Frequently Asked Questions (FAQs) Regarding Coronavirus Disease 2019 (COVID-19) Updated 4/3/2020

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Preguntas Frecuentes (FAQs) Sobre la Enfermedad por COVID-2019 (Actualizado 4/2/2020)

On March 17, 2020 and March 24, 2020, AHCCCS submitted requests to the Centers for Medicare and Medicaid Services (CMS) to waive certain Medicaid and KidsCare requirements in order to ensure ongoing access to care over the course of the COVID-19 outbreak.


  • 1. (added 3/19/20) Question: Are there billing codes available for COVID-19 testing outside of Centers for Disease Control and Prevention (CDC) testing laboratories?
    Answer: Yes. The Centers for Medicare & Medicaid Services (CMS) created a new Healthcare Common Procedure Coding System (HCPCS) code for COVID-19 tests administered outside of Centers for Disease Control and Prevention (CDC) testing laboratories. This code corresponds with a Food and Drug Administration policy that allows certain laboratories to develop their own tests. Providers should use existing HCPCS code U0001 for CDC testing laboratories and the new HCPCS code U0002 for non-CDC lab tests. In addition, the American Medical Association has added a new Current Procedural Terminology (CPT) code: 87635 infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.
    2. (added 3/19/20) Question: Will AHCCCS issue guidance regarding prior authorization expectations related to COVID-19 testing and treatment?
    Answer: Prior authorization is not permitted for COVID-19 testing or treatment.
    3. (added 3/20/20) Question: Is there a claims modifier for services related to the COVID-19 emergency?
    Answer: Yes, AHCCCS has designated the CR modifier to be used on all claims for services provided as a result of, or related to COVID-19. It is imperative that providers begin utilizing this modifier immediately in all appropriate instances in order for AHCCCS to identify the costs of services attributable to this emergency. All other guidance regarding use of modifiers continues to be applicable.
    4. (added 3/19/20) Question: Does AHCCCS cover testing for COVID-19?
    Answer: Yes, AHCCCS covers COVID-19 testing. HCPCS U0001 and U0002 have an effective date of February 4, 2020. CPT 87635 has an effective date of March 13, 2020. All codes have been entered in the AHCCCS PMMIS system.
    5. (updated 3/19/20) Question: Is there an ICD-10 diagnostic code for COVID-19?
    Answer: Yes, The World Health Organization has developed an emergency ICD-10 code for the coronavirus: U07.1, 2019-nCoV acute respiratory disease. The U07.1 is effective in PMMIS for dates of service February 4, 2020 and thereafter. Additionally, CDC’s National Center for Health Statistics will implement a new diagnosis code into the ICD 10th Revision, Clinical Modification, effective with the next update on October 1, 2020; CDC issued interim coding guidance and guidelines for health care encounters and deaths related to COVID-19.
    6. (added 3/25/20) Question: How should hospitals that are reimbursed by APR-DRG bill for inpatient services related to the new ICD-10 diagnosis code for COVID-19?
    Answer: AHCCCS has been notified that the 3M software will not recognize the new ICD-10 diagnosis code for COVID-19 prior to April 1, 2020. Until the April 1, 2020 software release, hospitals should bill for other related conditions such as:
    • Pneumonia
    • Acute Bronchitis
    • Lower Respiratory Infection
    • ARDS - Acute respiratory distress syndrome

    The April 1, 2020 release of 3M software will recognize the newly defined ICD-10 diagnosis code, U07.1, mapped to an existing APR-DRG code under the April 1, 2020 software release.

    7. (updated 3/30/20) Question: Does AHCCCS have a centralized resource for medical coding resources related to COVID-19?
    Answer: Yes, the AHCCCS Medical Coding Resources webpage includes a COVID-19 Medical Coding Information section and COVID-19 Emergency Medical Coding guidance.

  • 1. (updated 3/30/20) Question: Does AHCCCS have guidance about Prior Authorization (PA) and Concurrent Review procedures during the COVID-19 emergency?
    Answer: Yes, please see the AHCCCS March 27, 2020 memo. This guidance does not apply to AHCCCS Fee for Service Programs. Fee for Service guidance, in coordination with tribal stakeholders, is available in this Fee for Service memo.
    2. (added 3/23/20) Question: Is AHCCCS willing to suspend medical record review audits and behavioral health chart audit review processes at this time?
    Answer: Yes, AHCCCS is suspending medical record review/behavioral health chart audit efforts for providers that do not have any quality/utilization concerns. This suspension will be in place through April 30, 2020. At that time, the situation will be re-evaluated to determine provider and MCO capacity to conduct these review efforts.
    3. (added 3/27/20) Question: Will AHCCCS consider relaxing the timeframe for issuing Notice of Adverse Benefit Determination (NOABD) letters for non-urgent prior authorization requests? Due to the need to print securely we have been unable to deploy these staff home while complying with this AHCCCS requirement.
    Answer: No, AHCCCS will not be extending the timeframe for Notice of Adverse Benefit Determination (NOABD) letters for non-urgent prior authorization requests.

