The Centers for Medicare and Medicaid Services (“CMS”) recently released a Frequently Asked Questions “FAQs” document, to provide guidance to state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies responding to the 2019 coronavirus (“COVID-19”) outbreak. The questions in the FAQ document were generated by state Medicaid leads, and cover a range of topics. The answers highlight the resources available to states to address policy and program topics related to eligibility, enrollment, cost sharing, healthcare workforce and telehealth.
The FAQ document covers a number of topics, including:
Emergency Preparedness and Response: CMS has developed a Disaster Preparedness Toolkit which outlines strategies available to support operations and enrollees in times of crisis. It also describes the section 1915(c) Home and Community-Based Services (HCBS) waivers to be used during times of emergency.
Eligibility and Enrollment Flexibilities: CMS notes that states have the ability to add additional eligibility groups or populations to their Hospital Presumptive Eligibility (“HPE”) program. In addition, states are excused from the timeliness standards for processing applications due to emergencies beyond the agency’s control.
Benefit Flexibilities: States can add Live in Caregiver as a service, which authorizes family members to be providers, if a Medicaid beneficiary already requiring an institutional level of care is quarantined in the community. In addition, states have broad flexibility to cover telehealth through Medicaid, including various communication methods. Providers can be reimbursed for telehealth services at the same rate as for in-person services.
Cost-Sharing Flexibilities: States can submit a request to stop charging copayments, but that cannot be applied narrowly to only those individuals affected by a particular diagnosis. Rather, the exemption would apply to everyone who accesses a particular item or service.
Financing Flexibilities: At any time, states can submit a request to CMS for additional funding. In addition, CMS will work with a state to ensure continued funding even if the state cannot comply with the relevant grant award filing deadlines.
Workforce Flexibilities: States can expand healthcare provider qualifications to add additional providers (including to family members) and services, as well as temporary rate adjustments for those providers. States can apply to amend payment methodologies to account for increased costs in personal protective equipment (“PPE”) for home care workers.
Managed Care Flexibilities: CMS is encouraging states to take advantage of the flexibility to deliver care via telehealth. States have the flexibility to establish prior authorization and drug utilization review processes to permit extended day supplies and early refills of medication for emergency situations.
1115 Demonstration Flexibilities: A state may request to temporarily amend a demonstration, and if a state submits a demonstration amendment, a full public notice is not required.
In a press release, CMS Administrator Seema Verma noted that “[t]he Trump administration is actively working with governors to provide flexibility in Medicaid and CHIP programs, so states can respond effectively to this virus …. We are especially mindful of our beneficiaries with underlying health conditions that make them more vulnerable. CMS is doing everything its power to help states eliminate any barriers or delays in their care.”
CMS also encourages state agencies to continue to submit questions. As new questions are received, they will be answered and added to the FAQ document.