Substance Use Disorder (SUD) Frequently Asked Questions (FAQ)
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Answers for providers and members about how Hennepin Health manages SUD assessments, treatment access, notification/authorization processes, and covered SUD services for Hennepin Health members.
No material clinical or coverage changes in this revision.
Coverage and Notification Criteria
Coverage and notification criteria
Covered services and notification requirements
Initial placements do not require prior authorization; continued stay review intervals apply
Providers may be reimbursed for Comprehensive Assessments, initial peer recovery support services and treatment coordination without the form.
Medication-Assisted Treatment and OTP
Medication-Assisted Treatment / Opioid Treatment Program (OTP)
OTP, peer recovery support services and withdrawal management may be required to submit paperwork for utilization review upon request.
Provider Responsibilities and Submission Requirements
No PA for initial placement; continued stay review required
Initial SUD placements do not require prior authorization. For continued stays, providers must submit a current HH SUD Treatment Notification_Extension Request Form and participate in utilization review at the specified intervals (18 days inpatient; 60 days residential; 30 individual hours outpatient; 300 group hours outpatient). Notify Hennepin County Addiction & Recovery Services as described for processing.
- Initial placements require no prior authorization.
- Continued stay utilization review intervals: 18 days (inpatient), 60 days (residential), 30 individual hours (outpatient), 300 group hours (outpatient).
- A current HH SUD Treatment Notification_Extension Request Form must be provided for coverage of SUD inpatient and outpatient treatment.
OTP and related services may be subject to utilization review
Opioid Treatment Programs (OTP), peer recovery support services, and withdrawal management services may be asked to provide paperwork for utilization review upon request. Be prepared to submit requested documentation to the review team to support continued coverage or reauthorization.
- OTP, peer recovery support services and withdrawal management may be required to submit paperwork for utilization review upon request.
- Follow instructions in OTP-specific guidance for routing of new admission materials.
Submit HH SUD Treatment Notification_Extension Request Form and Comprehensive Assessment
Providers must send a current HH SUD Treatment Notification_Extension Request Form and a Comprehensive Assessment that documents the member’s SUD diagnosis and ASAM risk ratings for the requested level of care. These documents are required for coverage of SUD inpatient and outpatient treatment.
- Comprehensive Assessment must document SUD diagnosis and ASAM risk ratings for the level of care requested.
- HH SUD Treatment Notification_Extension Request Form must be current and sent for coverage processing.
Route OTP new-admission materials to Hennepin County Addiction & Recovery Services
For new OTP admissions, send the comprehensive assessment and HH SUD Treatment Notification_Extension Request Form to the Hennepin County Addiction & Recovery Services review team (HC.ReviewTeam@hennepin.us). For subsequent OTP reauthorization, send the HH SUD Treatment Notification_Extension Request Form to Hennepin Health (HH.SUD@hennepin.us) unless requesting additional external services.
- New OTP admissions: send documents to HC.ReviewTeam@hennepin.us.
- Subsequent OTP reauthorization: send forms to HH.SUD@hennepin.us unless external services are being requested.
Submit required forms within 10 business days or 10 days before units are exhausted
Send the Comprehensive Assessment and HH SUD Treatment Notification_Extension Request Form within 10 business days of service initiation or at least 10 days before initial or approved extension units are exhausted; failure to do so may affect processing and coverage.
- Forms should be sent within 10 business days of service initiation or 10 days before units are exhausted.
- Late or missing submissions may affect processing and coverage decisions.
Utilization Review Intervals and Visit Limits
Key Forms and Assessments
Policy Background
This policy guidance describes the administrative processes Hennepin Health and Hennepin County use for members to access substance use disorder (SUD) assessment and treatment services. Initial SUD placements do not require prior authorization; members may contact SUD providers directly and most programs accept Hennepin Health coverage. Members can locate programs via FastTracker or FindTreatment.gov, or contact Hennepin County Addiction and Recovery Services, the county review team, the county front door call center, or Hennepin Health Member Services for assistance (see contacts in source materials).
For coverage of ongoing inpatient and outpatient SUD treatment, Hennepin Health requires a current HH SUD Treatment Notification_Extension Request Form and a Comprehensive Assessment documenting SUD diagnosis and ASAM risk ratings. These forms are processed by the Hennepin County Behavioral Health, Addiction and Recovery Services review team; providers should send them within 10 business days of service initiation or 10 days before approved units are exhausted to ensure timely processing.
Continued stay utilization review applies at specific intervals depending on level of care: 18 days for inpatient hospital stays; 60 days for residential placements; 30 individual hours for outpatient treatment; and 300 group hours for outpatient treatment. Opioid Treatment Programs (OTPs) and certain services (peer recovery support, withdrawal management) may be asked to submit documentation for utilization review upon request; new OTP admissions should route the comprehensive assessment and Notification form to Hennepin County Addiction & Recovery Services, with subsequent reauthorization forms sent to Hennepin Health unless external services are being requested.
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