All Insurance Policy Changes (Page 755)

Continuing from page 754. 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
5160-10-21 - DMEPOS: incontinence garments and related supplies. (Amend/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio Medicaid has amended policy 5160-10-21 regarding DMEPOS incontinence garments and related supplies, with the final amendment effective July 1, 2024. This is a state-specific Medicaid policy update that affects coverage and billing requirements for incontinence-related durable medical equipment and supplies.
Medium impact
DSS Important Message - 10% Rate Add-On Extended for COPE, Confident Caregiver, and CAPABLE Services through 09.30.2025
Connecticut Medicaid (HUSKY Health)·Effective Oct 1, 2025
The 10% rate add-on for COPE, Confident Caregiver, and CAPABLE services has been extended through September 30, 2025, maintaining higher reimbursement rates of $31.16 per 15 minutes. After October 1, 2025, rates will decrease to $28.33 per 15 minutes for all affected services.
Medium impact
5160-10-07 - DMEPOS: bathing seats. (Amend/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio Medicaid has finalized amendments to their DMEPOS bathing seats policy (Rule 5160-10-07), which became effective July 1, 2024. This policy governs coverage and billing requirements for bathing seats provided to Medicaid beneficiaries in Ohio.
Medium impact
5160-32-04 - Electronic visit verification (EVV) program providers. (New/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio Department of Medicaid has implemented new Electronic Visit Verification (EVV) requirements for home and community-based services providers. This policy establishes conditions of participation for providers delivering services under Ohio's Medicaid waiver programs, requiring electronic verification of service visits.
Medium impact
DSS Important Message - Children's Health Insurance Program/HUSKY B Services - Elimination of Allowances for Eyeglasses and Hearing Aids – DSS Payment in Full
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Effective July 1, 2025, HUSKY B (Connecticut CHIP) will eliminate the $100 eyeglass and $1000 hearing aid allowances and instead reimburse providers in full up to fee schedule amounts. Members will no longer have cost-sharing responsibilities for these services.
Medium impact
5160-32-01 - Electronic visit verification (EVV) program. (New/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio Department of Medicaid has implemented new Electronic Visit Verification (EVV) program requirements effective July 1, 2024. This policy establishes verification requirements for home and community-based services visits provided to Medicaid beneficiaries.
Low impact
DSS Important Message - Chronic Disease Hospital Reimbursement Public Notice
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut DSS will increase reimbursement rates for free-standing chronic disease hospitals effective July 1, 2025. New chronic disease hospitals will initially be reimbursed at the lowest existing rate, then rebased to 75% of cost after their second month following Medicare cost report submission.
Medium impact
Federally Qualified Health Center Change in Scope Revisions and Alternative Payment Methodology Public Notice
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut is proposing changes to the reimbursement methodology for Federally Qualified Health Centers (FQHC) effective July 1, 2025. This includes scope revisions and alternative payment methods under Medicaid State Plan Amendment 25-AK.
Medium impact
5160-1-40 - Electronic visit verification (EVV). (Rescind/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio Department of Medicaid has rescinded Rule 5160-1-40 regarding Electronic Visit Verification (EVV) effective July 1, 2024. This rule, which required electronic verification for home and community-based services visits, is no longer in effect for Ohio Medicaid providers.
Low impact
Medicaid State Plan Amendment: Reimbursement Update for Private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut is implementing a State Plan Amendment (SPA 25-AG) that will change the reimbursement methodology for private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) effective July 1, 2025 through June 30, 2026. This is currently in public notice phase with draft changes available for review and comment.
Low impact
5160-9-10 - Ohio average acquisition cost (OAAC) appeal and managed care pharmacy dispensing fee modification request. (New/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio has established a new rule allowing pharmacies to appeal Ohio Average Acquisition Cost (OAAC) determinations and request modifications to managed care pharmacy dispensing fees. This creates a formal process for pharmacy cost disputes in Ohio Medicaid.
Medium impact
Nursing Facility Reimbursement Public Notice
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut Department of Social Services is proposing to amend the reimbursement rates and methodology for nursing facility services effective July 1, 2025. This is a public notice period where providers can submit comments on the proposed Medicaid State Plan Amendment (SPA 25-AJ) before the changes take effect.
Medium impact
5160-1-06.5 - Home and community based services (HCBS) waivers: assisted living. (Amend/Final File)
Ohio Medicaid·Effective Jul 1, 2024
Ohio Department of Medicaid updated Rule 5160-1-06.5 regarding Home and Community Based Services (HCBS) waivers for assisted living services. This amendment affects billing and coverage requirements for Medicaid patients receiving assisted living waiver services in Ohio.
