KMAP BULLETIN: Reminder Member's Written Consent Required

Date: 01/26/26

The Medicaid program reminds providers to submit the member’s written consent with an appeal of denied or reduced services, durable medical equipment (DME) or medication. A federal Medicaid regulation at 42 C.F.R. § 438.402(c)(1)(ii) requires that a provider have a member’s written consent to submit an appeal of an adverse decision that denies or reduces a service, DME or medication. Over the past few years, this requirement has been inconsistently enforced.

Effective March 1, 2026, providers will be required to submit the member’s written consent with an appeal of denied or reduced services, DME or medication. Providers submitting an appeal of a denied or reduced service, DME or medication to Healthy Blue, Sunflower and UnitedHealthcare® should ensure the affected member’s written consent is submitted to the health plan with the appeal.

After March 1, 2026, an appeal of a denied or reduced service, DME or medication submitted to Healthy Blue, Sunflower and UnitedHealthcare® by a provider without a member’s consent will not be processed as an appeal. The health plan will issue an acknowledgement of the appeal in a letter. The letter will inform the provider the appeal could not be processed without written proof of the member’s consent. The health plan will process the provider’s submission as an appeal if the member’s written consent is submitted during the appeal filing period of 63 calendar days following the date of the health plan’s adverse benefit determination notice.

Note: The effective date of the policy is March 1, 2026. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.