What to act on now, deadlines coming up and news to read, across every state and the federal rules. Pick a topic or a state to narrow it down. Each item links to the state page and the official source.
The state minimum wage has been $14.00 since September 30, 2025 and goes to $15.00 on September 30, 2026. From 2027 it will change each year with inflation. The current poster says $14.00 applies "through September 29, 2026."
Every Illinois Medicaid home care program now measures EVV by state fiscal-year quarter. At least 75% of visits must capture all six federal elements with no manual entry or edit, and claims without visit data also count against you. A first missed quarter brings a notice and required training; three in a row brings a referral to the HFS Office of Inspector General.
Providers whose specialty is listed in the Provider Types and Specialties handbook must enroll with Gainwell Technologies, and every National Provider Identifier (NPI) they bill to a health plan must be enrolled. PCS/Aged & Disabled Services Agency (253Z00000X) is on the list. From Aug. 31, 2026, health plans may suspend or deny payment to providers who are not fully enrolled. Providers enrolled by September 30, 2026 may get enrollment back-dated to April 1, 2026, case by case.
DMAS is ending the live-in caregiver exemption from EVV. From October 1, agency aides and consumer-directed attendants who give personal care, respite or companion services must log every shift through EVV. DMAS also revised its EVV FAQ and published a one-page notice.
DMAS updated the CCC Plus Waiver manual and the DMAS-97A/B Plan of Care and DMAS-99 assessment forms. From October 1, 2026, service authorization requests that use older versions will be denied.
From October 1, 2026, noncitizen adults age 19 and older with certain statuses (for example refugees and asylees) are no longer eligible for Wisconsin Medicaid. This includes current members. Lawful permanent residents, Compact of Free Association migrants and Cuban-Haitian entrants stay eligible, and so do lawfully present pregnant people.
Under House Bill 25-1328, direct care employers had to start giving workers the Direct Care Worker Notice of Rights on July 1, 2026. Employers must also make sure their direct care workers complete CDLE's Know Your Rights training, which is required beginning October 1, 2026, and pay them for the time. After October 1, every new direct care worker must complete it or show a certificate.
From October 1, 2026, claims from home health, personal care/homemaker (specialty 666), IHSS agencies and other long-term care providers may deny if the license dates CDPHE has on file don't match Medicaid's records. From August 1, 2026, you have 60 days from each license's "issued on" date to update it. The September bulletin adds that claims with dates of service from August 1, 2026 deny (EOB 3385) if an updated license is not on file.
DMMA moved the EVV "hard edit" from March 31, 2026 to October 1, 2026. After that date, personal care and home health claims will be denied unless the authorization, EVV visit and claim match. Until then, non-matching claims get a warning on the remittance advice.
HCSSAs must use the Search Engine for Multi-Agency Reportable Conduct (SEMARC), in addition to the Nurse Aide Registry, to decide whether a person can be hired, starting August 3, 2026. SEMARC combines HHSC's Employee Misconduct Registry with findings from DFPS, the Texas Education Agency and the Texas Juvenile Justice Department, and HHSC says it replaces the EMR search as rules are updated. HHSC will not survey for SEMARC compliance until October 6, 2026.
Maryland Medicaid is replacing its provider enrollment system. All providers lose access to ePREP on October 1, 2026, and anything not downloaded by 5 p.m. on September 30 will be lost. The new system, MPRIME, launches October 13. Providers without an SDAT (state business) ID in good standing won't be able to submit applications in MPRIME.
DHCF moved everyone enrolled with Wellpoint DC (formerly Amerigroup DC) to AmeriHealth Caritas DC on August 1, 2026. Members can switch to MedStar Family Choice DC until January 31, 2027. Referrals and prior authorizations issued before August 1 stay valid through October 31, 2026. Providers must request new prior authorizations from the member's new plan for services not already approved.
For calendar year 2025, LHCSAs send Department of Labor form LS300, and form LS301 with audited financial statements or Agreed Upon Procedures, to every contracted health plan and certified home health agency by November 1, 2026. The 2025 Annual Certification of Compliance is due to DOH through the eMedNY Provider Portal by November 15, 2026. The same dates repeat every year from 2027.
In-home agencies enrolled in Medicaid whose Medicaid census is at least 20% must report the average hourly base pay of their direct caregivers as of August 30, 2026. The Legislature asked for this data. ODHS may limit an agency's ability to serve Medicaid clients if it does not respond.
Health Management Systems, Inc. (HMS) is reviewing Medicaid claims that a commercial insurer should have paid, working with the DSS Office of Recoveries and Fraud Investigations (ORFI). HMS writes to providers directly. If you don't respond through the HMS portal within 60 days, that counts as accepting the finding, and DSS recoups the claims after the review cycle. More response periods follow from December 2026 to March 2027 and from April to July 2027.
SB 412 changed Health and Safety Code 1796.44. From January 1, 2027, every HCO must make sure affiliated home care aides’ annual training includes the special care needs of clients with dementia. CDSS will not set a curriculum, but will check training materials at application, renewal and inspections.
DMAHS says agencies giving personal care (PCA) and home health services to health plan members must electronically verify at least 80% of EVV visits with no manual edits. Some edit reasons, such as GPS address errors, overnight visits and retro-authorizations, do not count against you. After three months in a row below 80%, plans stop new referrals; after six months, they must end the contract. Paid service units with no matching confirmed visit in the plan's EVV system (CareBridge or HHAeXchange) will be recouped.
Every Medicaid-enrolled provider that billed non-DDA home and community-based services from July 1, 2025 to June 30, 2026 must complete the whole survey. The deadline moved from September 30 to December 31, 2026. Providers that miss it face a Medicaid payment suspension starting January 1, 2027.
One caregiver may give one member at most 84 hours a week through December 31, 2026, 70 hours from January 1, 2027 and 56 hours from July 1, 2027, unless HCPF has an exception approved or pending, or in a documented emergency. This covers personal care, homemaker, health maintenance activities and long-term home health nursing and aide services. Exception requests for members getting more than 70 hours a week from one caregiver go in during November 2026. Agencies must sign a yearly Provider Agency Attestation, with the first ones signed and ready by January 1, 2027.
From January 1, 2027, each homemaker-companion agency must provide at least 8 paid hours of initial training to new employees (within 90 days of hire) and of annual continuing education to every employee, using programs on DCP's approved list. Agencies must file a yearly attestation with DCP starting January 1, 2027, and keep a signed completion form for each worker. Nurse's aides, home health aides, personal care attendants and staff who don't give homemaker or companion services are exempt.
At CMS's request, Medicaid is revalidating providers off-cycle. Home health agencies and hospices are high-risk and will revalidate immediately. Private duty nursing is moderate or limited risk and will revalidate over 24 months. Notices go out in phases.
A court vacated most of the 2024 reproductive health privacy rule on June 18, 2025, and struck three parts of the Notice of Privacy Practices changes (45 CFR 164.520(b)(1)(ii)(F), (G) and (H)). HHS says the rest of the notice changes remain in effect and compliance was required by Feb. 16, 2026.
For services that need EVV, the claim must match a visit in Verified status in Sandata. Claims that don't match are denied, and so are claims that bill more units than the visit shows. This covers Ohio Home Care Waiver and PASSPORT dates of service from January 1, 2026, and MyCare claims from March 1, 2026.
Home Health Care Services, including applicable skilled nursing, now need EVV. Soft go-live was August 31, 2026, and claims have been mandatory since September 14. They must go through the State EVV solution (Netsmart) or an integrated third-party system.
MDHHS expects agencies, including financial management services providers, to have at least 85% of verified EVV visits each quarter with no manual edits, counted separately for each payer. Missing clock-ins or clock-outs, missing GPS or phone numbers, and changed times all count as manual edits. MDHHS checks Home Help and fee-for-service home health; the health plans and waiver agencies check their own networks. Corrective action can include retraining, required training, a compliance plan and a formal meeting.
The EVV Portal and the Long-Term Care Online Portal moved to TMHP IAMOnline on August 24, 2026. Users had seven days from TMHP's activation emails (sent July 7 and August 18) to activate, set a password and register for multi-factor authentication. Passwords must be changed every 90 days, and any account or application not used for 90 days is deactivated.
Fee-for-service home health, GAFC and ABI/MFP waiver providers must have at least 50% of visits auto-verified (no manual changes) until claim edits start; a second miss brings a formal notice of sanction. MassHealth will then deny claims that don't match a Verified EVV visit. The bulletins say "no earlier than July 2026"; the July 27 webinar lists the date as "TBC" and says unmatched claims will first be suspended for 30 days.
