MedicaidPrior AuthHigh impact
Medicaid Services Manual Chapters Updated
Nevada Medicaid·NV · Pediatrics, Physical Therapy, Occupational Therapy +2 more·Provider Announcement
Effective date
May 27, 2026
We identified it
Jul 11, 2026
Summary
Nevada Medicaid has updated three service manual chapters effective May 27 and July 1, 2026. Key changes include: (1) Updated provider qualifications for Community Health Workers and Doulas; (2) Expanded dental benefits for adults 21+ with a $1,000 annual limit covering diagnostic, preventative, periodontal, and operative services, plus unlimited emergency/palliative care; (3) Removal of prior authorization requirements for therapy services for children under age 3.
Action Required
By May 27, 2026: Billing team must remove prior authorization requirements from billing system for therapy services for patients under age 3. Update encounter forms and clinical workflows to eliminate prior auth submission for pediatric therapy claims under this age threshold. By July 1, 2026: Billing team must update system to reflect new dental benefit structure for Nevada Medicaid adult members age 21+, including the $1,000 annual expenditure limit for diagnostic, preventative, periodontal, and operative services (fillings/crowns). Remove any existing benefit limitations that conflict with expanded coverage. Configure system to allow unlimited emergency and palliative dental services outside the cap. Remove prior auth requirements if previously required for expanded benefits. All billing and front-desk staff should review updated MSM Chapter 1000 at the provided URL to understand new coverage parameters. Failure to implement changes will result in inappropriate claim denials for covered services.