Outreach to Medicaid Plans Across the United States

WASHINGTON, D.C. (April 21, 2020)—AAHomecare’s payer relations team has been coordinating outreach efforts to state Medicaid authorities in support of policy changes that will allow HME suppliers to better respond to the COVID-19 outbreak. In March, the Association developed a draft letter with extensive policy recommendations for state/regional associations, which was shared widely with Medicaid officials nationwide.

After the Centers for Medicare & Medicaid Services (CMS) released its COVID-19 Interim Final Rule, which allowed Medicare coverage for beneficiaries with acute respiratory conditions and relaxed documentation, testing, and other requirements, the Association drafted a follow-up letter highlighting the new CMS guidance and encouraged state Medicaid authorities to follow suit and adopt those changes.  

AAHomecare and our state/regional association partners have shared these recommendations with state Medicaid and health agency leaders nationwide and are involved in ongoing meetings and conversations taking place in 46 states to encourage quick adoption of these practices. There are currently 50 state Medicaid emergency waivers in effect and 27 state plan amendments have been enacted. 

AAHomecare will continue to work with our state/regional association partners to follow up with the state Medicaid plans and continue to advocate for common sense flexibilities during this public health emergency.  Please review your specific state Medicaid website for updated information.

TEXAS

Texas implemented multiple policy changes per this Waiver Notice.

• Temporarily extending existing prior authorizations for services so that Texans can get the care they need without delay.
• Extending deadlines for state fair hearings and appeals.
• Allowing services to be performed by telehealth, telemedicine, or telephonic contact.
• Allowing the state to waive any requirements that require the signature of a physician, durable medical equipment provider, or Medicaid recipient.

NEW HAMPSHIRE

The New Hampshire Medicaid Program has released new guidance that includes extensive HME-related policy changes:

• Waives prior authorization for oxygen, equipment, and supplies. Proof of delivery is required via text, email, photograph or confirmed shipment receipt from third-party carriers.
• Relaxed prior authorization requirements to allow for backdated requests, extend quality limits, and relax delivery requirements for other DMEPOS for confirmed-positive COVID-19 beneficiaries.
• Allows 30-day extensions for medical DMEPOS orders that expire during the State of Emergency period. 
• Grant home sleep studies and CPAP devices, subject to retrospective medical necessity review within 60 days of the rendered service date, during the State of Emergency period.
• Extends timely claim filing 180-days from the date of service.
• Authorizes fittings for assistive technologies through use of remote telehealth technology, whenever practical/appropriate.
• Permit non-participating and out-of-network providers to order durable medical equipment; at minimum, a temporary state license is required.
• Permits early fills of medical supplies for a maximum day supply of 30 days with a provider’s order.

NORTH CAROLINA

• Modified their regulations to allow coverage for beneficiaries with respiratory infections without requiring prior authorization for a wide range of respiratory equipment and products, including ventilators, stationary oxygen, CPAP, RAD, portable oxygen, concentrators, surgical masks, and accessories. See the complete list in per the COVID-19 Special Bulletin #2 under the Durable Medical Equipment: Temporary Flexibilities heading.
• Modified regulations to allow coverage without requiring prior authorization for additional medical equipment and supplies.  See complete list in the COVID-19 Special Bulletin #10.

SOUTH CAROLINA

The South Carolina Dept. of Health & Human Services has announced several policy changes per this Medicaid Bulletin:

• Expanding coverage of oxygen therapy to include coverage for acute, short-term treatment and waiving the requirement that portable systems be limited to periods when beneficiaries are not able to use stationary systems.
• Waiving prior authorization requirements and quantity limits for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and related supplies.  
• DME providers may continue to provide services, recurring medical supplies or DME rentals with otherwise valid provider orders that exceed SCDHHS’ duration or timeliness standards.
• DME providers may provide and deliver DME items to hospitalized individuals who may not otherwise meet the standards of medical necessity as long as: a) the discharging hospital or physician attests that the equipment is necessary to support the discharge; and, b) the discharge is consistent with the CDC guidelines for the statewide COVID-19 response.

QUICK TAKES FROM STATE PLAN AMENDMENTS

• Arizona is allowing physicians and other licensed practitioners to order Medicaid home health and eliminating Cost Sharing and Premium
• Alabama has suspended co-pays for all services; is expanding ability to utilize telehealth.
• Minnesota is waiving cost sharing for all COVID-19 treatments.
• Virginia has waived cost sharing for all services.

Visit aahomecare.org for more information.