COVID-19 FAQs For State Medicaid And CHIP Agencies
Last Updated January 6, 2021COVID-19 Frequently Asked Questions (FAQs)for State Medicaid and Children’s Health Insurance Program (CHIP) AgenciesThe Centers for Medicare & Medicaid Services (CMS) released six sets of general FrequentlyAsked Questions (FAQs) to aid state Medicaid and Children’s Health Insurance Program (CHIP)agencies in their response to the coronavirus disease 2019 (COVID-19) pandemic. CMS alsoreleased two sets of FAQs providing guidance to states on the implementation of the FamiliesFirst Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and EconomicSecurity (CARES) Act.On January 6, 2021, CMS released an updated FAQ document that incorporates all eight sets ofCOVID-19 FAQs into one, comprehensive FAQ document. Additionally, on November 2, 2020,a provision implementing section 6008(b)(3) of the FFCRA in CMS-9912 Interim Final Rulewith Comment (CMS-9912 IFC) became effective. CMS’s original interpretation of thecondition specified in section 6008(b)(3) was issued in FAQs in April, May and June 2020.While most of these FAQs remain in effect following the November 2, 2020 effective date of theIFC, some FAQs are applicable only through November 1, 2020. Each of the previouslypublished FAQs in Section II.I. of this document has been updated to respond to questions aboutsection 6008(b)(3) of the FFCRA and includes a note with a designation of applicability relatedto the IFC.Table of ContentsI. Emergency Preparedness and Response . 3II. Eligibility and Enrollment. 8A. Application and Renewal Processing . 8B. Premiums and Cost-Sharing . 14C. Eligibility. 20D. Notice and Fair Hearings . 28E. Presumptive Eligibility . 32F. Verification . 35G. Basic Health Program. 40H. Coverage for American Indians and Alaska Natives. 42I. Continuing Coverage under Section 6008 of the Families First Coronavirus Response Act . 43J. Children’s Health Insurance Program (CHIP) . 54K. Optional COVID-19 Testing Group . 56L. Medically Needy and Post-Eligibility Treatment of Income/Transfer of Assets/Estate Recovery . 64M. Expiration of Requirements for Claiming the Temporary FMAP Increase under Section 6008 ofthe FFCRA . 65III. Benefits . 67A. COVID-19 Testing . 67Page 1 of 161
Last Updated January 6, 2021B. Telehealth . 71C. Home and Community Based Services . 76D. Pharmacy/Prescription Drugs . 80E. Money Follows the Person (MFP) Program . 83F. Miscellaneous . 89G. Non-Emergency Medical Transportation. 92H. Health Resources and Services Administration (HRSA) Uninsured Provider Fund/MedicaidCoordination of Benefits . 94IV. Financing . 97A. Administrative Claiming . 97B. Advance and Retainer Payments . 98C. Federally Qualified Health Center (FQHC) and Rural Health Center (RHC) Services . 105D. Payment Rates and Methodologies . 106E. Upper Payment Limits . 112F. FFCRA Temporary FMAP Increase . 114G. Increased Federal Match Rate under Section 6004 of the FFCRA . 125H. Miscellaneous . 128V. Managed Care . 131A. Contracts and Rates. 131B. Quality Measurement . 141C. Miscellaneous . 144VI. Information Technology . 147A. Funding . 147B. Health Information Exchange . 149C. Transformed Medicaid Statistical Information System (T-MSIS) . 150D. Telework . 151E. Miscellaneous . 152VII. Miscellaneous. 153A. Quality Reporting . 153B. Workforce Issues . 156C. 1115 Demonstrations . 157D. Other . 158Page 2 of 161
Last Updated January 6, 2021I. Emergency Preparedness and Response1. What is the emergency period described in sections 6004 and 6008 of the Families FirstCoronavirus Response Act (FFCRA)?Sections 6004 and 6008 of the FFCRA refer to the emergency period defined in section1135(g)(1)(B) of the Social Security Act (the Act). Section 1135(g)(1)(B) of the Act defines theemergency period as the period during which there exists a public health emergency undersection 319 of the Public Health Service Act for COVID-19. The Health and Human Services(HHS) Secretary’s public health emergency declaration for COVID-19 was effective on January27, 2020, so the emergency period as defined in section 1135(g)(1)(B) began then, and continuesthrough any renewal of the HHS Secretary’s public health emergency declaration. 1 Theemergency period expires after 90 days, unless further extended by the Secretary. Theemergency period will terminate upon termination of the public health emergency, including anyextensions. At the time the public health emergency period for COVID-19 ends, Centers forMedicare & Medicaid Services (CMS) will inform states.2. What resources are available to assist states and territories in their responseto COVID-19?Medicaid and the Children’s Health Insurance Program (CHIP) play a critical role in helpingstates and territories respond to public health events, as well as natural and human-madedisasters. To assist states and territories in their preparedness efforts, CMS developed a DisasterPreparedness Toolkit that is a longstanding resource that has been available to states andterritories on CMS’ website, Medicaid.gov. States and territories are encouraged to be familiarwith this resource as part of their emergency preparedness planning. The toolkit outlinesnumerous strategies available to support Medicaid and CHIP operations and enrollees in times ofcrisis, and serves as a comprehensive disaster preparedness resource for states and territories.Many of the flexibilities described in the toolkit will help states and territories in their responseto COVID-19. The toolkit is organized by operational areas, such as eligibility and enrollment,benefits, cost-sharing and provider workforce. The toolkit also outlines the legal authoritiesavailable to effectuate various strategies, including flexibilities in current statute, Medicaid andCHIP state plan amendments, section 1915(c) waiver Appendix K, and section 1115demonstrations. The toolkit also describes authority that may be granted through section 1135waivers, which are only available when the President declares an emergency or natural disasterunder the National Emergencies Act or Stafford Act and the Secretary declares a Public HealthEmergency Declaration under Section 319 of the Public Health Service Act. The toolkit isavailable at: aster-responsetoolkit/index.html.The emergency period is defined in paragraph (1)(B) of section 1135(g) of the Act, as amended by H.R. 6074—The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Pub. L. 116-123). TheSecretary’s determination that a public health emergency exists was issued on January 31, 2020 with an effectivedate of January 27, 2020. The Secretary’s declaration is available /phe/Pages/2019-nCoV.aspx.1Page 3 of 161
Last Updated January 6, 20213. How can Appendix K support a state’s response to COVID-19 for 1915(c) Home andCommunity-Based Services (HCBS) Waivers?CMS developed Appendix K of the section 1915(c) waiver application for use by states duringemergencies. It describes actions states can take under existing section 1915(c) HCBS waiverauthority to respond to an emergency. The appendix may be approved retroactively, as needed,to the date of the event. A completed Appendix K should be submitted for each affected waiverand should be used to advise CMS of expected changes to state waiver operations. Changes mayinclude establishing a hotline, increasing the number of individuals served under a waiver,creating an emergency person-centered service plan, expanding provider qualifications,increasing the pool of providers who can render services, instituting or expanding opportunitiesfor self-direction, and/or permitting payment to HCBS providers when an individual is in a shortterm hospital or institutional stay.Appendix K also provides states with opportunities to: temporarily increase individual eligibility cost limits, modify service, scope, or coverage requirements, exceed service limitations, add services to the waiver, provide services in out-of-state settings, and/or permit payment for services rendered by family caregivers or legally responsibleindividuals.A state or territory may not include changes in Appendix K that are not permitted by statute,such as the inclusion of room and board costs in non-institutional settings. CMS will work withstates and territories to determine what changes may be needed and other key considerations,such as effective dates and impact to other programs.Please see attached link for instructions and nstructions.pdf and df4. What disaster response options do states have for separate CHIP programs?States that anticipate needing disaster relief flexibilities in CHIP are encouraged to submit adisaster relief state plan amendment (SPA). This may be submitted in advance of, or inresponse to, a disaster/public health crisis. Through a CHIP SPA, states can addflexibilities such as waiving premiums and cost sharing, and extending timeframes forrenewals. A CHIP SPA may be effective as early as the first day of the state’s fiscal year aslong as it is submitted by the end of a state’s fiscal year. Please see the attached link for moreinformation: amchip/downloads/chip disaster relief spa sample 01102012.pdfPage 4 of 161
