Behavioral Health Changes Nationwide

What changed. Web Announcement 4021, dated September 30, 2026, asks providers enrolled as provider type 63 (Rehabilitative Residential Treatment Services), specialty 963 (Psychiatric Residential Treatment Facility), to complete a cost report and submit it to rates@nvha.nv.gov by November 20, 2026. Nevada Medicaid says the cost reports will be requested annually beginning this year and that the data supports upper payment limit calculations and the next phase of the PRTF State Plan Amendment process, including development of quality incentive payments.

What it means. If you operate a Nevada PRTF, download the cost report template from the announcement, assign finance staff now and send it by November 20, 2026, because the figures feed the rate and quality incentive design. Expect the same request every year from now on.

What changed. An emergency regulation published in the Virginia Register on October 19, 2026 (VA.R. Doc. No. R26-8525) amends 12VAC35-105-20 and 12VAC35-105-30 and adds Article 8, 12VAC35-105-1412 through 12VAC35-105-1419, creating a Recovery and Empowerment Center (mental health clubhouse) license with admission and discharge criteria, service delivery, staffing and physical environment standards, as directed by Item 297 of Chapter 1 of the 2026 Acts of Assembly, Special Session I. Admission requires a face-to-face assessment by an LMHP, LMHP-R, LMHP-S or LMHP-RP within 12 months and a DSM diagnosis consistent with a serious mental illness. The emergency regulation is effective September 28, 2026 through March 27, 2028, and the Notice of Intended Regulatory Action for the permanent rule takes public comment through November 18, 2026.

What it means. If you run or plan a clubhouse program in Virginia, read the new Article 8 and compare your intake assessment, discharge policy, staffing and employment program (transitional, supported and independent employment) against it, since the emergency standards are in force now. File comments on the Virginia Regulatory Town Hall by November 18, 2026 if the permanent rule should differ, and calendar March 27, 2028 when the emergency rule expires.

What changed. An emergency regulation published in the Virginia Register on October 19, 2026 (VA.R. Doc. No. R26-8524) amends 12VAC35-105-20, 12VAC35-105-30 and 12VAC35-105-1420 and adds 12VAC35-105-1421 through 12VAC35-105-1425, establishing Article 9, Coordinated Specialty Care, with admission criteria, discharge criteria, treatment team and staffing, service delivery and location requirements. DBHDS says Item 297 of Chapter 1 of the 2026 Acts of Assembly, Special Session I directs it to align licensing regulations with the Medicaid behavioral health services redesign. The emergency regulation is effective September 28, 2026 through March 27, 2028, and comments on the Notice of Intended Regulatory Action are due November 18, 2026.

What it means. If you provide or plan first episode psychosis or coordinated specialty care services in Virginia, map your team composition, admission and discharge criteria and site arrangements to Article 9 now, and line it up with the DMAS CSC enrollment work ahead of the July 2027 Medicaid redesign launch. Submit comments on the Virginia Regulatory Town Hall by November 18, 2026 and calendar March 27, 2028 when the emergency rule expires.

What changed. DHS is seeking applications from one SUD treatment provider to establish a program using a family-centered approach for pregnant women and mothers with dependent children up to age 5, with follow-up aftercare for each woman and her children for at least two years after she leaves the program. Applicants must be a Wisconsin county public agency or a nonprofit serving Wisconsin, certified under Wis. Admin. Code ch. DHS 75 and Medicaid enrolled; agencies funded under the 2022 Family-Centered Treatment opportunity are eligible only for a new program. DHS expects one award of $125,000 per year, $627,500 in total over five years starting January 1, 2027, funded by the Substance Use Block Grant; written questions are due November 10, 2026 and applications are due November 24, 2026 at 11:59 p.m.

What it means. If your Wisconsin program holds DHS 75 certification and serves pregnant or parenting women, decide quickly whether you can staff a family-centered track with two years of aftercare and submit questions by November 10, 2026. Applications close November 24, 2026 at 11:59 p.m.

