News & Announcements

To continue delivering high quality care in every market we serve, Kaiser Permanente is making thoughtful plan adjustments to ensure our Medicare program remains sustainable for 2026 and beyond. These changes include the closure of some plans effective January 1, 2026

The purpose of this article is to explain the scope of these changes so providers can help support our members through this transition.

Members with plan closures
A subset of individual Medicare plan members across Maryland, Virginia, and Washington, D.C. will be affected by plan closures and must re-enroll in a new Kaiser Permanente Medicare plan by December 31, 2025 to avoid gaps in KP Medicare Advantage coverage and continue seeing their providers. Kaiser Permanente will continue to offer Medicare Advantage plans in all counties of our current Medicare service areas.

What Providers Need to Know

• Member Communication Timeline: As of October 1, 2025, members are receiving information about these changes through letters, calls, and emails with instructions to re-enroll. Providers should be ready for member questions because of this outreach.
• Enrollment Deadlines: All affected members must re-enroll by December 31, 2025, to maintain uninterrupted coverage.
• Re-enrollment Options: 
  • Online: kp.org/medicare 
  • Phone: (877) 370-8714
• Providing Support: Providers should be prepared to direct members who have Medicare health plan questions or are ready to enroll to visit kp.org/medicare or call Kaiser Permanente at (877) 370-8714 (TTY 711)
• Providers will not be expected to proactively communicate with patients about these changes.

Kaiser Permanente recognizes the critical role that providers play in helping members navigate these transitions and minimizing any potential disruption in care. Thank you for supporting Kaiser Permanente’s ongoing commitment to providing our members with integrated, high-quality, and sustainable care.

Kaiser Permanente is excited to announce the upcoming launch of a new DSNP for members who are dually eligible for Medicare and Medicaid in Maryland. Available starting January 1, 2026, the DSNP offers benefits that are specifically targeted to dual eligible members, ensuring that they receive coordinated care and comprehensive support.

For members enrolled in this DSNP, Medicare will be the primary payer for most medical services. Medicaid will assist with any remaining costs as a secondary payer, including Medicare deductibles and copayments, depending on eligibility. Providers may not collect any copay or coinsurance from these members at the point of service and should bill Medicaid for any listed cost-shares, as applicable.

In addition to the copay collection requirements, providers are required to complete the DSNP Model of Care training by December 31, 2025. These training materials will detail the specifics of the DSNP, including eligibility requirements, coordination of benefits, cost-sharing, and billing procedures.

Upcoming Actions and Key Dates

• Plan Launch: The new DSNP will be open for applications starting on October 15, 2025. The first DSNP members will be effective in Maryland on January 1, 2026. The plan will be available to new Kaiser Permanente members as well as existing members who meet eligibility criteria.
• Provider Notification: On October 31, 2025, Kaiser Permanente will send Medicare contracted providers an official announcement about the new plan.
• Provider Training: The required SNP Model of Care 2025 Training will be included in the October mailing.
• Provider Manual Updates: At the end of the year, Kaiser Permanente’s provider manuals will be updated with information about the DSNP ahead of its launch.

We encourage all providers to verify beneficiary eligibility and consult the forthcoming training materials for further details. As always, if you have any questions about a member’s eligibility, please contact Member Services at 800-777-7902.

We look forward to partnering with you to deliver exceptional care to our dually eligible members in the Mid-Atlantic region.

Effective October 15, 2025, the Virginia Department of Medical Assistance Services (DMAS) will require the “unbundling” or specification of the number of units requested for each type of ABA service.

As a result of this change, providers will no longer be able to request authorizations for the total number of units for any ABA services under the 97155 CPT code. Instead, providers will be required to submit service authorizations that include units for each separate treatment procedure code (97153, 97154, 97155, 97156, 97157, 97158, and 0373T).

DMAS has released a new ABA Initial Service Authorization Request Form with updated instructions to support this change. Providers can find this form on the “Provider Resources” page of the DMAS website. While existing authorizations will continue through the authorization end date, all new authorizations with start dates of October 15, 2025, or later must be requested using the new form.

DMAS will be mailing ABA providers the details of this change directly, and more information can be found on the “Medicaid Memos & Bulletins” page of the DMAS website.

As a reminder, for prior authorizations related to Virginia Medicaid, Kaiser Permanente follows DMAS’ guidelines, as established in the Behavioral Health Redesign for Access, Value, & Outcomes (Project BRAVO). More information about Kaiser Permanente’s ABA processes can be found in the ABA chapter of our provider manuals, accessible on the “Provider Information” page of our Community Provider Portal.

