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Public Notice to COVID-19 Medicaid Providers

Monday, March 16, 2020

Where can I get information and updates about COVID-19? 
Information is available from the Centers for Disease Control (CDC) at https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
Information about the District of Columbia’s response and updates about the coronavirus (COVID-19) is available at https://coronavirus.dc.gov/

Does Medicaid cover testing for coronavirus (COVID-19)? 
Yes. The Centers for Medicare and Medicaid Services (CMS) has created a new Healthcare Common Procedure Coding System (HCPCS) code for laboratories to bill for the test. Laboratories should use the newly designated HCPCS codes to bill for testing for coronavirus (COVID-19).

U0001 - This code is only to be used for the tests developed by the CDC.
U0002 – This code is for laboratories performing non-CDC laboratory tests.

DHCF will accept this code for services provided on or after February 4, 2020.
DHCF will develop a rate for coronavirus (COVID-19) testing based on the established Medicare rate. Medicare has not yet developed a rate for U0001 or U0002.

Is a telemedicine visit covered? 
Yes, DHCF covers telemedicine services. More information about telemedicine coverage is available at: https://dhcf.dc.gov/page/telemedicine

Is a telemedicine visit covered if the patients participate from their homes? 
DHCF has published an emergency and proposed rule to amend Chapter 9, MEDICAID PROGRAM. Effective March 12, 2020, the beneficiary’s home or other settings identified in the guidance published on the DHCF website at dhcf.dc.gov is an allowable originating site for telemedicine.

Can beneficiaries get extra medicine or supplies? 
DHCF is allowing an extended supply of prescriptions to beneficiaries, upon request only, at this time. When requested, a beneficiary will receive an early / extra 30 day supply of the prescription. This is effective March 6, 2020. 

Operationally, this is effectuated by a call from a pharmacy to the PBM’s 24/7 call center. 
DHCF is requiring the MCOs to apply the same protocols.