September 17, 2026
Behavioral health providers in Hawaiʻi have several important utilization review and revenue-cycle developments to watch this month. The biggest local development comes from Kaiser Permanente Hawaiʻi, where routine outpatient behavioral health authorization practices are becoming more focused on measurable treatment outcomes.
Headline: Kaiser Permanente Hawaiʻi Moves Toward Feedback-Informed Care
During a September 17 Behavioral Health Affiliate Provider session, Kaiser Permanente Hawaiʻi discussed changes providers are beginning to see in routine outpatient behavioral health continued-stay and reauthorization reviews.
Historically, many affiliate providers became accustomed to relatively lengthy authorizations, often as many as 52 sessions. More recently, authorization periods have become noticeably shorter.
The important change is not necessarily that Kaiser has created an entirely new utilization review standard. Rather, Kaiser indicated that existing expectations for measurable clinical progress are being more actively enforced.
Measurement-Based Care Is Becoming Increasingly Important
Providers should expect continued-stay or reauthorization requests to be supported by standardized measurement tools that correspond to the condition being treated.
Examples may include:
- Depression: PHQ-9
- Anxiety: GAD-7
- Trauma/PTSD: PCL
- Eating disorders: an appropriate eating-disorder assessment such as the EAT
- Substance use disorders: appropriate SUD assessment and dimensional measures
A treatment plan containing measurable SMART goals, documented progress toward those goals, and appropriate therapeutic-alliance or outcome measures may provide additional support.
The key is simple: the measurement tool should match the condition being treated, and repeated measurements should help demonstrate whether the patient is improving, remaining symptomatic, or regressing.
For years, many continued-care reviews could be completed primarily through Kaiser’s CCR form without submitting extensive clinical records. Providers should now prepare their documentation and outcome-measurement workflows with the expectation that objective evidence of progress may play a greater role in obtaining additional authorized visits.
Kaiser Permanente Hawaiʻi maintains an affiliated provider network that includes outpatient mental health and alcohol and drug treatment services.
Learn more about Kaiser Permanente Hawaiʻi affiliated behavioral health providers
What About 60-Minute Psychotherapy?
Kaiser also discussed psychotherapy coding during the September 17 session.
Providers were advised that 90834 should generally represent routine psychotherapy when the documented service supports that code, while frequent use of 90837 may attract additional utilization or coding scrutiny. Kaiser cautioned against treating 90837 as the automatic or routine psychotherapy code when the actual service and documentation do not support it.
This does not mean 90837 cannot be billed. CPT selection should reflect the actual service and time documented in the medical record. Providers should not shorten a clinically appropriate session simply to fit a particular code, nor should 90837 be selected routinely when the documentation does not support the service.
For practices with heavy 90837 utilization, now is a good time to review session duration, medical necessity and documentation consistency.
Also on Our Radar
ASAM 3.7 Detox: Emerging Fentanyl Adulterant Deserves Attention
ASAM recently highlighted growing concern regarding medetomidine, an alpha-2 agonist increasingly identified as an adulterant in parts of the illicit fentanyl supply. Reported withdrawal presentations can include severe hypertension, tachycardia and persistent vomiting, with some patients requiring hospital or ICU-level care.
For medically monitored withdrawal management programs, the revenue-cycle issue follows the clinical issue: documentation should clearly establish vital-sign trends, withdrawal severity, interventions, response to treatment and the medical necessity for transfer when a patient can no longer safely remain at the current level of care.
There is currently no new billing code associated with medetomidine withdrawal.
Read the ASAM Weekly discussion of medetomidine and the changing illicit drug supply
ASAM Utilization Review: Document Why the Patient Still Needs the Level of Care
For residential, detox, IOP and PHP programs, documenting attendance and a diagnosis alone is not enough to tell the medical-necessity story.
ASAM emphasizes multidimensional assessment followed by regular reassessment. Continued-service and transition criteria are intended to determine whether the patient should remain at the current level, step down, or move to a more intensive setting.