  • 1. (updated 3/23/20) Question: Where can I get information and updates about the coronavirus and COVID-19?
    Answer: Information about COVID-19 is available from the Centers for Disease Control (CDC) and the Arizona Department of Health Services. Additionally, the general public in Arizona can call the Arizona Poison Control System at 1-844-542-8201 or the statewide COVID-19 Hotline, available 8 a.m. to 8 p.m. daily, in English and Spanish, by dialling 2-1-1 in Arizona. The COVID-19 hotline is administered by 2-1-1 Arizona and the Crisis Response Network, and can address questions about how to prepare for and prevent COVID-19 spread; testing information for COVID-19; at-risk populations; what to do if an individual gets sick; COVID-19 and animals; and other resources for accurate, reliable, and up-to-date information.
    2. (updated 3/24/20) Question: Is COVID-19 laboratory testing available outside of the ADHS State Lab?
    Answer: Yes, as of March 16, 2020 COVID-19 testing is now available through private labs as well as the state lab. However, the COVID-19 test requires a specimen to be collected by a physician or other authorized healthcare providers. Do not visit a laboratory location to request the COVID-19 test. Instead, contact your physician or other authorized healthcare provider for guidance regarding getting tested. Your healthcare provider can best advise whether you meet criteria for testing and their office's availability of testing supplies.
    3. Question: Who does ADHS notify when there is a confirmed positive case of COVID-19?
    Answer: ADHS notifies the member’s ordering provider and the member’s County Public Health Department.
    4. (updated 3/19/20) Question: Does AHCCCS have a centralized resource for members who have general questions or are experiencing flu-like symptoms?
    Answer: Yes. AHCCCS has created a web page to address Medicaid-related questions from providers and contractors about COVID-19 at
    • For ACC Health Plan members experiencing symptoms: Call the 24-hour Nurse Line for your Health Plan. The Health Plans’ 24/7 Nurse Line numbers are posted on the AHCCCS COVID-19 web page.
    • For FFS Members, including those enrolled in the American Indian Health Program (AIHP), Tribal ALTCS, or a Tribal Regional Behavioral Health Authority (TRBHA): Please contact the nearest American Indian Medical Home (AIMH) 24-hour Nurse Line, your doctor, or the nearest IHS/638 facility. The AIMH Nurse Line phone numbers are posted on the AHCCCS COVID-19 web page.
    5. (updated 3/24/20) Question: Who is at high risk for serious illness?
    Answer: According to the CDC's Situation Summary,, pandemic COVID-19 poses a serious public health risk. Per the Arizona Department of Health Services Frequently Asked Questions, those at higher risk for serious illness include older adults, and people who have serious chronic medical conditions like heart disease, diabetes, and lung disease. It is recommended that these individuals practice enhanced prevention strategies. Check the ADHS website often for the most current information on COVID-19.
    6. Question: Should I keep doctor appointments for routine visits?
    Answer: Please call your health care provider regarding scheduled, routine visits.
    7. (updated 3/23/20) Question: What is the guidance on well-child visits during the COVID-19 pandemic?
    Answer: Please see the most recent guidelines from the American Academy of Pediatrics.
    8. (added 3/20/20) Question: Should elective and non-emergency medical procedures be delayed or postponed?
    Answer: Following a CMS recommendation, Governor Doug Ducey announced an Executive Order on March 19, 2020 that halts all elective surgeries in the state of Arizona in order to free up medical resources and maintain the capacity for hospitals and providers to continue offering vital services.
    9. Question: Arizonans are understandably stressed and anxious right now. What mental health resources do you recommend?
    Answer: AHCCCS covers a full array of behavioral health services for members, and crisis services are available to anyone in Arizona, regardless of insurance coverage. In addition, we have added behavioral health resources offered by the CDC and SAMHSA on the COVID-19 webpage.
    10. (added 3/24/20) Question: If the state decides to close all businesses except those that are essential, what businesses would remain open?
    Answer: To stem the spread of COVID-19, Governor Ducey issued an executive order clarifying businesses and operations that are deemed “essential” by the state, including, but are not limited to, the following roles and/or job functions:
  • Healthcare and Public Health Operations:
    • Hospitals, clinics, dental offices, pharmacies
    • Public health entities, including those that compile, model, analyze, and communicate public health information
    • Pharmaceutical, pharmacy, medical device and equipment, and biotechnology companies (including operations, research and development, manufacture and supply chain)
    • Home healthcare services providers
    • Mental health and substance use providers
    • Other healthcare facilities and suppliers
    • Includes doctors, nurses, and any other classification of medical personnel necessary to operate those functions in this category
    • This category of essential services shall be construed broadly to avoid any impacts to the delivery of healthcare, broadly define
  • Human Services Operations (including but not limited to):
