Nevada’s Medicaid program plans to seek waivers from the federal government to streamline and accelerate access to vital services as the Silver State grapples with the widespread impact of the novel coronavirus.
A draft of a planned emergency waiver last week included temporary requests for flexibility around in-person assessments typically required for programs like long-term care and the possibility of permitting care in alternative settings, if need be, said Suzanne Bierman, administrator for the Division of Health Care Financing and Policy.
The waiver would also relax prior authorization requirements for claims submitted by health care providers.
The state is preparing two requests — an 1135 waiver, which includes those appeals — and other alterations under “Appendix K,” which would involve targeting the needs of home and community-based health services.
Other states including North Carolina, Florida and Washington have submitted 1135 waiver requests in the days since President Donald Trump declared a national emergency over coronavirus concerns March 13. The administration initially showed little interest in granting states more Medicaid flexibility, but in recent days waiver requests from both Florida and Washington have been approved.
Both of Nevada’s requests are currently being drafted and will be sent to the Centers for Medicare & Medicaid Services when complete, Bierman said last week.
“It is certainly in progress,” Bierman said of the 1135 request. “I think we’re trying to balance getting as much feedback as possible with getting this in as quickly as possible.”
The state has already also submitted a request for an extension in processing Medicaid and Children’s Health Insurance Program renewals as it prepares for a double blow — an expected surge in Nevadans’ reliance on Medicaid just as medical providers are facing a number of challenges associated with COVID-19.
The flexibilities sought by the state “would not only allow us to help, but it also allows us for instance, to do antibiotics through IV. It will allow us to do home health occupational therapy,” said Angela Quinn, CEO of federally qualified health center FirstMed Health and Wellness.
Quinn, who has been in contact with the state over its requests to the federal government, said the temporary flexibility would go a long way toward improving care for Nevadans in the midst of the coronavirus outbreak.
Her clinics are undergoing a change in response to COVID-19 as they shift to telemedicine four days a week to accommodate patient concerns and a dearth of personal protective equipment.
They’ve run out of gowns, masks and are low on gloves.
“We can’t protect our patients or our providers in a normal health care setting, and our patients are scared to come into a normal health care setting,” Quinn said.
The clinic will continue to hold in-person hours one day a week and staff will be available around the clock.
The move follows a recent 60 percent cancellation rate for clinic visits at FirstMed, Quinn said.
At the same time, call volume has increased from about 300 a day to 500 or more a day, with some locals asking about Medicaid enrollment as layoffs and job losses hit Southern Nevada.
The economic effects of COVID-19 spurred bipartisan legislation signed by President Donald Trump on Wednesday that will, among other things, temporarily increase the federal government’s reimbursement rate to state Medicaid programs.
Democrats and Republicans sparred over details in an additional large aid package this weekend.
Quinn credited the state for communication in the midst of the COVID-19 troubles but said the limited access to personal protective equipment has been an issue of federal miscommunication.
“They’ve done a great job of communicating. They are frustrated,” she said of the state. “We’re really relying on the federal government. If the federal government has it, it’s not releasing” the equipment.
FirstMed is reacting to COVID-19 not only by shifting to telemedicine but also by increasing its mental health resources as many of the low-income and Medicaid patients who rely upon the organization may face hard times.
“We’re actually beefing up our response,” Quinn said. “We’re responding on the mental health side exactly as we did after Route 91.”
Other organizations are also making changes to accommodate COVID-19 worries.
Liberty Dental, which provides dental insurance to Nevada’s Medicaid population, announced last week that it would make emergency teledentistry services available to that population..
The state’s Medicaid program has also been working to update its system to allow medical providers to bill for COVID-19 testing.
“Nevada Medicaid full covers medically necessary treatment including treatment for COVID-19,” Bierman said.