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A-052 Service authorization rules updated 2026 (Appendix D)
DMAS, its prior-authorization contractor and the MCOs implemented CMS-0057-F from January 1, 2026: standard (non-urgent) authorization decisions within 7 calendar days (extendable up to 14 calendar days at the member's or provider's request, or when more information is needed and it is in the member's interest); expedited decisions within 72 hours; denial letters must state the specific reason and appeal rights. Fee-for-service requests are submitted in Atrezzo Next Generation (ANG), reached through the DMAS MES portal (required from August 3, 2026). Late fee-for-service requests are decided from the date received, and days not requested on time are denied. Before a DMAS appeal, a provider must exhaust Acentra Health's reconsideration: submitted in ANG within 30 calendar days of the initial determination letter, with added evidence; late reconsiderations are denied as untimely.
Appendix D (rev. 9/24/2026) pp. 2-3, 5-6, 10 · rev 9/24/2026 · P
Caution For ARTS 2.1/2.5 the manual's 72-hour response (A-010) is stricter than the 7-day standard and still applies.
A-060 Which ARTS levels need service authorization, and where withdrawal management is covered
Service authorization is required for ASAM 4.0, 3.7, 3.5, 3.3, 3.1, 2.5 and 2.1. It is not required for ASAM 1.0 outpatient, Opioid Treatment Programs, Preferred Office-Based Addiction Treatment (OBAT), or early intervention/SBIRT (0.5). Requests must include a current multidimensional assessment addressing all six ASAM dimensions; requests that do not meet the ASAM requirements for the requested level are not approved. Withdrawal management is covered when medically necessary as a component of 4.0, 3.7, 3.5, 3.3, 2.5, 2.1, OTP and Preferred OBAT, and ASAM 1.0 (it is not listed under 3.1). The MCOs and the FFS contractor respond within 72 hours for these levels (see A-010, A-052).
Ch. IV pp. 28-29 · rev 7/7/2025 · P
Caution Withdrawal management levels (1-WM through 4-WM) are not separately defined in this chapter; they are described as a component of the levels listed. Do not invent a WM authorization rule.