MHPA Wants States To Forgo COVID-19 Cost-Sharing, Seeks CMS Guidance

March 12, 2020

Medicaid Health Plans of America asks CMS to promptly take steps to make it easier for states to address COVID-19: The group says CMS should encourage states to forgo cost-sharing for Medicaid beneficiaries dealing with COVID-19, and issue additional guidance on Medicaid telehealth, prescription refills and how to handle face-to-face care management meetings.

Insurers on Tuesday (March 10) agreed to waive cost-sharing for COVID-19 testing in commercial plans, and Medicare will cover the cost of such testing under Part B, but the decision in Medicaid is up to each state.

MHPA President and CEO Craig Kennedy told Inside Health Policy that the plans believe Medicaid can play a key role in the COVID-19 response, and that a state Medicaid director letter from CMS would bolster that role.

Gerard Vitti, founder and CEO of Healthcare Financial, Inc., said there’s a lot of misinformation on how Medicaid could help stem the epidemic, and it would be helpful for the federal government to speak with one voice to the health care community -- especially since Medicaid covers some of the most vulnerable populations. Medicaid’s role in the COVID-19 response should be driven by CMS, and consistent messaging could mitigate disparities among states in terms of their ability and expertise to respond, he added. Vitti said 50 states doing 50 different things based on their own visions isn’t helpful.

“Medicaid exists to eliminate barriers to care for vulnerable populations and MHPA urges CMS to take immediate action to empower states to address the impact of COVID-19. This includes enabling States to remove any cost sharing for Medicaid enrollees that have or are suspected of having COVID-19,” MHPA says in a statement.

CMS, in Frequently Asked Questions released Thursday (March 12), said that if a state wants to stop charging copays for certain Medicaid items or services, the state can submit a state plan amendment. However, states can’t exempt only those affected by a particular diagnosis, like COVID-19, from copays.

“Rather, a copayment exemption under the state plan would need to apply to everyone who accesses a particular item or service. Alternatively, the state could request section 1115 authority to temporarily suspend copayments only for individuals needing treatment for COVID-19 infection,” CMS says.

The plans also say in a March 11 letter they want guidance from CMS on how states could implement or update Medicaid telehealth policies, including for remote monitoring, and how states could pay for telehealth at the same rate as in-person services.

The Center for Connected Health Policy said in an analysis that many state Medicaid programs don’t allow the home to be an eligible site for telehealth care, and some states limit the specialties that can use telehealth.

“One would think that if a state of emergency is declared in a state, then surely these currently existing telehealth limitations could be waived. However, very few states have in statute utilization of telehealth when a state of emergency is declared,” the group said.

The supplemental coronavirus funding bill includes policies to ease Medicare telehealth restrictions but does not include provisions on Medicaid telehealth.

CMS, in its Medicaid and CHIP guidance released on Thursday, says that “no federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.” However, a state plan amendment would be necessary for revisions to payment methods to account for telehealth costs, the agency says.

MHPA also asks whether a portion of the federal and state COVID-19 emergency response funds can be used to train long-term care facility and nursing home staff on prevention and treatment of the virus.

CMS has issued two sets of guidance for nursing homes on how to handle COVID-19 in the past week.

The plans also want guidance on allowing or a 90-day supply of medications at retail and mail-order pharmacies when such a supply is clinically appropriate. They also want guidance on waiving of early refill requirements during public health emergencies.

MHPA asks for flexibility around required face-to-face care management meetings, and for guidance on how states can work with Medicaid plans and community-based organizations to provide non-medical supports like meals and over-the-counter medications to Medicaid beneficiaries quarantined in their homes.

The plans also ask CMS to put out guidance on education, including how states can engage Medicaid beneficiaries, possibly in collaboration with plans, on Centers for Disease Control and Prevention best practices for infection control and medical management. MHPA asks CMS to encourage states to educate employers on allowing their workers diagnosed with COVID-19 to stay home.

MHPA also asks CMS to work with CDC to develop -- and give to states -- with written patient information about the disease that is appropriate for Medicaid beneficiaries.

Vitti said telehealth policy, training and medication refills are all areas where Medicaid stakeholders should be able to look to the federal government to implement consistent policy for beneficiaries and plans.

At press time, the National Association of Medicaid Directors and CMS had not responded to requests for comment on the plans’ call for additional guidance. -- Michelle M. Stein (mstein@iwpnews.com)