MedicaidAdministrativeMedium impact
MMP 25-31: Derek Waskul, et al. v. Washtenaw County Community Mental Health, et al. Settlement Agreement
Michigan Medicaid - MDHHS·MI · Psychiatry, Neurology·Specialty Services
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
This policy updates Medicaid behavioral health and intellectual/developmental disability services, clarifying medical necessity criteria must be tailored to individual beneficiaries and establishing new requirements for self-directed service arrangements. It specifies PIHP decision-making limitations, budget reduction procedures, and Administrative Law Judge authority in appeals.
Action Required
Before October 1, 2025: Billing team must update processes for Medicaid and HSW behavioral health claims to ensure medical necessity documentation is tailored to individual beneficiaries and includes assessments with beneficiary input. Update prior authorization workflows to comply with new PIHP decision requirements including separate 'Requests Not Approved' sections in IPOS. Train staff on new self-directed service arrangement termination and budget reduction notice requirements.