Prohibition of Cost Sharing for COVID-19 Vaccine, Treatment, and Testing Services

Beginning December 21, 2022, to comply with the American Rescue Plan Act (ARPA) of 2021, CHIP MCOs must ensure COVID-19 related vaccine, treatment, and testing services are provided without cost-sharing, including copayments. 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, CHIP MCOs 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.

Providers should not collect copays for COVID-19 related vaccine, testing, and treatment services (including treatment of health conditions that may seriously complicate the treatment of COVID-19).  Claims for 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.

Please contact NManagement@cfhp.com for further information or questions.

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