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CareSourceMedicaid · Coverage · Medical Policy · OH · Pulmonology, Gastroenterology, Psychiatry +3 moreHigh impact

[Ohio] August 2026 Policy Updates

Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Aug 4, 2026

Summary

CareSource Ohio Medicaid released 10 policy updates effective October 1, 2026 and November 1, 2026, including 3 new policies (Pediatric Medical Strollers, Postpayment Review Non-Submission of Medical Records, Telehealth and Place of Service for Community Mental Health Clinics, and Urgent Care Facilities) and 6 revised policies affecting home mechanical ventilation, endoscopic procedures, substance use disorder treatment, TENS units, penile implants, and administrative processes. Billing teams must review each policy's full text to understand specific coverage, documentation, and reimbursement changes before the October and November effective dates.

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What to do

by Sep 15, 2026 · 5 steps
01Billing team must access the full policy text for each of the 10 updated policies on CareSource.com (Providers > Tools & Resources > Provider Policies) and document any changes to: (1) coverage criteria and medical necessity requirements, (2) prior authorization triggers, (3) billing codes and modifiers, (4) documentation requirements, and (5) reimbursement rates.
02Update billing system rules, encounter forms, and provider training materials accordingly.
03Key policies requiring immediate attention: MM-1588 (Non-Invasive Home Mechanical Ventilation E0466), MM-1245 (POEM procedures), PY-0137 (Residential Treatment Services), PY-0039 (TENS units), MM-1877 (new Pediatric Medical Strollers coverage), PY-1813 (Telehealth CMH clinics), and AD-1644 (Urgent Care Facilities effective November 1, 2026).
04Failure to implement changes by effective dates will result in claim denials and delayed reimbursement.
05Providers and front desk staff must be notified of any new prior authorization requirements or documentation standards.

Codes mentioned

E0466

Original notice

[Ohio] August 2026 Policy Updates
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Georgia] Medical Policy UpdateMediumEffective Jan 1, 2027 · Medical Policy[Ohio] October 2026 Policy UpdatesMediumEffective Nov 1, 2026 · Medical Policy[Ohio] September 2026 Policy UpdatesHighEffective Oct 1, 2026 · Medical Policy[Ohio] July 2026 Policy UpdatesHighEffective Sep 1, 2026 · Medical PolicyBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesPulmonologyGastroenterologyPsychiatryPain ManagementUrologyPediatricsCode E0466

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