edition is implemented. The medical necessity definition now says services must meet applicable department criteria and that services not meeting criteria require prior authorization, and it cites IDAPA 16.03.26.006.15. Behavioral Modification and Consultation was removed from the Magellan IBHP guidelines, Skills-Building/Community-Based Rehabilitative Services moved to the MCG guidelines, trained technicians directly supervised by an eligible provider may administer but not interpret psychological tests, and the PHQ-9 and GAD-7 were added as examples of screening tools excluded when testing consists only of self-administered or self-scored inventories or cognitive screening tests.

What it means. Idaho Medicaid behavioral health providers should download the November 14 guidelines from Magellan of Idaho's medical necessity criteria page and check which criteria set now governs the CBRS and Behavioral Modification and Consultation services they request. Psychological testing providers should confirm their technician supervision fits the clarified rule and expect requests that rely only on self-scored screeners such as the PHQ-9 or GAD-7 to fall outside the testing criteria.

What changed. Magellan is preparing to move Idaho Behavioral Health Plan members receiving substance use disorder services from the ASAM Criteria, 3rd Edition to the ASAM Criteria, 4th Edition and will share more once an official transition date is identified. It asks providers to complete a voluntary readiness survey on the 4th Edition for adults and youth by November 15, 2026, and says later updates will cover training, system and workflow guidance, implementation timelines, reimbursement changes and billing guidance.

What it means. Idaho SUD programs in the Magellan network should complete the readiness survey by November 15 and start planning ASAM 4th Edition training for clinical staff. Watch for Magellan's transition date and its reimbursement and billing guidance before changing level of care documentation or assessment templates.

What changed. A federal indictment announced October 21 charges Brenda Copeland, who operated All Types Counseling Services in the southwest Chicago suburbs, office manager Samuel Carlson and four people described as purported patients with health care fraud and conspiracy, alleging that from 2010 to 2025 they submitted false claims to Blue Cross Blue Shield of Illinois for psychotherapy services that were never provided. The indictment alleges the purported patients supplied their insurance information in exchange for a share of the payments and recruited others to pose as patients, and that $19 million in claims led to more than $4.8 million in payments. An indictment is not evidence of guilt, and the defendants are presumed innocent.

What it means. Federal prosecutors bring cases over commercial insurance claims as well as Medicaid, so audit a sample of psychotherapy claims for every payer against signed, dated session notes and confirm each client was actually seen. Make sure no client, staff member or referral source receives cash or anything of value tied to visits or referrals, and put that rule in a written policy your staff sign.

What changed. OHA proposed permanent changes to the Mobile Crisis Intervention Services rules to carry out HB 4016 and HB 4069 (2026). Providers and owners with at least a 20 percent interest that provide mobile crisis or Mobile Response and Stabilization Services would have to certify in writing, under penalty of perjury, that they are not violating tax laws under ORS 305.380 and submit an Oregon Tax Compliance Certificate from the Department of Revenue. Mobile crisis organizations would also need a written physical safety policy or plan, effective July 1, 2027, that covers lone workers, built and community environments and how hazards are reported; the hearing was October 16 and comments are due November 16, 2026.

What it means. Mobile crisis providers should identify every owner with at least a 20 percent interest and request Oregon Tax Compliance Certificates from the Department of Revenue. Start drafting the lone worker and community safety plan, and submit comments by 5 p.m. on November 16.

What changed. OHA proposed amending OAR 410-200-0115 and 410-200-0130 to carry out section 71112 of H.R. 1, which cuts retroactive medical coverage from three months before the date of request to one month for the ACA Medicaid expansion adult group and Healthier Oregon adults, and to two months for all other types of assistance. The change applies to new applications with a date of request on or after January 1, 2027. The hearing was October 19 and the comment period closed October 21, 2026.

What it means. Withdrawal management, residential and other programs that help clients apply for OHP at admission should make sure applications go in right away, since a shorter look-back leaves fewer earlier months that OHP can pay for. Update intake and financial counseling workflows before January 1, 2027.

What changed. OHA's draft calendar year 2027 CCO rate certification, for January 1 through December 31, 2027, sets a statewide average of $627.68 per member per month, up 5.6 percent from $594.57 in 2026. Behavioral health directed payments continue: qualifying team-based high acuity providers get at least 110 percent of State Plan rates, culturally and linguistically specific services modifiers pay 22 percent (U9) or 27 percent (TN, rural) above State Plan rates, and co-occurring disorder modifiers pay 10 to 20 percent more. Residential SUD, mobile crisis, mobile crisis intervention and children's wraparound services must be paid no less than State Plan rates.

