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Maryland MedicaidMedicaid · Coverage · Behavioral Health Administration Services Organization · MD · Psychiatry, PediatricsHigh impact

Targeted Case Management and 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families Services Updates

Act
by Jul 6, 2026
Effective date
Jul 6, 2026
Identified
Aug 6, 2026

Summary

Maryland Medicaid updated eligibility criteria for 1915(i) Intensive Behavioral Health Services and Targeted Case Management (TCM) Level 3 for children ages 0-21, expanding enrollment eligibility and relaxing intensity thresholds. Additionally, Child and Family Team (CFT) meeting frequency was extended from every 30 days to every 60 days, and audio-only telehealth reimbursement was eliminated for five expressive/experiential behavioral services (art, dance, horticulture, music, and drama), which now require audio-visual telehealth with GT modifier.

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What to do

by Jul 6, 2026 · 6 steps
01Billing team must implement the following changes.
02Update authorization and eligibility verification systems to reflect expanded 1915(i) and TCM Level 3 enrollment criteria for children ages 0-5 (ECSII score 2-5) and ages 6-21 (CASII score 2-6).
03Modify claim submission workflows to allow CFT meeting billing at 60-day intervals instead of 30-day intervals for 1915(i) and TCM Level 3 participants.
04Update telehealth billing rules to DENY reimbursement for art, dance, horticulture, music, and drama behavioral services billed without audio-visual capability and GT modifier—these services will only be reimbursed when billed with GT modifier.
05Train billing and authorization staff on new eligibility criteria and telehealth requirements.
06Update provider encounter forms and templates to reflect 60-day CFT meeting schedules.
If missed: Failure to implement these changes will result in claim denials for telehealth-only expressive services and potential authorization failures for newly eligible participants.

Original notice

Targeted Case Management and 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families Services Updates
health.maryland.gov no longer serves this document. We saved a copy on Nov 6, 2026.
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Maryland Medicaid policiesMD policy changesPsychiatryPediatrics

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