Summer 2021 General Provider Transmittal Updates

REQUIREMENTS: By August 15, 2021: Billing team and clinical staff must discontinue use of COVID-19 emergency flexibilities (e.g., expanded telehealth delivery methods, waived visit-only vaccine administration limitations for non-FQHCs/non-hospitals). Revert all telehealth billing to standard pre-pandemic protocols. Update billing system to enforce standard rules for behavioral health telehealth visit lengths and modalities. By July 1, 2021: Billing team must implement new telehealth coverage rules: (1) Audio-only telehealth is now reimbursable through June 30, 2023; (2) Telehealth services are covered regardless of participant location; (3) Distant-site providers can deliver services from any location; (4) Facility/room/board charges cannot be billed for telehealth unless professional fee cannot be billed separately. Update billing software rules and provider encounter forms accordingly. Immediately: Verify all FFS professional services claims paid between January 1 - March 10, 2021 align with 2021 Professional Services Fee Schedule. Monitor remittance advice from June 14, 2021 onward for automatic system adjustments. For claims billed below current allowed amount, submit manual adjustment requests per PT 41-21 instructions to mdh.professionalservicespolicy@maryland.gov. By September 30, 2021: Providers with expired licenses should submit supplemental applications NOW to update licenses in system (deadline extended from earlier date). Failure to update may cause future billing issues and claim denials. By December 31, 2021: Do not process Medicaid eligibility terminations due to public health emergency extension. Billing team must flag denied claims citing eligibility issues for reversal review. Before April 1, 2022: Monitor for CMS State Plan Amendment guidance and prepare systems for postpartum coverage extension from 60 days to one year for eligible pregnant women (income ≤250% federal poverty level). Implementation details forthcoming. Pending Further Guidance: Await Maryland Medicaid guidance on pharmacist injection administration reimbursement policy before updating billing protocols for pharmacist-administered self-administered drugs and maintenance injectable drugs. All Providers: Review current COVID-19 fee schedules at health.maryland.gov/providerinfo for vaccine/infusion/lab codes and rates (updated frequently). Contact christa.smith@maryland.gov (vaccines/infusion) or tenesha.lynch@maryland.gov (laboratory) with questions.