2026
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Maryland Medicaid to Cover Cell and Gene Therapy for Sickle Cell
Disease Starting January 1, 2026, Maryland Medicaid will cover FDA-approved cell and gene therapies for sickle cell disease through the CMS Cell and Gene Therapy (CGT) Access Model. Maryland Medicaid will cover the full care journey for eligible participants, including evaluation, apheresis, infusion, recovery, and long-term follow-up at authorized treatment centers. For more information please click here (embed remediated PDF into link) Providers are encouraged to discuss this option with eligible patients. Clinical criteria and additional resources are available on the Maryland Medicaid CGT webpage
Introducing Aetna® Prior Authorization Bundles for Oncology
We’re pleased to announce Aetna Better Health Prior Authorization (PA) Bundles for Oncology. This offering enables providers to request oncology and imaging services together, streamlining the existing process and eliminating the need for separate submissions. Please click here for more information on Prior Authorization Bundles for Oncology
2025
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As of January 1, 2025, Mental Health and Substance Use member benefits have transitioned to Carelon. They will be the main point of contact for all member
and provider behavioral health needs. The following are the contact details:
Phone Number: 1-800-888-1965
Language assistance services: 1-800-888-1965 TTY: 711
Address:
7550 Teague Road, Suite 500
Hanover, MD 21076
Direct Emails for provider support are as follows:
Provider inquires: provider.relations.md@carelon.com
Utilization management: UMcorrespondenceMD@carelon.com
Case management inquires: casemanagementMD@carelon.com
It is vital that the release of information is signed in order coordinate care between medical and behavioral health providers. The following link to the ROI are available here:
Carelon behavioral health forms and documents
If a member is in a behavioral health crisis the following resources are available:
Behavioral Health Walk-In & Urgent Care Centers Resource Guide (PDF)
Designated psychiatric emergency facility list (PDF)
In addition, *988 is available 24/7 to members instant crisis support as well as CHAT support
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The EPSDT medical record review is conducted annually for Aetna Better Health of Maryland® to ensure the health plan meets the MDH-established compliance threshold of 80% for each component in the following categories: Health and Development History, Comprehensive Physical Examination, Laboratory Test/At-Risk Screenings, Immunizations, and Health Education/Anticipatory Guidance. Please click here to review opportunities for improvement (PDF) for each component category.
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2024
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Aetna Better Health of Maryland would like to make you aware of the opiate prescribing patterns of Value Based Solution providers patients as a way to help coordinate care between your primary care patients and any specialist in play. You can review the following notice of trends which have been identified (PDF).
Beginning May 1, 2024, a change to pharmacy benefits will include a copay for prescriptions for some medications, as directed by Maryland Medicaid:
Non-formulary brand-name - $3
Formulary brand-name - $1
Generic formulary and non-formulary - $1
Antiretroviral for the treatment of HIV/AIDS brand/generic - $1
Excluded from all pharmacy copays are:
Members under age 21
Members who are pregnant
American Indian tribal members
Members receiving a "short fill" (3-day supply) for emergency services
Members receiving hospice care
Members receiving family-planning activities
Members in long term care (LTC) facilities, skilled nursing facilities (SNF) and assisted living facilities
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