Attachment I - Planned Medicaid Policy Updates Memo_02.10.2026.docx

Joe Lombardo Governor

NEVADA HEALTH AUTHORITY

NEVADA MEDICAID

4070 Silver Sage Drive Carson City, Nevada 89701

NVHA.NV.GOV

Stacie Weeks, Director

Ann Jensen, Administrator

Request for Proposal for Medicaid Managed Care Organizations Attachment I —Planned 2026 Medicaid Policy Updates Memo

STATE OF NEVADA

DEPARTMENT OF ADMINISTRATION

Solicitation 41NHA-S3708 For Medicaid Managed Care Organizations Release Date: 02/12/2026 Attachment I — Planned Medicaid Policy Updates Memo

Consistent with its mission, the Division of Nevada Medicaid within the Nevada Health Authority is continuously improving and enhancing the State’s Medicaid Program. This RFP attachment is intended to provide Vendors with a list of policy updates and operational refinements that the Division expects to implement prior to or during the term of any Contract pursuant to this RFP. These changes have not yet been codified in the Attachment E—Scope of Work or Medicaid Services Manual (MSM) as either (1) they require approval from the Centers for Medicare and Medicaid Services (CMS), or (2) the Division is in the process of defining the specifics of the requirement.

1. Consolidated Appropriations Act of 2023 Section 5121 requirements and 1115 Waiver Application for Pre-Release Services: The Consolidated Appropriations Act of 2023 (CAA) Section 5121 requires Medicaid to cover services for certain justice-involved populations. Nevada Medicaid has received Medicaid state plan approval but is working with CMS to receive Children’s Health Insurance Plan (CHIP) State Plan Amendment(SPA) approval to provide pre- and post-release case management, screening and diagnostic services for eligible youth who are under age 21. Aged out foster youth up to age 26 who are post-disposition for 30 days prior to their release also may qualify. Nevada Medicaid has submitted a 1115 waiver application to provide a targeted set of pre-release services to individuals transitioning from incarceration to the community. The 1115 waiver application requires CMS approval and will allow Nevada Medicaid to receive federal Medicaid matching funds for pre-release services provided to Medicaid-eligible individuals in carceral facilities. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

2. Medicaid Health Homes: Nevada Medicaid has received state plan approval to include coverage for health home services provided to Medicaid recipients with fetal alcohol spectrum disorder (FASD). A new Medicaid Service Manual (MSM) Chapter 4200 has also been created to align with the newly approved benefit. A new Provider Type 85 Specialty 320 is in development for the Health Home Provider. Health home services will be reimbursed fee-for-service by Nevada Medicaid, but MCOs will be expected to provide identification, referrals, and care management for their Members who qualify for health home services.

3. Behavioral Health Training Clinics: Nevada Medicaid has submitted a State Plan Amendment (SPA) on December 19, 2025 to add a new Medicaid benefit for Behavioral Health Teaching Clinic Services through Nevada accredited universities. Medicaid will reimburse Nevada accredited university clinics at a per diem rate for providing mental and behavioral health services rendered by trainees. These proposed changes will have an effective date of October 1, 2025. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

4. Community Residential Mental Health Services (CRMHS): In compliance with requirements approved in Assembly Bill 514 during the 83rd Legislative Session, Nevada Medicaid plans to add coverage and reimbursement for Rehabilitative Residential Mental Health Care under Community Residential Mental Health Services. It is a similar concept to current Nevada residential substance use disorder services for the low intensity residential setting. CRMHS will be facilities not considered Institutions for Mental Disease (IMD). They must be community-based, in a group home setting with a 16-bed limit, serving as a short-term rehabilitative step down from the more structured Psychiatric Residential Treatment Facility (PRTF). They can also be used as a step up from community rather than placing within a PRTF initially. Unlike PRTFs, CRMHS facilities can provide services to help the adult population too. Nevada Medicaid submitted a SPA to CMS on December 22, 2025 and is developing a new provider type specialty under Provider Type 63 for CRMHS providers. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

5. Coordinated Specialty Care for Medicaid Beneficiaries experiencing their first episode of psychosis: Nevada Medicaid submitted a SPA on September 30, 2025 to include coverage for Coordinated Specialty Care for beneficiaries experiencing their first episode of psychosis. Coordinated specialty care (CSC) is the standard of care for treatment for individuals, typically in late adolescence to mid-20s experiencing their first episode of psychosis (FEP). It is an evidence-based, recovery-focused, team-based early intervention model that promotes access to care and shared decision-making among specialists, the person experiencing psychosis, and family members. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

