Effective with the end of the federal public health emergency (PHE), the Texas Health and Human Services Commission (HHSC) will end the temporary flexibilities for some COVID-19-related inpatient hospital claims. This article is intended to notify providers that this change will occur effective May 11, 2023, with the end of the federal PHE.
During the COVID-19 response, HHSC extended the inpatient hospital spell of illness limitation for fee-for-service clients 21 years of age and older, STAR+PLUS members, and individuals 21 years of age and older in STAR Health up to an additional 30 days for COVID-19-related hospital stays.
For COVID-19-related hospital stays, HHSC also waived the $200,000 inpatient hospital benefit limitation, which applies to adults in fee-for service Medicaid and for some members who remain in STAR Health after their twenty-first birthday.
HHSC will honor these flexibilities for inpatient hospital stays with a COVID-19-related diagnosis and admission date of service on or before May 11, 2023. Inpatient hospital stays with an admission date on or after May 12, 2023, will no longer be eligible for these flexibilities.
Providers can refer to the Texas Medicaid Provider Procedures Manual, Sections 3.1.1 and 3.1.2 of the Inpatient and Outpatient Hospital Services and Sections 3.2.1, 4.2.1, and 5.2.2 of the Medicaid Managed Care Handbooks for additional information about the spell of illness limitation for inpatient hospital stays.
For more information, refer to the previous notice on this topic: Spell of Illness Limitation for COVID-19-related Admissions | TMHP
For more information, call the TMHP Contact Center at 800-925-9126.