What changed. A Notice of Intent to Renew and Amend the Mental Health Home and Community-Based Services Waiver says the Commissioner of Social Services intends to submit a renewal of the 1915(c) waiver, which DMHAS operates, to CMS to be effective April 1, 2027. The renewal adds a fifth level of care under Assisted Living services to align with the Connecticut Home Care Program for Elders and makes technical updates on telehealth delivery, Transitional Case Management in acute care hospitals, the home and community-based settings appendix and quality performance measures. Written comments are due by December 3, 2026 to Katie Daly, Director of Long Term Services and Supports, Mental Health Waiver Program, at Katie.Daly@ct.gov.

What it means. If you deliver Mental Health Waiver services in Connecticut, such as assisted living, transitional case management or telehealth-delivered supports, read the draft renewal application on the DMHAS Mental Health Waiver page and check how the new assisted living level and the telehealth and hospital case management language fit your contracts. Send comments by December 3, 2026 and plan for the April 1, 2027 effective date.

What changed. IHCP Bulletin BT2026178, dated October 22, 2026, updates the prior authorization process for Medicaid Rehabilitation Option (MRO) equivalent services delivered by certified community behavioral health clinics and paid under the CCBHC prospective payment rate, effective January 1, 2027. Starting that day, DMHA will automatically send level of need 4 authorization data and diagnosis information to Gainwell for each Medicaid eligible CCBHC client with an MRO-eligible diagnosis in DARMHA, creating a LON 4 authorization without a CANS or ANSA; existing CCBHC MRO-equivalent authorizations will be reissued with the full LON 4 unit allotment. Each authorization runs 180 days with a start and end date, the 180 day lookback no longer applies, and providers who believe a client needs LON 5 or higher should complete the DARMHA steps by December 31, 2026.

What it means. If you run an Indiana CCBHC, make sure every Medicaid client has an MRO-eligible diagnosis recorded in DARMHA before January 1, 2027 so the LON 4 authorization is created, and submit CANS or ANSA data with Send for MRO set to Yes by December 31, 2026 for anyone who needs LON 5 or 6. Calendar authorization end dates, since higher LON requests must go in during the 30 days before an authorization ends.

What changed. An October 19, 2026 MaineCare bulletin says the Behavioral Health Home rule adopted January 30, 2026 lets the Department withhold 4% of per member per month payments once performance thresholds are set, pay the withheld 4% every three months to providers that meet the Minimum Performance Threshold, and, subject to appropriations, pay an additional 1% to providers that meet the Excellence Performance Threshold. The two measures are Quality of Life / Patient Experience and Access to Preventive and Ambulatory Care. The Department set the Minimum Performance Threshold at a composite score of 65% and the Excellence Performance Threshold at 78%, both as of May 21, 2027, and will begin withholding 4% of monthly payment on May 21, 2027.

What it means. If you operate a Behavioral Health Home in Maine, model the cash flow effect of a 4% PMPM withhold paid back quarterly from May 21, 2027 and review your patient experience and primary care utilization data against the 65% and 78% composite benchmarks. Read MaineCare Benefits Manual Chapter II, Section 92 for the measure methodology and calendar May 21, 2027.

What changed. The October 30, 2026 Maryland Register publishes proposed action 26-190-P amending Regulations .01 to .04 of COMAR 10.34.29, Drug Therapy Management, to implement SB 562 (2026), State Board of Pharmacy, Prescriber-Pharmacist Agreements, Treatment of Opioid Use Disorders. The amendments add licensed certified midwives as authorized prescribers, require a protocol that authorizes controlled dangerous substance therapy to have the pharmacist check the Prescription Drug Monitoring Program before starting or changing that therapy, remove the requirement that prescribers file agreements and amendments with their boards, and require a pharmacist treating opioid use disorder under an agreement to register individually with the DEA and with the Maryland Office of Controlled Substances Administration. Comments are accepted through November 30, 2026 and no hearing is scheduled.

What it means. If you run an outpatient SUD program or OTP in Maryland with prescribers who could partner with pharmacists on buprenorphine or other OUD medication management, read the proposed protocol and registration requirements and comment by November 30, 2026. Plan how a pharmacist partner would fit your medication workflow, PDMP checks and DEA registration before the rule is final.

