Utah DHHS (Medicaid) · May 12, 2026 · Primary source
May2026-MIB.pdf
Summary
Utah Medicaid's May 2026 Medicaid Information Bulletin details implementation of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), requiring payers to deploy Patient Access, Prior Authorization, Provider Access, and Payer-to-Payer FHIR APIs by January 1, 2027. The bulletin also announces that effective July 1, 2026, outpatient SUD services for Medicaid members in Box Elder, Cache, and Rich counties shift from fee-for-service to Bear River Behavioral Health Services as a Prepaid Mental Health Plan, ending FFS billing for those services by non-FQHC, non-OTP providers. Additional items cover a buprenorphine quantity limit update, behavioral health code standardization, and pharmacy submission clarification codes.
What this may mean
SUD treatment providers in the three named Utah counties that were billing Medicaid FFS for outpatient SUD services, including residential treatment level of care, lost FFS reimbursement eligibility as of July 1, 2026, and must contract with Bear River Behavioral Health Services to continue serving those members. OTPs billing methadone and FQHCs are exempt and continue FFS billing. Impacted payers must have all four CMS-0057-F APIs operational by January 1, 2027.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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