Medicaid and CHIP Services Information for People Receiving Services

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Medicaid CHIP COVID-19 Information Sessions

To reduce the potential for technical difficulties we will post pre-recorded sessions on this page by 1:00 p.m. CT each Thursday. These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.

WHEN:

Where to go for information on the novel coronavirus (COVID-19)

Visit the Centers for Disease Control (CDC) and Texas Department of State Health Services (DSHS) for information on the coronavirus, including:

  • Situation updates.
  • Who is at higher risk.
  • How the virus spreads, symptoms, prevention and treatment.
  • FAQs.

Any changes to Medicaid and CHIP services will be posted here.

Illness Concerns

People who are concerned that they might have COVID-19 should contact their healthcare provider via phone before going to a clinic or hospital to prevent spread in healthcare facilities. Call your healthcare provider for the following reasons:

  • You feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19.
  • If you live in or have recently traveled from an area with ongoing spread of COVID-19.

Testing for COVID-19

Medicaid and CHIP will cover COVID-19 testing for Medicaid or CHIP clients. Your healthcare provider will work with local public health officials to determine to if you should be tested for COVID-19.

No prior authorization will be required on the COVID-19 lab test by Medicaid and CHIP health plans or by traditional Medicaid.

Teleservices

Your health plan can cover teleservices, including in your home. HHSC has encouraged health plans to use this option when responding to COVID-19.

For people enrolled in the waiver programs, HHSC has also authorized certain services to be provided via telehealth, including some professional and specialized therapy and nursing services.

CHIP Co-Payments

Medical office visit co-payments for all CHIP members for services provided from March 13, 2020, through June 30, 2020 are waived.

Co-payments are not required for covered services delivered via telemedicine or telehealth to CHIP members.

Extra Medicine or Supplies

Medicaid recipients should call their drug store and ask if they are able to get a 30-day supply of medication and the availability of free home-delivery.

In-Home Service Delivery

You or your legally authorized representative (LAR) should talk to your in-home care provider, service coordinator or case manager about what to do if your provider can’t come to work because they are sick. You or your LAR should:

  • Work with your provider and your service coordinator or case manager to develop a backup plan if one is not in place.
  • Update any existing backup plans.
  • Keep a copy of the backup plan.

Provider agencies are required to have back-up and emergency plans in place, which include if an in-home care provider cannot work because they are sick. Your provider agency and MCO service coordinator must support you in developing those plans.

If you use the Consumer Directed Services (CDS) option, you or your LAR should work with your MCO and service coordinator or case manager to develop a backup plan if you don’t have one. Financial Management Services Agencies (FMSAs) can help you make CDS budget revisions as needed.

Temporary Change on Living in Same Home Prohibitions

HHSC temporarily lifted the prohibition on service providers of respite and CFC PAS/HAB from living in the same home as the person receiving Home and Community-based Services and Texas Home Living program services. More information about temporary changes to this policy are available in the bulletin issued on May 29. This guidance is effective through June 30.

Managed Care: Face to Face Visits

Service coordination visits

Face to face service coordination visits are suspended through June 30, 2020 for STAR Health, STAR Kids, STAR+PLUS MCOs, and Dual Demonstration Medicare-Medicaid Plans (MMPs).

Health plans may replace face to face visits with telephonic or telehealth outreach.

Extended enrollment MDCP and STAR+PLUS HCBS

To ensure members do not experience a gap in services due to the temporary suspension of face to face service coordination visits for COVID-19, HHSC is extending enrollment in the Medically Dependent Children’s Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS) for members with individual service plans (ISPs) expiring through June 30, 2020.

The extension applies to the member’s Screening and Assessment Instrument (SAI), STAR+PLUS HCBS Medical Necessity Level of Care (MNLOC) and corresponding ISPs.

However, health plans may process a change in condition via telehealth if a member’s service needs change. The member’s ISP may be adjusted but they will not lose eligibility. 

MDCP and STAR+PLUS HCBS reassessments

Health plans may not complete level of care reassessments via telehealth for members at this time.

Nursing facility MDS authorization extensions

HHSC is extending nursing facility minimum data set (MDS) assessment authorizations expiring through June 30, 2020 for 90 days.