Low impact
Non-Governmental Independent Financially Distressed Hospitals – Outpatient Supplemental Payment Public Notice
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut will provide supplemental outpatient payments to financially distressed non-governmental independent hospitals (those with total margins of -10% or less in FFY 2023) starting July 1, 2025. This is a Medicaid State Plan Amendment that aims to support continued access and quality for outpatient services at these facilities.
Medium impact
5160-1-17.3 - Provider disclosure requirements. (New/Final File)
Ohio Medicaid·Effective Jul 15, 2024
Ohio Department of Medicaid has finalized new provider disclosure requirements under rule 5160-1-17.3, effective July 15, 2024. This rule replaces previous disclosure requirements and establishes new compliance obligations for Medicaid providers in Ohio.
Medium impact
5160-1-17.3 - Provider disclosure requirements. (Rescind/Final File)
Ohio Medicaid·Effective Jul 15, 2024
Ohio Medicaid has updated provider disclosure requirements under rule 5160-1-17.3, with both rescission and new versions filed on 07/02/2024. The changes affect disclosure obligations for providers participating in Ohio Medicaid programs.
High impact
***June 2025 InterChange Newsletter***
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut Medical Assistance Program (CMAP/Medicaid) has implemented major changes including a new 1115 SUD Demonstration Waiver requiring ASAM criteria compliance and Carelon authorization for substance use disorder treatment, enrollment opportunities for Certified Dietitian-Nutritionists with reimbursement starting July 1, 2025, and mandatory use of updated Drug/Product Prior Authorization Forms as of April 1, 2025. These changes affect provider enrollment, billing procedures, and authorization requirements for Connecticut Medicaid providers.
Medium impact
5160-1-29 - Medicaid fraud, waste, and abuse. (Amend/Final File)
Ohio Medicaid·Effective Jul 18, 2024
Ohio updated its Medicaid fraud, waste, and abuse rule 5160-1-29, effective July 18, 2024. This amendment updates program integrity requirements and compliance obligations for healthcare providers billing Ohio Medicaid.
Medium impact
2025.22 - Provider Bulletin - July 2025 Quarterly HIPAA Compliant Update - Physician Office & Outpatient Fee Schedule
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut Medicaid (HUSKY Health programs A, B, C, and D) updated their physician office and outpatient fee schedule with July 2025 HCPCS code changes including additions, deletions, and description modifications. The updated fee schedule must be downloaded from the CMAP website to ensure proper billing and reimbursement.
Low impact
5160-48-01 - Medicaid coverage of targeted case management services provided to individuals with developmental disabilities. (Amend/Final File)
Ohio Medicaid·Effective Jul 31, 2024
Ohio Department of Medicaid updated Rule 5160-48-01 regarding Medicaid coverage of targeted case management services for individuals with developmental disabilities, with the final amendment effective July 31, 2024. This update represents the most recent version of coverage requirements for these specialized case management services.
Medium impact
2025.23 - Provider Bulletin - July 2025 Quarterly HIPAA Compliant Update – BH Clinic & Alcohol Treatment Centers Fee Schedule
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut Medicaid (HUSKY Health) has updated their behavioral health clinic and freestanding alcohol treatment center fee schedules to incorporate July 2025 HCPCS code changes (additions, deletions, and description updates) for HIPAA compliance. Providers must download the updated fee schedules from the CMAP website.
Medium impact
5160-59-03.3 - OhioRISE: intensive home-based treatment service. (Amend/Final File)
Ohio Medicaid·Effective Aug 16, 2024
Ohio Department of Medicaid updated Rule 5160-59-03.3 regarding OhioRISE intensive home-based treatment services, with the latest amendment taking effect on August 16, 2024. This policy specifically governs Medicaid-covered intensive home-based treatment services for children and youth under Ohio's RISE program.
Low impact
2025.29 - Provider Bulletin - Addition of CPT Code to the Rehabilitation Clinic Fee Schedule
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut Medicaid (HUSKY Health) is adding CPT code 92609 for therapeutic services for speech-generating devices to their rehabilitation clinic fee schedule at a rate of $87.52, effective July 1, 2025.
Medium impact
5160-27-14 - Behavioral health peer support service. (New/Final File)
Ohio Medicaid·Effective Sep 1, 2024
Ohio Medicaid has established a new rule 5160-27-14 for behavioral health peer support services, effective September 1, 2024. This creates a new category of covered services for Medicaid beneficiaries requiring behavioral health support.
Medium impact
2025.30 - Provider Bulletin - Updates to Autism Spectrum Disorder Services
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2025
Connecticut Medicaid (HUSKY Health) is adding new billing codes for Autism Spectrum Disorder services including parent training (97156, 97156-U2) and case management (T1016), all requiring prior authorization. Prior authorization requirements are waived until September 1, 2025, and several existing ASD service authorization periods are extended from 90 days to 6 months.

