To comply with the American Rescue Plan Act (ARPA) of 2021, COVID-19-related vaccine, treatment, and testing services are provided without cost-sharing, including copayments, to Community First Health Plans CHIP Members.
This policy is contingent on the public health emergency and will end on the last day of the first calendar quarter that begins one year after the last day of the COVID-19 public health emergency period.
In accordance with the ARPA’s amendment to Section 2103(c)(11)(B) of the Social Security Act, Community First must cover services for COVID-19, including:
- vaccines
- testing,
- treatment of COVID-19, including preventative therapies and Treatment of post-COVID conditions (long-haul COVID-19) and, during the period when a beneficiary is diagnosed with or is presumed to have COVID- 19, treatment of health conditions that may seriously complicate the treatment of COVID- 19.
- Examples of these health conditions include, but are not limited to, cardiovascular diseases, chronic lung diseases, diabetes, cancer, obesity, Down Syndrome, and being a recipient of a transplant or immunosuppressive therapy.
Additionally, ARPA’s amendment to Section 2103(e)(2) of the Social Security Act prohibits any financial requirement (including copayments) or treatment limitation to the COVID-19-related services listed above. CHIP providers are prohibited from collecting co-payments for these services.
COVID-19 Coding Guidance
- COVID-19 treatment services should have the U07.1 diagnosis code indicating confirmed COVID-19 infection as the primary diagnosis.
- Conditions that may seriously complicate COVID-19 treatment during the period when a beneficiary is diagnosed with or is presumed to have COVID- 19 should have the U07.1 diagnosis code indicating confirmed COVID-19 infection as a secondary diagnosis.
- Treatment of post-COVID conditions (long-haul COVID-19) should have the U09.9 diagnosis code indicating post-COVID-19 condition as a secondary diagnosis.
Resources:
State Health Official Letter #21-006, “Mandatory Medicaid and CHIP Coverage of COVID-19- Related Treatment under the American Rescue Plan Act of 2021”
Provider Attestation form: https://www.hhs.texas.gov/regulations/forms/5000-5999/form-5004- optional-covid-19-chip-provider-co-payment-attestation