This means nursing facility eligibility, Medical Necessity, and the current Resource Utilization Groups (RUG) level will be extended for 90 days for those residents who would otherwise have an eligibility lapse, or until the MDS is completed, whichever is sooner.

FMSA Orientations

HHSC directed STAR, STAR Health, STAR Kids, and STAR+PLUS MCOs to allow FMSAs to suspend providing face-to-face orientations for CDS employers through June 30, 2020. Employer orientations scheduled through the end of June 2020 will be virtual or by telephone. Face-to-face will be required after the suspension.

IDD Waivers and Other Services: Face to Face Visits

Service coordination visits

Face to face service coordination visits are suspended through June 30, 2020 for:

  • Fee-for-service Medicaid 1915(c) waiver case managers and service coordinators for Community Living Assistance and Support Services (CLASS), Texas Home Living (TxHmL), Deaf-Blind with Multiple Disabilities (DBMD) and Home and Community-based Services (HCS)
  • General Revenue service coordinators
  • Community First Choice service coordinators
  • Preadmission Screening and Resident Review (PASRR) habilitation coordinators

Eligibility extensions

To ensure members do not experience a gap in services due to the temporary suspension of face to face service coordination visits for COVID-19, HHSC is extending Intellectual Disability/Related Condition (ID/RC) assessments and individual plans of care (IPC) expiring through June 30, 2020 for individuals who are enrolled in the following programs:

  • Community Living Assistance and Support (CLASS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Home and Community-based Services Program (HCS)
  • Texas Home Living (TxHmL)

For reference:

IL 2020-11
IL 2020-12

FMSA Orientations

FMSAs may suspend providing face-to-face orientations for CDS employers through June 30, 2020. Employer orientations scheduled through the end of June 2020 will be virtual or by telephone. Face-to-face will be required after the suspension.

For reference:

IL 2020-08

Appeals and Fair Hearings

Appeals

In response to COVID-19, HHSC requires all health plans to extend the timeframes for the following through June 30, 2020:

  • Number of days members, legally authorized representatives or authorized representatives can request an appeal and continuation of benefits.
    • Normally 60 days to request an MCO internal appeal, now 90 days.
    • Normally 10 days to request continuation of benefits upon receipt of the adverse benefit determination, now 30 days.
  • Number of days MCOs, DMOs and MMPs have to resolve a standard member appeal.
    • Normally a member requested standard appeal must be resolved within 30 days of the request, now 60 days.

HHSC also requires all health plans to accept oral requests for appeals without the member having to provide a written request through June 30, 2020.

Fair Hearings

In response to COVID-19, HHSC is also extending the timeframes for the following through June 30, 2020:

  • Number of days members, legally authorized representatives or authorized representatives have to request a fair hearing.
    • Normally 120 days to request a fair hearing after the internal MCO appeal, now 150 days.

If the timeframe for a member to request a fair hearing would have expired in June 2020, they will have an extra 30 days from that expiration date to request a fair hearing.

  • Number of days HHSC has to make a fair hearing determination.
    • Normally fair hearings determinations are made within 60 - 90 days of the date HHSC receives a request for a fair hearing, now 120 days.

Prior Authorization

If you have a prior authorization set to expire March 1, 2020 through June 30, 2020, it will be extended for 90 days.

This extension does not apply to current authorizations for one-time services, new requests for authorization or pharmacy prior authorizations. For example, a single non-emergency ambulance trip would not be extended, but a recurring non-emergency ambulance authorization for dialysis would be extended.

In-Office Checkups

To limit exposure to COVID-19, providers may adjust in-office medical and dental checkups. These changes may include:

  • Temporarily postponing certain checkups.
  • Limiting checkups to certain times of the day.
  • Dedicating specific rooms for sick visits and well visits.
  • Prioritizing visits for younger children, especially those due for routine vaccines.

Contact your provider to find out more information.

School Health and Related Services

School Health and Related Services (SHARS) are provided to students with a disability to ensure individuals benefit from special education programs.

During any temporary closure of schools for in-person classrom attendance, schools may continue to provide instruction using alternative methods of delivery such as telemedicine or telehealth.

If schools are unable to provide instruction using alternative methods of delivery, families can work with their primary care provider and health plan to access needed services during this time.

Past Information Sessions

Resources