DHHS waiving copays for prescriptions, office visits, ER visits, radiology and lab services; allowing early refills of prescriptions

Tue, 03/17/2020 - 1:00pm

    AUGUSTA — The Maine Department of Health and Human Services (DHHS) is taking immediate steps, according to a news release, to ensure access to critical services and benefits for Maine people while protecting the health of employees and the public in response to the 2019 novel coronavirus, or COVID-19.

    “We are acting swiftly to maintain Maine people's access to health care coverage, nutritious food, and support for basic necessities in the face of COVID-19, while also safeguarding their health and the health of our valued employees,” said DHHS Commissioner Jeanne Lambrew.

    These steps include supporting MaineCare members through the implementation of emergency rules effective Wednesday, March 18 that will:

    • Waive all copays for prescriptions, office visits, emergency department visits, radiology and lab services

    • Allow early refills of prescriptions

    • Allow providers to extend 34-day supply maximums on brand prescriptions (MaineCare already allows 90-day supplies of generic prescriptions)

    • Waive initial prior authorization requirements for asthma and for immune-related drugs

    • Lengthen the period that prior authorization applies for prescription medications

    • Lengthen the period that prior authorization applies for certain durable medical equipment, such as home oxygen therapy, glucose test strips, and Continuous Positive Airway Pressure (CPAP) supplies for individuals diagnosed with COVID-19, those with pending test results who are in self-isolation, and those in a high-risk category for infection

    • Extend the amount of time that home health providers have to submit plans of care from within five business days to within 30 business days from the start of services

    In addition to these changes, the Department made an immediate change Tuesday to its telehealth policy through emergency rule, to allow for prescribing through telehealth, per the release. This change is effective immediately.

    MaineCare telehealth policy already allows providers and members to meet any face-to-face requirements for services through telehealth, when medically appropriate and when it will result in comparable quality of service.

    For services that traditionally have not been considered medically appropriate or of comparable quality via telehealth, such as Intensive Outpatient Treatment or Home and Community-Based Treatment, providers are encouraged to consider alternative treatment options that could be more appropriately delivered via telehealth (such as one-on-one counseling visits), according to the release. 

    Additionally, DHHS has made two changes effective immediately that do not require emergency rulemaking, the release said.

    First, to the greatest extent allowable under federal law, DHHS will accept eligibility verification by self-attestation to facilitate efficient processing of MaineCare applications and recertifications. Second, DHHS will waive premiums for MaineCare services, such as the Working Disabled, Cub Care, Katie Beckett, and Special Benefit programs. Failure to pay those premiums will not result in case closure.

    DHHS is also acting to support social distancing in its 16 regional offices, without disrupting critical benefits and services.

    In line with guidance from the U.S. Centers for Disease Control and Prevention, DHHS is limiting its interactions with the public to accepting paperwork for drop-off.

    Clients are being encouraged to fill out and submit applications and reviews for programs, including Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), and MaineCare online through My Maine Connection. Paperwork may be submitted via fax, email or postal carrier. The toll-free number is 1 (855) 797-4357 and agents are available from 7:00 a.m. to 4:30 p.m. Monday through Friday.

    DHHS offices remain open at this time, and clients can fill out applications in person if they prefer. If clients need assistance, they will be encouraged to call the toll-free number to speak with an agent.

    DHHS also issued an emergency rule effective Friday, March 13 allowing all TANF application and annual review interviews, which are required to determine eligibility, to be held by telephone rather than in person. TANF orientations, which are completed during the application process, also will be held by phone rather than through visits to one of the Department's vendor locations, also known as Fedcap Opportunity Centers. Fedcap is limiting in-person contact for ASPIRE participants, encouraging and facilitating remote participation.

    DHHS also will limit in-person interviews for fraud investigations and quality control audits, and will hold all administrative hearings by telephone.

    DHHS has requested approval from the federal government as needed to allow for additional flexibility, including extending annual review periods for TANF, SNAP and MaineCare for up to three months.

    These preliminary steps will help to streamline access to essential benefits and DHHS will continue to implement additional strategies as they become available.