All Insurance Policy Changes (Page 1360)

Continuing from page 1359. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Update to “Texas Health Steps Therapeutic Dental Services” in 2026 HCPCS Special Bulletin
Texas Medicaid·Identified Mar 7, 2026
Texas Medicaid has added a new coding restriction for dental services: procedure code D9239 will be denied when billed on the same day as the new procedure code D9224. This creates a same-day billing limitation that will result in automatic claim denials.
High impact
OASIS and iQIES Changes Effective April 1, 2026
Texas Medicaid·Effective Apr 1, 2026
CMS is discontinuing the legacy iQIES front-end user interface for manual assessment data entry and implementing OASIS-E2 updates effective April 1, 2026. Home Health agencies will no longer be able to manually input assessment data and must upload data in the correct format instead.
Low impact
Now Effective: Enhancements to LTCOP HCS and TxHmL IPC Revision Submissions
Texas Medicaid·Effective Feb 20, 2026
Texas Medicaid enhanced the Long-Term Care Online Portal (LTCOP) to streamline Revision Individual Plan of Care submissions for HCS and TxHmL programs by combining forms and adding automatic address population. The changes reduce administrative workload and prevent out-of-sequence submissions.
Medium impact
Texas Medicaid Prior Authorization Update for Onasemnogene Abeparvovec-xioi (Zolgensma) Effective April 1, 2026
Texas Medicaid·Effective Apr 1, 2026
Starting April 1, 2026, Texas Medicaid will require baseline platelet counts in prior authorization requests for Zolgensma (J3399) and mandate specific monitoring schedules. Providers must document weekly platelet counts for the first month, then every other week for months 2-3, with all results subject to retrospective review.
Low impact
EVV System Daylight Saving Time Change
Texas Medicaid·Effective Mar 8, 2026
On March 8, EVV systems (HHAeXchange and proprietary systems) will automatically adjust for Daylight Saving Time, reducing billable hours by one hour for visits recorded during the time change. Manual visits should record actual service start and end times, with the EVV system automatically handling the time adjustment.
Low impact
Updated User Guides and Videos for HCS and TxHmL Waiver Programs Now Available
Texas Medicaid·Identified Mar 6, 2026
TMHP has updated training materials and user guides for Texas Medicaid HCS and TxHmL waiver programs, including new YouTube videos and provider guides for the Long-Term Care Online Portal (LTCOP). The updates reflect improvements to form submission processes for intellectual and developmental disability services.
Low impact
OASIS for Clinicians Trainings Set for March
Texas Medicaid·Effective Apr 1, 2026
Training webinars are being offered in March 2026 for nurses and therapists to learn about OASIS-E2 data set changes effective April 1, 2026. This training covers outcome assessment information used in home health and skilled nursing settings.
Medium impact
Update: SFY 2024 PPR and PPC Hospital Adjustments Resumed
Texas Medicaid·Effective Mar 1, 2026
Texas HHSC will resume PPR and PPC reimbursement adjustments for hospital fee-for-service claims effective March 1, 2026, through August 31, 2026, after temporarily pausing them due to data quality concerns. The SFY 2024 hospital performance reports are now confirmed reliable and available for download.
Medium impact
2026-03-05 - DMEPOS: Temporary Enrollment Moratorium on Medical Supply Companies
Medicare/CMS·Effective Feb 25, 2026
CMS implemented a temporary 6-month nationwide moratorium on new DMEPOS medical supply company enrollments effective February 25, 2026. The moratorium prevents new medical supply companies from enrolling as Medicare providers and may be extended in 6-month increments.
High impact
Medical and Clinical Policy Updates - Effective June 1, 2026
Sentara Health Plans·Effective Jun 1, 2026
Sentara Health Plans has updated 27 medical policies effective June 1, 2026, including revisions to varicose vein treatment, spinal pain management procedures, electrical stimulation, non-oncology embolization, benign prostatic hyperplasia treatment, and ophthalmic procedures. Additionally, 7 policies have been archived and removed from coverage, including endometrial ablation, left atrial appendage occlusion, and vestibular testing. Billing teams must immediately review affected policies to determine which require prior authorization updates and which procedures are no longer covered.
Medium impact
System Maintenance Outages Scheduled in April, May, and June of 2026
Texas Medicaid·Effective Apr 17, 2026
TMHP has scheduled system maintenance outages on three weekends in 2026 (April 17-19, May 1-3, June 5-7) from Friday 7 PM to Sunday 11:59 PM Central time. All web-based applications and functions will be unavailable during these periods.
High impact
Multiple Cost Reports Now Open in the State of Texas Electronic Provider System (STEPS)
Texas Medicaid·Effective Mar 2, 2026
Texas has transitioned to a new web-based system called STEPS for collecting Medicaid and non-Medicaid cost reports, with multiple cost reports now open as of March 2, 2026. Providers must register in STEPS and ensure their Primary Entity Contact email in PEMS matches their STEPS registration email for enrollments to populate properly.
Medium impact
STAIRS to STEPS Transition for Cost Reports and GA-46 Reporting
Texas Medicaid·Effective Feb 2, 2026
