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Transmittal 20-15 Fee-For-Service Prior Authorization and Programmatic changes due to COVID-19

Tuesday, April 21, 2020

The purpose of this transmittal is to notify Medicaid fee-for-service (FFS) providers of temporary Prior Authorization (PA) and other programmatic changes due to the COVID-19 pandemic during the pendency of the federal Public Health Emergency (PHE) period. DHCF requested an 1135 Waiver from the Centers for Medicare and Medicaid Services (CMS) on April 1, 2020. Under section 1135 of the Social Security Act, the HHS Secretary may temporarily waive or modify certain Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled when the President declares a disaster or emergency and the Secretary declares a public health emergency. On April 3, 2020, CMS approved most of the flexibilities requested in the 1135 waiver. This transmittal describes the actions taken by DHCF to implement some of the flexibilities provided in the 1135 Waiver.