    • Long term care facilities
    • Residential settings and shelters for adults, seniors, children, andor people with developmental
    • disabilities, intellectual disabilities, substance use disorders, and/or mental illness
    • Transitional facilities
    • Home-based settings to provide services to seniors, adults, and children with physical, intellectual, and/or developmental disabilities, substance use disorders, and/or mental illness, including caregivers such as nannies who may travel to the child’s home and provide care and other in-home services including meal delivery
    • Field offices that provide and help to determine eligibility for basic needs including food, cash assistance, medical coverage, child care, vocational services, rehabilitation services
    • Developmental centers
  • Transportation:
    • Taxis, transportation network providers (such as Uber and Lyft), paratransit
  • Home-based care and services & residential facilities:
    • Home-based care for adults, seniors, children, and/or people with developmental disabilities, intellectual disabilities, Residential facilities and shelters for adults, seniors, children, and/or people with developmental disabilities, intellectual disabilities and substance use disorders and/or mental illness
    11. (added 3/30/20) Question: Will members lose coverage during the COVID-19 emergency?
    Answer: No, per the Families First Coronavirus Response Act, AHCCCS will not disenroll members during the emergency (with the exception of death, those who move out of state, or those who voluntarily withdraw). Members who lost AHCCCS eligibility in March 2020 will be notified of their reinstatement.
    12. (added 3/30/20) Question: Is AHCCCS aware of any opportunities for providers to secure loans during the COVID emergency?
    Answer: On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES) passed, including immediate loan assistance for small businesses. Providers may wish to review loan opportunities authorized under the Act to determine if they qualify for this stimulus funding. Stimulus loans are not under the purview of the Medicaid program and AHCCCS does not play a role in the administration of small business loan assistance.
    13. (added 4/2/20) Question: During the COVID-19 emergency will AHCCCS members be required to pay premiums?
    Answer: No. For the duration of the COVID-19 emergency, AHCCCS has suspended premium payments for the KidsCare and Freedom to Work programs as well as copayments for the Transitional Medical Assistance (TMA) and Adult populations. Members who have already paid March 2020 premiums will be credited, and individuals who were disenrolled in March will be reinstated for the duration of the emergency.
    14. (added 4/2/20) Question: How does AHCCCS plan to use the additional 6.2 % in federal matching funds appropriated for Medicaid programs under the Families First Coronavirus Response Act?
    Answer: We are aware of stakeholder interest in how AHCCCS plans to use the enhanced federal funding available through the Families First Coronavirus Response Act. We continue to evaluate how to best use the funds, in light of the expected member growth due to the COVID-19 emergency. In order to receive the match, AHCCCS is required not to disenroll members, and expects membership growth as the existing members remain enrolled and new members are added. As such, AHCCCS must first ensure that the additional funding will cover the cost of the enrollment growth that will occur.
    15. (added 4/2/20) Question: Does the one-time COVID-19 stimulus payment and/or the unemployment benefit increase affect AHCCCS eligibility?
    Answer: The one-time COVID-19 stimulus payments and the unemployment benefit increase will not affect AHCCCS eligibility.
    16. (added 4/3/20) Question: Due to the COVID-19 emergency, CMS is granting State Medicaid programs the flexibility to waive and/or modify certain Medicaid requirements. What flexibilities has AHCCCS requested?
    Answer: AHCCCS has requested various flexibilities to waive and/or modify certain Medicaid requirements under the 1135 and 1115 Waivers and the State Plan Amendment. CMS has begun to review and grant approval of these requests. As approval is granted, AHCCCS is making operational decisions regarding implementation, and tracking progress in this document.
    17. (added 4/3/20) Question: How does Governor Ducey’s March 24th Executive Order freezing all evictions in Arizona related to COVID for 120 days affect persons determined Seriously Mentally Ill (SMI) or persons with behavioral health needs (GMH/SU) in AHCCCS supported residential programs, including Permanent Supportive Housing, and/or Behavioral Health Residential Facilities (BHRFs), in which members pay room and board?
    Answer: AHCCCS intends for the Executive Order to apply to all AHCCCS and/or Medicaid funded permanent supportive and transitional housing programs as well as services settings in which AHCCCS members pay for room and board such as BHRFs, assisted living facilities, and group homes. Residential stability is critical for members to comply with mandated stay at home orders. To this end, there should be no disruption of service or alteration of existing subsidies for persons residing in AHCCCS funded Permanent Supportive and Transitional Living programs for persons determined SMI. Similarly, these protections should be broadly applied to any service setting whereby AHCCCS members pay for room and board.

