Provider Notice Issued 06/24/2022
- The date of COVID-19 diagnosis or suspected diagnosis on a completed HFS 3801 or other documentation; or
- The date the emergency medical application is received by the Department of Human Services or the Department of Healthcare and Family Services
- Facility name providing service
- Attending physician contact information
- Physician's statement identifying the dates of service being reviewed (beyond the 120th day through the end of the COVID-19 illness/treatment)
- The admission history and current physical examination from the current facility
- 1-2 page clearly readable summary of care delivered at the facility including a plan for further care
- Copies of all progress notes and test results within the past one week, and
- HFS 3801 Report of Medical Treatment (if available).
Date: June 24,2022
To: All Medical Assistance Program Providers
Re: Emergency Medical Coverage for Persons Not Meeting Immigration Status with COVID-19 Diagnosis
This notice details the requirements for extending emergency medical coverage for persons aged 19 and older who do not meet immigration status and have a COVID-19 diagnosis or suspected diagnosis.
Emergency medical coverage for a person with a COVID-19 diagnosis or suspected diagnosis is initially authorized for 60 days. The coverage period begins the earlier of:
Providers requesting coverage for a COVID-19 related individual must email the application to HFS.firstname.lastname@example.org.
If additional coverage is needed beyond the initial 60 days, the provider must email a request for the extension.
If extended coverage is needed beyond 120 days, the provider must email the request to the address above. Providers may request continued extended coverage at 60-day intervals. The following medical documentation is required:
Questions regarding this notice may be directed to the Bureau of All Kids at 866-255-5437.
Kelly Cunningham, Administrator
Division of Medical Programs