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Multiple COVID-19 Flexibilities for Services Ending

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective with the end of the federal public health emergency (PHE) on May 11, 2023, the Texas Health and Human Services Commission (HHSC) will end multiple temporary COVID-19 flexibilities. In some cases, providers were previously notified that these flexibilities would end, and this article provides the date when these changes will occur.

Spell of Illness

Effective March 13, 2020, through the end of the federal PHE on May 11, 2023, HHSC authorized the spell of illness limitation for fee-for-service clients 21 years of age and older, STAR+PLUS members, and STAR Health members 21 years of age and older to be extended up to an additional 30 days for COVID-19–related inpatient 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. 

For more information on the end of this flexibility, refer to Spell of Illness Extension for COVID-19–Related Inpatient Hospital Claims Ending with End of PHE.

Texas Health Steps (THSteps)

Effective May 7, 2020, through the end of the federal PHE on May 11, 2023, HHSC authorized providers to bill THSteps medical checkups for children 24 months and older through telemedicine (physician-delivered) audiovisual and telephone (audio-only) delivery platforms.

For more information on the end of this flexibility, refer to Texas Health Steps Flexibilities for Telemedicine (Audio-visual) and Telephone (Audio-only) Delivery Training Ending at End of PHE.

Case Management for Children and Pregnant Women (CPW)

Effective March 24, 2020, through the end of the federal PHE on May 11, 2023, HHSC authorized providers to bill comprehensive visits and follow-up visits through telehealth (non-physician delivered) audiovisual and telephone (audio-only) platforms. Effective September 1, 2022, CPW comprehensive visits and follow-up visits completed through the use of synchronous audiovisual technology are benefits of Texas Medicaid. Effective May 12, 2023, CPW comprehensive visits may not be delivered by telephone (audio-only).

For more information on the end of this flexibility, refer to Update on Case Management for CPW Policy Changes and COVID-19 Flexibilities.

Early Childhood Intervention (ECI) Specialized Skills Training (SST)

Effective March 15, 2020, through the end of the federal PHE on May 11, 2023, HHSC authorized providers to bill procedure code T1027 for telehealth (non-physician delivered) telephone (audio-only) ECI SST.

For more information on the end of this flexibility, refer to Flexibilities for Telephone (Audio-only) Early Childhood Intervention Specialized Skills Training Ending at End of PHE.

Nutritional Counseling

Effective March 15, 2020, through the end of the federal PHE on May 11, 2023, HHSC authorized providers to bill procedure code S9470 for telehealth (non-physician delivered) telephone (audio-only) nutritional counseling.

For more information on the end of this flexibility, refer to Flexibilities for Telephone (Audio-only) Nutritional Counseling Services Ending at End of PHE.

For more information, call the TMHP Contact Center at 800-925-9126.