Exhibit 2Q - SHARE ASAM Residential LOC Authorization Parameters.pdf

This document outlines the State Hospital Access to Rehabilitation & Education (SHARE) Fee for Service - Adult Residential ASAM Level of Care Authorization Parameters for the State of FY 2025, effective July 1, 2024 and revised on January 8, 2024. The document provides details on the authorization parameters for Short Term Residential (7 days), Short Term Residential (14 days), and Pre-Admission Residential services. It specifies the ASAM Level of Care, CPT codes, maximum units per authorization, authorization time frames, daily and weekly limits, and the authorization values for each service type. The document also includes information on the "RED ZONE" for adult annual client limits.

The pricing details indicate the rate per unit for the Pre-Admission Residential service is $28.49, with an authorization value of $113.96 for 4 units. The Short Term Residential (7 days) service has an authorization value of $1,713.46, and the Short Term Residential (14 days) service has an authorization value of $3,426.92. The document does not provide information on any set asides, incumbents, funding requirements or sources, or renewal options.