All Insurance Policy Changes (Page 283)

Continuing from page 282. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
Proposed Amendments to Physicians' Services, COMAR 10.09.02
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medicaid is implementing fee increases for approximately 1,400 procedures including general surgery, ENT, E&M and anesthesia services, along with updated CPT codes for 2006. The policy also revises limitations for sterilization reversals, gender changes, and services by non-physician extenders.
Medium impact
Amendment to COMAR 10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Private Duty Nursing
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medicaid increased private duty nursing reimbursement rates from $28.20 to $31.00 per hour effective July 1, 2006, and changed billing from half-hour to 15-minute units ($7.75 for one participant, $5.35 for multiple participants). This policy establishes a methodology for annual rate adjustments based on Consumer Price Index.
Low impact
Amendments to COMAR 10.09.27 Home Care for Disabled Children Under a Model Waiver
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medicaid increased reimbursement rates for certified nursing assistants and home health aides from $11.20 to $13.60 per hour under the Model Waiver Program for disabled children. The policy also updated definitions, provider participation criteria, and established HIPAA-compliant billing units.
Low impact
Changes to Pharmacy Co-payment for Prescriptions
Maryland Medicaid·Effective Aug 1, 2005
Maryland Medicaid is increasing co-payments for brand name drugs not on the preferred drug list from $2.00 to $3.00 per prescription effective August 1, 2005. Generic drugs and preferred brand name drugs remain at $1.00, with exemptions for children under 21, pregnant women, and nursing home residents.
Medium impact
New audit contractor
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medical Assistance Program has switched audit contractors from Clifton Gunderson LLC to Myers and Stauffer LC effective July 1, 2006. All financial and statistical data submissions for nursing facilities, residential treatment centers, and hospitals must now be sent to the new contractor's address starting August 1, 2006.
Medium impact
Medicaid rates for administrative days
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medicaid updated payment rates for administrative days effective July 1, 2006. New rates are $342.00/day for psychiatric patients awaiting residential placement, $627.08/day for ventilator patients no longer requiring hospital care, and $193.21/day for all other qualifying administrative days.
Medium impact
Preauthorization
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medicaid requires preauthorization for home health services when anticipated interim payments exceed $5,796 in any 30-day period, effective July 1, 2006. This updates the previous threshold amount but keeps all other preauthorization procedures unchanged.
Medium impact
Proposed Amendments to COMAR 10.09.04 Home Services
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medicaid is changing home health payment methodology to align rate adjustments with Medicare's schedule (January instead of July), eliminating annual cost reporting requirements, and adding coverage for newborn early discharge assessments with specific limitations and reimbursement rules.
Medium impact
Proposed Amendments to HealthChoice Regulations
Maryland Medicaid·Effective Jul 1, 2006
Maryland Medical Assistance Program (Medicaid) is implementing new capitation rates for Managed Care Organizations effective July 1, 2006. The rate increase totals $10.7 million for the first six months due to hospital trend changes and physician fee increases.
Medium impact
Proposed Amendments to HealthChoice Regulations
Maryland Medicaid·Identified Jun 20, 2026
Maryland's HealthChoice Medicaid managed care program is removing the term 'medically appropriate' from all regulations, extending MCO change periods to 90 days for new enrollees, requiring MCO responses to preauthorization requests within 2 days of receiving clinical information (maximum 7 calendar days), and adding Comprehensive Substance Abuse Assessment as a self-referral service.
High impact
New Policy for Reimbursement of Medicaid Waiver for Older Adults Assisted Living Services
Maryland Medicaid·Effective Sep 1, 2006
Maryland Medicaid implemented a new policy requiring assisted living facilities to reduce their waiver reimbursement rates by 25% on days when participants also receive medical day care services. Providers must now manually calculate monthly bills using specific daily rates and submit a billing worksheet with claims.
Medium impact
Distribution of provider service forms for the Waiver for Older Adults and the Living at Home Waiver Program
Maryland Medicaid·Effective Nov 1, 2006
Maryland's Waiver for Older Adults and Living at Home Waiver programs now require standardized provider service forms to be attached to all timesheets for payment. New forms include participant assessments, caregiver service plans, caregiver assessments, and nurse monitor timesheets with specific distribution requirements.
Medium impact
Authorization of Medical Day Care Services by Medicaid Waiver for Older Adults Case Managers
Maryland Medicaid·Effective Nov 1, 2006
Maryland Medicaid Waiver for Older Adults now requires case managers to preauthorize Medical Day Care services frequency for waiver participants, effective November 1, 2006. Physicians still must order MDC services but no longer need to specify frequency - case managers determine and authorize the number of days per week.
Medium impact
Acceptability of oral Prescriptions Under Medicaid Expansion of the Medicaid List of Maintenance Medications Elimination of the List of Non-substitutable Drugs in Maryland
Maryland Medicaid·Effective Nov 23, 2006
Maryland Medicaid now accepts oral prescriptions from providers over the phone, expands maintenance medications to allow up to 100-day supplies, and reinstates generic substitution for six previously non-substitutable drugs including carbamazepine, phenytoin, and warfarin.
Medium impact
Fee-for-Service Hospital Day Limits
Maryland Medicaid·Effective Jan 1, 2007
Maryland Medicaid updated hospital day limits for fee-for-service admissions effective January 1, 2007, using DRG Grouper Version 24. Day limits are based on 120% of average length of stay by diagnosis-related groups, with some DRGs receiving higher limits than previously allowed.
High impact
New Utilization Control Agent
Maryland Medicaid·Effective Feb 1, 2007
Effective February 1, 2007, KePRO replaced Delmarva Foundation as the utilization control agent for Maryland Medicaid, requiring all utilization review documentation to be submitted to KePRO's new address and contact numbers. This affects prior authorization requests, medical eligibility reviews, and administrative processes for hospitals and long-term care facilities.
Medium impact
Employee Education Requirement
Maryland Medicaid·Effective Jan 1, 2007
Maryland healthcare providers receiving $5+ million annually in Medicaid payments must establish written policies educating employees about the False Claims Act and fraud prevention procedures. This is a compliance requirement under the Deficit Reduction Act of 2005.
Medium impact
Proposed Amendments to HealthChoice Regulations
Maryland Medicaid·Identified Jun 20, 2026
Maryland Medicaid managed care (HealthChoice) is implementing several regulatory amendments including adding new recipient eligibility exclusions, requiring MCO participation in monthly enrollment reconciliation, allocating quality performance incentives, and adding emergency services to self-referred services list.
Medium impact
Proposed Amendments to COMAR 10.09.04 Home Health Services
Maryland Medicaid·Effective Mar 12, 2007
Maryland Medicaid updated home health services regulations under COMAR 10.09.04, adding coverage for newborn early discharge assessments and clarifying existing definitions. The changes eliminate annual cost report requirements and specify new reimbursement methodologies for home health agencies.
Medium impact
Amendments to HealthChoice Regulations
Maryland Medicaid·Effective Apr 9, 2007
Maryland's HealthChoice Medicaid managed care program updated eligibility rules, payment structures, and service requirements. Key changes include excluding two new disability programs from managed care, requiring monthly enrollment reconciliation, and adding emergency services to self-referral options.
Medium impact
Amendments to HealthChoice Regulations
Maryland Medicaid·Effective Apr 9, 2007
Maryland Medical Assistance Program adopted amendments to HealthChoice Regulations under COMAR 10.09.65, implementing January 2007 MCO capitation rates. This affects managed care organization operations and reimbursement structures for Maryland Medicaid providers.
Medium impact
Waiver for Adults with Traumatic Brain Injury- Amended Regulations COMAR 10.09.46
Maryland Medicaid·Effective Apr 9, 2007
Maryland Medical Assistance Program has amended regulations for the Traumatic Brain Injury waiver program, adding a new Individual Support Services benefit and expanding eligibility to include patients from CARF-accredited special hospitals. This affects Medicaid billing for TBI services in Maryland.
High impact
New billing procedure for reimbursement of Medicaid Waiver for Older Adults assisted living services
Maryland Medicaid·Effective Jun 1, 2007
Maryland Medicaid Waiver for Older Adults is implementing new billing procedure codes and automated payment calculations for assisted living facilities starting July 1, 2007. Providers must use new procedure codes (W0226, W0227, W0228, W0229) for services on or after June 1, 2007, and bill daily instead of monthly.
Low impact
Waiver for Older Adults- Amended Regulations COMAR 10.09.54
Maryland Medicaid·Effective Apr 9, 2007
Maryland Medical Assistance Program (Medicaid) updated regulations for the Waiver for Older Adults program, effective April 9, 2007. Key changes include new definitions, clarified unit of service requirements (1 hour for behavioral consultation, personal care, respite care, dietitian/nutritionist services, and family/consumer training), modified participant eligibility requiring use of one waiver service within 12 months, and updated provider participation requirements including criminal background checks.
Low impact
Periodic Oral Evaluation- Dental Services for Children under age 21 in accordance with COMAR 10.09.05- Dental regulations and COMAR 10.09.23.06.D- Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Regulations
Maryland Medicaid·Effective May 25, 2007
Maryland Medicaid clarifies dental coverage for children under 21, confirming periodic oral evaluations are covered every 6 months without prior authorization. This is informational guidance for existing benefits rather than a new policy change.

