Provider Notice issued 05/11/2023

This notice provides information regarding COVID-19 Disaster State Plan Amendment (SPA) services that are impacted by the end of the COVID-19 public health emergency (PHE). The PHE is scheduled to end on May 11, 2023. Some Disaster SPA flexibilities will end on May 11, 2023 and others will be amended or extended for one year, as noted below. This provider notice applies to fee-for-service and managed care.

Disaster SPA Flexibilities – Ending May 11, 2023

The following Disaster SPA flexibilities will end on May 11, 2023, with a return to regular operations on May 12, 2023:

·         Partial benefit COVID-19 uninsured eligibility group. Federal authority for the eligibility group is limited to the PHE. Additional detail is provided in the Uninsured Population Special COVID-19 Coverage Ends May 11, 2023 provider notice posted on May 9, 2023.

·         Waiver of signature requirements for prescription drugs.

·         Exceptions to the Preferred Drug List due to shortages.  Additional detail is provided in the Pharmacy – Resumption of Billing Policies at COVID-19 Public Health Emergency End provider notice published on May 3, 2023.

·         Automatically renewed prior authorizations without clinical review or time/quantity extensions. Additional detail is provided in the Resumption of Prior Approval Requirements at Public Health Emergency End provider notice published on April 4, 2023.

·         Reimbursement of lab processing for self-collected home tests approved by the Food and Drug Administration (FDA) without order or referral.

·         Payment of enhanced rates to COVID-19 designated facilities of $350 per day for isolation and quarantine and $620 per day for ventilator services.

Disaster SPA Flexibility – Amending Effective May 12, 2023

The following Disaster SPA flexibility will end on May 11, 2023:

·         Elimination of the resource test for the Aid to the Aged, Blind, and Disabled (AABD), Health Benefits for Workers with Disabilities (HBWD), and Medicare Savings Program (MSP) eligibility groups.

The Department has requested to amend its pre-PHE policy effective May 12, 2023:

·         Rather than reinstating the resource test to the pre-PHE levels of $2,000 for an individual and $3,000 for a couple, the Department has requested a resource test of $17,500 effective May 12, 2023 for the AABD eligibility group.

The Health Benefits for Workers with Disabilities (HBWD) and Medicare Savings Program (MSP) eligibility groups have pre-PHE resource test levels above $17,500 and will return to their pre-PHE resource test levels on May 12, 2023.

Regular SPA approval is required to maintain the $17,500 resource test beyond May 11, 2024 for the AABD eligibility group.

Disaster SPA Flexibilities – One Year Extension to May 11, 2024

The Department has requested that CMS extend the following flexibilities without change through May 11, 2024 for customers covered under the Medical Assistance Program:

·         Reimburse virtual check-in and e-visit codes, including reimbursement outside of encounter rates. Additional telehealth information is provided in the Continuation of Telehealth Flexibilities at COVID-19 Public Health Emergency End provider notice posted on May 9, 2023.

·         Reimburse COVID-19 tests, specimen collection, and antibody tests at the Medicare rate.

·         Reimburse COVID-19 vaccine administration at the Medicare rate.

·         Reimbursement COVID-19 monoclonal antibody treatment and administration at the Medicare rate.

·         Reimburse oral antivirals for the treatment of COVID-19 obtained from an enrolled pharmacy at the Medicare rate.

·         Reimburse COVID-19 specimen collection outside of the encounter rate.

·         Reimburse COVID-19 vaccine administration outside of the encounter rate.

·         Presumptive eligibility (PE) for the ACA Adults, Parent and Caretaker Relatives, Former Foster Care, and Pregnant Women, and Children eligibility categories increased to two times per calendar year.

·         Suspend premiums for the Health Benefits for Workers with Disabilities (HBWD) program.

·         Allow COVID-19 tests in non-office settings, such as parking lots.

A regular SPA is required to continue any of the policies above beyond May 11, 2024. 

Related COVID-19 Policy Extensions

Medicaid will continue to cover at-home COVID-19 tests billed through Medicaid participating pharmacies in accordance with Section 9811 and 9821 of the American Rescue Plan Act. Additional details are included in the Emergency Instructions for COVID-19 Home Test Kits provider notice published January 26, 2022.

Pharmacies will continue to be qualified providers of COVID-19 vaccinations, licensed pharmacists employed by an enrolled pharmacy are qualified to order and administer COVID-19 vaccines, and pharmacy technicians and pharmacy interns employed by an enrolled pharmacy may administer COVID-19 vaccines when ordered by the supervising licensed pharmacist in accordance with the HHS COVID-19 Public Readiness and Emergency Preparedness Act Declaration and authorizations.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

Kelly Cunningham, Administrator

Division of Medical Programs