MedicaidReimbursementHigh impact
Clarification of Administrative Days Reimbursement in Nursing Facilities
Maryland Medicaid·MD · Geriatrics, Palliative Care·Nursing Home
Effective date
Jun 22, 2026
We identified it
Jul 17, 2026
Summary
Maryland Medicaid clarifies that nursing facilities must bill administrative days using Form 2129 starting on the first day of a continued stay review (CSR) period when a patient lacks a valid level of care determination. Facilities may continue full Medicaid billing only if an appeal is filed within 10 days of a denied level of care notification. Any claims already paid at full rate during denied periods must be corrected through the claims adjustment process.
Action Required
IMMEDIATELY: Billing team must implement the following changes for all Maryland Medicaid nursing facility claims: (1) Establish workflow to identify when continued stay review periods begin and when level of care determinations are invalid; (2) Begin billing Form 2129 (administrative day rate) on the first day of CSR review periods unless a valid level of care determination exists; (3) Monitor for denied level of care notifications and track the 10-day appeal window—if no appeal is filed within 10 days, submit corrected claims using Form 2129 retroactively from the denial date; (4) If an appeal IS filed within 10 days, continue billing full Medicaid rate during the appeal period. WITHIN 30 DAYS: Billing team must contact the Adjustment Unit (mdh.adjustmentunit@maryland.gov or 410-767-6874) to identify and submit corrections for any claims paid at full rate instead of administrative rate during denied CSR periods. Update billing system logic to automatically apply administrative day rate when level of care status is 'invalid' or 'denied.' Failure to comply will result in claim denials and potential overpayment recoupment.