DSHS moved its EVV edits from 'pay and report' to 'deny' in three steps: missing or invalid caregiver SSSOP IDs from January 1, missing or wrong start and end times (and units longer than the shift) from April 1, and missing GPS location from July 1. This includes claims submitted after January 1, 2026 for earlier dates of service.
CMS approved a statewide moratorium on certifying and enrolling providers for PathWays, H&W, TBI, CIH and Family Supports waiver services. It covers Attendant Care, Home and Community Assistance, respite, Structured Family Caregiving and more. Existing agencies also cannot change ownership, add counties or add services that fall under it. It runs for six months from Aug. 1, 2026, and the IHCP may extend it six months at a time.
From July 1, 2026, IHCP home health agencies must be enrolled with Medicare. Under Senate Enrolled Act 222 (2026), an agency that sent its CMS-855A before April 1, 2026, or started with a CMS-approved accrediting organization, can stay enrolled, but must finish Medicare enrollment by June 30, 2027. Agencies that did neither are deactivated.
For dates of service from April 1, 2026, MO HealthNet denies claims for DSDS-authorized services (provider types 26 and 28: personal care, advanced personal care, consumer-directed services, homemaker, chore and respite) that have no matching visit in the EVV Aggregator Solution (EAS); MO HealthNet said such claims would not be paid, starting with the April 24, 2026 check or deposit. Bulletin 48-59 set June 1, 2026 for home health (provider type 58). The claim must match the participant's DCN (Medicaid ID), the dates of service, your Medicaid provider ID, the procedure code and modifiers, and the units. Developmental disabilities and Brain Injury Waiver personal care (type 85) come in a later phase, with no date yet.
From July 1, 2026, Independent Living Waiver personal care is limited to 49 hours a week per participant, and Aged & Disabled Waiver basic and advanced respite to 49 hours a week per participant. The February 2026 waiver drafts said 32 Independent Living Waiver and 23 respite participants would be affected.
ForwardHealth will deny incomplete personal care prior authorization (PA) requests. Each request needs the Personal Care Screening Tool (F-11133), the Personal Care Addendum (F-11136), a plan of care with orders from a prescribing provider, and clinical records dated within 12 months, including at least a yearly physical exam. A letter asking for a number of hours is not enough on its own. This applies to fee-for-service and to BadgerCare Plus and Medicaid SSI health plans.
DHS began enforcing EVV compliance thresholds on Jan. 1, 2026: at least 50% from Jan. 1 and 80% from July 1. HHAeXchange sends DHS and providers a compliance report around the 25th of each month. Providers that miss the threshold get corrective action notices in the PRVLTR folder of their MN–ITS mailbox. You must track compliance for every tax ID and provider number that has to send EVV data.
Following a federal push that started in April 2026, SCDHHS will rapidly revalidate 5,713 higher-risk providers within 12 months, with document reviews, site visits and fingerprint-based background checks. Home health agencies are on the list, and SCDHHS added providers offering personal care services. Each provider gets a letter with a unique revalidation code. Revalidation cannot start until that letter arrives.
At CMS's request, Louisiana Medicaid is revalidating selected providers outside the normal five-year cycle, in phases that began in June 2026. The first phase includes personal care services (PCS) and personal care attendant (PCA) providers. Providers that miss the due date are deactivated and are not paid for services between the due date and completing revalidation.
Any 1915(c) waiver claim, traditional or participant-directed, for a service that must use EVV is denied if there is no matching visit in EVV. This applies whether you use Therap or a third-party system that feeds the Therap aggregator.
OHCA says all providers must already be submitting claims in an EVV-compliant way, with no exceptions, though the same slides say the state is creating specific exceptions for outliers. Providers billing OHCA directly use the state system or a compliant vendor; providers contracted with a SoonerSelect plan use HHAeXchange or a vendor that integrates with it. OHCA's March 2026 slides list live-in caregivers among those affected by EVV.
Iowa Medicaid is revalidating all enrolled providers over two years, in phases. Once you get your notice, you have about 30 days to finish. The letter applies to fee-for-service enrollment.
Since July 21, 2026, providers can submit personal care services (PCS) initial prior authorization requests directly in the Provider Web Portal by choosing "PCS Initial". The transfer form FA-24T was merged into FA-24. After September 21, 2026, requests on any earlier version of FA-24 are not accepted. An incomplete FA-24 can be pended, and it is denied if the missing information is not in within 30 calendar days.
Utah Medicaid is running a two-year mid-cycle revalidation. It covers billing providers in the high risk level that have not revalidated since July 1, 2025. Medicaid mails a letter to your 'Pay-To' address in PRISM, and you must finish revalidation in PRISM within 90 days. If you don't, your Medicaid enrollment ends.
CMS (the federal Medicare and Medicaid agency) found widespread gaps in HCBS background checks in Kansas. From the July 1 to September 30, 2026 audit quarter, and each quarter after, the KanCare plans must audit 100% of HCBS provider employees. Providers must send complete staff files when Averifi asks. Providers still out of compliance after June 30, 2026 may face payment denial, suspension or termination.
CMS is requiring "high risk" providers to complete an off-cycle revalidation. This applies to all HCBS providers that have not revalidated in the past year. Gainwell mails a letter; if you don't submit your revalidation in the MESA portal within 60 days, your fee-for-service Medicaid payments are suspended until you do. Continued failure ends your Medicaid enrollment.
As part of a federal push, NH Medicaid said it would begin reviewing enrollment records ahead of the usual five-year cycle, on or about July 1, 2026. Newly enrolled providers and those not revalidated since June 1, 2025 will be picked over the next two years. Selected providers get a letter at the mailing address on file, plus an email if one is on file. Not responding in time can lead to claims suspension or termination.
Fee-for-service Medicaid now requires service authorization for G0156 and G0156 GY (home health or hospice aide, each 15 minutes). The Program Integrity Unit started this because of high use of these codes. Requests use Form 273AT.
RI Medicaid restarted automated EVV checks on fee-for-service claims for T1000, S5125, S5130 and S5125 U1. A claim suspends if the Aggregator has no EVV record, if any of the six required data points is missing, or if the service code doesn't match. If the EVV data is still missing or wrong after 30 days, the claim denies.
State training for CCW providers on the renewal changes.
September 1–30 is the enrollment period for all EDWP services except Structured Family Caregiving.
The April 1, 2026 notice says on or around this date.
From 2027 it changes each year with inflation.
Agencies under 75% EVV compliance for the quarter, or with claims lacking visit data, face the next step of the penalty ladder.
By 5 p.m. Anything not downloaded will be lost.
This is the end of an audit period, not a filing deadline: the KanCare plans must audit every HCBS provider employee from the July 1 – September 30, 2026 quarter, and each quarter after.
Case by case. Health plans may suspend or deny payment to providers not fully enrolled from Aug. 31, 2026.
Consumer-directed shifts must go through the fiscal agent's app or phone (IVR) system; web-portal entries do not count.
Service authorization requests on older versions will be denied.
For CHC and CHIP. The table lists home visit code S9122 as "PA Required".
Draft only. It would add APS abuse registry checks for all provider staff.
Health plan PCA and home health providers have October 1 to December 31, 2026 to meet the 80% no-manual-edit standard.
Adds the Home Help audit form and compliance review changes (MMP 26-21) and the MI Coordinated Health revisions (MMP 26-26) to the manual.
10A NCAC 13O. The date is only proposed. The Medical Care Commission approved the rules on August 14, 2026, and the Rules Review Commission lists the filing for its September 29, 2026 meeting.
Decisions on requested ALTCS services due within seven calendar days (now 14).
RSAs providing private duty nursing may hire nurses without the usual clinical experience if they train them, have them supervised and test their competency, under a program the Department approves (Ch. 217 of 2026).
Certain noncitizen adults age 19 and older lose Wisconsin Medicaid eligibility, including current members. Check eligibility before serving.
Direct care workers must have completed it; after this date, all new direct care workers must complete it or provide their certificate.
Claims for dates of service from October 1 may deny if CDPHE license dates don't match the Medicaid claims system.
The list of approved homemaker-companion employee training programs, under Public Act 26-50.
They replace the Health and Disability, Children's Mental Health, AIDS/HIV and Physical Disability waivers.
Codes S5125, S5125 U3, S5130 and T2031; amounts are on the Iowa Medicaid Fee Schedules webpage.
Fingerprint-based checks go from $12.00 to $15.00 ($16.00 on the website with the service fee).
Providers must be enrolled with KMAP under the new CSW specialties before delivering services. EVV is mandatory for CSW personal care.
Applies to personal care and home health care services subject to EVV.