What changed. The October 30, 2026 Maryland Register publishes proposed action 26-189-P adopting new Regulations .01 to .06 under COMAR 10.31.03, General Continuing Education Requirements, which applies to all health occupations boards and their licensees, including the Board of Professional Counselors and Therapists, the Board of Examiners of Psychologists and the Board of Social Work Examiners, each of which considered it in June and July 2026. The chapter sets guidelines in addition to each board's own rules: implicit bias and structural racism training must be a program approved by the Cultural and Linguistic Health Care Professional Competency Program for a licensee's first renewal after April 1, 2026; boards must allow at least 1 hour of credit for a Department approved human trafficking awareness program; and boards whose scope covers perinatal care or menopause must grant at least 2 hours of credit for every 1 hour of Department approved training on perinatal behavioral health conditions or menopause. Comments are accepted through November 30, 2026 and no hearing is scheduled.

What it means. If you employ Maryland licensed counselors, therapists, social workers or psychologists, note the implicit bias program approval rule for their first renewal after April 1, 2026 and the extra credit options once the Department approves training programs. Comment by November 30, 2026 if the renewal mechanics would be hard for your staff, and update your CE tracking when the rule is final.

What changed. DMH Provider Bulletin IO0182, issued November 4, 2026 to all DMH certified providers, says proposed revisions to the 2024 DMH Operational Standards for mental health, IDD and substance use community service providers are posted for public comment on the Secretary of State's website as System Number 28991, with clean and redlined copies. DMH's summary of substantive changes includes adding Mental Health Intensive Outpatient Program, Peer Operated Respite, Crisis Respite Living Room and EmPATH services as certifiable programs, renaming Crisis Stabilization Units to Crisis Residential Units and DMH Addiction Therapists to DMH Substance Use Therapists, removing Supported Employment and DUI Assessment as required services for community mental health centers, a repeat deficiency definition, a requirement that subcontracted required services be delivered by DMH certified entities, new Executive Director qualifications, an annual employee acknowledgment form and new PACT and ICSS requirements. The public comment period closes Monday, November 30, 2026 at 5:00 p.m.; comments go to certification@dmh.ms.gov with the rule and page number.

What it means. If you hold or are seeking DMH certification in Mississippi, pull the redlined standards from the Secretary of State site (System Number 28991) and map the changes to your required services, staffing, subcontracts, training and records before November 30, 2026. Decide early whether to add the new IOP, respite or EmPATH service lines once the standards are final.

What changed. The November 2, 2026 Missouri Register (Vol. 51, No. 21) publishes a proposed rescission of 9 CSR 30-4.195, Access Crisis Intervention (ACI) Programs, filed September 28, 2026. DMH says the rule reflects an earlier crisis structure with multiple regional entry points, that 988 is now the primary access point, and that crisis response continues under CCBHC criteria, provider contracts and existing guidance. DMH says it is drafting replacement rules 9 CSR 30-7.005 (Definitions), 9 CSR 30-7.030 (988 Contact Centers) and 9 CSR 30-7.040 (Mobile Crisis Response), now in stakeholder review and expected to be filed in the coming months; comments on the rescission are due within 30 days of publication and no hearing is scheduled.

What it means. If you hold an ACI contract or certification in Missouri, check which of your crisis policies cite 9 CSR 30-4.195 and plan to re-anchor them to the CCBHC criteria, your DMH contract and the coming Chapter 7 rules. Calendar the 30 day comment window from November 2, 2026 and watch the Register for the 988 and mobile crisis response proposals.

What changed. The November 2, 2026 Missouri Register publishes a proposed amendment to 9 CSR 10-5.200, Report of Complaints of Abuse, Neglect, and Misuse of Funds/Property, filed September 24, 2026. The amendment brings self-directed services into the rule, requires that arrangements for an alleged perpetrator during an investigation be approved by the DMH Regional Director or designee and at a minimum ensure no contact with DMH consumers, and keeps the 20 calendar day letter and appeal steps. Comments are due within 30 days of publication and no hearing is scheduled.

