MedicaidPrior AuthMedium impact
Long Term Care Facility Roles and Responsibilities When Admitting HealthChoice MCO Beneficiaries
Maryland Medicaid·MD · Geriatrics·Hospital
Effective date
Jan 10, 2003
We identified it
Jun 20, 2026
Summary
Long-term care facilities in Maryland must obtain prior authorization from HealthChoice MCO plans before admitting Medicaid beneficiaries enrolled in MCOs, or notify the MCO by the next business day if prior authorization wasn't possible. Facilities must complete and submit required forms within 20 days of admission to expedite the MCO disenrollment process.
Action Required
Immediately: Long-term care facilities must verify Medicaid beneficiary enrollment in HealthChoice MCO using the Eligibility Verification System (EVS) before admission. Contact the appropriate MCO for prior authorization before admission when possible, or notify MCO by next business day if prior authorization wasn't obtained. Submit completed disenrollment forms to MCO within 20 days of admission. Billing team must bill MCO first for all services during the first 30 days of admission.