    In all situations during this crisis, AHCCCS encourages increased care coordination of members with behavioral health needs in housing or residential programs/settings to ensure housing/placement security during this crisis. This will allow members to maintain their residential setting and comply with social distancing and stay at home practices required under our State and National COVID response orders for their own health and the health of our community.

  • 1. (updated 3/19/20) Question: Should Health Plans be educating their members and contracted providers about COVID-19?
    Answer: Yes, Health Plans and FFS Programs should be proactively educating members and providers utilizing information from the Centers for Disease Control (CDC), the Arizona Department of Health Services (ADHS), and other applicable entities outlined in the AHCCCS Contractor Operations Manual (ACOM) 404, Attachment A. If the only source of information in member education materials is one of the entities listed in ACOM 404, Attachment A, it does not need to be submitted to AHCCCS for review or approval.
    2. (updated 3/19/20) Question: Should Health Plans and FFS providers continue routine staff visits to healthcare facilities, provider practices, and members’ homes?
    Answer: We highly recommend that, when feasible, both Health Plans and FFS Programs and providers leverage technological platforms to conduct virtual visits whenever possible. For example, a 180 day case manager visit for an Arizona Long Term Care System (ALTCS) member located at a Skilled Nursing Facility (SNF) can be done via telehealth.
    3. (updated 3/19/20) Question: Should Health Plans continue to go onsite to provider locations to investigate immediate quality of care concerns?
    Answer: In accordance with CMS guidance, AHCCCS is requesting that Health Plans and FFS Programs maintain investigative efforts for serious health and safety threats (e.g. allegations of abuse). Health Plans and FFS Programs should do their part to support sound infection control protocols, including limiting the number of staff that go onsite for the investigation, implementation of preventive practices such as handwashing and use of hand sanitizer before engaging with members and staff, and assessment of staff health before entering the facility. If Health Plans and FFS Programs encounter issues with ability to conduct onsite/in-person investigation of immediate quality of care concerns, please notify AHCCCS QM of the limitation at
    4. (added 3/19/20) Question: Should ALTCS Health Plans and Tribal ALTCS programs continue to conduct in-person case management and support coordination visits with members?
    Answer: Per AMPM 1620-E, case managers (and support coordinators) must conduct in-person visits for members residing in a skilled nursing facility every 180 days and to a member receiving HCBS or acute-only services every 90 days. AHCCCS is suspending the in-person requirement at this time. Case managers should continue to reach out to members telephonically to complete monitoring/reassessment efforts to the extent possible. If members are not able to be reached via telephone or other electronic means, outreach attempts should be documented in the member’s case management file.
    5. Question: Are Health Plans permitted to conduct targeted outreach to members at risk to ensure they know the warning signs, understand precautions, and are prepared to take appropriate action should they become ill?
    Answer: Yes, AHCCCS encourages health plans to conduct targeted outreach to at risk members. We highly recommend that Health Plans leverage technological platforms to conduct virtual visits whenever possible.
    6. (added 3/30/20) Question: Is the newborn notification requirement continuing during the COVID19 emergency?
    Answer: The Newborn notification requirements have NOT changed and remain in place.

  • 1. (added 3/23/20) Question: Will AHCCCS consider waiving or suspending certain deliverables to allow greater flexibility to MCOs considering much of our workforce is telecommuting and focused on member care?
    Answer: Yes, AHCCCS is currently evaluating where flexibility can be offered for deliverables. Additional guidance will be issued in the near future. If an MCO has a specific request, please send it to your AHCCCS Operations/Compliance Officer.
    2. Question: Do the Health Plans need to request and review COOP documents from providers?
    Answer: During the MCO-AHCCCS Weekly COVID-19 call on 3/16, Director Snyder conveyed the message that AHCCCS expects the health plans to check in with critical provider types to ensure these providers, such as Mobile Crisis providers, Stabilization Crisis providers, Long Term Care facilities, and Outpatient Treatment Program (OTP) providers have Continuity of Operations Plans (COOP) and have reviewed them with staff. This expectation to check in does not mean that the health plans need to request copies of providers’ COOP documents.
    3. (added 3/19/20) Question: Is AHCCCS willing to halt hybrid performance measure efforts in light of COVID-19?
    Answer: After careful consideration, AHCCCS has directed HSAG to suspend all medical record procurement and abstraction activities for the CYE 2018 Hybrid Performance Measure Calculations. At this time, AHCCCS is prioritizing MCO and provider response to COVID-19. Once the COVID-19 emergency response has passed, AHCCCS will re-evaluate project timelines and determine next steps for hybrid audits.
    4. (added 3/20/20) Question: Are there any changes to timeframes for behavioral health service delivery during the COVID-19 emergency for members in DCS custody?
    Answer: No, there are no changes to behavioral health response timeframes for children in DCS custody. For example, the Rapid Response is still required within 72 hours after referral from DCS. Please refer to ACOM 417 and ACOM 449 for additional information on AHCCCS timeframe requirements for children in DCS custody.
    5. (added 3/24/20) Question: Will AHCCCS consider relaxing the mandatory 72-hour turnaround time for Behavioral Health Residential Facility (BHRF) prior authorization (PA) determinations due to high volume and possible capacity issues?
    Answer: No, as there are concerns that expanding the 72-hour turnaround time on BHRF determinations could impact the continuity of care between inpatient facilities and transitions into the community.
    6. (added 3/27/20) Question: Will Corporate Compliance Audits be suspended during the COVID-19 emergency?
    Answer: Yes, AHCCCS is suspending Program Integrity/Corporate Compliance audits until April 30, 2020. At that time, the situation will be re-evaluated.
    7. (added 4/1/20) Question: Can MCOs delay sending Quality of Care (QOC) Concern acknowledgement and closing letters to the member when a QOC concern is being processed based on the member’s grievance/request?
    Answer: The MCOs must still comply with this requirement; however, electronic signatures shall be permitted. MCOs must maintain a process for printing and mailing letters in a timely manner. Alternatively, if a concern originated via electronic means (e.g. an email), an email response may be sent to the member in lieu of a hard copy mailed letter. If an email is sent, it should be documented in the QOC file.
    8. (added 4/1/20) Question: Can MCOs delay or suspend redaction of the Seclusion and Restraint reports or Incident, Accident, Death (IAD) report/Quality of Care (QOC) Concern report documentation?
    Answer: AHCCCS will not suspend or delay the redaction requirement. This must be maintained in order to ensure timely submission to the Independent Oversight Committees for review.
    9. (added 4/2/20) Question: Is AHCCCS considering any modifications to the CYE 2020 Performance Measure calculations or requirements?
    Answer: Depending on the length and extent of the current COVID-19 emergency, it is likely that most CYE 2020 performance measures will be impacted nationwide.AHCCCS is aware of this potential impact and is monitoring/awaiting CMS guidance for CMS reportable measures. AHCCCS will post additional guidance for performance measures and performance improvement projects once it becomes available; however, it is anticipated that AHCCCS performance measure calculations and reporting will align with associated technical specifications [CMS Adult and Child Core Set or NCQA HEDIS® (for HEDIS® only measures)] for the measurement period and related reporting requirements.