Proposed effective date in the April 2026 draft waiver for people with intellectual disabilities or autism. Not confirmed as approved.
Some clients may lose coverage. EOHHS materials are at StayCovered.ri.gov.
DSS's H.R. 1 timeline says these changes come by October 1, 2026.
Due by the 5th of every month, 5:00 PM Central, with visit data for claims billed the month before.
The hold-harmless period (August 3 to October 5, 2026) ends. SEMARC has been required since August 3.
Last day of AHCCCS's public comment period on proposed exempt rulemaking for the HCBS Needs Tool (HNT) and the Extraordinary Care Review (ECR) process.
You don't have to set up your account on launch day.
In-home designated managers and Certified CDS Managers must attend one update meeting a year to keep their status.
MMAC's training prints October 31. The rule says 30 days after the quarter ends, which could be read as October 30, so filing by October 30 is safest.
All DCP registrations expire each October 31. Renew in time.
Send a complete renewal application before the expiration date. You can ask for reinstatement within 90 days of expiration, but you may not operate in the meantime.
Referrals and prior authorizations issued before August 1, 2026 are valid only through this date. Get new ones from AmeriHealth or MedStar.
Send to every contracted health plan and certified home health agency, with audited financial statements or Agreed Upon Procedures.
Phase 2 of the weekly caregiver limit: exception requests are submitted during November 2026 (the memo prints "November 1, 2026 through November 31, 2026").
Only for entities with $5 million or more in yearly Medicaid payments. Email it to hcpf_draact2005@state.co.us.
About 6 months from May 13, 2026. The notices print no end date; CMS may extend in 6-month steps and will publish any extension in the Federal Register.
ODM's moratorium on new enrollments for home health, hospice, waiver and other listed provider types remains in effect until November 14, 2026 unless CMS authorizes an extension.
Filed through the eMedNY Provider Portal by LHCSAs, fiscal intermediaries and certified home health agencies.
Chapters 35 (ID waiver) and 52 (Living at Home waiver) were amended effective July 13. Chapter 11 rule 560-X-11-.14 (EPSDT services, including private duty nursing) was amended effective Aug. 14.
The renewal adds Companion Services and Assistive Technology. DD waiver providers can more easily certify for adult day, homemaker, respite and companion services.
CMS stopped enrolling new home health agencies, new branches and practice locations, and new hospices in Medicare, nationwide. Applications the Medicare contractor received before May 13 aren't affected, and neither are current enrollments. Ownership changes that need an initial enrollment are covered. Any extension will appear in the Federal Register; CMS left Medicaid to each state.
Proposed, not final. CMS estimates payments would rise 2.4% in 2027 (a 2.1% update plus 0.3% from an outlier update). It would also revise home health quality reporting deadlines and move OASIS and HHCAHPS reporting to a calendar year of data.
DOL's July 2025 proposal would return to the 1975 rules and let home care agencies and other third-party employers claim the companionship and live-in exemptions again. The August 2026 agenda puts the final rule at November 2026. It is not final: agencies must still pay minimum wage and overtime.
KPMG is auditing the 2025 Home Care Cost Reports of agencies DOH selected. If an agency does not answer an audit request, the audit team sends a follow-up email; if there is still no response within three business days, a finding is documented and shared with DOH. Adjusted cost report data will be used for 2027 rates.
DOH ended the Alternative Competency Demonstration, which let experienced candidates test out of personal care aide basic training. Everyone seeking certification must now complete an approved 40-hour basic training program.
DOH reminded providers that only Authorized Persons employed by and under the control of the agency may request or see criminal history results. A third-party contractor is not the provider and may not be given this information.
DHS now sends alerts to fee-for-service providers whose EVV manual edits exceed 15% in a quarter, and sends CHC plans a list of their noncompliant providers. Two quarters in a row over 15% leads to a corrective action plan, and possibly sanctions. Some plans act sooner: PA Health & Wellness says a provider below 85% for any 3 months in a row faces a corrective action plan.
At the federal government's request, DHS is revalidating Medicaid providers classed as high-risk, for example those under a payment suspension for a credible allegation of fraud, excluded by the federal Inspector General in the last 10 years, or with an unpaid overpayment over $1,500 that is more than 30 days old. DHS will email the providers who must revalidate. High-risk providers that miss their due date will have the service location closed in PROMISe.
The CHC Waiver amendment (PA.0386.R05.01) moved to the federal government's new application template, which puts teleservice rules in a section of their own; OLTL's summary of the OBRA Waiver renewal shows the same changes. Behavior therapy and benefits counseling were added to the services that may be delivered by teleservice; personal assistance is not on that list. The CHC Waiver also restates that State Police, FBI and child abuse certifications for workers in homes with children must be renewed every 60 months.
MyCare now covers all 88 Ohio counties. People on the Ohio Home Care, Assisted Living or PASSPORT waiver who were enrolled in Next Generation MyCare moved to the MyCare Ohio Waiver. Providers must enroll with ODM and contract with each plan; a plan may offer a single case agreement instead. Buckeye is not an option for new members in plan year 2026.
OHCW personal care aide, home care attendant and waiver nursing, PASSPORT waiver nursing, and state plan RN assessment and consultation need the recipient's (or authorized representative's) co-signature. PASSPORT personal care aide, home care attendant and enhanced community living need a signature or unique identifier. EVV does not collect these signatures; service documentation is kept separately.
ODM's moratorium covers new enrollments for other accredited and Medicare-certified home health agencies, waivered services organizations and individuals, non-agency personal care aides and home care attendants, private duty nurses and hospices. No new applications or service locations are accepted, and applications filed before May 14 that were not yet processed will be denied. Enrolled providers keep operating, and managed care plans may contract with providers that have an active ODM provider agreement effective on or before May 13, 2026.
The EDWP General Services and Personal Support Services manuals add rules against misleading advertising (605.1.28), set March as the only enrollment month for Structured Family Caregiving, and make consumer-directed employers responsible for GCHEXS background checks. Since April 2026, the RN must live in Georgia, not just be licensed here.
From September 1, 2026, SFC providers need internal auditing, accreditation from the National Committee for Quality Assurance (NCQA), EVV, daily note review and GCHEXS checks for all caregivers. Existing providers have until September 1, 2027. New providers from March 31, 2027 must have everything at application.
The Live Scan form LIC 9163 (11/25) now has a required applicant signature line confirming the applicant read the privacy notices. The clearance and exemption transfer forms (LIC 9182, LIC 9188) were reworded, with one form per facility number. CDSS recommends starting each background check in Guardian before the applicant goes to a Live Scan vendor.
DHCS told Medi-Cal health plans that network providers must be enrolled in Medi-Cal and hold a written agreement that meets new requirements. Plans must bring agreements into line at the next renewal or by December 31, 2027, whichever is earlier.
The updated policy (rule 59G-4.261, in effect since July 2, 2026) covers family home health aide services for up to 12 hours a day and 40 hours a week for a child getting private duty nursing. The 2024 version said up to 8 hours a day. The 2026 family home health aide fee schedule still says "up to 8 hours per day."
Each Medicaid health plan must verify at least 85% of paid personal care and home health visits with EVV, without overriding exceptions or entering claims by hand. HHAeXchange's January 2026 refresher says any change made to a visit makes it non-compliant, and missed visits must be reported right away.
Agencies serving Community Care Program and Home Services Program customers must use the free HHAeXchange system or send visits to it from their own vendor. Agency administrators in HHAeXchange get a "Know Your Numbers" compliance report on the 15th of every month. The free version does not do billing, so keep your current billing process.
The draft adds a check of the Adult Protective Services (APS) abuse registry for all provider staff, and says background check results go into IDoA's Training Tracking Portal. It says 2 of a homecare aide's 12 yearly training hours must be dementia training, and updates grievance procedures. It is a draft and is not in effect yet.
For individual providers who need a license to enroll (servicing, billing, attending, prescribing, supervising and operating providers), claims pend for up to 4 weeks when the license on file in NJMMIS is not current, and then deny.
The state minimum wage has been $13.73 since January 1, 2026 and goes to $15.00 on January 1, 2027. The Improved Workforce Opportunity Wage Act covers employers with 2 or more employees age 16 or older. Covered employees who are not exempt must be paid 1-1/2 times their regular rate for hours over 40 in a workweek.
Since May 1, agency owners must make sure every agency caregiver completes CHAMPS revalidation and is actively enrolled while giving Home Help. Since August 1, audits and new agency compliance reviews use forms HS-2601 (caregiver list, marking approved live-in EVV exemptions), HS-2602 (submission checklist) and HS-2603 (payroll template, for agencies without a payroll company), and new agencies must send a current W-9. Audited agencies have 30 calendar days to send documents.