What it means. Use the 2027 directed payment terms in CCO contract talks, and check whether your program meets the team-based high acuity test of a Certificate of Approval, at least half of revenue from Medicaid patients and team-based psychiatric or addiction medicine, peer and case management care. The certification is still a draft, so confirm final terms with each CCO before you set 2027 budgets.

What changed. OHA proposed reorganizing its OHP billing rules and updating the Agreement to Pay form (OHP 3165) after feedback from providers and members. A rewritten OAR 410-120-1350 would bar providers from seeking payment from a member except in listed situations, make a signed agreement valid only if the estimated fee does not change and the service is scheduled within 30 days of signing, and prohibit using the form as a global agreement, for services already provided, for missed appointments or for concierge or membership fees. A hearing is November 17 and comments are due November 21, 2026.

What it means. Billing and front desk staff who collect private pay from OHP members, including for non-covered services or services a member chooses to pay for, should compare current consent forms and workflows with the proposed OAR 410-120-1350. Send comments to medicaid.rules@oha.oregon.gov by 5 p.m. on November 21.

What changed. A notice dated October 15, 2026 tells contracted providers that Providence Health Plan, Providence Health Assurance and Providence Plan Partners are discontinuing all lines of business and terminates provider participation by line: Medicare Advantage and Oregon Health Plan participation end January 1, 2027, with providers performing through December 31, 2026, and commercial participation, including the Behavioral Health Network listed among the commercial networks, ends January 1, 2028, with providers eligible to participate through December 31, 2027. Commercial value based programs such as pay for performance end January 1, 2027, except the Providence Choice Medical Home exhibit, while MCO Services Agreements and credentialing delegation agreements end January 1, 2028. Medicare and OHP services provided before termination and billed on time during 2027 will be processed and paid as before, and provisions on claims payment, overpayment recovery, audit rights and record retention survive termination.

What it means. If you bill Providence Health Plan or Providence Health Assurance, sort your current patients by Medicare Advantage, Oregon Health Plan and commercial coverage and plan for authorizations, care transitions and contracts with their next plans before each end date. Keep submitting 2026 claims on time through existing channels, and check the Providence provider FAQ on ProvLink, which the notice says will be updated through the wind down.

What changed. OHA issued RFGP 6312 on October 15, 2026 for $13.5 million in Opioid Settlement Community Grants allocated by the Opioid Settlement Prevention, Treatment, and Recovery Board, with Tier One awards of $25,000 to $75,000 and Tier Two awards of $100,000 to $500,000 across primary prevention, overdose prevention and risk reduction, treatment, recovery and innovative research. Oregon-based SUD treatment providers including opioid treatment programs, behavioral health clinics, community mental health programs, recovery community centers, recovery housing providers, local governments and nonprofits may apply, while state agencies and Oregon's nine federally recognized tribes may not. Proposals are due through Smartsheet by 4:00 p.m. Pacific on December 17, 2026, for grant agreements running July 1, 2027 through June 30, 2029.

What it means. Choose one primary funding category and one tier before you write, since each proposer may submit only one proposal and requests between $75,001 and $99,999 fit neither tier. Calendar the November 16 deadline for questions and the remaining OHA webinars and office hours, and keep any Tier Two renovation, vehicle or equipment costs under the $250,000 capital cap.

What changed. Three emergency regulations in effect from September 28, 2026 through March 27, 2028, published in the October 19, 2026 Virginia Register, add DBHDS licensing standards to 12VAC35-105 for recovery and empowerment centers (Virginia's mental health clubhouse), community psychiatric support and treatment (CPST) and coordinated specialty care (CSC) to align with the redesigned Medicaid services. CPST providers need a full-time LMHP clinical director, 24/7 crisis support and an office in Virginia, with office-based services capped at 50% of each person's weekly service hours; CSC serves people 15 to 30 with psychotic symptoms for less than five years through a team led by an LMHP with at least three years of mental health experience; recovery and empowerment centers must open at least five days a week for five hours a day under a full-time director who has completed Clubhouse International training or a department-approved equivalent. Separate notices of intended regulatory action to make the three rules permanent take public comment until November 18, 2026.

What it means. If you plan to offer CPST, CSC or clubhouse services, check your staffing plan, crisis coverage, office location and policies against the new sections before you apply for or modify a DBHDS license. Calendar November 18, 2026 if you want to comment on the permanent rules through Virginia Regulatory Town Hall.

