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Ask about a client, ask for the draft, or ask what is due. The answer comes from this desk and cites its rules. A person still signs, and a person still records the filing.
Matching primary seed-rule summaries are below. Open the source and check its applicability before using it.
Layers searched that had a match: 3 State Medicaid manual (DMAS); 1 Federal law/regulation.
Layers with no match for this question: 2 State regulation (Virginia); 4 MCO contract / provider manual; 4 MCO contract/manual; 5 Payer clinical criteria; 6-7 Accreditation / case law / guidance. A rule found in one layer can still be changed by another, especially the plan's own contract (layer 4) and the program's policies (layer 7), which are not loaded.
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Payer contracts, proprietary criteria, and internal policies are not loaded.
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A-011 When to submit initial and extension requests
DMAS-recommended timeframes: initial requests for ASAM 2.1 to 4.0 - 1 business day from service initiation, no more than 5 calendar days before service initiation. Extension requests - submitted BEFORE the current authorization ends but no more than 5 calendar days before its end date; if submitted after the current authorization ends, the extension begins on the day of receipt. (FFS contractor follows these; MCOs follow NCQA requirements.)
Ch. IV p. 29-30 · rev 7/7/2025 · P
Caution 'Recommended' timeframes; each MCO has its own contract rule. Collect each MCO's actual rule (payer profile).
A-058 Residential and inpatient (3.1 to 3.7): discharge, absences and readmission
If a member needs acute non-psychiatric inpatient treatment, is on runaway status, or is in detention for more than seven days (ten days at Level 3.1), the authorization is end-dated and treated as a discharge, and any later admission to 3.1, 3.3, 3.5 or 3.7 is a new admission. If a member needs acute psychiatric inpatient admission, the authorization is end-dated and treated as a discharge, and the later admission is a new admission. After any discharge from 3.1, 3.3, 3.5 or 3.7, a later admission to any of them is a new admission. Discharge is warranted when documentation does not show the service definition is met, or when maximal benefit has been reached. The member must be discharged when less intensive services may achieve stabilization, the member requests discharge, the member leaves, or a higher level is needed.
Ch. IV p. 21 (absence and readmission rules); each level's Service Units and Limitations (pp. 48-63) · rev 7/7/2025 · P
Caution The 7-day and 10-day counts are the manual's; how a plan counts partial days is not stated, so confirm with the plan.
F-008 Continuation of benefits while appealing
Benefits must continue only if ALL are true: the appeal was filed timely; it concerns termination, suspension or reduction of previously authorized services; the services were ordered by an authorized provider; the period covered by the original authorization has NOT expired; and the enrollee timely requests continuation (within 10 calendar days of the notice or by the effective date of the action, whichever is later). If the plan wins, it may recover the cost of services furnished only because of this rule, per state policy and contract.
438.420(a)-(d) · rev eCFR as of 2026-09-28 · P
Caution My reading of how this applies to a denied *extension* request is an interpretation. Confirm with DMAS/counsel before telling staff it is or isn't available.