  • 1. Question: Will AHCCCS relax refill requirements for medications?
    Answer: Yes, AHCCCS will relax refill requirements including allowing “refill too soon” and allowing 90-day refills for medications that are not Controlled Substances. Many major pharmacy chains are offering free prescription delivery. Please inquire with your pharmacy for more details.
    2. Question: Will AHCCCS allow a 30-day prescription for a Controlled Substance to be filled early?
    Answer: Yes, the pharmacy staff may contact the prescribing clinician to request approval for the early refill. If the prescribing clinician approves the early refill, the pharmacy staff will contact the health plan's Pharmacy Benefit Manager (PBM) Help Desk for an override.
    3. (added 3/20/20) Question: Are pharmacy supplies and durable medical equipment (DME) supplies available for 90-day fills?
    Answer: Yes, supplies, including but not limited to insulin pump supplies, glucose testing strips, lancets, syringes, tubing and other supplies for sleep apnea equipment, nutritional supplements, and incontinence briefs are available for 90-day fills.

  • 1. (updated 4/2/20) Question: Will provider credentialing requirements be relaxed during the COVID-19 response?
    Answer: AHCCCS is requiring that all providers be considered for provisional credentialing, both to limit the immediate burden to providers as well as expedite their availability to serve members during this crisis. Additionally, to reduce burdens on providers, AHCCCS will allow a 6-month extension on the re-credentialing process for all providers in good standing (those with no quality or utilization concerns). Please see the AHCCCS Credentialing/Recredentialing Standards memo.
    2. (added 3/19/20) Question: Do providers still need to conduct in-person supervisory visits of Direct Care Workers?
    Answer: Per AMPM 1240a (Direct Care Services), Direct Care Worker (DCW) agencies are required to perform periodic supervisory/monitoring visits to assess the DCW’s competency in performing the assigned duties in accordance with member’s individualized service needs and preferences. At this time, AHCCCS is suspending in-person supervisory visits. Supervisory review of case notes/charts should continue to the extent possible, as well as supervisory engagement with staff via available telephonic or other electronic means.
    3. (added 3/19/20) Question: Are quality monitoring requirements at facilities being revised?
    Answer: AHCCCS is recommending that quality monitoring visits, including desk-based audits, be suspended unless there are known quality or utilization concerns with the provider. If a known concern exists, the MCO should conduct a desk audit, including review of member charts, personnel files, etc. AHCCCS is still contemplating a provider attestation statement in lieu of the onsite quality monitoring process.
    4. (updated 3/26/20)Question: Providers have expressed concerns about the availability of personal protective equipment (PPE). What resources are available? How can providers obtain some of the FEMA allocated PPE?
    Answer: The Arizona Department of Health Services has issued this COVID-19 Infection Control and Personal Protective Equipment (PPE) Guidance for Arizona. The FEMA allocated PPE initially comes through ADHS and then is distributed to county health departments. Providers are to submit requests directly to their County Health department. See this provider guidance from Maricopa County.
    5. (updated 4/3/20) Question: What is the expectation for coordination and continuity for Opioid Treatment Program (OTP) providers specific to Medication Assisted Treatment (MAT) in the event that an OTP clinic or OTP network becomes compromised?
    Answer: Each OTP should develop a business continuity plan that is inclusive of the recommendations from ADHS, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency (DEA). Should there be a disruption to services, notification should be made to AHCCCS and the Health Plans with which the provider is contracted, or to AHCCCS and the FFS Program(s) with which the member is enrolled, to ensure coordination of care efforts are implemented and access to care is not compromised. Providers should reference and utilize SAMHSA's TAP 34: Disaster Planning Handbook in the development of their plans. Providers should also work with Health Plan and FFS Program Emergency Response Coordinators for additional support. Please see SOTA OTP guidance memo on strategies for OTP Emergency Preparedness; Prevention and Education; Dosing for Take-Homes; Clinic Hours and Self-Administered Medication.

    Please see SAMHSA guidance, issued March 19, 2020, on the provision of methadone and buprenorphine for the treatment of Opioid Use Disorder during the COVID-19 emergency.