Texas is transitioning from STAIRS to a new STEPS system for cost reports and GA-46 reporting, with phased rollout beginning February 2, 2026. Providers must verify and update their email addresses in PEMS to ensure proper access to the new system.
Medium impact
SFY 2027 CHIRP, DPP BHS, RAPPS, TIPPS, and QIPP Enrollment Deadline; Support for STEPS Users With an Active Help Ticket
Texas Medicaid·Effective Mar 5, 2026
Texas Health and Human Services Commission has set enrollment deadlines for five directed payment programs for State Fiscal Year 2027. Most programs (CHIRP, DPP BHS, RAPPS, TIPPS) must enroll by March 5, 2026 at 5:00 PM CST, while QIPP enrollment closes March 18, 2026 at 5:00 PM CST.
Medium impact
HHSC Publishes Fiscal Year 2025 Cost Reports Primary Entity Contacts List
Texas Medicaid·Effective Mar 2, 2026
Texas HHSC is transitioning to a new web-based system called STEPS for collecting Medicaid cost reports, with fiscal year 2025 cost reports due starting March 2, 2026. Primary Entity Contacts must register in STEPS and ensure their email addresses match between the PEMS system and STEPS, or cost reports will not populate properly.
Low impact
Calling All Nursing Facility Administrators and Directors of Nursing
Texas Medicaid·Identified Mar 3, 2026
The Texas Center for Nursing Workforce Studies is conducting a 2026 survey to assess nurse staffing issues in nursing facilities throughout Texas. This is a research study requesting participation from nursing facility administrators and directors, not a policy change affecting medical billing or reimbursement.
Low impact
March 11 Quarterly Nursing Facility Webinar with HHSC LTCR
Texas Medicaid·Effective Mar 11, 2026
HHSC Long-Term Care Regulation is hosting a mandatory nursing facility provider webinar on March 11 from 2:30-4 p.m. Central time. The webinar will cover regulatory updates, COVID protocols, trust fund monitoring, and PASRR requirements that nursing facility providers must stay current with.
Low impact
CDPHP Foundation Announces 2026 Grant Recipients
CDPHP·Identified Mar 3, 2026
This is a philanthropic announcement from the CDPHP Foundation regarding 2026 grant awards to three community organizations. This is NOT a policy change affecting billing, coverage, coding, or reimbursement for healthcare providers. No billing team action is required.
Medium impact
Other Medical Service PA Process Type Now Available for Carved-Out Drugs and Services
Arkansas Medicaid·Effective Mar 2, 2026
Arkansas is now offering an alternative prior authorization process type for carved-out drugs and services under the 'Other Medical Service' PA category. This expands PA submission options and may simplify authorization workflows for certain services. Billing teams need to understand when to use this new process versus existing PA methods.
Medium impact
North Carolina Medicaid: Updated coverage for GLP-1 medications
UnitedHealthcare·Effective Dec 12, 2025
North Carolina Medicaid is reinstating coverage for GLP-1 medications (Wegovy, Zepbound, Saxenda) for weight management effective December 12, 2025. Wegovy is preferred, while Zepbound and Saxenda require prior authorization with step therapy or documented contraindication to Wegovy.
Medium impact
North Carolina Medicaid: Submitting hospice claims for members in SNFs
UnitedHealthcare·Effective Feb 10, 2026
North Carolina Medicaid has clarified billing procedures for hospice claims when members are in skilled nursing facilities. Only hospice providers should bill for room and board services using specific revenue codes, then reimburse the SNF directly to avoid duplicate claim denials.
Medium impact
North Carolina Medicaid: Billing guidance for cell and gene therapy treatments
UnitedHealthcare·Effective Feb 11, 2026
North Carolina Medicaid now allows providers to participate in the Cell and Gene Therapy (CGT) Access Model, providing eligible Medicaid enrollees access to cell and gene therapy treatments at reduced costs. Prior authorization is required for all CGT treatments through UnitedHealthcare Community Plan, with specific billing procedures for different drug therapies.
High impact
New Mexico Medicaid: Taxonomy and ZIP codes required on claims
UnitedHealthcare·Effective Mar 1, 2026
Beginning in March 2026, New Mexico Medicaid (Turquoise Care) will reject claims without taxonomy codes and deny claims with incorrect taxonomy or ZIP codes. All claims must include the correct taxonomy code matching the provider's HCA registration and the ZIP code where services were provided.
High impact
New Mexico Medicaid: State changes to the claims process
UnitedHealthcare·Identified Mar 1, 2026
New Mexico Medicaid is launching a new claims management system called Turquoise Claims, requiring providers to switch from payer ID 87726 to payer ID 87748 for UnitedHealthcare Community Plan of New Mexico on the launch date. Claims submitted with the incorrect payer ID will be denied and require resubmission.
High impact
Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
UnitedHealthcare·Effective Jan 1, 2026
Effective January 1, 2026, Massachusetts SCO and One Care members who lose MassHealth Medicaid eligibility will have only Medicare benefits covered during a 60-day deeming period. Providers must verify eligibility through the UnitedHealthcare portal and will not be reimbursed for Medicaid-only services during this period.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Update to “Texas Health Steps Therapeutic Dental Services” in 2026 HCPCS Special Bulletin

