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CMS FAQs and Guidance for COVID-19 Response

March 25, 2020

In response to COVID-19, CMS has published updated FAQs in order to provide flexibility to states and providers in how they administer and utilize Medicaid and the Children’s Health Insurance Program (“CHIP”). While these FAQs are directed toward state agencies, we have created a list of provider-focused takeaways to inform you about some of the changes taking place for state agencies.

  1. Testing will typically be covered. The test for the detection of COVID-19 is covered under Medicaid’s mandatory laboratory benefit as described at 1905(a)(3) of the Social Security Act and 42 C.F.R. § 440.30. However, if testing procedures do not meet those criteria, the test may still be covered under the optional diagnostic benefit as described at 1905(a)(13) of the Social Security Act and 42 C.F.R. § 440.130(a).

    Check to see if your state’s current Medicaid cost-sharing policies include cost-sharing for the COVID-19 detection test. States have a variety of options to change cost-sharing requirements during public health emergencies. If a provider decides to waive cost-sharing, that provider may be less likely to be subject to any enforcement action by HHS.
  2. Health care workers can be utilized more flexibly than under normal circumstances.  States have substantial authority to respond to issues relating to shortages of health care workers. Check your state’s Medicaid agency for changes to the types of providers authorized to deliver various services and for changes in required provider qualifications.

    For example, some state Medicaid programs are issuing FAQs, which provide guidance on how providers may deliver and bill for services during the COVID-19 outbreak.
  3. Review your capabilities to provide telemedicine services.  Both Federally Qualified Health Centers (“FQHCs”) and Rural Health Centers (“RHCs”) are eligible to provide more flexible telemedicine during a declared state of emergency. Your state may have to amend its current state plan; however, options are in place for states to expedite this process, and many states have already done so.
  4. Reimbursements will be lower if you are utilizing federal health care workers.  During a declared state of an emergency, and where healthcare facilities face critical staffing shortages, providers (in some circumstances) have the ability to utilize federal health care workers. This creates billing complications for reimbursement, as your state agency will not receive federal financial participation for costs associated with those federal workers.
  5. CMS has released COVID-19 specific billing codes.  CMS developed U0001, a code specifically for CDC testing laboratories to test patients for COVID-19. CMS recently added U0002, which allows laboratories to bill for non-CDC lab tests for COVID-19. These codes will begin being accepted starting on April 1, 2020 for dates of service on or after February 4, 2020. For additional guidance on specific billing codes, check our Telemedicine billing toolkit.
  6. Review CMS guidance.  CMS has released a disaster response toolkit that provides additional information and guidance to help inform Medicaid providers’ responses to COVID-19.

If you have any questions regarding appropriate responses to COVID-19, please do not hesitate to contact any member of our Health Law Practice Group. For additional updates and guidance on responding to COVID-19 check our Coronavirus (COVID-19) Resource Center.

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