    The Drug Enforcement Administration (DEA) has created new exceptions for the prescription of controlled substances via telemedicine for the duration of the COVID-19 public health emergency. In order to ensure access to quality care, the DEA is waiving requirements for prescribers to obtain additional registrations in additional states where the prescribing and administering of controlled substances occurs. This new exception also applies to the prescription of controlled substances via telemedicine to patients in states in which a provider is not DEA-registered. Read the full guidance from DEA. Further guidance may be found in this SAMHSA/DEA letter.
    6. (added 3/24/20) Question: Will AHCCCS consider temporary changes to the Direct Care Worker (DCW) requirements for family members who reside with a member over age 18 to streamline hiring of family members in cases where there is no provider or where there are concerns of exposure due to providers coming into the home?
    Answer: The 90-day training requirement has been suspended, which allows DCWs to provide care while receiving training. The DCW agencies should consider remote learning opportunities to support DCWs, with evaluation of in-person skills and completion of required training following the conclusion of the COVID-19 emergency.
    7. (added 3/19/20) Question: Will AHCCCS relax the requirement for NEMT drivers to collect a passenger’s signature, whether on paper or electronically?
    Answer: Yes, this requirement has been waived.
    8. (added 3/24/20) Question: Can CPR/First Aid classes be completed online?
    Answer: CPR/First Aid classes can be completed via a credible online/virtual format sponsored by a nationally-recognized organization with in-person evaluation occurring following the conclusion of the COVID-19 emergency.
    9. (added 3/30/20) Question: Should providers continue to conduct supervision of staff, such as Licensed Professional Nurses (LPNs) providing home health nursing services?
    Answer: Yes, clinical supervision requirements have not changed during the COVID-19 Emergency. Specific to LPNs, AHCCCS Medical Policy Manual (AMPM) 1240-G Home Health Services outlines requirements for service delivery by LPNs, which includes supervision requirements.
    10. (added 4/3/20) Question: Should health plans make exceptions for providers not registered with AHCCCS for payment of a claim?
    Answer: No. Providers (in-state and out-of-state) need to be registered with AHCCCS in order to receive payment.
    11. (added 4/3/20) Question: Will AHCCCS permit providers located out of state to offer both emergency and non-emergency care to Arizona Medicaid and CHIP enrollees?
    Answer: Yes. AHCCCS has created a “short-form” for out-of-state providers in order to streamline the provider enrollment and approval processes for the duration of the emergency. The form, called the Out-of-State Packet, is posted on the AHCCCS Provider Enrollment web page.
    12. (added 4/3/20) Question: Will AHCCCS streamline provider enrollment requirements for out-of-state providers?
    Answer: Yes. AHCCCS will provisionally and temporarily enroll out-of-state providers for the duration of the public health emergency and in order to accommodate members who were displaced by the emergency. Approved out-of-state providers will be terminated from AHCCCS enrollment at the end of the COVID-19 national emergency; no extensions will be granted beyond the duration of the public health emergency. The out of state provider must be a certified provider enrolled in Medicare or with another State’s Medicaid program and be in good standing.
    13. (added 4/3/20) Question: Will AHCCCS suspend revalidation of providers who are located in Arizona or otherwise directly impacted by the disaster event?
    Answer: Yes, AHCCCS has suspended the provider revalidation process at this time.
    14. (added 4/3/20) Question: Will AHCCCS waive the provider enrollment application fee?
    Answer: Yes. The provider enrollment application fee is currently waived at this time, including for Out-of-State provider applications.
    15. (added 4/3/20) Question: Will AHCCCS waive requirements for site visits to enroll a provider?
    Answer: Yes, provider site visits are waived at this time.
    16. (added 4/3/20) Question: What strategies can providers consider to minimize exposure to newborns that require immunizations?
    Answer: One strategy providers can consider is using vaccinations with shorter courses, such as Rotarix (2-dose series) over RotaTeq (3 dose series). AHCCCS is continuing to explore other options.

  • 1. (added 3/19/20) Question: What are the AHCCCS fee for service (FFS) rates for the COVID-19 testing codes?
    Answer: The rates as of March 15, 2020 are $35.91 for code U0001 and $51.31 for code U0002. The rate as of March 13, 2020 for code 87635 is By Report (BR), which is 58.66% of the covered billed charges; this rate is subject to change as additional information becomes available.
    2. (updated 3/30/20) Question: Will AHCCCS provide financial assistance to providers to address revenue losses experienced as a result of the COVID-19 emergency?
    • AHCCCS recognizes that some providers may experience a reduction in the number of services they can provide during the emergency period as a result of members avoiding provider offices. AHCCCS is actively exploring opportunities to ensure provider sustainability to address this challenge.
      • One option that AHCCCS intends to implement is to make interim payments to Targeted Investment (TI) Program participants for Year 3 as soon as possible. Information has been emailed to TI participants regarding these interim payments.
      • AHCCCS is also evaluating potential flexibility the Centers for Medicare and Medicaid Services (CMS) may provide, which would allow AHCCCS and its Health Plans to make limited "retainer" payments to specific types of providers.These payments would be specifically related to reductions in utilization of services related to the COVID-19 emergency, such as missed appointments or decreased frequency of members receiving services. Such payments would be intended to help offset the reduction in revenue experienced by providers due to members staying home and avoiding care.
      • The Arizona Legislature has passed legislation stating that AHCCCS may authorize payments to specific types of providers to ensure that providers maintain capacity to continue to provide services during the state of emergency, however, no additional funding was appropriated for this purpose.
    • Any action AHCCCS takes will require CMS approval and upon approval AHCCCS will work swiftly to operationalize the dissemination of retainer/retention dollars.
    3. (added 4/3/20) Question: Does AHCCCS have any update on retainer payments for providers?
    Answer: CMS has indicated that it will approve retainer (also referred to as retention) payments for HCBS providers of personal care services. As such, AHCCCS intends to make retention payments to providers serving members enrolled in the ALTCS Elderly and Physical Disabilities (EPD) program, to include both Attendant Care and Personal Care services.

    At this time, CMS’ approval is limited to 30 days of retention payments for participating providers. AHCCCS has established preliminary guidelines for provider qualifications to receive retention payments but is still developing details. Among those guidelines is a requirement that providers not lay off staff, and maintain staff salary and wages at pre-COVID-19 levels. This FAQ will be updated when the guidelines are finalized and an effective date is established.