OASIS and iQIES Changes Effective April 1, 2026

Now Effective: Enhancements to LTCOP HCS and TxHmL IPC Revision Submissions

Texas Medicaid Prior Authorization Update for Onasemnogene Abeparvovec-xioi (Zolgensma) Effective April 1, 2026

EVV System Daylight Saving Time Change

Updated User Guides and Videos for HCS and TxHmL Waiver Programs Now Available

OASIS for Clinicians Trainings Set for March

Update: SFY 2024 PPR and PPC Hospital Adjustments Resumed

2026-03-05 - DMEPOS: Temporary Enrollment Moratorium on Medical Supply Companies

Medical and Clinical Policy Updates - Effective June 1, 2026

System Maintenance Outages Scheduled in April, May, and June of 2026

Multiple Cost Reports Now Open in the State of Texas Electronic Provider System (STEPS)

STAIRS to STEPS Transition for Cost Reports and GA-46 Reporting

SFY 2027 CHIRP, DPP BHS, RAPPS, TIPPS, and QIPP Enrollment Deadline; Support for STEPS Users With an Active Help Ticket

HHSC Publishes Fiscal Year 2025 Cost Reports Primary Entity Contacts List

Calling All Nursing Facility Administrators and Directors of Nursing

March 11 Quarterly Nursing Facility Webinar with HHSC LTCR

CDPHP Foundation Announces 2026 Grant Recipients

Other Medical Service PA Process Type Now Available for Carved-Out Drugs and Services

North Carolina Medicaid: Updated coverage for GLP-1 medications

North Carolina Medicaid: Submitting hospice claims for members in SNFs

North Carolina Medicaid: Billing guidance for cell and gene therapy treatments

New Mexico Medicaid: Taxonomy and ZIP codes required on claims

New Mexico Medicaid: State changes to the claims process

Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees