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TO:   All Providers

RE:   COVID-19 Unwinding – Changes to Services

Per federal guidance, the COVID-19 public health emergency (PHE) will end on May 11, 2023. Therefore, some flexibilities the Alabama Medicaid Agency (Medicaid) implemented due to the COVID-19 PHE will end at this time. Medicaid intends to keep providers updated on changes that will be forthcoming during the return to normal operations. Medicaid is working with the Centers for Medicare and Medicaid Services (CMS) to prepare to end some flexibilities implemented during the COVID-19 PHE. Notice of changes will be provided through additional notices via State Plan Notice, Administrative Code Notice, waiver notice, or provider ALERTs. 

Below are some changes that are forthcoming:

Effective May 12, 2023:

·     Recipient signatures will be required to be obtained and kept on file as verification that the recipient was present on the date of service for which the provider seeks payment. More information can be found in the Alabama Administrative Code, Chapter 1, Rule No. 560-X-1-.18 Provider and Recipient Signature Requirements.

·     Medicaid will discontinue reimbursement for transportation to a mass administration site to obtain COVID-19 vaccines.

Effective June 1, 2023:

·     Medicaid will resume the referral requirements for EPSDT visits. Once the child has an EPSDT screening, all subsequent visits to other providers for further diagnosis or treatment must have a written referral (Form 362) from the EPSDT screening provider.

o   An EPSDT referral will be required so that recipients under the age of 21 do not run out of office or hospital visits.

o   Please refer to Appendix A – Well-Child Checkup (EPSDT) of the Provider Billing Manual for billing instructions related to EPSDT services.

o   Prior Authorization requests for services that required an EPSDT referral prior to the PHE will once again be required. Therefore, those prior authorizations for services requiring an EPSDT referral submitted on or after June 1, 2023 will be required to include a current EPSDT referral with the prior authorization.

·     Medicaid will discontinue the use of the CR modifier to identify COVID-19 related services or equipment. Providers should no longer bill the CR modifier for COVID-19 related services or equipment.

Effective October 1, 2024:

·     Copayments will be reinstated for applicable services and recipients.

Medicaid is working with the CMS to prepare to end other flexibilities implemented during the COVID-19 PHE. Please continue to visit the Alabama Medicaid website for up-to-date information related to the “unwinding” process. If you have questions, please contact the Provider Assistance Line at (800) 688-7989.

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