What it means. If your agency is licensed, certified, accredited or funded by Missouri DMH, compare your abuse and neglect reporting and staff reassignment policy against the amended text, especially the no contact and regional approval language. Calendar the 30 day comment window from November 2, 2026 if you want to weigh in.

What changed. A November 3, 2026 notice of hearing says the Health Care Authority is finalizing the repeal and replacement of 8.369.3 NMAC, Certification Requirements for Child and Adolescent Mental Health Services. The notice lists changes including naming HCA as the licensing authority, updated certification requirements, sanctions, hearings and appeals, waivers and variances, survey and monitoring visits, CYFD background check processes, personnel and incident reporting requirements, removal of day treatment licensure in favor of certification, removal of therapeutic hold language, updated personal restraint and seclusion expectations, PRN medication and two-identifier verification rules, CCSS certification expectations, clinical supervision and treatment foster care requirements. The hybrid hearing is December 4, 2026 from 1:00 p.m. to 3:00 p.m. Mountain Time, written comments are due by 5:00 p.m. on December 3, 2026, and the proposed effective date is December 22, 2026.

What it means. If you hold or seek a New Mexico certification for children's mental health services such as day treatment, CCSS or treatment foster care, read the proposed rule on the HCA DHI regulations page and compare your restraint, seclusion, PRN medication, supervision and incident reporting policies against it. Send comments to HCA-DHI-Public-Comment@hca.nm.gov by December 3, 2026 and plan for a December 22, 2026 effective date.

What changed. A November 3, 2026 notice of hearing says the Health Care Authority is finalizing the repeal and replacement of 8.369.4 NMAC, Licensing Requirements for Child and Adolescent Mental Health Facilities, which apply to public, for-profit and nonprofit residential facilities. The notice lists updated definitions, licensing procedures, waivers and variances, facility capacity, grounds for revocation, suspension and denial, emergency sanctions, hearings and appeals, surveys and monitoring visits, corrective action, incident reporting, children's rights language, staff records, transportation, management of pharmaceuticals, medical care, nutrition, building requirements for residential treatment facilities, and fire safety clearance and inspection changes. The hybrid hearing is December 4, 2026 from 3:00 p.m. to 5:00 p.m. Mountain Time, written comments are due by 5:00 p.m. on December 3, 2026, and the proposed effective date is December 22, 2026.

What it means. If you operate a residential treatment facility or other licensed children's mental health facility in New Mexico, pull the proposed text from the HCA DHI regulations page and check your building, fire safety, medication management, staffing records and incident reporting practices against it. Comment by December 3, 2026 and plan for the December 22, 2026 effective date.

What changed. A November 3, 2026 notice of hearing says the Health Care Authority is finalizing the repeal and replacement of 8.369.2 NMAC, Regulations Governing Residential Shelter Care Facilities for Children. The notice says the new rule updates the scope for children's crisis shelters, multi-service homes and new or innovative programs, removes oversight of community homes, moves statutory authority from the Department of Health to the Health Care Authority, creates general licensing requirements, adds waivers and variances, a corrective action section and survey or monitoring visits, and updates staffing ratios, personnel requirements, incident reporting, children's rights, building and fire safety provisions. The hybrid hearing is December 4, 2026 from 8:00 a.m. to 10:00 a.m. Mountain Time, written comments are due by 5:00 p.m. on December 3, 2026, and the proposed effective date is December 22, 2026.

What it means. If you run a children's crisis shelter or multi-service home in New Mexico, or a community home that would leave this rule, read the proposed text on the HCA DHI regulations page and check the staff-to-child ratios, incident reporting and building requirements against your operation. Comment by December 3, 2026 and calendar the December 22, 2026 effective date.

What changed. In a public notice dated November 9, 2026, OHA said it will ask CMS to extend the OHP 1115 demonstration for October 1, 2027 through September 30, 2032, and posted the draft renewal application for 30 days of public comment through December 9, 2026. The draft includes services for OHP-eligible incarcerated people within 60 days before release: case management to assess physical, behavioral health and health-related social needs, medication-assisted treatment as clinically appropriate, and a 30-day supply of prescriptions at reentry. OHA will take verbal comments at the Medicaid Advisory Committee on December 2 and at a public webinar on December 4, 2026.

