ASAM 4th edition v. State Statutes/Manuals

This article explains how U.S. states are adopting different versions of the ASAM Criteria (3rd vs. 4th edition). It highlights key trends and what providers should expect when documenting care, assigning levels of care (LOC), and meeting compliance requirements.

Note: Most states still operate under the ASAM 3rd Edition. Transition timelines for the 4th Edition vary by state and payer.

National Context: Transition from 3rd to 4th Edition

States follow different approaches when adopting ASAM Criteria. While the 4th Edition is now available, many systems still rely on the 3rd Edition.

• 3rd Edition (2013): Remains the most widely used standard.
• 4th Edition: is now published and ASAM is releasing Level of Care Assessment Guides to support implementation.
• Federal Requirement: Federal SUD 1115 guidance requires states to use ASAM Criteria (or similar nationally recognized guidelines) but does NOT require a specific edition.

For EMR purposes, the key is whether a state:

1. Hard-codes "Third edition, 2013" into law/regulation/manuals;
2. References "most recent / most current version of ASAM Criteria";
3. Is explicitly moving 4th edition on a defined date; or
4. Uses ASAM generically or state-developed LOC tools (edition not specified).

States Explicitly Moving to ASAM 4th Edition

These jurisdictions have formal state-level commitments or Medicaid policy with effective dates for ASAM 4th edition.

• Illinois: Transitioned on July 1, 2025 for state-licensed providers
  • On July 1, 2025, IDHS/SUPR will adopt The ASAM Criteria, 4th Edition
  • Substance use disorder treatment rules define ASAM Criteria by explicitly referencing the third edition (2013) in 77 III. Admin. Code 2060.120.
  • Shift to 4th: Illinois' SUD 1115 monitoring report states that Division of Substance Use Prevention and Recovery (SUPR) is implementing ASAM 4th edition statewide for all SUPR-licensed providers effective July 1, 2025
  • EMR Implications (IL)
    • Configure state-level 4th-edition assessment/LOC rules for all SUPR-licensed SUD services effective 7/1/2025, with a legacy 3rd-edition mode for historical episodes and payors that lag.
    • Expect a period where statute still names the 3rd edition while SUPR operationally enforces the 4th; rules engine should allow per-payor/per-contact overrides.
       
• Louisiana: Effective January 1, 2026 (full compliance required by July 1, 2026)
  • Louisiana Medicaid and major plans (e.g., Louisiana Health Connect, Humana, UHC) have issued bulletins stating that ASAM 4th edition service and rate revisions take effect January 1, 2026 for Medicaid beneficiaries 18+.
  • New
    • A Louisiana Medicaid plan posting (dated 02/19/2026) states providers are required to be in full compliance by July 1, 2026, while also reaffirming that the updated fee schedule/rate changes went into effect January 1, 2026.
    • EMR implication: treat LA as 4E-live for adult SUD services as of 01/01/2026, with a hard compliance milestone of 07/01/2026 for workflow enforcement, templates, and UM alignment.
    • EMR Implication (LA)
      • Implement 4th-edition criteria and LOS expectations for adult SUD services as of 1/1/2026; maintain 3rd-edition logic for adolescents and for any plan that still specifies the 3rd edition (many commercial plans continue to reference 3rd).
         
• Washington: effective 1/2028
  • WA law previously set ASAM Criteria as the single standard for SUD medical necessity and levels of care, defined as “the most recent version of the ASAM Criteria,” with state agencies to set the effective date for updated versions.

  • SB 5361 (2025 session) explicitly delays the use of ASAM 4th edition, pushing the adoption timeline out (the bill title: “Delaying the use of the ASAM 4 criteria…”).

  • EMR Implication (WA)
    • Continue to treat 3rd edition as the operative standard until the Health Care Authority/Insurance Commissioner publish a formal Implementation date for 4th edition under the "most recent version' language.
    • Rules engine should support a future-dated switch at the statewide date the agencies ultimately publish.
       
• Oregon: effective on July 1, 2027
  • Oregon Health Authority indicates it plans to transition to “The ASAM Criteria, 4th Edition” rules effective July 1, 2027, while using 3rd Edition rules for compliance reviews/investigations in the interim.

States that Hard-Code the ASAM 3rd Edition

These states explicitly incorporate the 3rd edition by name/year into statute, regulation, or Medicaid policy. Moving to the 4th edition will require amending those authorities (or issuing superseding guidance).

