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MMP 26-24: Hospital 15-Day Readmissions
Effective date
Aug 1, 2026
Identified
Oct 10, 2026
Summary
Effective August 1, 2026, Michigan Medicaid modifies hospital reimbursement for 15-day readmissions. Readmissions within 15 days to a DIFFERENT hospital for the SAME condition now receive full payment to both hospitals (previously considered part of a single episode). Readmissions to the SAME hospital for a related condition remain part of a single episode; unrelated conditions are always separate episodes regardless of hospital. This policy is contingent on CMS State Plan Amendment approval.
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What to do
Action · 6 steps
01On or after August 1, 2026: Billing team must update claim submission logic and internal billing systems to correctly identify and process 15-day readmissions according to the new rules: (1) readmissions to a DIFFERENT hospital for the SAME condition = two separate paid episodes; (2) readmissions to the SAME hospital for a RELATED condition = single episode; (3) readmissions for UNRELATED conditions = separate episodes regardless of hospital.
02Verify that the practice's billing software can capture and differentiate same vs. related vs. unrelated conditions and can flag hospital changes on readmissions.
03Confirm that prior authorization and service criteria limits continue to apply.
04Note that this policy applies to Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, and MI Coordinated Health programs.
05Retain this bulletin until incorporated into the MDHHS Medicaid Provider Manual.
06Flag that implementation is contingent on CMS State Plan Amendment approval—monitor michigan.gov/medicaidproviders for confirmation before full system deployment.
Original notice
MMP 26-24: Hospital 15-Day Readmissions
michigan.gov · Always check the source before changing claims.