What types of policy changes does Maryland Medicaid issue?

Maryland Medicaid regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Maryland Medicaid update its policies?

Maryland Medicaid typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Maryland Medicaid policy changes are tracked here?

This page currently tracks 50 documented Maryland Medicaid policy changes. New items are added as they are identified.

What should I do when Maryland Medicaid changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Maryland Medicaid Policy Changes 2026 | Prior Auth & Coverage Updates

Maryland Medicaid Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Maryland Medicaid across MD. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Maryland Medicaid notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Maryland Medicaid updates automatically.

High impact

PT 32-26: Correction to PT 13-26 Requirements for Providers Referring to Psychiatric Rehabilitation Programs

Maryland Medicaid·Effective Jan 1, 2026

Maryland Medicaid corrects PT 13-26 to clarify that only fully licensed mental health practitioners who can independently practice and enroll as Medicaid providers can refer patients to Psychiatric Rehabilitation Programs (PRPs). Licensed graduate-level practitioners (LMSW, LGPC) cannot enroll as Ordering, Referring, and Prescribing (ORP) providers and must have their supervising practitioner's NPI used for PRP referrals.

PT 87-25: Payable Status of Revenue Code 0483: Echocardiology

PT 80-25: Clarification on MCO Payment Responsibility for Health Behavior Assessments Administered in an Acute Care Setting

PT 90-25: Delivery of Services through Telehealth

PT 89-25: Extension of Temporary Moratoria for Certain Behavioral Health Providers for Certain Counties

PT 88-25: Primary Care Investment: E&M Increases

PT 01-26: Nursing Facility Quality Assessments - Changes to Pay-for-Performance Eligibility

PT 03-26: FY 2026 Quality Assessments Reporting and Payments

PT 02-26: Minimum Data Set Validation

PT 04-26: Notice for All Providers Regarding Payment Reissuance: Prompt Responses to Outreach Necessary for Timely Action

PT 10-26: Primary Care Investment: E&M Increases Technical Update

PT 09-26: Updated Clarification on MCO Payment Responsibility for Health Behavior Assessments Administered in an Acute Care Setting

PT 08-26: Medicaid Coverage for Coronary Calcium Score Testing

PT 07-26: Medicaid Coverage for Radiological and Imaging Services Provided by Certified Nurse Practitioners

PT 06-26: Fiscal Year 2026 Rates for Nursing Facility Services

PT 05-26: Correction to PT 28-25 PACE Rates for Calendar Year 2024 and Update on PACE Rates for Calendar Year 2025

PT 11-26: Coverage of Assistance in Community Integration Services for Fee-for-Service Medicaid Participants

PT 14-26: Updates to Communication with Provider Relations and Resolution Units

PT 13-26: Requirements for Providers Referring to Psychiatric Rehabilitation Programs

PT 12-26: Psychiatric Rehabilitation Program Referring Provider Requirements

PT 16-26: Fiscal Year 2026 Medicaid Rates for Administrative Days

PT 15-26: Updates to the Medicaid Provider Finder

PT 17-26: Dental Administrative Service Organization (DASO) Vendor Change

PT 19-26: HealthChoice MCO Timeframes for Written Acknowledgements of Enrollee Grievances

PT 18-26: Additional Guidance - HealthChoice Long Term Care Coverage

PT 20-26: Submission of Doctor's Order for 257 Authorization

PT 22-26: Clarification on Medicaid Coverage of Pediatric Vaccines

PT 21-26: Continued Medicaid Coverage of COVID-19 Vaccines for Adults

PT 26-26: PACE Payment Rates for Calendar Year 2025

PT 25-26: Clarification of HealthChoice Reimbursement and Payment Responsibility for the Hospice Room and Board Pass-Through Process

PT 24-26: Payment for Revenue Code 0810 in an Inpatient and Outpatient Setting

PT 23-26: Changes to Adjustment Unit Contact Information and Medicare Part A Claim Submissions

PT 28-26: Clarification of 257 Submission Processes

PT 27-26: Hospice Enrollment and Disenrollment Process via MarylandBenefits Portal

PT 32-26: Correction to PT 13-26 Requirements for Providers Referring to Psychiatric Rehabilitation Programs

PT 31-26: Community Preadmission Screening and Resident Review Process

PT 30-26: Fall 2025 General Provider Updates

PT 29-26: Fiscal Year 2025 Nursing Facility Pay-for Performance Scores

PT 33-26: Billing Clarification for Toxicology Testing and Pain Management Clinics

PT 34-26: Notice of Technical Issues Causing Payment Delays

PT 36-26: Consolidation of Medicaid Waiver Programs Operated by the Developmental Disabilities Administration

PT 37-26: Hospice Payment Rates for Federal Fiscal Year 2026

PT 38-26: Billing Practices of Individual Consideration Priced Items

PT 35-26: Additional Extension of Temporary Moratoria for Certain Behavioral Health Providers for Certain Counties

PT 39-26: Removal of MOM Program Release of Information Requirement

PT 40-26: Dental Administrative Service Organization Vendor Change Update - Early 2026 Go-Live

PT 43-26: Cell and Gene Therapy Access Model for Sickle Cell Disease

PT 42-26: Updates to ABA Combination of Service Rules and Discontinuation of H2012

PT 41-26: Updated Clinical Criteria for Wegovy for Adults with Non-cirrhotic Metabolic Dysfunction-associated Steatohepatitis

PT 46-26: Calculating Continuous Stays under HealthChoice Long Term Care Coverage

PT 45-26: Extension of Doula Self-Referral Requirement and Expansion of Doula Certification Organizations