Examples (not exhaustive):

• Arizona - AHCCCS contracts and amendments require contractors to “utilize the American Society of Addiction Medicine (ASAM) Criteria (Third edition, 2013)” for SUD assessment, service planning, and LOC placement.
• Illinois - State SUD treatment rules define ASAM Criteria by reference to the Third edition, 2013 (see above), even as SUPR moves to 4th edition by policy.
• Minnesota - DHS 245G Comprehensive Assessment Reference Guide explicitly “utilizes the ASAM Criteria, Third edition.”
• New Jersey - N.J.A.C. 10:162-1.2 and related chapters define “ASAM Criteria” as “The ASAM Criteria… Third edition, 2013,” incorporating it by reference.
• North Carolina - State-funded SUD service definitions and withdrawal management documents define ASAM levels “as defined in The ASAM Criteria, Third edition, 2013.”
• Ohio - OAC 5122-29-09 (Residential and Withdrawal Management SUD Services) requires services be provided as published in “the ASAM Criteria, Third edition, 2013”; other rules and nursing/PA standards also reference “The ASAM Criteria, Third edition”.
• Oregon - OAR 309-019-0105 and 309-019-0184 define ASAM Level of Care “as described within The ASAM Criteria, Third edition.”
• Pennsylvania - DDAP ASAM resources and SUD 1115 documentation describe adoption of “The ASAM Criteria, Third edition (2013)” as the clinical standard.
• Virginia - The ARTS provider manual requires that LOC intensity “shall be based on the most current version of the ASAM Criteria Third edition, 2013,” effectively binding to 3rd edition even while allowing updated printings.

EMR Implications (hard-coded 3rd)

• Legal edition = 3rd until the state amends its regulations or issues a formal notice changing the incorporated edition.

• EMR should:

  • Maintain 3rd-edition LOC labels, decision rules, and documentation expectations as the default "regulatory" mode for these states.

  • Allow payor-specific overrides if a commercial plan or county authority adopts the 4th edition before the statute changes.

  • Track a “requires statutory/manual update to move to 4E” flag in your regulatory database.

States that adopt "Most Recent/Current Version" of ASAM Criteria

These states incorporate ASAM Criteria by dynamic reference, often saying “most recent version” or “most current version.” When the state decides to use the 4th edition, the legal language already supports it; agencies still typically set an effective date.

Examples include:

• Alaska - Behavioral Health Provider Service Standards state that treatment hours and some service parameters are determined by “the most current version of the ASAM Criteria adopted by reference in 7 AAC 70.910.”
• Kentucky - Several KAR provisions specify services are delivered in accordance with “the most recent” or “most current version of The ASAM Criteria” (e.g., 908 KAR 1:374, 907 KAR 1:082, 907 KAR 15:070), and Medicaid/DBHDID materials sit on top of ASAM Level of Care Certification.
• Washington - SB 6228 sets ASAM Criteria as the single standard, defined as “the most recent version…,” with joint HCA/OIC decisions on when an updated version must be used. SB 5361 then delays use of ASAM 4 specifically.
• California (insurance) - DMHC parity/benefit regulations and the Kennedy Forum “Generally Accepted Standards of Care” document reference ASAM inpatient and residential levels “as described in the most recent version of The ASAM Criteria,” with cross-references to 3rd edition language.

EMR Implications

• Treat these as policy-driven effective dates, not edition-locked law.
• Until you see a state, BHIN, or Medicaid notice explicitly adopting ASAM 4th, operate with 3rd-edition rules but build easy toggles to shift to 4th at the published date.
• Flag these states as low friction for 4th edition adoption;

States with State-Developed LOC Certification Frameworks

These states layer state-specific level-of-care designation or certification on top of (or alongside) ASAM.

California:

• DHCS has a Level of Care (LOC) Designation program for AOD/SUD facilities and an option to obtain ASAM LOC Certification (via ASAM/CARF). All licensed AOD facilities must obtain at least one DHCS LOC Designation and/or residential ASAM LOC Certification consistent with their program services.
• Health & Safety Code §11834.015 adopts the ASAM treatment criteria as minimum standard of care for licensed AOD facilities.
• State Medicaid (DMC-ODS) guidance requires use of an ASAM Criteria assessment for members starting in 2025 but does NOT name the edition.

EMR Implications (CA)

• At the facility level, you must track whether a program holds DHCS LOC, ASAM LOC Certification, or both.
• At the criteria level, treat CA as ASAM-based but edition-neutral, with an expectation that 3rd edition remains operative until DHCS/DMHC issue explicit 4E adoption.

