COVID-19 Issues and Medicaid Policy Options for People Who Need Long-Term Services and Supports

• Allow self-attestation to verify eligibility for all criteria except citizenship and immigration status on a case-by-case basis; verify assets if financial institution unable to verify due to disaster; verify incurred medical expenses for spend down eligibility
• Extend renewal timeframes
• Temporarily suspend periodic data checks on case-by-case basis
• Temporarily delay acting on certain changes in circumstances affecting eligibility
• Reinstate services or eligibility if discontinued because whereabouts unknown due to evacuation, after whereabouts become known and if still eligible
• Consider people evacuated from state as temporarily absent to maintain enrollment
• Suspend adverse actions for those in disaster area where state has completed determination but has not yet sent notice or state believes notice likely not received
• Temporarily increase HCBS waiver service payment rates if no change to rate methodology and no impact on cost neutrality

• Apply host state’s asset limit, or if less restrictive, asset limit from state where individual evacuated (if statewide rule)

Enrollment::

• Extend hospital presumptive eligibility to non-MAGI groups

Benefits:

• Offer additional benefits, such as state plan HCBS (if comparable for all categorically needy groups and statewide with free choice of provider, or via alternative benefit plan with free choice of provider)
• Change amount, duration, or scope of covered benefits
• Amend payment methodology to account for increased cost of personal protective equipment for home care workers

• Temporarily suspend out of network requirements for managed care enrollees
• Require health plans to expedite processing of new prior authorization requests and allow flexibility in documentation (e.g., physician signature)

• Temporarily suspend requirement to be institutionalized at least 30 days and have income below 300% SSI to be eligible for special income group
• Temporarily suspend asset transfer rules for those placed in nursing homes
• Apply host state’s asset limit, or if less restrictive, asset limit from state where individual evacuated (if less than statewide)
• Do not reduce institutional provider payments by post-eligibility treatment of income

• Temporarily suspend fee-for-service prior authorization requirements and/or require providers to extend prior authorization through the termination of emergency declaration
• Covered Providers:
• Temporarily waive requirements for out-of-state providers to be licensed in state where they are providing services if provider is licensed by another state Medicaid agency or Medicare
• Temporarily waive provider screening requirements, such as application fees, criminal background checks, and site visits, to ensure sufficient number of providers
• Temporarily cease revalidation of providers in state or who are otherwise directly impacted by disaster
• Temporarily suspend pending enforcement or termination actions or payment denial sanction to specific provider
• Allow facilities to provide services in alternative settings such as temporary shelters when provider facility is inaccessible
• Temporarily allow non-emergency ambulance providers

• Provide nursing home care to evacuees in host state for less than 30 days if individual is Medicaid-eligible in home state
• Temporarily suspend pre-admission screening and annual resident review assessments for 30 days
• Extend minimum data set authorizations for nursing home and skilled nursing facility residents
• Temporarily suspend requirement that home health agency aides be supervised for 2 weeks by registered nurse
• Temporarily suspend requirement that hospice aides be supervised by registered nurse every 14 days
• Modify or suspend certain state survey agency activities

• Increase number of unduplicated waiver enrollees
• Temporarily increase individual cost limit to assure health and welfare
• Modify eligibility targeting criteria to serve more enrollees and forestall institutionalization in emergency
• Extend level of care authorizations for 12 months

Benefits:

• Add covered services not expressly authorized in statute if necessary to assist waiver enrollees to avoid institutionalization
• Modify scope of covered services and temporarily exceed individual service limits to ensure health and welfare
• Institute or expand self-direction
• Temporarily suspend prior authorization and extend medical necessity authorizations
• Modify person-centered planning process, including qualifications of individuals required to develop plan

Providers:

• Temporarily increase payment rates with a temporary change in rate methodology and/or impact on cost neutrality
• Amend payment methodology to account for increased cost of personal protective equipment for home care workers
• Allow payment for services provided by family caregivers or legally responsible relatives
• Temporarily modify provider types, qualifications, and licensure or other setting requirements
• Include retainer payments to personal care assistants when waiver enrollee is hospitalized or absent from home up to 30 days
• Expand covered settings to include out-of-state
• Temporarily allow payment for waiver services up to 30 days to support enrollees in acute care hospital or short-term institutional stay when services are required for communication and behavioral stabilization and not provided by institution

APPENDIX K: Emergency Preparedness and Response.