MedicaidCoverageMedium impact
Kennedy Krieger Institute Immediate Initial Intervention Service Pilot
Maryland Medicaid·MD · Psychiatry, Pediatrics·Hospital
Effective date
Jul 1, 2026
We identified it
Jul 17, 2026
Summary
Maryland Medicaid is launching a new pilot program at Kennedy Krieger Institute for web-based behavioral health services (3i) targeting children aged 3-10 with non-dangerous behavioral problems. Billing teams must implement revenue code 0919 with a flat annual rate of $3,500 per beneficiary and ensure prior authorization through BHASO before claims submission. Services require minimum engagement criteria (two navigator meetings, 30+ minutes of module engagement, and completion of all assigned modules) before reimbursement eligibility.
Action Required
By June 30, 2026: Billing team must configure billing system to recognize revenue code 0919 for KKI 3i services with flat rate of $3,500 per beneficiary per year. Implement workflow requiring authorization request submission to Behavioral Health Administrative Services Organization (BHASO) following initial screening, with auto-approval once per year per beneficiary. Establish verification process to confirm minimum engagement criteria are met before claims submission: (1) at least two navigator meetings documented, (2) at least 30 minutes module engagement recorded, and (3) all assigned modules marked complete. Train billing staff on eligibility exclusions (self-injury, suicidal ideation, weapon use, dangerous behaviors) and ensure only qualifying patients are enrolled. Update claim submission procedures to include proof of engagement criteria. Claims submitted without meeting minimum criteria will be denied by BHASO.