Kentucky (KLOCS): 

• State licensing/Medicaid leverage ASAM Level of Care Certification plus “most recent version” ASAM wording, and DBHDID has educational materials on the Criteria and 4th edition training.
• Facilities must obtain at least one LOC Designation and/or ASAM LOC Certification to ensure they meet the necessary standards for AOD treatment. 

Minnesota DHS-7325

• Statutory chapter 245G and DHS guidance require programs to certify their ASAM level(s) of care via DHS checklists and licensing, which today are grounded in the 3rd edition.

EMR Implications (MN)

• You need two mapping layers:

  • State LOC designation / certification (e.g., DHCS Level 3.5 vs ASAM 3.5 Certification);

  • Underlying ASAM edition and LOC definitions used for clinical/UM rules.

New York:

• NYS OASAS, working in collaboration with the NYS Department of Health, is using the Health Commerce System (HCS) to access and support LOCADTR tools. The HCS houses hundreds of web-based applications for the State of New York. It is highly secure and well-supported.

• New York’s OASAS relies heavily on LOCADTR (a state tool aligned conceptually with ASAM) rather than naming a specific ASAM edition in rule.

EMR implications (NY)

EMR/Rules Engine should address the following:

1. Integration or Interface

   • Provide a link or embedded access point within the EMR for providers to launch LOCADTR via HCS.

   • Capture and store the LOCADTR output (initial LOC determination, date/time, module used) in your system.

   • Ensure authentication tracking (clinic affiliation, user ID) is captured or referenced if needed for audit.

2. Data-Mapping and Rule Logic

   • Since LOCADTR is versioned (currently 3.0), the EMR must be designed to handle version changes (e.g., 3.1, 4.0) and apply the correct logic based on date of service.

   • Map LOCADTR output (e.g., “Level of Care = 3.7 Residential”, “Concurrent Review = maintain current LOC”) into your internal clinical decision support logic.

   • Configure EMR workflows so that the LOCADTR result triggers correct care pathways, authorizations, length-of-stay rules, and document templates.

   • You may need to support CLIA-style audit logs of when the LOCADTR was run, by whom, and what decision was generated.

3. Documentation and Audit Trail

   • Store the module used (initial vs concurrent vs gambling) alongside the result.

   • Archive the manual summary/print-out from LOCADTR into the patient’s chart (PDF or scanned image) or link to the state tool output.

   • Maintain versioning of the LOCADTR tool (e.g., 3.0) so you can reference which version of the decision tool was used for each client.

   • Maintain time stamp and user credentials for compliance, especially as audits will check for proper use of state tools.

4. Workflow Impact for Staff

   • Prior to admission or service change, trigger LOCADTR run as a required step in the intake workflow.

   • For concurrent reviews (ongoing care), embed a workflow reminder or flag to run the LOCADTR concurrent module when required (e.g., when treatment plan changes, LOS thresholds met, or per payer/contract intervals).

   • For gambling-disorder services, provide a pathway for the LOCADTR Gambling module so staff know to launch that version.

States Referencing ASAM Criteria Without a Specific edition

A majority of states reference “ASAM Criteria” or “ASAM placement criteria” in the following bodies of work, but do not hard code “Third edition, 2013” or “Fourth edition, 2024.”:

• SUD 1115 demonstration STCs

• State Medicaid manuals

• Plan contracts or policy manuals

Examples:

• Florida – IMD/SUD 1115 documentation requires that care “align with the American Society of Addiction Medicine (ASAM) criteria or similar nationally recognized guidelines,” without edition.

• Indiana – SUD waiver/Medicaid documents require managed care entities to incorporate ASAM Criteria into medical management criteria but allow other nationally recognized guidelines; edition not specified.

• Georgia – DBHDD and the accountability courts promote use of ASAM placement criteria; training materials are 3rd-edition based, but state rules generally reference ASAM generically.

• Many other states (e.g., TX, NY, MI, WI, etc.) reference ASAM Criteria in waivers, contracts, or payor policies but not by edition;

EMR implications (generic ASAM reference)

• Operationally, 3rd edition remains the de-facto standard in these states until:

  • The state explicitly adopts 4th edition in Medicaid manuals/waivers, or

  • Dominant payors (BCBS, UHC, etc.) switch UM criteria to 4th edition and require alignment.

• Your rules engine should:

  • Default to 3rd-edition LOCs and decision rules.

  • Be able to flip to 4th per payor or per contract as those entities migrate.