What changed. HCA filed proposed rules creating chapter 182-567 WAC, Contingency Management Services, a structured outpatient program of at least 12 weeks that gives eligible Apple Health clients with a substance use disorder incentives, such as gift cards of low retail value, for negative point of care drug tests, in line with the Medicaid Transformation Project 2.0 section 1115 waiver. Delivery would be limited to agency-approved waiver-funded or grant-funded sites using SUDPs, certified peer support specialists or other trained staff under supervision, after HCA training and a readiness review, and payment for waiver services would cover incentives and point of care tests only, paid through a direct HCA invoicing process rather than claims with a procedure code. A virtual hearing is set for November 24, 2026 at 10:00 a.m., written comments to arc@hca.wa.gov are due by 11:59 p.m. that day, and adoption is intended no sooner than November 25, 2026.

What it means. Outpatient SUD programs, OTPs and primary care clinics that want to offer contingency management to Apple Health clients should read the provider eligibility, readiness review and invoicing sections and send any comments to arc@hca.wa.gov by November 24. Plan now for the auditable records the rule would require, including participant eligibility, service encounters, incentive amounts and fidelity to the approved model, since payment would depend on them.

What changed. WAC 182-115-0100 currently allows certified peer counselors to provide Medicaid-reimbursable peer services until December 31, 2026 and provides that certified peer support specialists will supersede them as of January 1, 2027. HCA filed a preproposal statement, WSR 26-14-043, on June 24, 2026 saying it intends to remove both dates to allow sufficient time for new peer support specialists to become credentialed. HCA's behavioral health rulemaking page still lists the project as pending formal proposal, with no proposed rule or hearing posted.

What it means. Until HCA proposes and adopts a change, the current rule still ends Medicaid-reimbursable peer services by certified peer counselors after December 31, 2026, so list which peer staff hold only the peer counselor credential and how far each is from certified peer support specialist status. Watch HCA's behavioral health rulemaking page for the proposed rule and ask the rulemaking contact for the early draft HCA offers to interested parties.

What changed. A UnitedHealthcare Network News article dated October 1, 2026 says mental health and substance use disorder prior authorization requests will soon be submitted through Provider Express, and that requests started in the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal will be redirected to Provider Express to complete. The change does not affect Surest and Rocky Mountain Health Plans, no effective date is given, and providers are told to log in to Provider Express with their existing One Healthcare ID and connect their organizations as soon as possible to avoid disruption.

What it means. If your program requests mental health or SUD authorizations from UnitedHealthcare through its provider portal, have your utilization review staff log in to Provider Express with their One Healthcare ID and connect each of your organizations before the switch. Watch Provider Express and UnitedHealthcare Network News for the go live date and update your authorization workflow and staff guides when it is announced.

What changed. In a proposed rule published October 20, 2026, CMS would implement the REAL Health Providers Act (section 6220 of the Consolidated Appropriations Act, 2026) from contract year 2028: Medicare Advantage organizations would verify each listed provider's directory information at least once every 90 days (every 12 months for acute inpatient hospitals, intensive care units and surgical services), flag listings they cannot verify as possibly out of date, remove a provider within 5 business days of determining it has left the network, and add a term to every provider contract obligating the provider to keep its directory information current and accurate. Each plan's annual accuracy analysis would draw 35 percent of its sample from mental health or substance use disorder provider types, which CMS expects to include psychiatry, psychologists, clinical social workers, addiction medicine, opioid treatment programs, marriage and family therapists and mental health counselors, and CMS would post the accuracy scores publicly beginning in contract year 2029. Enrollees who book with a provider listed as in network who turns out to be out of network would pay no more than in-network cost sharing, provider contracts would have to require the provider to document the earliest date the appointment was made, and comments are due by 5 p.m. Eastern on December 15, 2026.

What it means. If you are in Medicare Advantage networks, expect plans to ask you to confirm your listing every 90 days starting in 2028 and to add contract terms on directory accuracy and appointment date records, so name someone to answer verification requests and make sure your scheduling system keeps the date each appointment was first booked. If the specialty codes CMS plans to sample or the verification methods do not fit how your clinicians are enrolled, submit comments on docket CMS-2026-2533 by 5 p.m. Eastern on December 15, 2026.

