MedicaidAdministrativeMedium impact
Process for Implementation of the HealthChoice Stop Loss Regulation Amendments for Affected MCOs
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Dec 1, 2000
We identified it
Jun 20, 2026
Summary
Maryland Medicaid managed care organizations (MCOs) must now follow new stop loss regulations effective December 1, 2000, changing the stop loss period from contract-based to calendar year. For inpatients hospitalized across calendar years, MCOs must incur $61,000 in costs before the Department pays stop loss reimbursement.
Action Required
Billing teams working with Maryland Medicaid MCOs must update stop loss claim procedures to follow calendar year periods instead of contract periods. For patients hospitalized across calendar years, ensure $61,000 threshold is met before submitting stop loss claims to the Department. Submit required documentation: evidence of billing original entity for $61,000, total hospitalization charges, service dates/diagnoses, and Delmarva certification for hospital days beyond $61,000.