We are pleased to announce the launch of the Kaiser Permanente Attestation Portal, a streamlined and efficient platform designed to simplify your attestation processes for validating provider information. This portal offers a user-friendly interface for submitting and managing your 90-day provider demographics attestations with ease and accuracy.

Outlined below are several resources detailing the features and functionalities of the Attestation Portal:

• Kaiser Permanente Attestation Portal Introductory Video
• Kaiser Permanente Attestation Portal Guide

Should you have any questions about the Attestation Portal or other Online Affiliate features, please visit the Online Affiliate Support Site at https://kpnationalclaims.my.site.com/support/s/

Thank you for your continued partnership and commitment to maintaining accurate provider information. We look forward to working with you to streamline and enhance our processes.

Members have the right to free language services for health care needs. We provide free language services including:

• 24-hour access to an interpreter: When members call to make an appointment or talk to their personal physician, if needed, we will connect them to a telephonic interpreter.
• Translation services: Some member materials are available in the member’s preferred language.
• Bilingual physicians and staff: In some medical centers and facilities, we have bilingual physicians and staff to assist members with their health care needs. They can call Member Services or search online in the medical staff directory at kaiserpermanente.org.Braille or large print:
  Blind or vision impaired members can request for documents in Braille or large print or in audio format.
• Telecommunications Relay Service (TRS): If members are deaf, hard of hearing, or speech impaired, we have the Telecommunications Relay Service (TRS) access numbers that they can use to make an appointment or talk with an advice nurse or member services representative or with you.
• Sign language interpreter services: These services are available for appointments. In general, advance notice of two or three business days is required to arrange for a sign language interpreter; availability cannot be guaranteed without sufficient notice.
• Educational materials: Health education materials can be made available in languages other than English by request. To access Spanish language information and many educational resources go to kp.org/espanol or kp.org to access La Guía en Español (the Guide in Spanish). Members can also look for the ñ symbol on the English language Web page. The ñ points to relevant Spanish content available in La Guía en Español.
• Prescription labels: Upon request, the KPMAS pharmacist can provide prescription labels in Spanish for most medications filled at the Kaiser Permanente Pharmacy.

At Kaiser Permanente, we are committed to providing quality health care to our members regardless of their race, ethnic background or language preference. Efforts are being made to collect race, ethnicity and language data through our electronic medical record system, HealthConnect®. We believe that by understanding our members’ cultural and language preferences, we can more easily customize our care delivery and Health Plan services to meet our members’ specific needs.

Currently, when visiting a medical center, members should be asked for their demographic information. It is entirely the member’s choice whether to provide us with demographic information. The information is confidential and will be used only to improve the quality of care. The information will also enable us to respond to required reporting regulations that ensure nondiscrimination in the delivery of health care.

We are seeking support from our practitioners and providers to assist us with the member demographic data collection initiative. We would appreciate your support with the data collection by asking that you and your staff check the member’s medical record to ensure the member demographic data is being captured. If the data is not captured, please take the time to collect this data from the member. The amount of time needed to collect this data is minimal and only needs to be collected once. Recommendation for best practices for collecting data is during the rooming procedure.

In conclusion, research has shown that medical treatment is more effective when the patient’s race, ethnicity and primary language are considered.

To access organization wide population data on language and race, please see our Diversity & Inclusion Annual Report*.

To obtain your practice level data on language and race, please email the Provider Relations Department at Provider.Relations@kp.org.

All of our medical plans are located in Maryland, Virginia, or the District of Columbia or is a Federal plan. Each jurisdiction has unique guidelines for billing claims such as member balance billing. Be sure to know the member’s plan situs to ensure appropriate claim processing.

Finding the situs of a member’s plan is simple. Locate the member’s plan name when verifying the member benefits in Kaiser Permanente Online Affiliate. The plan name is under Coverages & Benefits. The Payor/Plan name will contain one of the following as part of the plan name:

• Maryland or MD
• Virginia or VA
• District of Columbia or DC
• Federal or FD (Maryland guidelines apply to Federal plans)

Some examples of what you will see online are:

• Payor/Plan
  • MAS KP-MEDICAID MCO MARYLAND / MD MEDICAID PLAN (20325) 0718
  • MAS KP-MID ATLANTIC / VA KPIF ON HCR HMO SILVER $15/$40 (3787
    

If you are uncertain about the situs of a member’s plan, please contact our Member Services Call Center at 1-800-777-7902.

If you are not registered for access to Kaiser Permanente Online Affiliate, you may register online at kp.org/providers/mas.