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MMP 26-22: Updates to the MDHHS Medicaid Provider Manual
Effective date
Jul 1, 2026
Identified
Jun 16, 2026
Summary
The July 2026 update to the MDHHS Medicaid Provider Manual is effective July 1, 2026 and is mostly technical, with updates across chapters and bulletins incorporated. Transfers from an off-campus outpatient hospital (including Free Standing Emergency Departments) to an inpatient hospital do not require prior authorization, and all charges go on one claim when the tax ID is the same, while separate claims are submitted when the tax ID differs. Electronic Visit Verification (EVV) providers, including FMS providers, must reach a quarterly threshold of 85 percent of verified EVV records without manual edits.
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What to do
Action · 16 steps
01Already effective July 1, 2026: Billing team: For transfers from an off-campus outpatient hospital (including Free Standing Emergency Departments) to an inpatient hospital, do not request prior authorization.
02If the inpatient hospital has the same tax ID as the originating outpatient hospital, submit all charges from both on one claim.
03If the tax ID is different, the outpatient and inpatient hospitals submit separate claims.
04Billing team: For newborn transfers in a NICU, elective newborn transfers must be authorized by MDHHS, and authorization for emergent or urgent transfers must be requested by the next business day.
05Billing team: For Transitional Residential Brain Injury Services, PA is required for the per diem and requests are submitted for days of service.
06For Outpatient BIS, PA is required and requests are submitted for individual services for a specified duration.
07Billing team: For Ancillary Physical and Occupational Therapy and Speech Pathology, enter the PA number from the Medicaid authorization letter on the claim.
08If a beneficiary is approved for both complex care and therapy, one PA number is issued for both.
09Billing team: Enrollees in MI Coordinated Health (MICH) who use metabolic formulas (HCPCS codes B4157 and B4162) receive all of their Medicaid services through the Medicaid FFS Program.
10Billing team: Medical equipment and supplies providers must enroll in Medicare and Medicaid as DMEPOS providers, with enrollment verified at the start of service delivery and annually.
11Billing team: Dental Prior Authorization Request (MSA-1680-B), Special Services Prior Authorization Request (MSA-1653-B), Practitioner Prior Authorization Request (MSA-6544-B), and Occupational Therapy, Physical Therapy and Speech Therapy Prior Authorization Request (MSA-115) are the revised forms, version 3/2026.
12Billing team: Evaluation and justification for Complex Seating Systems and Mobility Devices (MSA-1656) must be submitted within 90 days of the date the evaluation was completed.
13Agency providers: Home Help agency caregivers must be actively enrolled in CHAMPS at the time they provide services, and the agency owner monitors their revalidation status.
14Agency providers and MDHHS or MCEs: Achieve a quarterly threshold of 85 percent of EVV records for verified visits without manual edits, using the monthly Compliance Report generated by HHAeXchange (HHAX).
15Providers: Manually entering or changing a visit clock-in or clock-out time makes a visit non-compliant and requires manual entry or edit.
16Corrective action for providers below the EVV threshold may include retraining, mandatory training, a compliance plan, or a formal meeting with MDHHS or the MCE.
Codes mentioned
B4157B4162
Original notice
MMP 26-22: Updates to the MDHHS Medicaid Provider Manual
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MSA 20-25HighEffective Mar 1, 2020 · Provider BulletinMMP 23-27: End of the Federal Public Health Emergency and Unwinding of COVID-19 Response PoliciesMediumEffective May 11, 2023 · Provider BulletinMMP 24-30: Updates to the MDHHS Medicaid Provider ManualMediumEffective Oct 1, 2024 · Medical PolicyMMP 25-47: Implementation of MI Coordinated Health (MICH) ProgramMediumEffective Jan 1, 2026 · Provider BulletinBrowse every Michigan Medicaid - MDHHS change in the policy list