Medicaid B: Substance Abuse Intensive Outpatient Program (SAIOP)

• Clinical Coverage Policy 8A

Submission Requirements

Initial:

• Service Authorization Request (SAR)
• Person Centered Plan (PCP) with Service Order
• Comprehensive Clinical Assessment (CCA)

Concurrent:

• Service Authorization Request (SAR)
• Updated Person Centered Plan (PCP)

Service Definition Authorization Parameters

Initial:

• No prior authorization for the first 30 days with billing maximum up to 12 units/month

Concurrent:

• Up to 60 days/24 units
• Can request additional 2 week extension

ASAM Level of Care

2.1