Health Law Daily Medicaid and CHIP agencies get answers relating to coronavirus concerns
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Friday, March 13, 2020

Medicaid and CHIP agencies get answers relating to coronavirus concerns

By Rebecca Mayo, J.D.

CMS has published FAQs relating to issues raised by Medicaid and CHIP agencies about how to handle challenges relating to COVID-19.

State Medicaid and Children’s Health Insurance Program (CHIP) agencies have some discretion in how to handle challenges arising out of the 2019 Novel Coronavirus (COVID-19) outbreak. CMS has provided some guidance to state agencies by publishing Frequently Asked Questions (FAQs) that cover a range of topics, including eligibility and enrollment, how to handle quarantined beneficiaries, flexibility in benefits and access to care, and how to handle staff and technology shortages. States are encouraged to look at existing resources such as the Disaster Preparedness Toolkit developed by CMS specifically for state Medicaid and CHIP agencies to address a variety of policy and program topics. In a recent press release, CMS has indicated that it is working directly with impacted states and associations to provide guidance and answer questions about existing federal flexibilities, and it will continue to address questions and issues as they come into CMS.

Eligibility and enrollment. States have the authority to add additional Medicaid eligibility groups or populations (if covered by the state) to their Hospital Presumptive Eligibility program. States may also utilize Appendix K of the section 1915(c) waiver application to temporarily increase individual eligibility cost limits, modify service, scope, or coverage requirements, exceed service limitations, add services to the waiver, provide services in out-of-state settings, and/or permit payment for services rendered by family caregivers or legally responsible individuals.

States are excused from meeting the timeliness standards for processing Medicaid and CHIP applications due to an administrative or other emergency beyond the agency’s control, such as COVID-19. There is also flexibility in meeting the timeliness standards for renewing Medicaid eligibility during these times. A state plan amendment (SPA) is not required for either of these delays, but the reason for the delay or exception should be documented in the applicant’s or individual’s case record.

Quarantine. Access to Medicaid services provided in an individual’s private home or group residential setting should not change because the beneficiary is quarantined, however a SPA may be necessary to amend language to clarify where services may be provided. States have broad flexibility to cover telehealth through Medicaid and no federal approval is needed to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services. However, a SPA would be necessary if any changes are made to payment methodologies. States have flexibility to establish and manage prior authorization processes for supplies and prescription drugs without CMS approval, however a SPA may be needed if there is a change in the quantity of a prescription drug dispensed.

Access to care. Rural health clinics (RHCs) may serve as originating sites for telehealth services furnished by a remotely located "distant site" health care provider, but are not authorized to furnish telehealth services as distant site health care providers to provide services to residents in the rural communities. The test for the detection of COVID-19 is coverable under Medicaid’s mandatory laboratory benefit and if the state’s current Medicaid cost sharing policies include cost sharing for the test, the state can submit a SPA to eliminate cost sharing for that test. A state may also submit a SPA to stop charging copayments for particular items or services in Medicaid, however this could not be applied narrowly to only those affected by a particular diagnosis, such as COVID-19. Instead, a state may request section 1115 authority to temporarily suspend copayments only for individuals needing treatment for COVID-19 infection.

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