What it means. If you serve OHP members, read the draft application and send written comments to 1115Waiver.Renewal@odhsoha.oregon.gov by December 9, 2026 on the parts that affect your services. Programs that work with jails or reentry should look closely at the proposed pre-release benefit, including MAT before release.

What changed. DHS published proposed 55 Pa. Code Chapter 1350, Crisis Intervention Services Payment, in the Pennsylvania Bulletin on November 7, 2026 (56 Pa.B. 7343). It sets Medical Assistance participation requirements and payment conditions for licensed crisis intervention providers, which the department lists as crisis call centers, mobile crisis teams, medical mobile crisis teams, emergency behavioral health crisis walk-in centers and crisis stabilization units, and says it codifies current payment standards with no fiscal impact. Comments are due within 30 calendar days of publication, and the rule would take effect 180 days after final-form publication.

What it means. If you run a crisis call center, mobile crisis team, walk-in center or crisis stabilization unit in Pennsylvania, check your enrollment, provider agreement and licensing against proposed Chapter 1350 and send comments to RA-PWCRISISSRVSREGS@pa.gov, citing Regulation No. 14-560, within the 30 day window. Track proposed Chapter 5250 as well, because payment depends on holding that crisis intervention license.

What changed. In the October 2, 2026 Texas Register, HHSC announced its intent to submit transmittal number 26-0012 to the Texas State Plan for Medical Assistance to extend the age of eligibility for the Peer Specialist Services Medicaid benefit to individuals 14 through 20 who meet the clinical criteria, effective December 1, 2026. The benefit is currently available to people 21 and older with a mental health or substance use condition whose plan of care includes peer specialist services. HHSC estimates an annual aggregate cost savings of $68,830 in federal fiscal year 2027.

What it means. If your Texas program employs certified peer specialists and serves adolescents or young adults, plan to add peer services to plans of care for members 14 to 20 from December 1, 2026 and confirm that your peer staff are trained for youth work. Watch for the approved SPA and any billing guidance that follows.

What changed. Article 26-96 in the September 2026 Medicaid Information Bulletin says that effective January 1, 2027, behavioral health residential treatment, partial hospitalization and intensive outpatient programs for mental health and SUD will be reported on a per diem basis through the 837I institutional transaction, billed one unit per day. Each claim must carry the revenue code with the supporting HCPCS code: 1001 with H0017 or H2013 for mental health residential, 1002 with H0018 or H2036 for SUD residential, 0912 with H0035 and 0913 with H0037 for partial hospitalization, and 0905 with S9480 or 0906 with H0015 for intensive outpatient. Questions go to dmhfmedicalpolicy@utah.gov.

What it means. If you bill Utah Medicaid for residential, PHP or IOP care, work with your EHR and clearinghouse now to move those services from professional claims to institutional 837I claims with the listed revenue and HCPCS pairs, one unit per day. Test the new claim format before January 1, 2027 so January cash flow does not stall.

What changed. On November 10, 2026 the U.S. Attorney's Office for the Eastern District of Virginia said the owners of Live 4 Life, Inc., which provided Mental Health Skill Building (MHSB) and Intensive In-Home (IIH) services to Medicaid recipients, were sentenced for conspiracy to commit health care fraud, Erica Jackson to four years in prison and Jason Jackson to six months. According to court documents, from January 2019 QMHPs were directed to bill brief interactions as one or more hours of service, to bill two or more clients at the same time and to submit progress notes with overlapping times, and the owners billed further hours on top.

What it means. Audit time-based services such as skill building and in-home therapy for overlapping session times, simultaneous billing for siblings and units that exceed documented contact time. Make sure no one who submits claims can add hours that are not in a signed progress note.

What changed. An August 26, 2026 memorandum from the DBHDS Office of Licensing to all current and prospective providers of the new behavioral health services, Community Psychiatric Support and Treatment for youth and adults, Coordinated Specialty Care and Mental Health Center-Based Recovery and Empowerment Center services, requires completion of a mandatory Behavioral Health Redesign pre-application training before a service modification or new application is submitted; applications filed without it will be administratively withdrawn. A complete application must be received by January 15, 2027 to allow review time for licensure by July 1, 2027, and all legacy service licenses will be closed by the Office of Licensing as of July 1, 2027.