MI Coordinated Health (MICH) replaced MI Health Link on January 1, 2026. In Regions 1, 8, 10 and 12, a Home Help client who enrolls in a MICH plan gets personal care from that plan from the first day. The plan must finish a criminal history review of the caregiver within 30 calendar days and may pay only CHAMPS-enrolled agencies.
NC Medicaid's home health policy no longer limits skilled nursing to 75 visits a year or home health aide services to 100 visits a year. The amendment also moved the quality assessment and performance improvement (QAPI) and infection control requirements into a note in Section 7.0.
NC Medicaid changed the adult age for State Plan personal care from 21 to 18. It also added a note: an annual reassessment may be done by telephone if the beneficiary agrees; if it doesn't lead to a denial, reduction or termination, a face-to-face assessment must follow within six to eight months.
HHSC's rates for personal attendant services in PHC, CAS, FC, CFC, PCS, STAR+PLUS and other programs now support an average attendant wage of $13.00 an hour, plus 14% or 15% for payroll taxes and benefits and $0.24 an hour more for administration. The personal attendant base wage requirement and the Attendant Compensation Rate Enhancement (ACRE) program ended August 31, 2025. HHSC will use cost reports to calculate each provider's direct care wage and benefits expense ratio and report providers below 0.90 to state leaders; there is no recoupment.
Senate Bill 463 (2025) extended the workplace violence program law to every HCSSA category, including PAS-only agencies, that employs two or more registered nurses (anyone with a current RN license who gets a W-2 from the agency, whatever their job). Newly covered agencies had to adopt and implement the program by September 1, 2026: a committee that includes a direct-care RN, a written prevention policy and plan, yearly training, and a yearly review of the plan.
Home care agencies, including referral and matching services, will need a 3-year license from EOHHS. EOHHS must adopt rules within 1 year of the Act's effective date and issue temporary licenses within 180 days of it; EOHHS must give one to any applicant verified as currently contracted with an ASAP or MassHealth. The deadline to be licensed is a date EOHHS sets, no later than 1 year after the rules. The rules will cover background checks, service contracts, insurance, training, emergency plans and yearly reporting.
MassHealth proposed adding EVV requirements for all home health services and a value-based payment service to 130 CMR 403, and removing the statement of fiscal soundness. The current home health manual we hold (HHA-55, July 1, 2022) does not yet show these changes.
The state's alternate EVV specification changed its payer, program and service code combinations and added a new Mass General Brigham SCO ASAP program. The July webinar says visits with a service code that is not on the in-scope list do not import, so they cannot match a claim.
WSR 26-04-110 raised the fees in WAC 246-335-990. A new license now costs $5,000 for each service category (was $3,283). Standard two-year home care renewals are $2,400 to $3,700 by FTE count (were $1,530 to $2,408), or $1,700 to $2,600 for agencies under contract with and monitored by DSHS or an AAA that meet DOH's substantial-equivalency requirements. The old renewal rule for agencies with more than one service category (the full home health or hospice fee plus 75% of the fee for each other category) was removed. A change of ownership now costs $500 per service category (was $350), and the late fee of $50 a day now tops out at $1,000 (was $650).
Under a 2025 law, DOH extended the home care aide certification deadline from 200 to 365 days from hire, or 425 days (instead of 260) with a provisional certificate, which is for workers with limited English. It applies to applications submitted by December 31, 2027. The 120-day training deadline and the 14-day application deadline did not change.
Increases in the state home care agency vendor rate may be used only for the wages, benefits and related employer costs of workers who give direct care. Starting July 1, 2027, DSHS or its designee will verify spending, and each agency must submit an independent third-party audit or a written attestation from the workers' union.
A court order stopped the move to new ALTCS-EPD contracts, so AHCCCS extended its contracts with UnitedHealthcare Community Plan, Banner-University Family Care and Mercy Care through Sept. 30, 2026. In September 2025 AHCCCS ended that procurement, and in February 2026 it asked for input on an upcoming ALTCS E/PD request for proposals. AHCCCS's ALTCS E/PD contract amendment, effective Oct. 1, 2026, extends the contract through Sept. 30, 2027. The copy we hold leaves the contractor name blank, so it doesn't name the plans, but it still auto-assigns members among three plans in the Central area and two in Pima County.
The revised policy drops the state-sponsored EVV system (all providers now buy their own) and adds the live-in caregiver rule already in AMPM 1240-A: record each live-in and their relationship to the member within 30 days of hire or change. In December 2025, AHCCCS said this rule was being added to the health plans' yearly quality monitoring.
AHCCCS is seeking feedback on proposed exempt rulemaking for the Home and Community Based Services (HCBS) Needs Tool (HNT) and the Extraordinary Care Review (ECR) process for ALTCS members. Its draft waiver renewal (posted July 23, 2026) asks CMS to let ECRs of children's attendant care and habilitation hours take longer than the usual deadline for service decisions, and to keep the Parents and Spouses as Paid Caregivers models.
TennCare's protocol, citing state law (Tenn. Code Ann. § 71-5-1414), lets members in CHOICES, ECF CHOICES, the 1915(c) waivers and Katie Beckett direct and supervise a paid aide doing certain health care tasks, such as giving medicines. Taking part is optional for agencies. Agencies opt in through a survey the plans or DDA run twice a year. TennCare's FAQ says there is no additional payment on top of the service rate. PSSA agencies licensed by DMHSAS need a waiver from DMHSAS.
TennCare's LTSS Training Operational Protocol sets onboarding, pre-service (30 days) and core (60 days) training for staff in the 1915(c) waivers, ECF CHOICES and Katie Beckett. CHOICES-only agencies must give initial and ongoing training on listed topics, including EVV, and the health plans check this at credentialing and recredentialing.
CMS approved amendments to the H&W, TBI, PathWays, CIH and Family Supports waivers, effective Aug. 1, 2026. FSSA removed the proposed lower rate for Attendant Care given by live-in caregivers (Bulletin BT202673) and rescinded that bulletin. For H&W, relatives and legal guardians can now be paid only for certain services, and each can be paid for no more than 40 hours a week across Attendant Care, Home and Community Assistance and Skilled Respite.
Under House Enrolled Act 1277, HCBS waiver providers must give a member or guardian the service delivery records on request (up to once a quarter) and a plain-language itemized statement of services billed (up to twice a year). You must complete each request within 30 calendar days.
MDH explained its compliance audit process for RSAs in CFC and CPAS: complaint to OHCQ, desk review and site visit, a plan of correction after repeated problems, then suspension and withheld payment. Providers that don't respond get suspended after three outreach attempts. You have 15 calendar days to answer a plan of correction.
The CNA law took effect April 1, 2026. CNA/GNA certificates became CNA-I, and CNA certificates became CNA-II; the home health designation no longer exists. Certificate numbers did not change. CNA-IIs can work in any setting except nursing facilities.
The state's EVV vendor specification now says modifier order matters: visits with modifiers in the wrong order will be rejected. It also updates Healthy Blue's service descriptions (MOBCBS is replaced by MOHB) and adds a recommendation for handling overnight visits.
ForwardHealth now decides on a PA request when it is first submitted. If the plan of care has only verbal orders, it may approve up to 20 business days. To get the full period, send a PA amendment with the signed plan of care within 20 business days.
Providers of base wage services had to file the 2026 Base Wage Attestation and Workforce Report by August 31, 2026. The September bulletin says HCPF will publicly identify providers that didn't file and begin suspending their claim payments until it gets the report. The minimum base wage is $17.00 an hour statewide ($18.17 in Edgewater, $19.29 in Denver).
Fee-for-service claims for 14 high-risk services, including CFSS, adult companion, individualized home supports, integrated community supports and night supervision, go through pre-payment review by Optum. Claims may be held for up to 90 days. Separately, DHS and CMS may ask for records on flagged claims after payment, and you have 15 days from the notice to send them.
PCA and CFSS agency rates now depend on each worker's tier (Base, then Levels 1 to 4 by hours of experience). DHS said it would reprocess claims for Jan. 1 to Feb. 12, 2026 that include a Level 1 to 4 worker, with reprocessed claims appearing from March 24 through April 2026. Agencies must document that at least 72.5% of PCA and CFSS revenue goes to worker wages and benefits.
