Temporary Changes to Medicaid during COVID Outbreak

As I mentioned in an earlier post, the Centers for Medicare and Medicaid (CMS) and the Trump Administration are reducing certain regulatory requirements for Medicare and Medicaid to better help medical providers and states respond to and stop the spread of the 2019 Novel Coronavirus Disease (COVID-19). This is in response to President Trump’s declaration of a national emergency due to COVID-19 on March 13th. Specifically, the Secretary of Health and Human Services (HHS) is now allowed to waive certain program requirements for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These are called 1135 Waivers because they are waiving certain requirements under Section 1135 of the Social Security Act.

The following changes to Medicaid rules and policies have been enacted by the State of Florida’s Agency for Health Care Administration (AHCA) and the Department of Children and Families (DCF).

1.     Medicaid Recertification Extension – Medicaid recipients who have an annual re-certification due in April or May 2020 will now have a six-month extension to finish their annual re-certification. Medicaid recipients who received a denial in March 2020 due to failure to finish their annual re-certification in time, will be re-instated. Normally, the annual Medicaid re-certification must be finished by the 10 – day deadline given by DCF. Thus, no current Medicaid recipient will lose their Medicaid eligibility during this state of emergency.

2.     Additional Time to Complete Medicaid Application – New Medicaid applicants will now be able to submit any necessary documentation to DCF within 120 days from the date of application. Normally, new Medicaid applicants must submit everything within 30 days or risk being denied. This will be allowed for application dated February 2020 forward and during the state of emergency. Once the Medicaid application is approved, the individual’s Medicaid eligibility will still be the first day of the month that the application was received.

3.     Bed Hold Policy – Medicaid has waived the bed hold requirements for a nursing home bed if the Medicaid recipient leaves the nursing home to go to the hospital during this state of emergency. Normally, Medicaid does not pay for a bed hold when the recipient goes to the hospital, unless the skilled nursing facility has an occupancy rate of 95% or greater. 

4.     Prior Authorization Requirements – Florida Medicaid is waiving initial and ongoing prior authorization requirements for certain medically necessary services, such as skilled nursing facilities, long term acute care hospitals, hospital services, physician services, advanced practice registered nursing services, home health services and durable medical equipment and supplies. This applies to all Medicaid recipients who are enrolled in a Medicaid managed care plan. Also, the managed care plan must waive all prior authorization requirements for all other services, except for pharmacy services, that are necessary to evaluate and treat recipients who have been diagnosed with COVID-19. This lifting of the prior authorization requirement does not apply to pharmacy services.

5.     Limits on Services – Florida Medicaid is waiving limits on services, such as their frequency, duration or scope, that are needed in order to maintain the health and safety of a patient with COVID-19 or if it is necessary to maintain a Medicaid recipient safely in their own home. These services include the hospital inpatient limit, home health services, durable medical equipment, in-home physician visits, etc.

6.     Telemedicine – AHCA will now cover telemedicine for medical and behavioral health services, such as evaluation and management consultations, physical therapy, behavior analysis services, occupational therapy, speech therapy. Medicaid recipients can even receive telemedicine services with a physician if they are in a long-term care facility, such as a Nursing Home or Assisted Living Facility.

As always, Osterhout & McKinney, is here with you during the crises.

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