ASAM Edition Posture - EMR Configuration Grid

Current as of 2/23/2026

State	Status (Regulatory Posture re: ASAM Edition)	EMR-Ready Implementation Fields
AL	GENERIC	effective_date: Not established (3E operative) compliance_deadline: Not established
AK	MOST-RECENT	effective_date: Agency-determined (no 4E date published) compliance_deadline: Not established
AZ	3E-LOCK	effective_date: 3E operative (no 4E adoption) compliance_deadline: Statutory amendment required
AR	GENERIC	effective_date: Not established (3E operative) compliance_deadline: Not established
CA	STATE-LOC + MOST-RECENT	effective_date: Not established (3E operative pending DHCS notice) compliance_deadline: Not established
CO	4E-DATE	effective_date: 07/01/2027 compliance_deadline: 07/01/2027 (state transition date)
CT	GENERIC	effective_date: Not established (3E operative) compliance_deadline: Not established
DE	GENERIC	effective_date: Not established compliance_deadline: Not established
DC	GENERIC	effective_date: Not established compliance_deadline: Not established
FL	GENERIC	effective_date: Not established compliance_deadline: Not established
GA	GENERIC	effective_date: Not established compliance_deadline: Not established
HI	GENERIC	effective_date: Not established compliance_deadline: Not established
ID	GENERIC	effective_date: Not established compliance_deadline: Not established
IL	3E-LOCK+4E-DATE	effective_date: 07/01/2025 (SUPR) compliance_deadline: 07/01/2025 (operational enforcement)
IN	GENERIC	effective_date: Not established compliance_deadline: Not established
IA	GENERIC	effective_date: Not established compliance_deadline: Not established
KS	GENERIC	effective_date: Not established compliance_deadline: Not established
KY	MOST-RECENT + STATE-LOC	effective_date: Agency-determined (no 4E date published) compliance_deadline: Not established
LA	4E-DATE (Adults)	effective_date: 01/01/2026 (Adults 18+) compliance_deadline: 07/01/2026 (Full compliance required)
ME	GENERIC	effective_date: Not established compliance_deadline: Not established
MD	GENERIC	effective_date: Not established compliance_deadline: Not established
MA	GENERIC	effective_date: Not established compliance_deadline: Not established
MI	GENERIC	effective_date: Not established compliance_deadline: Not established
MN	3E-LOCK + STATE-LOC	effective_date: 3E operative compliance_deadline: Statutory/manual amendment required
MS	GENERIC	effective_date: Not established compliance_deadline: Not established
MO	GENERIC	effective_date: Not established compliance_deadline: Not established
MT	GENERIC	effective_date: Not established compliance_deadline: Not established
NE	GENERIC	effective_date: Not established compliance_deadline: Not established
NV	GENERIC	effective_date: Not established compliance_deadline: Not established
NH	GENERIC	effective_date: Not established compliance_deadline: Not established
NJ	3E-LOCK	effective_date: 3E operative compliance_deadline: Regulatory amendment required
NM	GENERIC	effective_date: Not established compliance_deadline: Not established
NY	GENERIC / STATE TOOL	effective_date: LOCADTR version-controlled (no 4E mandate) compliance_deadline: Not established
NC	3E-LOCK	effective_date: 3E operative compliance_deadline: State manual amendment required
ND	GENERIC	effective_date: Not established compliance_deadline: Not established
OH	3E-LOCK	effective_date: 3E operative compliance_deadline: Rule amendment required
OK	GENERIC	effective_date: Not established compliance_deadline: Not established
OR	3E-LOCK + 4E-DATE	effective_date: 07/01/2027 (OHA transition) compliance_deadline: 07/01/2027
PA	3E-LOCK	effective_date: 3E operative compliance_deadline: Regulatory amendment required
RI	GENERIC	effective_date: Not established compliance_deadline: Not established
SC	GENERIC	effective_date: Not established compliance_deadline: Not established
SD	GENERIC	effective_date: Not established compliance_deadline: Not established
TN	GENERIC	effective_date: Not established compliance_deadline: Not established
TX	GENERIC	effective_date: Not established compliance_deadline: Not established
UT	GENERIC	effective_date: Not established compliance_deadline: Not established
VT	GENERIC	effective_date: Not established compliance_deadline: Not established
VA	3E-LOCK / MOST-RECENT HYBRID	effective_date: 3E operative compliance_deadline: Manual update required
WA	MOST-RECENT + 4E-DELAY	effective_date: 01/01/2028 (Delayed adoption) compliance_deadline: 01/01/2028
WV	GENERIC	effective_date: Not established compliance_deadline: Not established
WI	GENERIC	effective_date: Not established compliance_deadline: Not established
WY	GENERIC	effective_date: Not established compliance_deadline: Not established