09/05/2024 | Press release | Distributed by Public on 09/05/2024 09:35
TO: All Providers
RE: Reminder of Changes to Services on October 1, 2024 Related to COVID-19 Unwinding
The following information was published in a Provider ALERT on July 2, 2024; however, the Alabama Medicaid Agency (Medicaid) is sending this information to providers again as a reminder of upcoming changes starting on October 1, 2024.
Per federal guidance, the phase down for funds related to the COVID-19 public health emergency (PHE) ends on September 30, 2024. Therefore, some flexibilities Medicaid implemented due to the COVID-19 PHE will end at that time. Effective October 1, 2024:
· Pregnant adult recipients (ages 21 and older) will only be eligible for dental benefits during pregnancyand through the end of the month of 60 days postpartum when rendered by enrolled dental providers.· At-Home over-the-counter (OTC) COVID-19 Diagnostic Tests from a pharmacy will no longer be covered. Medicaid recipients may still be tested for COVID-19 through a physician office or clinic.· COVID-19 vaccine administration reimbursement will changefrom $40 to $8 per administration. This applies to pharmacy and non-pharmacy providers.· COVID-19 vaccine counseling reimbursement will changefrom $31.70 to $13.00. This applies to pharmacy and non-pharmacy providers.· All non-COVID vaccine administration reimbursement will change from $5 to $8 per administration. This applies to pharmacy and non-pharmacy providers.· Copayments for Medicaid covered services will be reinstated.The amounts are based on the federally approved maximum amounts and are shown below (including Medicare crossovers):
ServiceswithCopayments |
Copayment Amounts |
Based on Medicaid's Allowed Amount for the Services |
Office Visits (including visits to physicians, optometrists, nurse practitioners) |
$0.65 to $3.90 per office visitcode | $50.01 or more - $3.90$25.01 - $50.00 - $2.60$10.01 - $25.00 - $1.30$10.00 or less - $0.65 |
Federally Qualified Health Centers (FQHC) | $3.90 perencounter | |
Rural Health Clinic (RHC) | $3.90 perencounter | |
Inpatient Hospital | $50.00 per admission | |
Outpatient Hospital |
$3.90 per visit | |
Ambulatory Surgical Centers | $3.90 pervisit | |
Durable Medical Equipment/Medical Supplies and Appliances | $0.65 to $3.90 per line item |
$50.01 or more - $3.90$25.01 - $50.00 - $2.60$10.01 - $25.00 - $1.30
$10.00 or less - $0.65 |
Prescription Drugs |
$0.65 to $3.90 per prescription | $50.01 or more - $3.90$25.01 - $50.00 - $2.60$10.01 - $25.00 - $1.30$10.00 or less - $0.65 |
A provider may not deny services to any eligible Medicaid recipient because of the recipient's inability to pay the cost-sharing (copayment) amount imposed.
Please continue to visit the Alabama Medicaid websitefor up-to-date information related to the 'unwinding' process. If you have questions, please contact the Provider Assistance Line at (800) 688-7989.