Medica's updated Elderly Waiver billing guide adds a second payer ID as part of the UCare to Medica transition. Claims for former UCare MSC+ members use payer ID 71890 from Oct. 1, 2026, and Medica MSC+ claims move to 71890 from Jan. 1, 2027. Payer ID 94265 stays for Medica MSHO (Dual Solution), and for Medica MSC+ through Dec. 31, 2026. Paper claims for 71890 go to Medica, PO Box 211435, Eagan, MN 55121, and electronic payments for 71890 come through InstaMed instead of Optum Pay.
DPH replaced Regulation 60-122 in full. New sections cover SLED checks and drug tests for the people who sign the application, policies and insurance, infection control, client rights and disaster plans. It also updates caregiver drug testing, training and incident reporting (24 hours, with a written report in 5 days). Fees are $1,000 for the first license and $800 to renew.
CMS approved both five-year renewals, retroactive to July 1, 2026. In answers to provider questions (sent online and at its March 2026 webinars) printed in the renewal, SCDHHS said no EVV updates had been made and no scope changes had been announced, and that policy updates will be issued at least 30 days before they start.
LDH has paused Medicaid enrollment of new home health agencies, hospices and DME suppliers for six months, through December 17, 2026. It will deny initial enrollments, changes in majority ownership that need a new enrollment, and new branch or practice locations. Health plans may not add these providers to their networks. Providers already enrolled before June 18 are not affected. LDH may ask CMS to extend it.
Since December 1, 2025, LDH checks fee-for-service claims for home health and EPSDT personal care against EVV records: service code, dates and member. Claims without a matching EVV record get edit codes such as 370 (no EVV record) or 518 (worker not registered in EVV).
LDH's EVV policy now says the owner or executive director must sign the attestation for providers using a third-party EVV system every year. The form says it should be signed annually, and again whenever ownership or the executive director changes.
Healthy Blue's Medicaid health plan contract ends December 31, 2026. Its members can pick a new plan from October 15 to November 16, 2026, or are assigned one, effective January 1, 2027. The new plan honors Healthy Blue prior authorizations for up to 60 days, or until they end if sooner, and may not deny one only because you are out of network. Healthy Blue keeps taking claims within its 365-day timely filing allowance.
DMS will stop accepting phone, fax and mail prior authorization requests. Providers must use the Essette Provider Portal, reached through a KYID account, for members in fee-for-service Medicaid; home health and private duty nursing both need prior authorization. First-time users must complete training. Reconsideration and hearing requests can still go by mail. DMS's 2023 letter said the portal excludes 1915(c) waiver providers, who use MWMA.
Oversight of participant-directed services is moving from DAIL to each waiver's operating agency in phases, expected to be complete by January 1, 2027. HCB stays with DAIL. Critical incidents, mortality reviews, inability to access services and involuntary terminations were set to move to the operating agencies in MWMA on July 1, 2026.
The Legislature passed a cost-of-living increase for in-home care agencies and other community providers. The contracted in-home care agency rate went from $39.40 to $40.40 an hour for July 1, 2026 to June 30, 2027.
ODHS added Agency with Choice as a new Medicaid in-home option. The provider, GT Independence, co-employs caregivers the client picks and handles hiring paperwork, background checks, payroll and training. Case managers are asked to describe it to people who have no caregiver or who are not using all their authorized hours. It is open only to people on certain benefit plans (not Oregon Project Independence). In-home care agencies remain an option.
Senate Bill 537 led to new rules for home health agencies. From May 1, 2026, each agency needs a workforce violence prevention program: safety risk questions at intake, annual safety training, quarterly safety assessments, a way for staff to do safety checks, and a flagging system for potential threats.
Since October 1, 2025, home health care, home health aide and hospice agencies must report each year each instance of threatening verbal abuse, physical, sexual or other abuse by a client or any other person against a staff member, and what the agency did to keep the staff member safe. A separate report of workplace violence incidents is due by February 1 each year. DPH wants the abuse report through its FLIS web portal, not on paper or by fax.
OHCA is replacing the state-sponsored EVV system with Acumen, using DCI software, which will also be the state's EVV data aggregator. Agencies can move to DCI or use another compliant vendor that sends data to the DCI aggregator. Health plan providers are not affected and stay on HHAeXchange. The slides give no go-live date.
OHCA says it has cut its backlog of contract actions by nearly 40% and expects normal processing times by mid-October. Some claims were denied because contracts were not in place on time; OHCA will set up a process to resubmit those claims, if appropriate, and will share who is eligible.
Iowa HHS plans to replace the Health and Disability, Children's Mental Health, AIDS/HIV and Physical Disability waivers with two age-based waivers on October 1, 2026. Attendant care, nursing and home health aide services are not offered on the Children and Youth waiver; children get them through EPSDT (Iowa Care for Kids). The Elderly, Intellectual Disability and Brain Injury waivers stay for now.
Under 2026 House File 2782, rates increase from October 1, 2026 for Attendant Care (S5125) and Skilled Attendant Care (S5125 U3) on six waivers, Home Maintenance Support (S5130) on the AIDS/HIV, Elderly and Health and Disability waivers, and Elderly Waiver assisted living (T2031).
Chapters 73 (managed care), 77 (who may enroll), 78 (covered services), 79 (provider policies), 83 (waivers) and 90 (case management) were amended throughout. Chapter 77 lists who may provide attendant care and home maintenance. The enrollment rule 79.15 was changed again by an emergency rule on Aug. 10, 2026.
DHS no longer certifies State Plan personal care, ARChoices attendant care or ARChoices respite providers. New providers must be licensed by the Department of Health as a private care agency before they enroll. Current providers must get an ADH license and submit it when they revalidate or re-enroll.
DHS proposed replacing the Personal Care manual. Optum would do an Evaluation Referral, your registered nurse would do the functional assessment, and prior authorizations would last 12 months. The 64-hour monthly cap stays for adults. After comments, DHS said it is putting the original rounding and unit rules back in.
DMS proposed new EVV rules in Section I of the Medicaid manual. Agencies file an EVV Declaration Form (DMS-9654), put each worker's PIN on claims, and use place of service 12. More than 10% non-compliant visits over three months triggers a corrective action plan.
The FBI part of a fingerprint-based check on the state's online system goes from $12.00 to $15.00. With the $1.00 service fee, the website will show $16.00.
Nevada Medicaid removed the language that kept providers from submitting initial personal care requests, so they can go straight to the QIO-like vendor. Chapter 2600 (intermediary service organizations) also removes the PCS Independent Contractor model as obsolete. Both chapters now use the name "Nevada Medicaid".
EVV claims are no longer routed through Optum. Payers have new claim payer IDs: NVMED (Medicaid fee-for-service), MLNNV (Molina), 76342 (Health Plan Nevada UHC), 000265 (Anthem) and 68069 (Silver Summit). Sandata users need no action beyond authorizing Sandata to receive 835 files. Alternate EVV users must update payer IDs with their billing vendor. Denials for EVV error codes 3802, 3807, 3808, 3809 and 3810 became informational, and claims denied April 1 to 10, 2026 were reprocessed (remittance advice dated May 15, 2026).
Following a CMS moratorium that began May 13, 2026, Nevada Medicaid put a six-month temporary moratorium on new enrollment of home health agencies (HHAs) and hospices, from June 11, 2026. No end date is printed: six months from June 11, 2026 unless extended. New applications are denied during the moratorium. Revalidations, changes of ownership and updates to existing enrollments are not affected. An exemption can be requested for areas with access-to-care concerns.
The Aging Waiver rate for agency personal attendant services (T1019) went from $7.17 to $9.30 per 15 minutes. Homemaker (S5130) went from $8.42 to $9.00, companion (S5135) from $6.62 to $8.25 and unskilled respite (S5150) from $6.01 to $8.25.
T1019 personal care is now reported in 15-minute units instead of one unit per hour. The rural add-on (modifier TN) is capped at 1.75 times the rate. In July 2026 Medicaid also clarified the manual's wording on where the rural add-on applies.
OL's Personal Care Agency inspection checklist now includes the 2026 law changes, enforceable from May 20, 2026. H.B. 472 requires critical incident reporting across human services, health facility and child care programs. The checklist also covers parents' access to children's medical records (H.B. 259) and the life-sustaining treatment order rule R432-31, updated May 7, 2026. Under that rule, if a client has an order, a personal care agency must make sure a copy is left in the home.
The Community Support Waiver serves people with I/DD who need fewer supports than the comprehensive I/DD waiver, within a $20,000 yearly cost cap. It includes personal care, respite and other services. KMAP added 29 provider specialties for enrollment dates on or after September 1, 2026. Agency-directed personal care is enrolled as a home health agency (provider type 55, specialty 584), and EVV is mandatory for it.
