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Utah DHHS (Medicaid) · November 2, 2026 · Primary source

November2026-MIB.pdf ,

Score 78PRIMARYregulatoryState MedicaidUT

Summary

Utah Medicaid's November 2026 Medicaid Information Bulletin announces multiple policy changes taking effect November 1, 2026 and January 1, 2027. Key changes include the launch of electronic prior authorization (ePA) FHIR API testing ahead of a January 1, 2027 go-live date, new community engagement requirements for Hospital Presumptive Eligibility Adult Expansion beneficiaries mandated by H.R. 1, standardization of Targeted Case Management billing for individuals with Serious Mental Illness exclusively under code T1017 (closing code H0006), updates to behavioral health revenue codes, and expanded Mobile Crisis Outreach Team policies. Several additional changes affect school-based services, fluoride coverage, and dental periodontal maintenance.

What this may mean

Providers billing Utah Medicaid for Targeted Case Management for Serious Mental Illness must transition exclusively to CPT code T1017 and discontinue use of H0006 by January 1, 2027. Providers must register for the ePA system and complete sandbox testing before the January 1, 2027 production go-live for electronic prior authorization. Hospitals conducting Hospital Presumptive Eligibility determinations for Adult Expansion must screen applicants for community engagement compliance under H.R. 1 beginning 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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