All Insurance Policy Changes (Page 744)

Continuing from page 743. 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
2025.82 - Updating Physician Administered Drugs on Select Fee Schedules
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Connecticut Medicaid will update reimbursement rates for physician-administered drugs, immune globulins, vaccines, and toxoids to 100% of the January 2026 Medicare Average Sales Price (ASP) Drug Pricing file. This affects behavioral health, dialysis, family planning, medical clinics, and substance use disorder treatment facilities.
Medium impact
5160-44-27 - Nursing facility-based level of care home and community-based services programs: home care attendant services. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Department of Medicaid has finalized amendments to Rule 5160-44-27 governing home care attendant services for nursing facility-based level of care home and community-based services programs. The policy change became effective January 1, 2024, updating requirements for Medicaid home care services.
Medium impact
2025.83 - January 2026 Quarterly HIPAA Compliant Update - Dental Fee Schedules for Adults & Children
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Connecticut Medicaid is adding 6 new dental CDT codes to fee schedules effective January 1, 2026, including implant procedures and anesthesia services. Two codes require prior authorization and specific provider qualifications are required for anesthesia codes.
Medium impact
5160-44-01 - Nursing facility-based level of care home and community-based services programs: home and community-based settings. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Medicaid has updated Rule 5160-44-01 regarding nursing facility-based level of care home and community-based services programs, specifically addressing home and community-based settings requirements. This amendment affects billing and service delivery standards for nursing facility-level care provided in community settings.
High impact
2025.84 - Policy Updates and Changes to Clinical Review Criteria
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Connecticut Medicaid (CMAP) is implementing extensive policy changes with new coverage policies for habilitative therapy services and gene therapies effective January 1, 2026, plus 25+ new and updated policies for various medical services, devices, and treatments effective February 1, 2026. Several policies are also being retired including External Lower Extremity Nerve Stimulator and Synagis.
Medium impact
5160-44-14 - Nursing facility-based level of care home and community-based services programs: community integration services. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Department of Medicaid updated Rule 5160-44-14 regarding community integration services for nursing facility-based level of care home and community-based services programs. This amendment took effect January 1, 2024 and affects Medicaid billing for community integration services in Ohio.
Low impact
5160-45-03 - Ohio department of medicaid (ODM) -administered waiver program: individual rights and responsibilities. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Medicaid has updated Rule 5160-45-03 regarding individual rights and responsibilities for ODM-administered waiver programs, effective January 1, 2024. This rule governs patient rights and protections within Ohio's Medicaid waiver services program.
Medium impact
2025.86 - Changes to Prior Authorization of Physical, Occupational, and Speech Therapies for Individuals Whose Primary Diagnosis is Intellectual Disability, Developmental Delay, Autism or Other Developmental Disorder
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Connecticut Medicaid is changing prior authorization requirements for physical, occupational, and speech therapy services for patients with intellectual disability, developmental delay, autism, or other developmental disorders. Key changes include new medical necessity review criteria, 12-week authorization periods, elimination of IEP requirements for patients under 21, and new attestation requirements from treating therapists.
Low impact
5160-3-16.31 - Nursing facilities (NFs): private room incentive payment reimbursement. (New/Emergency)
Ohio Medicaid·Effective Nov 30, 2023
Ohio Department of Medicaid has implemented an emergency rule creating a new private room incentive payment reimbursement program for nursing facilities. This creates additional reimbursement opportunities for qualifying nursing facility services in Ohio.
Medium impact
2025.87 - January 2026 Updates to the CMAP Telehealth Table - Subsequent Hospital Care & Nursing Facility Care
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Effective January 1, 2026, Connecticut Medicaid (CMAP) is removing telehealth frequency limits for subsequent hospital care visits (previously limited to one telehealth visit every 3 days) and nursing facility care visits (previously limited to one telehealth visit every 14 days). Providers can now bill these telehealth services without frequency restrictions while maintaining clinical appropriateness.
Medium impact
5160:1-6-06.6 - Medicaid: undue hardship exemption. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Department of Medicaid has amended Rule 5160:1-6-06.6 regarding undue hardship exemptions for Medicaid eligibility, with changes taking effect January 1, 2024. This is an amendment to existing policy rather than a completely new rule, building on the original rule established in 2017.
Medium impact
2025.88 - Obstetrics Pay for Performance Program for Non-Participating Maternity Bundle Providers
