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July 2024 Issue 

Transition to ASAM 4th Edition Criteria Underway  

Optum Behavioral Health has begun rolling out contracting and clinical guideline changes to align with the updated ASAM Criteria 4th Edition for the treatment of adults with addiction. This transition will occur throughout the remainder of 2024 and through 2025. 

Optum Behavioral Health uses The ASAM Criteria to outline our network facility and provider roles, responsibilities and requirements, as well as guidelines and protocols for treating patients with substance use disorders.

The parameters help ensure members receive the treatment that best fits their needs and that resources are used wisely.

What you need to know

  1. Optum Behavioral Health will reach out to update your participation agreement. Until you have a fully executed, updated contract, you should continue to follow 3rd Edition guidelines.

  1. For 2024, changes will only apply to Commercial health plans. States have indicated Medicaid plans will not transition to the 4th Edition guidelines until Jan. 1, 2025, at the earliest. We’ll update you later this year. 

  1. ASAM has focused the 4th Edition criteria on adults (ages 18+) only. You’ll continue to follow the 3rd Edition criteria for adolescents (under age 17).

  1. Many clinical criteria and standards have been updated. The 6 dimensions and sub-dimensions reflect the current state of scientific evidence and clinical practice, and help to integrate more person-centered considerations when assessing the level of care needed. 

    Get up to speed on ASAM 4th Edition 

    Here are some highlights of the resources available to help you learn more about the 4th Edition changes, how to use the updated criteria with patients and incorporate them into your processes and billing: 

    Frequently Asked Questions

    The ASAM Criteria 4th Edition guide: You can purchase a digital or print copy of The ASAM Criteria 4th Edition to support your transition to the updated criteria.

    A set of 300+ slides: The slides are publicly available. To request them, accept ASAM's terms and conditions.

    Understand the 4th Edition and its Clinical Application: Offered by the Hazelden Betty Ford Foundation, this 2-day virtual course reviews the updated criteria in detail. Significant time is allotted to practice applying the core components in diverse scenarios. CE and CMEs are available

Questions?

For questions about the criteria, please contact ASAM. For questions related to your Optum Behavioral Health contract, please contact your Provider Relations Advocate or Network Management contact.  

 

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Article published July 9, 2024