MedicaidAdministrativeMedium impact
Utilization Review Policy and Procedures
Maryland Medicaid·MD · Geriatrics, Occupational Therapy, Physical Therapy·Community Personal Assistance Services
Effective date
Jan 24, 2025
We identified it
Jun 20, 2026
Summary
Maryland's Office of Long Term Services and Supports has issued updated utilization review policy and procedures for Community Personal Assistance Services (CPAS), Community First Choice (CFC), Home and Community-Based Options Waiver (HCBOW), and Increased Community Services (ICS) programs. Providers must reference the Plan of Service Reviewer Training Manual and standard operating procedures (accessible via the Maryland Department of Health website) to ensure medical necessity determinations align with evidence-based standards of care and COMAR regulations.
Action Required
By February 24, 2025: Billing and clinical staff must review the Plan of Service Reviewer Training Manual and accompanying standard operating procedures at https://health.maryland.gov/mmcp/longtermcare/Pages/Community-First-Choice.aspx. Update internal utilization review procedures and plan of service documentation requirements to align with the evidence-based standards outlined in the training manual. Ensure all staff involved in CPAS, CFC, HCBOW, and ICS billing and authorization understand the new utilization review policy. Non-compliance may result in claim denials due to insufficient medical necessity documentation. Direct questions to Carrie Goodman, Chief, Division of Clinical Support, at (410) 767-6765 or Carrie.Goodman@maryland.gov.