All Insurance Policy Changes (Page 772)

Continuing from page 771. 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
Newsletter Vol. 2, No. 32
New Jersey Medicaid·Identified Jun 20, 2026
Healthcare providers must provide auxiliary aids (like qualified sign language interpreters) for deaf and hard of hearing patients under the ADA. Providers cannot charge patients or their insurance for interpreter costs and must ensure effective communication during medical care.
Medium impact
5160-1-42 - Provider credentialing. (Amend/Emergency)
Ohio Medicaid·Effective May 18, 2026
Ohio Department of Medicaid issued an emergency amendment to provider credentialing requirements (Rule 5160-1-42) effective May 18, 2026. This is an administrative change to credentialing processes that affects how providers enroll and maintain their status with Ohio Medicaid.
Medium impact
Newsletter Vol. 2, No. 33
New Jersey Medicaid·Identified Jun 20, 2026
New billing procedure for MMIS Claim Adjustment Form (FD) when provider costs exceed assigned Medicaid fee allowances. Providers must complete the FD form with specific modifier requirements and attach invoices/price lists for consideration of payment adjustments.
Medium impact
5160-10-16 - DMEPOS: wheelchairs. (Amend/Original File)
Ohio Medicaid·Effective Jun 22, 2026
Ohio Medicaid has filed an amendment to their DMEPOS wheelchair policy (Rule 5160-10-16) with an effective date of June 22, 2026. This appears to be a routine policy update for wheelchair coverage requirements under Ohio Medicaid.
High impact
Newsletter Vol. 2, No. 34
New Jersey Medicaid·Identified Jun 20, 2026
This policy establishes prior authorization requirements for prosthetic and orthotic services in New Jersey Medicaid, effective immediately. All prosthetic appliances (except preparatory temporary prostheses), all orthotic appliances, and all labor charges for repairs/replacements above specified thresholds now require prior authorization using the FD form with a prescription. Requests must be submitted to the appropriate Medicaid District Office (MDO), with orthopedic footwear and foot orthotic appliances routed to the Podiatric Consultant Division.
Medium impact
Newsletter Vol. 2, No. 35
New Jersey Medicaid·Identified Jun 20, 2026
Co-payment amounts have changed for Pharmaceutical Assistance to the Aged and Disabled (PAAD) beneficiaries. This affects how much patients will pay out-of-pocket for prescription medications, which may impact medication adherence and patient inquiries.
Medium impact
5160:1-4-02 - MAGI-based medicaid: coverage for children younger than nineteen years of age. (Amend/Final File)
Ohio Medicaid·Effective Jun 1, 2026
Ohio is amending its MAGI-based Medicaid coverage rules for children under 19 years of age. This is a procedural filing that shows multiple amendment dates, with the most recent activity indicating ongoing rule updates for pediatric Medicaid eligibility and coverage determination.
Medium impact
Newsletter Vol. 2, No. 36
New Jersey Medicaid·Identified Jun 20, 2026
New policy notice regarding ABC Program's Home and Community Based Services Waiver specifically for medically fragile children. This appears to be an update to waiver services that may affect billing for pediatric home health and community-based care services.
Medium impact
5160:1-4-01 - MAGI-based medicaid: household composition and income. (Amend/Final File)
Ohio Medicaid·Effective Jun 1, 2026
Ohio has amended Rule 5160:1-4-01 regarding MAGI-based Medicaid household composition and income determination, with changes effective June 1, 2026. This update modifies how Medicaid eligibility is calculated based on household size and income, potentially affecting patient eligibility verification processes.
High impact
Medicaid Alert - MA-1992-19
New Jersey Medicaid·Identified Jun 20, 2026
This appears to be a Medicaid coding alert (MA-1992-19) that is 1 day old and requires immediate attention. Without access to the specific policy content, this fresh policy update likely contains important coding changes, coverage updates, or billing requirements that could significantly impact Medicaid claim processing.
Medium impact
5160:1-4-03 - MAGI-based medicaid: coverage for Ribicoff and former foster care children. (Amend/Final File)
Ohio Medicaid·Effective Jun 1, 2026
Ohio Medicaid has amended Rule 5160:1-4-03 regarding MAGI-based Medicaid coverage for Ribicoff children and former foster care youth, with the final amendment taking effect June 1, 2026. This policy update changes eligibility or coverage provisions for a specific Medicaid population in Ohio.
Medium impact
Medicaid Alert - MA-1992-20
New Jersey Medicaid·Identified Jun 20, 2026
This appears to be a Medicaid policy update (MA-1992-20) related to coding changes, but the actual policy content was not provided in the analysis request. Without the full policy text, specific details about coding changes, effective dates, and billing requirements cannot be determined.
Medium impact
5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (New/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Medicaid has updated Rule 5160-1-17.12 regarding qualified entity requirements and responsibilities for determining presumptive eligibility for Medicaid enrollment. This appears to be a procedural update that may affect how healthcare practices handle Medicaid eligibility determination processes.
Medium impact
Medicaid Alert - MA-1992-21
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has issued guidance regarding the use of Form MC-19 (9/91) for reporting and claiming EPSDT/HealthStart screening and related procedures. This affects pediatric preventive care billing and claim submission processes for Medicaid patients.
Low impact
5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (Rescind/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid is rescinding and simultaneously refiling Rule 5160-1-17.12 regarding qualified entity requirements for determining presumptive eligibility. This appears to be an administrative action to update the rule structure while maintaining similar requirements for entities that determine Medicaid presumptive eligibility.
Medium impact
5160-44-05 - Nursing facility-based level of care home and community-based services programs and specialized recovery services program: incident management. (New/Original File)
Ohio Medicaid·Effective Oct 6, 2024
Ohio Medicaid has updated Rule 5160-44-05 regarding incident management requirements for nursing facility-based level of care home and community-based services programs and specialized recovery services programs. This policy establishes new incident reporting and management procedures for Medicaid providers serving these populations.
Medium impact
Medicaid Alert - MA-1992-23
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid is reinstating recoupments, meaning they will resume recovering overpayments from providers. This likely affects providers who previously received overpayments that were temporarily suspended from collection.
Medium impact
Medicaid Alert - MA-1992-24
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid policy MA-1992-24 introduces changes to claim attachment requirements. Billing teams must review updated procedures for submitting supporting documentation with Medicaid claims to ensure proper processing and avoid denials.
Low impact
5160-44-05 - Nursing facility-based level of care home and community-based services programs, medicaid managed care organizations, the OhioRISE program, and specialized recovery services program: incident management. (Rescind/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid has updated Rule 5160-44-05 regarding incident management requirements for nursing facility-based level of care home and community-based services programs, Medicaid managed care organizations, and the OhioRISE program. This appears to be a rescission and replacement of existing incident reporting rules that will take effect on June 26, 2026.
Medium impact
Medicaid Alert - MA-1992-25
New Jersey Medicaid·Identified Jun 20, 2026
Failed to analyze policy change
Medium impact
Medicaid Alert - MA-1992-26
New Jersey Medicaid·Identified Jun 20, 2026
Unable to analyze policy MA-1992-26 as the actual policy content was not provided - only metadata including title, category, and source URL were available.
Medium impact
5160-26-14 - Medicaid managed care organizations: incident management. (New/Original File)
Ohio Medicaid·Effective Jun 26, 2026
Ohio Department of Medicaid has filed a new rule 5160-26-14 establishing incident management requirements for Medicaid managed care organizations. This is a new administrative rule that will define how managed care organizations must handle and report incidents.
Low impact
Newsletter Vol. 2, No. 37
New Jersey Medicaid·Identified Jun 20, 2026
Unable to analyze policy change due to insufficient content provided. Only document metadata (title, URL, age) was included without the actual policy text or substantive information about what changes are being implemented.
Medium impact
5160-59-09 - The OhioRISE program: incident management. (New/Original File)
Ohio Medicaid·Effective Jun 26, 2026
The Ohio Department of Medicaid has established a new rule (5160-59-09) for incident management within the OhioRISE program. This creates new administrative requirements for providers participating in Ohio's specialized Medicaid program for children and youth with complex behavioral health needs.
Medium impact
Newsletter Vol. 2, No. 38
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has established a procedure for healthcare providers to request payment for uncollected PAAD (Pharmaceutical Assistance to the Aged and Disabled) co-payment balances from patients. This affects pharmacy-related billing and may require additional documentation or claim submission processes.