ASAM also offers standardized admission and continued-service request forms organized around the dimensions, risk ratings, progress and transition planning.
Explore ASAM Fourth Edition assessment and utilization-review resources
Hawaiʻi SUD Workforce: New ADAD Training Opportunities
The Hawaiʻi Department of Health Alcohol and Drug Abuse Division updated its training calendar on September 10, 2026. The calendar includes upcoming SUD and behavioral health education opportunities and information about obtaining ADAD-approved continuing education.
Residential, detox and outpatient SUD programs should consider incorporating relevant offerings into staff development and competency planning.
| Training | Date | Relevance |
|---|---|---|
| Annual Hawaiʻi Health Workforce Summit | Sept. 12 | Workforce/staffing development |
| Multidisciplinary Approaches to SUD | Sept. 16 | Clinical SUD competency |
| Guam Behavioral Health & Addictions Conference | Sept. 24–25 | SUD/BH education, up to 7 CE hours |
| Trauma-Informed Health Care Practices | Oct. 7 | Residential/detox clinical competency |
| SUD in Older Adults | Nov. 9 | Older-adult SUD treatment |
| Opioids 101 | Nov. 19 | Useful for detox/residential staff |
| Co-occurring Mental Health & SUD | Dec. 2 | Particularly relevant to dual-diagnosis programs |
| Kratom | Dec. 7 | Emerging-substance education |
Access to Recovery
Hawaiʻi’s Access to Recovery (ATR Ohana) program works with community providers that have formalized partnerships with the Hawaiʻi Department of Health, Alcohol and Drug Abuse Division (ADAD), to deliver substance use treatment and recovery support services to individuals and families. Inclusion in ATR resources reflects participation in the program and does not constitute ADAD endorsement.
View the ATR Ohana Quick Reference Guide and the ATR Ohana Provider Directory.
View the Hawaiʻi ADAD Training Calendar
UHC/Optum: Gold Card Does Not Mean “No Authorization”
UnitedHealthcare’s Gold Card program can reduce traditional prior authorization requirements for qualifying provider groups and eligible services. However, advance notification is still required for Gold Card-designated services, and UHC warns that claims for Gold Card-eligible codes may not be paid without that notification.
Providers should therefore check both their individual Gold Card status and the authorization requirement for the specific member and service. UHC’s portal now provides earlier visibility into whether authorization is required.
For residential treatment and detox programs, do not assume that Gold Card status eliminates authorization or concurrent-review requirements.
Check UnitedHealthcare Gold Card requirements
The Bottom Line
This week’s most important change for Hawaiʻi outpatient behavioral health providers is Kaiser’s increasing emphasis on measurable outcomes during continued-stay reviews.
For providers, the message is straightforward: match outcome measures to the diagnosis, measure them consistently, establish measurable treatment goals, document progress or regression, and make sure the clinical record supports both the service being billed and the continued medical necessity for treatment.
For higher levels of SUD care, the same principle applies. Whether requesting another outpatient psychotherapy authorization or continued ASAM 3.5/3.7 treatment, utilization review is increasingly about demonstrating why this patient needs this service, at this intensity, right now.
Access Revenue Hawaii will continue monitoring Hawaiʻi and national payer changes affecting behavioral health, substance use treatment, utilization review and reimbursement.
Not all billers are bad. But some are dangerous. The lazy biller lets credentialing drag on, the ghost biller only responds when you ask, and the checkbox biller thinks submitting claims is the finish line. The result can be untouched A/R, missed appeals, underperforming contracts, and unstable cash flow.
Revenue cycle management is more than claims submission. It requires ownership, follow-up, payer strategy, and relentless attention to detail. At Access Revenue Hawaii, we touch aged claims every 7 days until they are paid and manage the full behavioral health revenue cycle from credentialing and contracting through billing, utilization review, appeals, and collections.
If your A/R feels heavy, it usually is. Visit www.accessrevenuehawaii.com or request your free revenue cycle audit.