Medicaid SUPR Providers: Public Act 100-1023 Opioid Addiction Treatment Access Act Changes Benefit Preauthorization Process

Posted December 27, 2018

Effective Jan. 1, 2019, Illinois Public Act 100-1023, also called the Opioid Addiction Treatment Access Act, will be implemented for Blue Cross and Blue Shield of Illinois (BCBSIL) Medicaid members, including those with Blue Cross Community MMAI (Medicare-Medicaid)SM and Blue Cross Community Health PlansSM plans.

In accordance with this act, benefit preauthorization is not required for substance abuse services when the provider notifies BCBSIL within 24 hours of initiation of treatment. If providers fail to notify BCBSIL of the treatment initiation, BCBSIL will follow the normal benefit preauthorization process. All services are subject to establishment of medical necessity and may require a medical necessity review. Levels of care in scope for this state mandate include the following American Society of Addiction Medicine (ASAM) levels of treatment:     

  • ASAM Level 2.1 Intensive Outpatient
  • ASAM Level 2.5 Partial Hospitalization
  • ASAM Level 3.5 Clinically Managed High Intensity Residential
  • ASAM Level 3.7 Medically Monitored Intensive Inpatient

All other inpatient and outpatient substance abuse services should follow the normal benefit preauthorization processes.

If you have any questions, please contact your Provider Network Consultant (PNC).