    The Department of Economic Security/Division of Developmental Disabilities (DES/DDD) has established COVID-19 Value Based Payments for HCBS providers serving members enrolled in the ALTCS DD program. See more details here regarding this DES/DDD VBP initiative. AHCCCS is in frequent contact with CMS regarding its request for approval authority for retention payments for other provider types and services including but not limited to behavioral health providers. The FAQs will be updated as new information is received.

  • 1. (updated 4/1/20) Question: Are telehealth services covered by AHCCCS?
    Answer: Yes, AHCCCS covers all forms of telehealth services including asynchronous (store and forward), remote patient monitoring, teledentistry, and telemedicine (interactive audio and video).

  • As per AHCCCS Medical Policy Manual 320-I:
    • There are no AHCCCS restrictions for where the provider is located when providing services via telehealth.
      • In addition to utilizing current AHCCCS registered providers, Arizona was authorized by CMS on March 23rd to provisionally and temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare for the duration of the public health emergency.
  • For more information about telehealth services, please see this March 20, 2020 presentation, or visit the AHCCCS Medical Policy Manual 320-I Telehealth and the AHCCCS Telehealth Code Set.

    AHCCCS will present a Telehealth webinar on April 9, 2020 at 2 p.m.

    2. (added 4/1/20) Question: Question: Can all AHCCCS covered services be delivered via telehealth (including telephonic) and reimbursed by AHCCCS?
    Answer: All services that are clinically able to be furnished via telehealth modalities will be covered by AHCCCS throughout the course of the COVID-19 emergency. Ultimately, it is up to the treating provider to follow clinical best practices and use clinical judgement to determine what services can reasonably be provided via telehealth versus what services must be provided in-person. All scope of practice, coding, and documentation requirements still apply to services delivered via telehealth. For more detail about medical coding please see the Medical Coding Resources web page.
    3. (updated 3/31/20) Question: What codes can be used when services are provided telephonically?
    Answer: AHCCCS has established two telephonic code sets that are available for use:
    • Table I, AHCCCS Telephonic Code Set (Temporary) provides the lists of codes available on a temporary basis to be provided telephonically starting on dates of service March 17, 2020 until the end of the COVID-19 declared emergency.
      1. The UD modifier must be used when billing the applicable CPT or HCPCS code to designate telephonic service.
      2. The Place of Service (POS) is the originating site (ie, where the member is located at the time of the telephonic service delivery). POS home (12) is allowable for all temporary telephonic codes.
    • Table II, AHCCCS Telephonic Code Set (Permanent) are codes that have been available for use telephonically prior to the COVID-19 declared emergency and will continue to be available after the end of the emergency. There is no change to the coding standards for these codes. When providing these services telephonically, please continue to utilize POS 02 telehealth.

    Both code sets, along with additional medical coding information and guidance, are posted on the AHCCCS Medical Coding Resources web page.

    Respite is not available to be provided telephonically. For any AHCCCS coding related questions, please contact: Telehealth services should otherwise continue to be billed in compliance with AMPM 320-I Telehealth.

