MedicaidAdministrativeMedium impact
Utilization control criteria for ventilator patients
Maryland Medicaid·MD · Pulmonology, Critical Care, Internal Medicine·Nursing Home
Effective date
Apr 11, 2006
We identified it
Jun 20, 2026
Summary
Maryland Medicaid establishes new medical eligibility criteria and utilization review process for ventilator-dependent patients in chronic hospital settings. The policy requires completion of specific forms (DHMH Form 3871b, Additional Information Form, Vent Specific Question Form, and Patient Comorbidity Rating Scale) and sets administrative day rates of $603.28 for ventilator patients and $187.05 for non-ventilator patients.
Action Required
For Maryland Medicaid ventilator patients: Ensure physicians or nurse practitioners complete all required forms (DHMH Form 3871b, Additional Information Form, Vent Specific Question Form, Patient Comorbidity Rating Scale) for medical eligibility determinations. Update billing systems to reflect administrative day rates: $603.28 for ventilator patients, $187.05 for non-ventilator patients. All medical eligibility requests for ventilator patients will go directly to physician review through the utilization control agent.