NOTICES
DEPARTMENT OF
HUMAN SERVICES
Coverage and Prohibition of Copayments for COVID-19 Vaccines, Vaccine Administration, Testing and Treatments
[52 Pa.B. 8291]
[Saturday, December 31, 2022]The Department of Human Services (Department) announces that, consistent with the American Rescue Plan Act of 2021 (ARP) (Pub.L. No. 117-2), the Medical Assistance (MA) Program is covering COVID-19 vaccines, vaccine administration, testing and COVID-19-related treatments, including specialized equipment and therapies with no copayment.
Background
The Centers for Medicare & Medicaid Services (CMS), in response to the novel coronavirus (COVID-19) public health emergency (PHE), advised states that they could suspend cost sharing for Medicaid services related to COVID-19 testing and treatment. Section 6004 of the Families First Coronavirus Response Act (FFCRA) of 2020 (Pub.L. No. 116-127) as amended by section 3717 of the Coronavirus Aid, Relief and Economic Security (CARES) Act, required states to provide Medicaid coverage with no cost sharing for COVID-19 diagnostic and testing services. Section 6008 of the CARES Act also provided for an enhanced Federal medical assistance percentage for states that met specified conditions, including covering without imposition of cost sharing, testing services and treatments, including vaccines, specialized equipment and therapies.
In response, the Department submitted a Disaster State Plan Amendment to CMS seeking to suspend cost sharing during the PHE. The Department issued communications, including MA bulletins, notifying providers and beneficiaries that it was covering COVID-19 vaccines, vaccine administration, testing and COVID-19-related treatments, including specialized equipment and therapies, with no copayments. See MA Bulletin 99-20-05 entitled, ''COVID-19 Testing and Related Treatment Exempt from MA Copayment Requirements,'' issued on May 1, 2020.
Section 9811 of the ARP added a new mandatory Medicaid benefit in section 1905(a)(4)(E) of the Social Security Act (act) (42 U.S.C.A. § 1396d(a)(4)(E)). Under this provision, beginning March 11, 2021, State Medicaid programs were required to cover COVID-19 vaccines and vaccine administration. Section 9811 also required State Medicaid programs to cover COVID-19 testing and treatment, including specialized equipment and therapies (including preventive therapies, both pharmacological and non-pharmacological). CMS has interpreted these provisions as requiring states to cover the treatment of a condition that may seriously complicate the treatment of COVID-19, if that treatment is otherwise covered under the Medicaid State Plan, for individuals who are diagnosed with or presumed to have COVID-19 during the period the individual has or is presumed to have COVID-19, and for treatments and therapies for post-COVID conditions, sometimes called ''long COVID.'' See CMS's State Health Official letter #21-006, ''Mandatory Medicaid and CHIP Coverage of COVID-19-Related Treatment under the American Rescue Plan Act of 2021,'' issued October 22, 2021.
Section 9811 also amended sections 1916 and 1916A of the act (42 U.S.C.A. §§ 1396o and 1396o-1) to specify that states cannot impose cost sharing with respect to COVID-19 vaccines, vaccine administration, testing or COVID-19-related treatments that are required under ARP and described in sections 1905(a)(4)(E) and (F) (42 U.S.C.A. §§ 1396d(a)(4)(E) and (F)).
The ARP requirements for coverage and cost-sharing prohibitions end on the last day of the first calendar quarter that begins 1 year after the last day of the COVID-19 emergency period described in section 1135(g)(1)(B) of the act (42 U.S.C.A. § 1320b-5(g)(1)(B)). As required by section 9811 of the ARP, the Department will suspend copayments at least during the period required by the ARP.
Fiscal Impact
The Department does not anticipate any fiscal impact related to the ARP requirement for coverage of COVID-19 vaccines, vaccine administration, testing or treatments provided to MA beneficiaries without copayment because the MA Program has already been covering these services without copayments.
Public Comment
Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revisions related to coverage of COVID-19 testing and treatment services.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1557. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 22-2038. Filed for public inspection December 30, 2022, 9:00 a.m.]
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