COVID-19 Coding and Billing Interim Guidance : PPE
Medicaid state plan through base and supplemental payments . Such adjustments could include , but are not limited to , an increase resource utilization to account for the need for more personal protective equipment or other increased safety measures , but we would consider state ’ s justification for increases in payment rates during the PHE . We recognize the uncertainty and challenges states and providers are facing and will work with them on their proposals to increase Medicaid payments to help assure Medicaid patients have access to services . Payments must comport with all applicable requirements , including those under section 1902 ( a )( 30 )( A ) of the Act .”
“ Can a state increase provider payments to recognize higher costs of delivering care due to personal protective equipment ?
Yes . States may increase Medicaid and CHIP service payment rates to recognize increases in costs associated with personal protective equipment ( PPE ) and we encourage states to review their payment structures to determine whether such increases are warranted and would increase access to care during the public health emergency . Consistent with section 1902 ( a )( 30 )( A ) of the Act , States may set Medicaid payment rates consistent with efficiency and economy and have the option of increasing service rates to incorporate PPE costs or paying an add-on to a service rate for PPE costs in instances when such equipment is necessary to deliver care to a beneficiary . PPE is not a distinct benefit under the Medicaid or CHIP programs and , therefore , payments to providers are only available when PPE is used in the delivery of a Medicaid or CHIP service . We note that regulations at 42 C . F . R . 447.15 require the Medicaid agency to limit participation in the Medicaid program to providers who accept , as payment in full , the amount paid by the agency plus any deductible , coinsurance or copayment required by the plan to be paid by the individual . Based on this requirement , providers are prohibited from charging beneficiaries for the cost of PPE when delivering Medicaid services .”
I heard that some payers may pay a standard fee without my reporting a D1999 code ?
Yes . Some payers have begun launching programs to provide financial support for reopening or recovery of dental offices and / or to support the cost of PPE . Please read the following “ Payer Programs & Policies ” section of this guidance publication for the latest information available . This information is separate and different from other financial programs that third party payers have offered in the past few weeks .
As of 10 AM CENTRAL June 30 , 2020
Payer Programs & Policies
This section provides information ( as provided ) on the different carrier policies that have been announced . This is not a complete list and only includes information reported to the ADA by members . If you have additional information to share please send to dentalbenefits @ ada . org
Washington
State Healthcare Authority : Apple Health ( Medicaid )
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