MedicaidReimbursementHigh impact
Consolidation of Medicaid Waiver Programs Operated by the Developmental Disabilities Administration
Maryland Medicaid·MD · Occupational Therapy, Physical Therapy, Speech Therapy·Community Pathways Waiver
Effective date
Oct 6, 2025
We identified it
Jun 20, 2026
Summary
Effective October 6, 2025, Maryland consolidated three Medicaid waiver programs (Family Supports Waiver, Community Supports Waiver, and Community Pathways Waiver) into a single Community Pathways Waiver (CPW) program. Provider-managed service rates have changed across all CPW services. Billing teams must immediately update fee schedules for all affected procedure codes and begin applying new rates to all claims for services rendered on or after October 6, 2025.
Action Required
By October 6, 2025: Billing team must immediately update billing system fee schedules with all new provider-managed service rates from Attachments A, B, and C. For each of the 58+ affected procedure codes (W-series Maryland waiver codes), replace old rates with the new standard and differential rates effective October 6, 2025. Update self-directed services rates using the revised DDA Self Directed Services Manual (October 6, 2025) from the Self-Directed Services Guidance and Forms website. Configure billing system to automatically apply new rates to all claims dated on or after October 6, 2025, and old rates to claims dated before that date. Verify that all Community Living and Supported Living service codes reference the correct rate charts (Attachments B and C). Notify providers that Family Supports Waiver and Community Supports Waiver service codes are no longer valid—all services must now be billed under Community Pathways Waiver codes. Do not submit claims using discontinued waiver program codes or old rates; claims will be denied. For questions, direct inquiries to Denise Farmer (denise.farmer@maryland.gov) or Robert White (robert.white2@maryland.gov).