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Archive by year

2023 2024 2025 2026

5160-10-21 - DMEPOS: incontinence garments and related supplies. (Amend/Final File)

DSS Important Message - 10% Rate Add-On Extended for COPE, Confident Caregiver, and CAPABLE Services through 09.30.2025

5160-10-07 - DMEPOS: bathing seats. (Amend/Final File)

5160-32-04 - Electronic visit verification (EVV) program providers. (New/Final File)

DSS Important Message - Children's Health Insurance Program/HUSKY B Services - Elimination of Allowances for Eyeglasses and Hearing Aids – DSS Payment in Full

5160-32-01 - Electronic visit verification (EVV) program. (New/Final File)

DSS Important Message - Chronic Disease Hospital Reimbursement Public Notice

Federally Qualified Health Center Change in Scope Revisions and Alternative Payment Methodology Public Notice

5160-1-40 - Electronic visit verification (EVV). (Rescind/Final File)

Medicaid State Plan Amendment: Reimbursement Update for Private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

5160-9-10 - Ohio average acquisition cost (OAAC) appeal and managed care pharmacy dispensing fee modification request. (New/Final File)

Nursing Facility Reimbursement Public Notice

5160-1-06.5 - Home and community based services (HCBS) waivers: assisted living. (Amend/Final File)

Non-Governmental Independent Financially Distressed Hospitals – Outpatient Supplemental Payment Public Notice

5160-1-17.3 - Provider disclosure requirements. (New/Final File)

5160-1-17.3 - Provider disclosure requirements. (Rescind/Final File)

***June 2025 InterChange Newsletter***

5160-1-29 - Medicaid fraud, waste, and abuse. (Amend/Final File)

2025.22 - Provider Bulletin - July 2025 Quarterly HIPAA Compliant Update - Physician Office & Outpatient Fee Schedule

5160-48-01 - Medicaid coverage of targeted case management services provided to individuals with developmental disabilities. (Amend/Final File)

2025.23 - Provider Bulletin - July 2025 Quarterly HIPAA Compliant Update – BH Clinic & Alcohol Treatment Centers Fee Schedule

5160-59-03.3 - OhioRISE: intensive home-based treatment service. (Amend/Final File)

2025.29 - Provider Bulletin - Addition of CPT Code to the Rehabilitation Clinic Fee Schedule

5160-27-14 - Behavioral health peer support service. (New/Final File)

2025.30 - Provider Bulletin - Updates to Autism Spectrum Disorder Services

June 2025 InterChange Newsletter