FE personal care S5130 and S5125 UA are now $7.50 per 15 minutes. PD personal care S5125 U9 and S5125 UA are $7.25 per 15 minutes. The bulletin also lists new FY2027 rates for many I/DD services. KMAP notes that the plans may put state policy in place on a different date.
Because of FBI changes on handling criminal history records, the MSDH Background Check Unit reviews all healthcare rap sheets and makes the final employment eligibility decision. Waiver letters are discontinued for new rap sheets processed on or after July 1, 2026. The change is not retroactive.
DOM moved general provider enrollment requirements into Part 200 and revised Part 208 Rule 1.3 (E&D Waiver provider enrollment), Part 215 (home health) and Part 223 (EPSDT, including personal care). It also revised the Part 208 chapters for the Independent Living, Assisted Living and TBI/SCI Waivers, including provider qualifications and the rules on paying family members, and removed the Bridge to Independence chapter.
The 2026 legislature funded a 5.8% increase for Community Benefit personal care. HCA raised its recommended rates for 99509 and T1019 by 5.8%, effective July 1, 2026. It told the health plans to reprocess claims no later than September 1, 2026. Plans that pay below the recommended rates must tell HCA.
New Mexico's EVV is now an open (hybrid) system. Agencies can keep using AuthentiCare at no cost, or pay for another vendor that sends visits through the AuthentiCare Data Aggregator. Switching is optional. Conduent must approve your declaration and attestation forms before testing.
Emergency services, law enforcement and environmental hazard incidents no longer go to the HCA MAD Critical Incident Portal unless they involve abuse, neglect, exploitation, misuse of restraints or seclusion, or a provider's medication error that leads to a poison control call, an emergency room or urgent care visit, a hospital stay or death. Insufficient staffing is reportable only in narrow cases. Agencies report within 24 business hours.
Before each participant's next eligibility year, the service coordinator reviews high use; when waiver and state plan costs together exceed the limit, the coordinator works with the participant to bring services below 175% of the institutional cost limit. The renewal limits Personal Care and LRI Personal Care (care by a legally responsible individual, such as a spouse or the parent of a minor child) to 40 hours a week combined for live-in caregivers, and Personal Care, LRI Personal Care and Companion to 70 hours a week combined for other caregivers; the state can approve exceptions for immediate health and safety needs. Waiver payments move from NFOCUS to the state's web-based case management system.
MLTC published chapters one to five of a new provider manual, which supersedes earlier manuals and bulletins. At your next annual renewal or five-year revalidation, you sign an updated agreement to follow it. For HCBS providers, a missed revalidation closes the agreement and can't be backdated.
BMS published a new Chapter 501. Changes in the change log include: personal attendants must be 'awake and alert', the Conflict-of-Interest Assurance form must be signed at the start as well as every year, parents of minor children were taken off the list of legally responsible persons, and new rules on who may give personal attendant training. BMS also published its answers to public comments.
BMS replaced Chapter 513 for the Intellectual/Developmental Disabilities Waiver. The change log adds a new skilled nursing medication administration service, changes how often case managers must see members in person, and says the IDD-10 discharge form is due to the UMC within 10 business days of the discharge date.
BMS raised rates for ADW, TBI, IDD and Personal Care services. ADW personal attendant and Personal Care direct service went from $6.36 to $6.75 per 15 minutes. BMS asked agencies to update their billing systems and the rates in HHAeXchange.
The state plans to add geofencing to all procedure codes that require EVV. It has not set a start date. The EVV team planned a survey of agencies in June and a town hall on Aug. 17.
The ALI, APDD, CCMC and IDD waivers were renewed. For ALI and APDD, SDS is moving from the Consumer Assessment Tool (CAT) to the Alaska Home Care Tool over about a year; an enrolled participant found ineligible on the new tool is reassessed with the CAT. Host care homes can now be respite providers, and the waivers clarify which services a relative or legally responsible person may provide.
Waiver and personal care agencies named on the list must send an annual financial report to the Office of Rate Review within 8 months of their fiscal year end. This year every listed agency files a reduced report. Agencies not on the list don't file this cycle.
If you don't send records to the DMMA Surveillance and Utilization Review (SUR) Unit within 45 days and can't be reached, the claims get a "technical denial" and the money is recouped within 7 days. You then have 10 days to send what's missing.
Med-QUEST's fee-for-service HCBS rates took effect for services from January 1, 2026. Compared with the 2025 memo, homemaker (S5130) rose from $6.13 to $9.32, attendant care (S5125) from $16.32 to $23.34 and home health aide or CNA care (S9122) from $7.28 to $12.17, each per 15 minutes. Personal care (T1019) stays at $13.28. Health plan rates may differ from these amounts.
QI-2605 replaces the 2021 code list (QI-2125). Three home health therapy codes (S9131, S9128 and S9129) are removed from EVV. Five new personal care code combinations were added for agencies using the neighborhood model of care. All EVV authorizations and claims must use the Appendix A codes and modifiers, and claims must match an EVV visit before they are paid.
Personal Assistance Agencies must update their NPI taxonomy to In Home Care Supportive Care, 253Z00000X, before updating their Medicaid account or going through revalidation.
The Idaho Department of Health and Welfare (DHW) added a line to the Medicaid Provider Agreement: the provider certifies it is materially compliant with Chapter 25, Title 56 of Idaho Code. Providers who enrolled or revalidated before July 1 must sign the updated agreement at their next opportunity. It also applies to providers under contract with the health plans.
BLTC listed electronic visit verification (EVV) patterns that should prompt a review: sudden jumps in hours, end-of-month hour spikes, services logged during school hours for school-age children, overlapping schedules, and GPS check-ins from a caregiver's home or other job. It warns that ignoring warning signs can lead to corrective action or a referral to the Medicaid Fraud Control Unit.
Chapter 129 took effect August 20, 2024, and agencies were given time to comply step by step. In August 2025 DLC said it was beginning to inspect agencies as they reach the end of provisional licensure. Its August 11, 2025 notice says an agency needs a physical site in Maine, and that the rule does not allow virtual sites or sites shared with another personal care agency.
The Chapter 108 rule requires a license for agencies that give DHHS-funded services, including personal care, home support and respite, to adults with an intellectual disability, autism spectrum disorder, a related condition or an acquired brain injury. It began as an emergency rule adopted September 3, 2025.
SLTC published a new EVV policy (612) for the agency-based CFC/PAS manual. It confirms live-in caregivers must use EVV and that IVR needs prior approval, with shifts scheduled ahead. The agency administrator must verify attendant hours before billing, and the agency must verify any manual edits to visits. Agencies that don't fix EVV problems in time can be barred from admitting new members or disenrolled.
Newly enrolling home health, hospice and nursing facility providers are now "high" risk and revalidating ones "moderate" risk. SLTC will visit them before enrollment or revalidation can be finalized.
The Primary Care Montana program began July 1, 2026, and Passport to Health ended June 30. Claims for dates of service after June 30 no longer need a Passport referral ID; earlier dates still do. Other rules on medical orders and prior authorization still apply.
When authorized hours are reduced, the member gets 30 business days' notice, and current hours stay in place for at least 30 business days from the denial letter. It applies to all home health services, including private duty nursing, visiting nursing, LNA, Personal Care Attendant and Personal Assistant services.
Members could change plans during open enrollment. New plan coverage started September 1, 2026. The three plans are AmeriHealth Caritas New Hampshire, NH Healthy Families and WellSense Health Plan.
ND Medicaid put a temporary moratorium on new QSP agency and DD agency enrollments in Burleigh and Cass Counties, and on new NEMT agencies statewide, citing a heightened risk of fraud, waste or abuse. Agencies already enrolled are not affected. Applications already in the final approval stage on June 11 continue; applications that had not reached final approval by then will be denied.
HHS's rate sheet effective July 1, 2026 lists agency rates of $9.59 per 15 minutes for personal care, homemaker and respite and $9.28 for companionship and supervision, plus rural differential rates for QSPs who travel at least 21 miles round trip. The sheet doesn't show the earlier rates, so we can't say what changed.
The amendment brings in rate changes approved by the legislature, allows quarterly case manager monitoring by phone, and clarifies provider qualifications for Family Personal Care, Supervision and Waiver Personal Care. Live-in relatives who meet the rule's definition of family member cannot provide Waiver Personal Care or Supervision, even when an agency hires them; they provide Family Personal Care instead.
Medicaid Provider Enrollment will not approve new Severely Disabled Nursing Homecare (Type 65), Personal Care Aid/Assistant (Type 72), home health or hospice providers during this six-month freeze. Existing providers, and applications sent before July 1, are not affected.
