MedicaidPrior AuthMedium impact
MMP 24-49: Update to the Community Transition Services Chapter of the Michigan Department of Health and Human Services Medicaid Provider Manual
Michigan Medicaid - MDHHS·MI · Geriatrics, Physical Therapy, Occupational Therapy +1 more·Medical Policy
Effective date
Dec 1, 2024
We identified it
Jun 20, 2026
Summary
Michigan Medicaid updated Community Transition Services (CTS) eligibility and billing requirements, expanding coverage to include beneficiaries at risk of returning to nursing facilities and requiring prior authorization for most services except Transition Navigation Case Management. The policy clarifies covered services, adds 100% state-funded services, and updates billing procedures for both Medicaid-eligible beneficiaries and those with presumed eligibility.
Action Required
By December 1, 2024: Billing teams serving Michigan Medicaid beneficiaries must update Community Transition Services workflows to require prior authorization for all services except Transition Navigation Case Management. Update billing systems to use CHAMPS Professional Invoice claims for Medicaid-eligible beneficiaries and ensure Transition Services Expenditure Reports are submitted by the 15th day of the month following denial notification for presumed eligibility cases. Review the Michigan Medicaid Provider Manual CTS chapter and Transition Services Coding Structure document for specific billing requirements.