MedicaidCoverageHigh impact
Medicaid Services Manual Chapters Updated
Nevada Medicaid·NV · Pharmacy, Psychiatry, General Practice·Provider Announcement
Effective date
Jul 29, 2026
We identified it
Aug 25, 2026
Summary
Nevada Medicaid updated three manual chapters effective July 29 - August 3, 2026: (1) Chapter 100 reorganized provider enrollment sections and updated agency references per SB 464; (2) Chapter 1200 removed discontinued drugs (Actiq, Viekira Pak, Kynmobi, Relyvrio, Ocaliva), updated GLP-1 refill quantities, and reformatted billing sections; (3) Chapter 4100 renamed substance use disorder treatment levels (LOC 1.0→1.5, PHP→HIOP) per ASAM 4th Edition and now requires PHP affiliation with hospital or FQHC per CMS requirements.
Action Required
By August 3, 2026: (1) Billing team must update pharmacy billing system to remove claims processing for discontinued drugs: Actiq (fentanyl citrate transmucosal lozenge), Viekira Pak (ombitasvir/paritaprevir/ritonavir/dasabuvir), Kynmobi (apomorphine), Relyvrio (sodium phenylbutyrate/taurursodiol), and Ocaliva (obeticholic acid). Claims for these medications will be denied. (2) By July 29, 2026: Update billing and clinical staff records to reflect new substance use disorder treatment level nomenclature in Chapter 4100 (LOC 1.0 is now 1.5; PHP is now HIOP; LOC 3.7 is now Medically Managed Residential Treatment). (3) Verify all HIOP (formerly PHP) provider contracts document hospital or FQHC affiliation per CMS requirements; claims from non-affiliated HIIPs will be denied. (4) Providers must update authorization request forms and billing software to use new terminology when submitting SUD treatment claims. (5) Billing team should review GLP-1 maintenance medication refill quantity requirements in updated Chapter 1200 and adjust prior authorization rules accordingly. (6) Update internal documentation and provider communications to reference Nevada Medicaid instead of DHCFP and DSS instead of DWSS per SB 464 alignment.