    4. Question: Will all AHCCCS Health Plans and the AHCCCS Fee-For-Service Programs honor the use of the telehealth and/or telephonic services and service codes, as expanded by AHCCCS in response to COVID-19?
    Answer: Yes, regardless of whether a provider is specifically contracted to provide telehealth and/or telephonic services, AHCCCS Health Plans and AHCCCS Fee for Service Programs will reimburse for services.
    5. Question: For members who have been receiving behavioral health services through the AHCCCS Behavioral Health in Schools Initiative, can telephone and telehealth be leveraged to provide these services in the member’s home and/or community while school is closed?
    Answer: Yes, AHCCCS strongly encourages Behavioral Health Providers to continue to provide behavioral health services to children and their families in their home and community while schools are closed. Please see other telehealth FAQs for additional information on telehealth and telephonic service delivery.
    6. Question: Is there an AHCCCS Fee Schedule rate difference for services provided “in-person” versus services offered via telehealth and/or telephonically?
    Answer: No, there is no rate difference in the AHCCCS Fee Schedule between services provided “in-person” and services offered via telehealth and/or telephonically.
    7. Question: Are AHCCCS health plans required to reimburse at the same rate for services provided “in-person” and services provided via telehealth and/or telephonically?
    Answer: Yes, effective March 18, 2020 until the end of the COVID-19 emergency declaration, AHCCCS health plans shall not discount rates for services provided via telehealth and telephonically as compared to contracted rates for "in-person" services.
    8. (added 3/19/20) Question: Can Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) offer services via telehealth?
    Answer: On March 18, 2020, CMS issued guidance for Medicaid programs confirming that FQHCs and RHCs can offer services via telehealth, including services via telephone. For more information on the services that can be offered via telehealth/telephone, please see other telehealth questions/answers in this FAQ document.
    9. (added 3/19/20) Question: What rate will AHCCCS pay an FQHC/RHC for services delivered via telehealth?
    Answer: In accordance with the March 18, 2020 guidance from CMS, for services offered via telehealth within the scope of the FQHC/RHC benefit, health plans and AHCCCS FFS programs will pay the established PPS rate. For services offered via telehealth that are not covered as part of the FQHC/RHC benefit, health plans will reimburse FQHCs/RHCs at contracted rates and AHCCCS FFS programs will reimburse FQHCs/RHCs consistent with the AHCCCS fee schedule.
    10. (added 3/26/20) Question: Are there any AHCCCS restrictions on the AHCCCS provider types that are permitted to provide services via telehealth (including telephonic) modalities?
    Answer: As per Governor Ducey’s Executive Order 2020-15 effective March 25, 2020 through the end of the COVID-19 declared emergency, telehealth services may be provided by any Arizona licensed healthcare provider type, including but not limited to, physicians, physicians assistants, advanced practice nurses, optometrists, psychologists, dentists, occupational therapists, physical therapists, pharmacists, behavioral health providers, chiropractors, athletic trainers, hearing aid dispensers, audiologists, and speech-language pathologists.
    11. (added 3/20/20) Question: Can telehealth and telephonic service delivery methods be leveraged to provide behavioral health services to children in DCS custody?
    Answer: Yes, telehealth and telephonic service delivery methods can be utilized when clinically appropriate to provide behavioral health services to children in DCS custody.
    12. (update 3/26/20) Question: Typically providers require in-person visits for controlled substance refills. Can these services be provided via telehealth or telephone during the COVID-19 emergency?
    Answer: AHCCCS has updated its telephonic and telehealth code sets to enable providers to be able to conduct visits remotely, including for controlled and non-controlled substance medication refills when clinically appropriate.
    13. (added 3/24/20) Question: During the COVID-19 emergency period, how do providers handle the informed consent requirements and treatment plan agreements/signatures and/or other documents that require a member or guardian's written consent, agreement and/or signature if they are providing services via telehealth or telephone?
    Answer: During the COVID-19 emergency, providers delivering services through telehealth and telephonic means can obtain verbal consent and verbal treatment plan agreements and document the Member's/Guardian's verbal consent and verbal agreement in the Electronic Medical Record (EMR). It will not be necessary to gather retroactive signatures once the COVID-19 emergency period ends provided the documentation is in the EMR.
    14. (updated 3/31/20) Question: Can Local education agencies (LEAs) receive reimbursement for Medicaid-covered medical services provided to eligible students through telehealth and telephonic means during school closures due to COVID-19?
    Answer: AHCCCS, working in conjunction with the Arizona Department of Education and Public Consulting Group (AHCCCS’ third party administrator for the Medicaid School Based Claiming program), anticipates that local education agencies will be able to bill for telehealth services for the Medicaid in Schools program, and that telehealth codes will be available after April 10, 2020.
    15. (added 3/27/20) Question: How does an IHS/638 Provider bill telehealth services?
    Answer: Telehealth is billed the same way as any other service. IHS/638 hospitals (including their satellite clinics) have the ability to bill for telehealth, including the newly released telephonic services released due to COVID-19, at the same rate, so long as the service provided is within its scope. Tribally owned/operated 638 facilities also have this ability, regardless of where the clinician and member are located.
    16. (added 3/27/20) Question: How does the “Four Walls” apply to IHS/638 free-standing clinics?
    Answer: Free-standing clinics are subject to the “Four Walls” provision. Currently, if either the member or the clinician is within the four walls and a facility defined service is being provided via telehealth (including telephonic), the All-Inclusive-Rate (AIR) may be billed. AHCCCS is working with CMS to seek authority to reimburse free standing clinics at the AIRs for telehealth during the COVID- 19 emergency (including telephonic), if neither the member nor clinician is within the four walls but a facility defined service is being provided. Guidance will be issued if AHCCCS is granted this authority.
    17. (updated 3/31/20) Question: Can physician interns and residents provide telehealth services to AHCCCS members?
    Answer: AHCCCS reimburses for telehealth services provided to our members by physician interns and residents. Billing parameters remain the same and additional information can be found in the FFS Provider Manual (page 40).
    18. (added 3/30/20) Question: Can telehealth be utilized for initial appointments (i.e. when members that have not been seen face-to-face previously)?
    Answer: Yes, telehealth can be utilized for initial appointments when clinically appropriate. For Medication Assisted Treatment (MAT), please see SAMHSA guidance, issued March 19, 2020, on the provision of methadone and buprenorphine for the treatment of Opioid Use Disorder during the COVID-19.
    19. (added 3/30/20) Question: Are behavioral health technicians (BHTs) permitted to provide services via telehealth modalities (including telephonically)?
    Answer: Yes, BHTs can utilize telehealth modalities to provide behavioral health services. AMPM 320-O Behavioral Health Assessments and Treatment/Service Planning and 310-B -TITLE XIX/XXI Behavioral Health Service Benefit outline requirements for service delivery by BHTs, including clinical oversight requirements.
    20. (added 3/31/20) Question: For the DDD population, can habilitation codes be added to the Temporary Telephonic Code List during the COVID-19 emergency?

    Answer: AHCCCS had added the following habilitation codes to the Temporary Telephonic Code List for the DDD population only: T2016, T2017, T2019, T2020 and T2021.

    All codes must still meet medical necessity, scope of practice and all coding, policy and documentation requirements. Refer to Table 1 AHCCCS Telephonic Temporary Codes on the Medical Coding Resources web page.

    21. (updated 4/1/20) Question: Is there Federal Guidance for utilizing widely available communications applications for providing telehealth services, such as FaceTime or Skype during the COVID-19 emergency?

    Answer: On March 17, 2020 the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency. More information can be found at HHS Office of Civil Rights and SAMHSA.