Last Updated January 6, 2021In addition to the disaster relief SPA, states may use CHIP Health Services Initiative (HSI)for additional COVID-19 related activities that are targeted to low-income children.Interested states should consult with CMS regarding the application process and parametersfor HSIs.5. Can states activate their existing CHIP disaster provisions due to a public healthemergency such as COVID-19, or is this type of SPA limited to geographically localizednatural, environmental, and man-made disasters?Some states have disaster provisions in their state plan that say that the provisions may beactivated up in “Governor or FEMA declared disaster areas.” States may activate these disasterprovisions in response to the public health emergency. CMS’s Disaster Preparedness Toolkitgives examples of natural and human-made disasters such as hurricanes (e.g., HurricanesKatrina, Maria, Harvey and Irma), wildfires (e.g., California wildfires), flooding (e.g., HurricaneHarvey floods in Texas), and public health emergencies (e.g., Flint, Michigan lead contaminationcrisis). For the purposes of CHIP disaster relief provisions, CMS deems a significant outbreak ofan infectious disease to be a disaster.To the extent that states have not yet incorporated disaster relief provisions into their CHIP stateplans, CMS recommends including a federal or Governor declared emergency as events that cantrigger the disaster provisions.6. What options do states have for obtaining required signatures on SPA submissions, giventhat current state telework policies may present challenges with obtaining signatures?Federal regulations at 42 C.F.R. § 430.12 set forth requirements for state plan amendmentsincluding the format and when the state plan must be amended. The regulations do not set forthrequirements related to signatures on SPA submissions; as such, states have flexibility to utilizedifferent options for signatures on the Form CMS-179, including electronic signature, scannedclearly legible signature, wet signature, and insertion of /s/. States need to ensure that the person“signing” is duly authorized to submit SPAs.7. Are states granted any flexibilities with regard to public notice, effective dates and thesubmission of SPAs during the Public Health Emergency (PHE) period?Yes. A state may request that CMS waive the requirement that a SPA be submitted no later thanthe last day of the same quarter as the requested effective date of the SPA, waive public noticerequirements, and permit the state to modify the tribal consultation timeline, under section 1135of the Act. Section 1135 of the Act allows CMS to permit SPAs submitted after the last day ofthe quarter to have an effective date in a previous quarter, but no earlier than the effective date ofthe public health emergency. These flexibilities will be permitted only with respect to SPAs thatprovide or increase beneficiary access to items and services related to COVID-19 (such as costsharing waivers, payment rate increases, or amendments to Alternative Benefit Plans (ABPs) toadd services or providers) and that would not restrict or limit payment, services, or eligibility, orotherwise burden beneficiaries and providers. There is no waiver of the requirement that statesmust submit SPAs in order to amend their Medicaid state plan during this period.Page 5 of 161
Last Updated January 6, 2021For CHIP, states may request to modify their tribal consultation timeline for a disaster relief SPAby requesting a waiver under section 1135 when submitting the SPA. Because states have untilthe last day of their state fiscal year to submit a CHIP SPA, section 1135 authority is not neededto modify the submission date for CHIP disaster relief SPAs that are submitted by that date.Additionally, CMS does not require public notice of CHIP SPAs, except when they restricteligibility or benefits under 42 C.F.R. § 457.65, and we do not anticipate that CHIP disasterrelief SPAs will be restrictive.The Medicaid SPA template and instructions for the COVID-19 pandemic and information onCHIP disaster relief SPAs are available at x.html.8. What are the effective and termination dates for the various Medicaid authorities thatassist states with addressing the COVID-19 pandemic?Effective and termination dates for the various authorities are provided in the table below.AuthorityMedicaid disaster relief SPAtemplate for the COVID-19PHECHIP disaster SPA (specificto COVID-19 PHE)Appendix KEffective dateMarch 1, 2020 or any laterdate elected by the stateMedicaid and CHIP 1135Waivers1115 demonstration torespond to the COVID-19PHEMarch 1, 2020Start of state or federallydeclared emergencyJanuary 27, 2020 or any laterdate elected by the stateMarch 1, 2020Termination dateEnd of PHE (including anyextensions), or any earlierdate elected by the stateEnd of PHE (including anyextensions)January 26, 2021 or anyearlier date elected by thestateEnd of PHE (including anyextensions)No later than 60 days afterend of PHE (including anyextensions)9. What is the coverage period for the uninsured COVID-19 testing eligibility group, thenew optional group authorized by sections 1902(a)(10)(A)(ii)(XXIII) and 1902(ss) of theSocial Security Act?Coverage for this optional Medicaid eligibilit
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