6. Assertive Community Treatment: Nevada Medicaid submitted a SPA on September 30, 2025 to include coverage for Assertive Community Treatment (ACT) for individuals with serious and persistent mental illness. ACT is a team-based, community-focused treatment approach that provides comprehensive psychiatric treatment, rehabilitation, and support. Its goal is to improve functioning and help individuals remain in their communities, avoiding inpatient treatment. ACT services are delivered assertively, meaning team members go above and beyond to support and empower individuals to achieve their goals. It is a service-delivery model, not a case management program. ACT is designed for individuals with the most severe and persistent symptoms of mental illness, who struggle with basic daily activities, safety, self-care, and maintaining safe and affordable housing. These individuals require intensive interventions that traditional, less intensive services have not effectively addressed. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

7. Peer Service Expansion: Nevada Medicaid recently expanded access to peer support services through the addition of Family Peer Support and Youth Peer Support. Nevada Medicaid received approval of a SPA define these specifics andto increase the reimbursement rates across peer support specialties. A new MSM Chapter 4300 was developed along with a new Provider Type 97 for non-clinical peer support agencies. Implementation of this expanded access and increased rates for Peer Services will require participation from the contracted MCO when approved by CMS.

8. 1115 Waiver Amendment for Housing Supports & Services and psychiatric treatment for individuals with Serious Mental Illness (SMI) in an Institution for Mental Disease (IMD): Nevada Medicaid has submitted an amendment to the 1115 Substance Use Disorder Demonstration Waiver to seek additional Section 1115 waiver authority to add housing supports and services along with other health-related social needs as a Medicaid waiver benefit for adults with serious mental illness and substance use disorder. Additionally, this amendment seeks to add psychiatric treatment in an IMD for individuals with SMI for up to 30 days. If approved, these would be mandatory benefits to be covered by Nevada Medicaid and incorporated into the managed care program.

9. Crisis and Planned Respite Services: Planned for implementation beginning July 1, 2027, crisis and planned respite services are services provided to a child or youth in order to provide temporary or short-term relief to the usual caregiver and deliver all the necessary care that the usual caregiver would provide during that period. The primary purpose is to provide relief to family members/caregivers, help de-escalate stressful situations and provide a therapeutic outlet for the child so that they can remain in their current living situation. Respite may be either planned or provided on an emergency basis and can be used as day, evening, or overnight care to meet a range of needs. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

10. Intensive Care Coordination and Wraparound Facilitation Services: Planned for implementation by July 1, 2027, Nevada Medicaid plans to develop a new benefit for intensive care coordination and high-fidelity wraparound services. Intensive Care Coordination is a service that coordinates all formal and informal supports and services delivered to a Child in the Focus Population. Intensive Care Coordination includes development of the Plan of Care and referral and linkage to and coordination with appropriate services, based on the Comprehensive Assessment and the Plan of Care. Wraparound Facilitation is a benefit that facilitates comprehensive care planning and coordination for a Child in the Focus Population. The benefit is based on a structured approach to service planning and coordination and includes the following service components: (1) meetings with Child and Family Teams for assessing needs in support of the service delivery process; (2) state and local provider and agency collaboration to develop the supports to ensure the Child's success in the home and community; and (3) strengths-based planning and facilitation to assist the Child and Family Team with the Child’s care. Implementation of this new coverage program will require participation from the contracted MCO when approved by CMS.

11. Prior Authorization Standardization: Nevada Medicaid plans to establish standards for prior authorization forms across managed care and fee-for-service in order to reduce administrative burden associated with prior authorizations. Once developed, MCOs will be required to implement the new standards and utilize any required forms and documentation. Additionally, prior authorization process reform is occurring to implement new state legislation (AB463).

12. Adult Dental Expansion: Effective July 1, 2026, Nevada Medicaid will expand dental benefits for the adult population. The current dental benefits for adults are on a palliative care model and the expansion will be aligning the adult benefits with those of the pregnancy and child populations. The new adult benefits will have $1000 per year, per recipient monetary cap.

13. Non-Emergency Medical Transportation (NEMT) in Rural Regions: Nevada Medicaid is taking the necessary steps to “carve in” NEMT services into managed care for rural service areas. MCOs will be responsible for providing adequate access to NEMT services for Members living in rural regions of the state with this change. MCO members who live in the urban Clark and Washoe County service areas will receive NEMT services through the State’s single NEMT vendor and not the managed care program.

14. Value-Based Payment (VBP) Standardization: Nevada Medicaid plans to release additional standards for VBP models to reduce provider administrative burden associated with participating in multiple payment models that utilize different outcomes.

This list is not an exhaustive list of the policy updates or operational changes that Nevada Medicaid will implement prior to or during the term for any Contract pursuant to this RFP.

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