Medicaid Services Manual Chapters Updated

REQUIREMENTS: - By July 6, 2026: Pharmacy billing staff must update pharmacy management systems to reflect new 24-month Pharmacy Lock-In duration (previously 108 months) and document good cause exceptions per MSM Chapter 1200 guidelines. - By July 1, 2026: Prior authorization team must update workflows to allow direct submission of prior authorization requests to the Quality Improvement Organization (QIO)-like vendor for Personal Care Services (Chapter 3500) and Intermediary Service Organization services (Chapter 2600), eliminating the restriction on initial provider submissions. Update internal authorizations processes and provider education materials. - By July 1, 2026: Clinical staff managing peer support services must update recipient eligibility determinations to reflect maximum age of 26 years (Chapter 4300) for youth and family peer support programs. - By July 6, 2026: Billing and clinical teams must review MSM Chapter 1200 for newly added medications requiring clinical criteria documentation: Aqvesme (mitapivat), Itvisma (onasemnogene abeparvovec-brve), Exdensur (depemokimab-ulaa), Tryvio (aprocitentan), Pivya (pivmecillinam), and ATTR agents (Vyndamax, Attruby, Onpattro, Tegsedi, Wainua). Add corresponding clinical criteria to prior authorization templates and provider documentation requirements. - Immediately: Remove language from internal procedures referencing Personal Care Services Independent Contractor (IC) Model, which is now obsolete. - All affected staff should access updated chapters at https://www.nevadamedicaid.nv.gov/resources/medicaid-services-manual/ and incorporate into training. Failure to implement Lock-In changes and prior auth workflow updates may result in claim denials and authorization processing delays.