What changed. State Medicaid Director Letter 26-004, dated October 6, 2026, explains how states can add Certified Community Behavioral Health Clinic services to their Medicaid state plans under the optional benefit at section 1905(a)(31) of the Social Security Act created by section 209 of the Consolidated Appropriations Act, 2024, covering clinics the state certifies as meeting the most recent SAMHSA CCBHC Certification Criteria (the March 2023 version at publication) and providing the nine required services directly or through Designated Collaborating Organizations. Unlike the section 223 demonstration, the state plan option does not require a prospective payment system, so states may pay through a fee schedule or bundled payment, and the CAA, 2024 did not authorize the enhanced federal match available in the demonstration for state plan expenditures. States electing the option must submit a state plan amendment that attests to state certification and describes the payment methodology, and must report the same CCBHC quality measures as the demonstration to SAMHSA.

What it means. If you run or plan to become a CCBHC, ask your state Medicaid agency whether it will file a state plan amendment under this option and which payment method it intends to use, because the option does not require the demonstration's prospective payment system. Check your readiness against the 2023 Certification Criteria, including Designated Collaborating Organization agreements, the sliding fee scale and quality measure reporting.

What changed. CMS's interim final rule CMS-2454-IFC, effective July 31, 2026, requires states that cover the Medicaid adult group or certain section 1115 populations to implement the community engagement requirement of section 1902(xx) of the Social Security Act no later than January 1, 2027 unless CMS grants the state a temporary good faith effort exemption, under which applicable adults must work or take part in education or community service for at least 80 hours a month unless an exception or exclusion applies. Excluded people include those who are medically frail, defined to include a person whose condition significantly impairs their ability to comply and who has a substance use disorder (other than someone in stable recovery for 5 or more years) or a disabling mental disorder, and people participating in a drug addiction or alcoholic treatment and rehabilitation program as defined in section 3(h) of the Food and Nutrition Act of 2008, which names programs run by a private nonprofit organization or a publicly operated community mental health center, with states allowed to set a minimum time commitment for participation. States must first try to verify these exclusions from claims, payment and encounter data, must align data sharing for both SUD exclusions with 42 CFR part 2, and must give anyone whose compliance it cannot verify a notice of noncompliance and 30 calendar days to make a satisfactory showing.

What it means. If you serve adults covered through the Medicaid adult group, ask your state Medicaid agency how it will identify the SUD, disabling mental disorder and treatment program exclusions from your claims and which programs it will count as qualifying treatment programs. Calendar January 1, 2027 and prepare intake and billing staff to confirm diagnoses are coded on claims and to help clients answer a state noncompliance notice within its 30 day window.

What changed. OJJDP released the FY 2026 Expanding Youth Access to Community-Based Treatment solicitation on October 8, 2026 to fund community-based programs treating youth with substance use disorders or co-occurring mental health and substance use disorders who are at risk of or have already been in the juvenile justice system, with about $4,000,000 for 6 awards of up to $650,000 over 36 months starting January 1, 2027. State, county, city or township and federally recognized tribal governments and nonprofits (with or without 501(c)(3) status, other than institutions of higher education) may apply, and no match is required. The SF-424 is due in Grants.gov by 11:59 p.m. ET on November 16, 2026 and the full application in JustGrants by 8:59 p.m. ET on November 23, 2026.

What it means. Nonprofit youth SUD and co-occurring treatment programs can apply directly, and OJJDP advises beginning SAM.gov registration or renewal no later than October 30. Calendar the November 16 Grants.gov step and line up juvenile justice and community referral partners, since the objectives center on identifying these youth, improving referrals to community services and diverting them from the justice system where appropriate.

What changed. ASAM is taking public comment until November 20, 2026 on the draft framework for The ASAM Criteria, Fourth Edition, Volume 4: Behavioral Addictions, which sets out a proposed definition and diagnostic criteria, treatment principles, a continuum of care for adults and adolescents and core service characteristics for each level of care. The framework proposes that all addiction treatment programs meet core behavioral addictions capability standards (screen, assess, triage, support symptom management, refer and coordinate care), plus added standards for Behavioral Addictions Enhanced programs, such as a Level 2.1 BAE program, and for Behavioral Addictions Specialized programs. ASAM says full service characteristic standards will be drafted from this input and released for another public comment period before the volume is finalized.

What it means. Read the framework and submit comments by November 20, because the proposed core capability standards would reach every addiction treatment program, not only programs that specialize in gambling, gaming or other behavioral addictions. Note now where your intake already screens, assesses and refers for behavioral addictions so you can measure the gap when the full standards are released for comment.