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Connecticut Medicaid (HUSKY Health) is launching a new voluntary Obstetrics Pay for Performance program for non-participating maternity bundle providers, offering bonus payments for meeting specific prenatal and postpartum care quality measures. Providers must register and submit notification forms for each pregnancy to be eligible for these supplemental payments.
Medium impact
5160:1-3-02.3 - Medicaid: coverage for individuals receiving supplemental security income (SSI) benefits. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Medicaid updated Rule 5160:1-3-02.3 regarding coverage for individuals receiving Supplemental Security Income (SSI) benefits, effective January 1, 2024. This amendment modifies eligibility and coverage provisions for SSI recipients under Ohio's Medicaid program.
Medium impact
DSS Important Message - Private Psychiatric Residential Treatment Facility Rate Increase
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Connecticut Department of Social Services (DSS) is proposing to increase reimbursement rates for private psychiatric residential treatment facilities (PRTFs) under Medicaid effective January 1, 2026. This rate increase requires a Medicaid State Plan Amendment with public notice and comment period.
Medium impact
5160-8-35 - Skilled therapy services. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Medicaid has updated Rule 5160-8-35 for skilled therapy services, with changes taking effect January 1, 2024. This amendment modifies the existing policy for skilled therapy billing under Ohio Medicaid programs.
Low impact
5160:1-2-05 - Medicaid: notice of privacy practices. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Department of Medicaid amended rule 5160:1-2-05 regarding notice of privacy practices, effective January 1, 2024. This administrative rule change updates privacy notice requirements for Ohio Medicaid providers and beneficiaries.
Medium impact
DSS Important Message - DRG Calculator Updated
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
The Connecticut Department of Social Services has updated the DRG Calculator with new DRG weights, average length of stays, outlier thresholds, and hospital reimbursement rates effective for discharges on or after January 1, 2026. The updated calculator also includes new behavioral health and rehabilitation per diem rates for the same timeframe.
Medium impact
5160:1-6-06.1 - Medicaid: treatment of annuity purchases and transactions. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Medicaid has updated Rule 5160:1-6-06.1 regarding the treatment of annuity purchases and transactions for Medicaid eligibility determination. This amendment affects how annuities are evaluated when determining patient eligibility for Medicaid benefits, effective January 1, 2024.
Medium impact
2026.01 - Changes to the Prior Authorization of Radiology Services for HUSKY Health Members with Limited Benefit Coverage
Connecticut Medicaid (HUSKY Health)·Effective Feb 1, 2026
Starting February 1, 2026, radiology prior authorization requests for HUSKY Health members with limited benefit coverage (Family Planning, Emergency Outpatient Dialysis, and Tuberculosis) must be submitted to CHNCT first instead of directly to EviCore. CHNCT will review for benefit coverage before forwarding to EviCore for medical necessity review.
Medium impact
5160:1-6-06.5 - Medicaid: restricted medicaid coverage period. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Medicaid has updated rule 5160:1-6-06.5 regarding restricted Medicaid coverage periods, with the latest amendment taking effect January 1, 2024. This policy change affects how restricted Medicaid coverage is administered and may impact eligibility verification and billing processes for Ohio Medicaid patients.
Medium impact
DSS Important Message - Reminder: New Pharmacy Clinical Prior Authorization Criteria and Prior Authorization Forms for Non-Preferred Drugs in 11 Targeted Classes
Connecticut Medicaid (HUSKY Health)·Effective Jan 1, 2026
Effective January 1, 2026, Connecticut Medicaid has implemented new clinical prior authorization criteria and forms for non-preferred drugs in 11 targeted classes including anticonvulsants and GLP-1 agonists. All prior authorization requests must use the new forms or they will be denied.
Medium impact
5160:1-3-05.8 - Medicaid: lump-sum payments. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Department of Medicaid amended Rule 5160:1-3-05.8 regarding lump-sum payments, with the final amendment filed on December 19, 2023, and effective January 1, 2024. This policy specifically affects how Medicaid handles lump-sum payment scenarios for Ohio providers.
Medium impact
Electronic Visit Verification Claim Denials
Connecticut Medicaid (HUSKY Health)·Identified Jun 20, 2026
Electronic Visit Verification (EVV) claims processed between 12/23/2025 and 01/06/2026 were incorrectly denied due to a system file issue. Gainwell Technologies will automatically reprocess all affected claims before the 01/08/2026 cycle deadline.
Medium impact
***December 2024 InterChange Newsletter***
Connecticut Medicaid (HUSKY Health)·Identified Jun 20, 2026
Connecticut Medical Assistance Program (Medicaid) released their December 2024 quarterly newsletter with multiple provider reminders including ownership change reporting requirements, wheelchair repair documentation, behavioral health updates, and claims submission procedures.
Medium impact
5160:1-4-06 - Medicaid: coverage for individuals in receipt of adoption or foster care assistance. (Amend/Final File)
Ohio Medicaid·Effective Jan 1, 2024
Ohio Department of Medicaid updated Rule 5160:1-4-06 regarding coverage for individuals receiving adoption or foster care assistance, with amendments effective January 1, 2024. This policy change affects Medicaid eligibility and coverage requirements for this specific population in Ohio.