What it means. If you intend to hold a Virginia license for CPST, CSC or a Recovery and Empowerment Center, complete the mandatory training and exam now and file a complete application or service modification by January 15, 2027. Plan the closure of your legacy service licenses for July 1, 2027 and confirm enrollment deadlines with DMAS and the managed care plans.

What changed. A DMAS bulletin dated September 18, 2026 says provider enrollment for the new Collaborative Behavioral Health Services, which replace Community Mental Health Rehabilitative Services on July 1, 2027, opened October 1, 2026 through the Provider Services Solution (PRSS). DMAS strongly encourages providers to submit enrollment applications by January 29, 2027 so enrollment, managed care credentialing and service authorization transitions finish before go-live; later applications are accepted but completion by July 1, 2027 is not guaranteed. The bulletin lists the DBHDS licenses under 12VAC35-105 for each new specialty, and CPST and Mental Health Clubhouse providers must show accreditation or proof of accreditation intent from COA, CARF or The Joint Commission at enrollment, with 18 months from July 1, 2027 to become fully accredited.

What it means. If you plan to deliver CPST, clubhouse or coordinated specialty care in Virginia, gather your DBHDS license numbers and accreditation evidence now and file in PRSS by January 29, 2027. Start the COA, CARF or Joint Commission process immediately if you have not, since proof of intent is required at enrollment.

What changed. A proposed regulation published in the October 5, 2026 Virginia Register (Vol. 43 Issue 4) amends 18VAC125-20-42 to let the Board of Psychology accept evidence of a retired or expired license from another United States or Canadian jurisdiction, in good standing before it retired or expired, as part of an application for licensure by endorsement, to remove the requirement that applicants attest to having read Virginia's psychology laws and regulations, and to state that verification of an active license in good standing must be provided for endorsement. A public hearing was held November 2, 2026 at the Department of Health Professions in Henrico, and the public comment deadline is December 4, 2026.

What it means. If you are recruiting psychologists to a Virginia program, note that candidates who let an out of state license retire or expire in good standing may soon qualify by endorsement, with the board weighing time since practice. Comment by December 4, 2026 if you want the board to hear how the change affects hiring.

What changed. A fast-track regulation published in the Virginia Register on November 2, 2026 (VA.R. Doc. No. R27-8460) adds a subsection to 18VAC125-20-55 so the board may accept graduate-level coursework completed outside a doctoral program toward the education requirements for applied psychologist licensure. The board says the change expands the pathway to licensure and reduces barriers for applicants who would not otherwise qualify. Public comment runs through December 2, 2026, and the effective date is December 17, 2026 unless the fast-track process is halted by objections.

What it means. If you employ psychologists in Virginia or have staff with doctorates who fell short of the applied psychology coursework rules, check whether their graduate coursework now qualifies and plan applications after December 17, 2026. Comment on the Virginia Regulatory Town Hall by December 2, 2026 if the change affects your hiring or credentialing.

What changed. DHS is seeking applications to implement Family Centered Treatment-Recovery (FCT-R), a model that combines the Family Centered Treatment model with SUD treatment practices, including family system interventions, integrated trauma treatment, a peer professional, contingency management and random drug screens. Awardees must contract with the Family Centered Treatment Foundation for training, certification and fidelity oversight, and initiate contact with a family within 48 hours of referral. DHS expects three awards of $166,666 over two years from a total of $500,000, with contracts starting January 1, 2027; eligible applicants are Wisconsin nonprofits, public agencies and Tribal nations sharing boundaries with Wisconsin. A virtual information session is set for November 12, 2026, written questions are due November 10, and applications are due December 14, 2026 at 11:59 p.m.

What it means. If your Wisconsin SUD program serves parents and caregivers, join the November 12, 2026 information session and budget for the Foundation contract, implementation team and about 10 hours of pre-service training per staff member. Submit the application by December 14, 2026 at 11:59 p.m.