EOHHS ended its care management program with RIPIN. Home care agencies no longer get RIPIN referrals. People who need non-LTSS home care refer themselves with an order from their practitioner, and agencies can start once the person is enrolled in the program in the Health Care Portal. Existing clients continue as authorized.
OHA At Home Cost Share prior authorizations now come in one-week segments (Sunday through Saturday) instead of monthly. S5125 (personal care only) and S5130 (homemaking) can now be billed as well as S5125 U1.
CMS asked every state for a two-year provider revalidation strategy. South Dakota Medicaid is ending enrollment for providers inactive 24 months or longer, screens all providers monthly, and will contact you by email first if it needs information. A new enrollment system, SD PECS, is expected to go live at the end of 2026 or early 2027, and revalidation will then be done in it.
DHS LTSS issued an HCBS Provider Enrollment Manual covering business location standards, the self-assessment, good standing, change of ownership and Therap accounts. Providers must be in good standing, with no open corrective action plans or unresolved EVV or documentation problems.
At the request of the U.S. Department of Health & Human Services, Vermont Medicaid is revalidating high-risk providers off-cycle, starting July 1, 2026. High-risk includes home health agencies for five years after they first enroll or after a change in ownership. About 300 enrolled providers are affected, and Gainwell will notify them. Selected moderate-risk provider types come next.
Vermont Medicaid raised home health, high-tech nursing and pediatric palliative care rates by 3.5% for state fiscal year 2027, effective July 1, 2026. The new rates are on the Vermont Medicaid fee schedule.
The District's living wage rose to $18.40 an hour on July 1, 2026. DHCF kept personal care and home health aide rates at $30.76 an hour ($7.69 per 15 minutes), still built on a $21.11 direct support professional wage.
Every DC Medicaid provider must give people with limited or no English free, timely language services, including a real-time phone interpreter for scheduling. You may not require clients to bring their own interpreter, or require minors or untrained people to interpret. For health plan members, request services through the plan; for fee-for-service clients, through DHCF's vendor, Context Global. Noncompliance can lead to sanctions or termination of Medicaid enrollment.
VDH has proposed a full rewrite of 12VAC5-381, including a $2,000 initial license fee. On June 10, 2026, the Attorney General's office returned the proposal to VDH, asking for more information. It has not been published for public comment, and the current chapter does not include these changes.
The state posted a draft renewal of the ACT waiver with a 30-day public comment notice.
HHS adopted HIPAA standards for health care claims attachments transactions and a standard for electronic signatures used with them. The rule took effect May 26, 2026; compliance is required by May 26, 2028.
DOH revised its procedure for adding or deleting services and counties, adding sites and changing names. License closures now go through a separate regional office process instead. Requests go to LHCSA-Amend@health.ny.gov with the revised Attachment A checklist.
OLTL's July 1, 2026 fee schedule for the OBRA Waiver and Act 150 shows the same agency PAS (W1793) and agency respite (T1005) rates as January 1, 2026. Participant-directed PAS rates (W1792 and W1792 TU) were raised, retroactive to January 1, 2026, to fund a wage increase for workers, subject to federal approval of an OBRA Waiver amendment.
PA Health & Wellness (PHW) is paying a retention bonus to participating home care agencies. Agencies must pass 100% of the worker bonus funds to eligible workers serving PHW participants (less employee-related taxes), and PHW will audit this. The program period runs through 2026. The attestation deadline was July 31, 2026.
OAC 5160-12-03 says Medicaid home health services come from Medicare-certified home health agencies licensed by ODH. Give 30 days' written notice before ending services, except in listed cases.
DCH will not accept Certificate of Need applications for new or expanded home health services in the current batching cycle. Its next assessment of need is on or around September 30, 2026.
DCH proposed renewing ICWP for July 1, 2026 to June 30, 2031. It adds a Determination of Need-Revised screening (score of 15 or higher) and telehealth assurances, and says current policy and practice will not change. The comment period closed March 16, 2026.
DHCS has proposed that health plans tighten rules on the concurrent referral to IHSS and on authorizing hours beyond those IHSS approves, and set minimum enrollment requirements for all Community Supports providers. It is a proposal, with savings estimated from the 2026-27 budget year.
The California Department of Aging revised the MSSP Site Manual. Vendor contracts must include EVV self-registration and ongoing compliance, and the minimum age for MSSP services moved from 65 to 60.
AHCA scheduled a hearing on rule 59A-18.018 (nurse registry emergency management plans) for September 10, 2026, to be held if someone asked for one. A draft of the planning criteria form (AHCA Form 3110-1017, March 2026) is posted.
AHCA posted a draft update to Form 3110-1011. It adds questions on serving only pediatric patients, the home health aide for medically fragile children program, and licensing exemptions under s. 400.464(6)(b).
HFS says it plans to explore EVV claim edits across Illinois Medicaid programs and health plans, but has not started. Agencies will get advance notice and training first. Claims without visit data already count against your quarterly EVV rate.
The Department of Health postponed the call for home health care applications scheduled for July 1, 2025 while it surveys home health agencies. It will publish either a call or a cancellation in the New Jersey Register. The 2022 call was cancelled because the Department found no need for more home health services.
MDHHS said it would ask CMS to add Coordinated Caregiving (structured family caregiving) to MI Choice, with a proposed daily rate of no less than $80.80 and at least 70% going to the live-in caregiver as a stipend. The letter gave an anticipated effective date of July 1, 2026. The same amendment updates the waiver's EVV language to reflect that EVV is now operational and required. The documents we hold do not show CMS approval.
The N.C. Medical Care Commission proposed readopting five rules on the Health Care Personnel Registry, medication aides and Nurse Aide I training (10A NCAC 13O). DHSR's June 1 notice said no substantive changes were proposed. The Commission approved the rules on August 14, 2026, and sent them to the Rules Review Commission, which lists them for its September 29, 2026 meeting. Its filing log marks the definitions rule (.0101) as "readopt with changes" and the other four as without changes, with approval recommended for all five.
MassHealth no longer covers services by any one PCA over 60 hours a week, and caps authorized meal preparation at seven hours a week unless more is authorized.
Eligible people can now use WA Cares benefits, up to $36,500 over a lifetime (adjusted for inflation), for services that include in-home personal care. Benefits are paid to long-term services and supports providers registered with DSHS, and licensed in-home services agencies are one kind of provider. Qualified family members may be paid through a licensed home care agency.
The revised policy says a decision on requested services must be made within seven calendar days of the request (three business days when the member's health is at risk). The current policy allows 14 days.
The protocol covers CHOICES, ECF CHOICES, Katie Beckett, the 1915(c) waivers and ICF/IID. Tier 1 events go to the DDA Abuse Hotline within 4 hours, with a Reportable Event Form within 1 business day. Tier 2 events need a Reportable Event Form within 1 business day.
Medicare crossover claims are excluded from EVV. When commercial insurance pays first and TennCare second, the health plans pay their contracted rate and then recover from the other insurer, until TennCare announces a lasting fix. You still record the visit in EVV.
In February the IHCP said Attendant Care and Home and Community Assistance providers would need a PSA license from March 25, 2026. In May it withdrew that: a PSA license or a home health agency license is accepted for new enrollments and recertifications. Either license must stay current, and you must upload the renewed license before the old one expires.
From October 1, 2026, some immigrants lose Medicaid eligibility. From January 1, 2027, expansion adults aged 19 to 64 face work requirements and six-month renewals, and retroactive coverage is shortened.
19 CSR 30-82.060, which lets people with disqualifying criminal findings apply to DHSS for a waiver so they can be hired, was amended. A listing on the Employee Disqualification List still can't be waived.
For dates of service from Jan. 1, 2026, personal care (T1019) pays $6.26 per 15 minutes and a home health RN or LPN visit (99600) pays $117.86.
HCPF planned to send amendments to nine waivers to the federal Centers for Medicare & Medicaid Services (CMS) on September 11, 2026 and will ask for a January 1, 2027 start. They include new caps on assistive technology and medical equipment, and removal of the Class A license requirement for Brain Injury waiver Supported Living and Transitional Living programs.
DHS stopped accepting new 245D license applications and new service lines from Jan. 1, 2026, and canceled pending applications; the moratorium is expected to last until Dec. 31, 2027. Separately, from Jan. 27, 2026, DHS froze new Medicaid enrollments in 13 service categories it identified as high risk for fraud; DHS's January list of 13 high-risk services includes CFSS and PCA agencies and companion care. The freeze was initially slated to last six months, with exceptions where more capacity is needed, and the documents we hold don't say whether it was extended. Current providers can keep serving their clients.