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Archive by year

2023 2024 2025 2026

2025.82 - Updating Physician Administered Drugs on Select Fee Schedules

5160-44-27 - Nursing facility-based level of care home and community-based services programs: home care attendant services. (Amend/Final File)

2025.83 - January 2026 Quarterly HIPAA Compliant Update - Dental Fee Schedules for Adults & Children

5160-44-01 - Nursing facility-based level of care home and community-based services programs: home and community-based settings. (Amend/Final File)

2025.84 - Policy Updates and Changes to Clinical Review Criteria

5160-44-14 - Nursing facility-based level of care home and community-based services programs: community integration services. (Amend/Final File)

5160-45-03 - Ohio department of medicaid (ODM) -administered waiver program: individual rights and responsibilities. (Amend/Final File)

2025.86 - Changes to Prior Authorization of Physical, Occupational, and Speech Therapies for Individuals Whose Primary Diagnosis is Intellectual Disability, Developmental Delay, Autism or Other Developmental Disorder

5160-3-16.31 - Nursing facilities (NFs): private room incentive payment reimbursement. (New/Emergency)

2025.87 - January 2026 Updates to the CMAP Telehealth Table - Subsequent Hospital Care & Nursing Facility Care

5160:1-6-06.6 - Medicaid: undue hardship exemption. (Amend/Final File)

2025.88 - Obstetrics Pay for Performance Program for Non-Participating Maternity Bundle Providers

5160:1-3-02.3 - Medicaid: coverage for individuals receiving supplemental security income (SSI) benefits. (Amend/Final File)

DSS Important Message - Private Psychiatric Residential Treatment Facility Rate Increase

5160-8-35 - Skilled therapy services. (Amend/Final File)

5160:1-2-05 - Medicaid: notice of privacy practices. (Amend/Final File)

DSS Important Message - DRG Calculator Updated

5160:1-6-06.1 - Medicaid: treatment of annuity purchases and transactions. (Amend/Final File)

2026.01 - Changes to the Prior Authorization of Radiology Services for HUSKY Health Members with Limited Benefit Coverage

5160:1-6-06.5 - Medicaid: restricted medicaid coverage period. (Amend/Final File)

DSS Important Message - Reminder: New Pharmacy Clinical Prior Authorization Criteria and Prior Authorization Forms for Non-Preferred Drugs in 11 Targeted Classes

5160:1-3-05.8 - Medicaid: lump-sum payments. (Amend/Final File)

Electronic Visit Verification Claim Denials

***December 2024 InterChange Newsletter***

5160:1-4-06 - Medicaid: coverage for individuals in receipt of adoption or foster care assistance. (Amend/Final File)

December 2024 InterChange Newsletter