MedicaidPrior AuthMedium impact
PT 18-26: Additional Guidance - HealthChoice Long Term Care Coverage
Maryland Medicaid·MD · Geriatrics·Managed Care
Effective date
Sep 15, 2025
We identified it
Jun 18, 2026
Summary
Maryland Medicaid clarifies HealthChoice long-term care coverage requirements, emphasizing that long-term care facilities must verify eligibility through EVS and obtain MCO prior authorization before admission. The policy specifies payment responsibilities for skilled nursing versus administrative days and requires coordination for safe discharge planning.
Action Required
Immediately: Long-term care facilities must verify all Medicaid enrollee eligibility through EVS prior to admission and obtain MCO prior authorization by the next business day if admitted on weekends/holidays. Submit level of care determination requests to Utilization Control Agent on day 75 of enrollee stays. Maintain documentation of discharge coordination with minimum twice-weekly updates. Failure to obtain proper authorization may result in non-reimbursement.