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Archive by year

2023 2024 2025 2026

Newsletter Vol. 2, No. 32

5160-1-42 - Provider credentialing. (Amend/Emergency)

Newsletter Vol. 2, No. 33

5160-10-16 - DMEPOS: wheelchairs. (Amend/Original File)

Newsletter Vol. 2, No. 34

Newsletter Vol. 2, No. 35

5160:1-4-02 - MAGI-based medicaid: coverage for children younger than nineteen years of age. (Amend/Final File)

Newsletter Vol. 2, No. 36

5160:1-4-01 - MAGI-based medicaid: household composition and income. (Amend/Final File)

Medicaid Alert - MA-1992-19

5160:1-4-03 - MAGI-based medicaid: coverage for Ribicoff and former foster care children. (Amend/Final File)

Medicaid Alert - MA-1992-20

5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (New/Original File)

Medicaid Alert - MA-1992-21

5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility. (Rescind/Original File)

5160-44-05 - Nursing facility-based level of care home and community-based services programs and specialized recovery services program: incident management. (New/Original File)

Medicaid Alert - MA-1992-23

Medicaid Alert - MA-1992-24

5160-44-05 - Nursing facility-based level of care home and community-based services programs, medicaid managed care organizations, the OhioRISE program, and specialized recovery services program: incident management. (Rescind/Original File)

Medicaid Alert - MA-1992-25

Medicaid Alert - MA-1992-26

5160-26-14 - Medicaid managed care organizations: incident management. (New/Original File)

Newsletter Vol. 2, No. 37

5160-59-09 - The OhioRISE program: incident management. (New/Original File)

Newsletter Vol. 2, No. 38