Alternative Care (AC) members can no longer get PCA after 11:59 p.m. on March 31, 2026. They must move to CFSS, another AC service or informal supports.
Adult members of the CC, HIV/AIDS and Vent waivers were moved into managed care for medical services, including home health and incontinence supplies. Personal care, companion, respite and other waiver services are still authorized and paid fee-for-service through Phoenix.
DMS announced a 4% cut to many provider rates, including home health and the HCB, Michelle P., SCL and Model II waivers, from August 1, 2026. On July 23 it said the cut has been reversed and rates stay at current levels. DMS calls this a temporary solution.
Under House Bill 2 (2026), people on the HCB or Michelle P. waitlist who want to stay on it must send a Provider Attestation signed by a physician, physician assistant, advanced practice registered nurse (APRN) or licensed psychologist by January 31, 2027. People already getting waiver services are not affected.
The most-cited items in the first half of 2026 were client records, caregiver orientation, service plans, caregiver training and medication administration. OHA also warns that agencies cannot refuse or reschedule a survey, and that training logged in a single day must be backed by payroll showing the full hours.
DSS plans to renew the Acquired Brain Injury (ABI) I waiver, which now runs until December 31, 2026. The draft's proposed effective date is January 1, 2027. The one substantive change is adding agency-based Personal Care Assistance, which the ABI II waiver already offers.
DSS raised rates by 4.9% for many CHCPE, ABI, PCA, Mental Health and Autism waiver services, including agency homemaker, companion, chore, personal care and respite codes, and for home health aide codes T1004 and T1021.
OHCA no longer asks for a separate attestation under Executive Order 2025-16. Enrolled providers complete it through their regular OHCA contract renewal.
Providers may send contract applications to OHCA and credentialing requests to the plans together. Plans can't finish credentialing until OHCA issues a provider ID, and they pay 90% of the rate until credentialing is done.
CDAC is now Attendant Care and Skilled Attendant Care; homemaker and chore are now Home Maintenance Support. Iowa Medicaid stopped enrolling individual CDAC providers; members chose agency attendant care or the Consumer Choices Option.
The private care rule would drop DHS certification and regional office language, add registry checks, cover contracted workers, and let caregivers who already finished the training skip repeating it. The home health rule would add exemptions for PACE programs and for agencies that give only therapy not paid under Medicare Part A. The background check rule update covers definitions, proof of checks, applicants and employees, and applications.
The State Board of Health raised many license fees. The personal care agency fee stays at $1,374 to apply and $687 to renew. Employment agencies for nonmedical services go to $1,498 and $749. ISO certificates go to $2,940 and $1,470. Home health home offices go to $5,530 and $2,765.
KDHE plans three separate licenses (skilled home health services, HCBS and supportive care services). The draft would also narrow supportive care work, for example no lifts and no setting oxygen flow. Current skilled agencies would get a one-time chance to add an HCBS or supportive care license with no initial fee. Feedback closed October 31, 2025.
E&D personal care and in-home respite now pay $6.24 per 15-minute unit, and adult day care pays $4.93. In HHAeXchange, set the visit rate to the hourly $24.96, not the unit rate.
HCA posted an updated Turquoise Care Managed Care Policy Manual (its web address says "Effective August 11, 2026"). Section 4 (Care Coordination) and Section 8, which holds the personal care agency and attendant requirements, show August 11, 2026 revision dates. The documents don't say what changed.
Personal assistance stays at $3.75 per 15 minutes. The home health fee schedule was reissued with no increase because the state made no rate increase appropriations.
DDA reissued the provider policy manual for the developmental disabilities (DD) waivers.
The Office of Inspector General approved changes to the WV CARES rule (71CSR11) and filed them with the Legislative Rule-Making Review Committee. The proposal lets people ask for a variance when they apply, and sets decision times: 30 days if the request comes after an ineligible finding, 60 days if it comes with the application. The current rule is still in force.
The FY27 rate charts raise personal care to $9.30 per 15 minutes and waiver respite to $9.09 per 15 minutes. Separately, the state took comments until July 30, 2026 on a Medicaid state plan amendment for its 2026 annual rate update.
Applications for personal care agencies and home health agencies now include an addendum requiring you to follow EVV rules when providing services, submitting claims and reporting changes.
The 2025 home health fee schedule sets home health aide services at $10.48 per 15 minutes, and RN and LPN services at $49.07 per 15 minutes.
DMMA reminded providers to keep records that back up every claim for at least five years, including the date, authorization, service given and its amount and duration. Money for services your records don't support must be paid back.
The Department of Labor and Industrial Relations approved Med-QUEST's request to keep letting health plans pay self-directed personal assistance providers up to 15 days after the pay period ends, through July 20, 2027. From January 1, 2026, those providers are paid twice a month. A terminated provider must be paid no later than the next working day.
From October 1, 2025, MQD no longer offers Sandata-issued smartphones. Those phones were used by 0.5% of caregivers on the Sandata mobile app. MQD is re-procuring the EVV contract; the other options (FOB device, landline, or the app on a personal or company device) stay in scope.
Non-exempt Idaho Medicaid fee-for-service rates were cut 4% for dates of service from Sept. 1, 2025. The amended release lists PAA rates for PCS and Attendant Care ($6.11 per 15 minutes) among the exempt rates. Providers in health plan networks should check their plan fee schedule.
A rate study for Sections 12, 18, 19, 20, 29 and 96 proposes, for example, $16.96 per 15 minutes for Section 19 agency personal care (now $8.61). The draft rates include inflation through January 2027. Putting them in place depends on legislative funding, rulemaking and federal approval, and final rates may be lower or higher.
DHHS posted a draft of a new waiver for people with intellectual disabilities or autism spectrum disorder, with a proposed start date of October 1, 2026. We do not hold a document showing that it has been approved.
Because of projected budget shortfalls, DPHHS will not make legislatively authorized provider rate adjustments in state fiscal year 2027, except those required by statute, federal rules or CMS fee schedules. Separately, DPHHS posted proposed July 1, 2026 fee schedules for services including Community First Choice, personal care, the Big Sky Waiver and home health, and pays from them starting July 1.
Paid and partly paid EVV claims must be adjusted inside Mobile Caregiver+, or the visit and claim details fall out of sync. CFC has a new CG modifier for members whose caregiver is a legally responsible individual.
The manual now uses the Bureau of Adult and Aging Services (BAAS) name, updates non-covered services and service authorization sections for the new He-W 530 rules (adopted May 19, 2026), and explains service authorization when Medicaid is the secondary payer.
Four sections of NDAC 33-03-10.1 were amended: definitions, governing body, quality assessment and performance improvement, and nursing services. The rule text we hold does not show what changed.
North Dakota's draft amendment adds a Host Home service, revises provider qualifications for Extended Home Health Care and updates the rules on paying relatives. The draft gives no comment deadline. Its proposed effective date has passed, and we don't hold an approved version.
Neighborhood INTEGRITY for Duals, a fully integrated dual-eligible special needs plan (FIDE-SNP), replaced the INTEGRITY Medicare-Medicaid Plan. Existing Medicare-Medicaid Plan members were set to move to it automatically. The plan covers long-term services and supports, and its contract requires personal care and home health providers to use EVV.
On the HOPE Waiver, personal care and homemaker went from $11.02 to $11.17 per 15 minutes, adult companion, chore and respite from $10.66 to $10.81, RN nursing from $22.88 to $23.20 and LPN nursing from $19.07 to $19.34. The State Plan personal care fee schedule lists the same in-home rates.
Eligibility changes for qualified noncitizens take effect by October 1, 2026. From January 1, 2027, new Adult Expansion applicants must meet work (community engagement) requirements, retroactive coverage is limited to 1 month for Adult Expansion applicants and 2 months for everyone else (now 3), and Adult Expansion adults renew every 6 months (current enrollees from their first renewal starting March 2027). DSS will hold a webinar on medical frailty on November 4, 2026.
A new or re-enrolling provider can request an effective date up to 90 days before a complete application is accepted, or up to 90 days in the future. Enrolled providers can ask for 90 to 180 days back with a separate form, sent within 90 days of approval. Claims for the backdated period still have to meet timely filing rules.
Vermont Medicaid no longer requires prior authorization for home health physical, occupational and speech therapy, whatever the member's age or condition. A doctor's referral is still required for home health therapy.
New EPD Waiver providers must attend an information session, send a letter of intent and apply through PDMS within 90 days. DHCF's enrollment vendor, Maximus, will make site visits before and after enrollment for all EPD Waiver providers, including existing ones. DHCF is also rebuilding its DC Care Connect case management system under a 12-month contract that started February 1, 2026.