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Proposed Amendments to Physicians' Services, COMAR 10.09.02

Amendment to COMAR 10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Private Duty Nursing

Amendments to COMAR 10.09.27 Home Care for Disabled Children Under a Model Waiver

Changes to Pharmacy Co-payment for Prescriptions

New audit contractor

Medicaid rates for administrative days

Preauthorization

Proposed Amendments to COMAR 10.09.04 Home Services

Proposed Amendments to HealthChoice Regulations

Proposed Amendments to HealthChoice Regulations

New Policy for Reimbursement of Medicaid Waiver for Older Adults Assisted Living Services

Distribution of provider service forms for the Waiver for Older Adults and the Living at Home Waiver Program

Authorization of Medical Day Care Services by Medicaid Waiver for Older Adults Case Managers

Acceptability of oral Prescriptions Under Medicaid Expansion of the Medicaid List of Maintenance Medications Elimination of the List of Non-substitutable Drugs in Maryland

Fee-for-Service Hospital Day Limits

New Utilization Control Agent

Employee Education Requirement

Proposed Amendments to HealthChoice Regulations

Proposed Amendments to COMAR 10.09.04 Home Health Services

Amendments to HealthChoice Regulations

Amendments to HealthChoice Regulations

Waiver for Adults with Traumatic Brain Injury- Amended Regulations COMAR 10.09.46

New billing procedure for reimbursement of Medicaid Waiver for Older Adults assisted living services

Waiver for Older Adults- Amended Regulations COMAR 10.09.54

Periodic Oral Evaluation- Dental Services for Children under age 21 in accordance with COMAR 10.09.05- Dental regulations and COMAR 10.09.23.06.D- Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Regulations