Mid-Atlantic Health Law TOPICS

1.  Beginning July 1, 2026, Maryland Medicaid will deny Psychiatric Rehabilitation Program (PRP) claims if the referring provider field is not completed with an active Maryland Medicaid-enrolled individual referring provider, including the correct National Provider Identifier (NPI). Claims will not be reimbursable if the referring practitioner’s NPI is a group or facility. There was also previously an announcement that Maryland Medicaid will implement a temporary provider enrollment pause this summer as the program transitions away from using the electronic Provider Revalidation and Enrollment Portal (ePREP), and the new enrollment portal will not go live until October. To avoid interruptions in workflow, PRP providers are encouraged to verify the enrollment status of referring practitioners and proactively reach out to frequent referrers who are not yet enrolled. PRP providers can verify a referring practitioner’s enrollment status using the Maryland Medicaid Provider Verification System.

2.  Effective April 1, 2026, all Applied Behavioral Analysis (ABA) providers must include the required telehealth information released in the updated Maryland Medicaid Treatment Plan Template & Telehealth Readiness Checklist when submitting treatment requests for prior authorization. These changes are expected to alter how treatment plans are developed, authorized, and delivered. The updated materials include graphs, an updated utilization report, and a revised telehealth readiness checklist. These updates accompany a transmittal from the Maryland Department of Health requiring certain telehealth-only services to incorporate in-person components.

Kennedy M. Hagens
410-576-4146 • khagens@gfrlaw.com