Medicaid Providers and the Federal Public Health Emergency

A federal public health emergency (PHE) was issued on January 27, 2020. Idaho Medicaid enacted some temporary policy changes to make sure participants continued to have access to Medicaid services and to support the provider networks. Although we have not received a formal notice announcing the end date of the PHE, the White House has issued a statement which strongly indicates that the PHE will end on May 11, 2023. Based on that statement, we are preparing for some changes to occur on May 11, 2023. We will post the official end date as soon as it is announced.

Below you will find answers to frequently asked questions, and links to other important items to help you plan for the end of the PHE. 

For information about Medicaid coverage and Medicaid Protection, visit the Medicaid Protection web page.

Public Health Emergency Policy

  • Idaho Medicaid sought and secured several temporary federal authorities, including an 1135 waiver, Appendix Ks for 1915(c) waivers, and Medicaid and CHIP Disaster State Plan Amendments.
  • See the list of rules waived in Idaho Administrative Code that are under the authority of the director of the Idaho Department of Health and Welfare. These are tied to the end of the federal PHE. Current Idaho Administrative Code also refers to the current PHE in a number of places. 
  • Idaho Medicaid also published a number of Medicaid Information Releases beginning in 2020, that establish and/or describe these temporary changes.
  • Idaho Medicaid is developing policies and parameters for telehealth and virtual services when the PHE ends.  The Idaho Medicaid program remains committed to the use of telehealth to support access to services in our state.
  • Regarding participant eligibility and enrollment, CMS is working with states to ensure evaluation of eligibility after the end of the PHE.

Thank You

Idaho Medicaid deeply appreciates the dedication providers have shown during this challenging and demanding time.

Frequently Asked Questions
We have put together information to answer some of the most common questions about what will happen to Medicaid services and Medicaid policy after the end of the PHE.
The Participant Page also has Frequently Asked Questions, which you may find beneficial. If you have questions which you do not see listed below, please email MCPTpolicyteam@dhw.idaho.gov

General - Cost Sharing

Will my patients be required to start paying co-payments when the PHE ends?

Yes. Participants and services subject to co-payments will return to their normal status after the end of the PHE.

Will my patients on CHIP be required to pay all of their premium when the PHE ends?

Yes. They will go back to paying their normal premium amount at the end of the PHE.

General - Benefits/Limitations

Will some prior authorizations continue to be suspended after the PHE ends?

No. While some prior authorizations were suspended during the PHE, you will be required to submit a prior authorization for all services that you normally would have prior to the PHE.

Will I be able to continue providing services to a group of more than three siblings when the PHE ends?

No. You will only be able to provide services to a group of three siblings at a time.

Will facilities continue limiting visitors when the PHE ends?

No. At the end of the PHE, they will go back to what their policies were prior to the PHE.

Can I continue to provide services for more than 30 days before needing a physician’s signature on the IFSP when the PHE ends?

No. The state will resume normal operations after the PHE.

Can I continue being a PCS provider for my child when the PHE ends?

No. Please reach out to your agency and they will help you find a different caregiver.

Can I continue to be a PCS or in-home care provider for my spouse when the PHE ends?

No. Please reach out to your agency and they will help you find a different caregiver.

General - Provider Requirements

Can providers not licensed in Idaho, or in inactive status, continue to provide services after the PHE ends?

Providers should contact their respective licensing board to ensure they meet all licensure requirements. 

Can I still provide and receive payment for HCBS services in an acute care hospital and other institutional settings when the PHE ends?

No. At the end of the PHE you will no longer receive reimbursement for providing services in those expanded locations.

Will I need to start revalidating my enrollment applications when the PHE ends?

Yes. Idaho Medicaid will resume normal operations with provider revalidation.

Can direct care staff continue to work without completing their criminal history background check and training requirements when the PHE ends?

No. The state will resume normal operations at the end of the PHE.

Can I continue referring patients to facilities where I may have an ownership interest when the PHE ends?

No. At the end of the PHE, you will have to refer these patients to other facilities or providers.

Developmental Disabilities Waiver - Provider Requirements

Can my DD waiver participants continue using community support services in settings that aren’t on their plan when the PHE ends?

Yes, for six-months after the PHE ends, then they will be required to use services as defined in their plan.

As a residential habilitation provider or community support worker can I continue providing services in an acute care hospital to DD waiver patients when the PHE ends?

Yes, for six-months after the PHE ends. Then you will be required to go back to providing services in the normal settings.

Will I continue receiving payment rate increases for DD waiver participants who use adult day health services when the PHE ends?

Yes, for six-months after the PHE ends. After that prior authorizations will go back to what they were normally before the PHE.

Will I still be able to allow staff to work prior to completing required training after the PHE ends?

No. Staff will need to complete all required training prior to working with participants.

As a support broker will I have to complete all my training requirements before I start working with participants when the PHE ends?

Yes. The state will resume normal operations at the end of the PHE.

Can I continue providing services and meetings via telehealth to participants in the DD Program when the PHE ends?

Yes, if the services can be provided safely and effectively and meet the requirements of Idaho Medicaid’s telehealth policies.

As an independent respite provider can I continue providing services to a group of more than three siblings when the PHE ends?

No. You will only be able to provide services to a group of three siblings at a time.

Developmental Disabilities Waiver - Benefits/Limitations

No. You will only be able to provide services to a group of three siblings at a time.

Yes, for six-months after the PHE ends. After that prior authorizations will go back to what they were prior to the PHE.

Will some exceptions continue to be allowed to adjusting assessment requirements when the PHE ends?

Yes, for six-months after the PHE ends. After that, all requirements will return to normal.

Will multiple families be able to attend family education trainings I provide when the PHE ends?

No. You will only be able to provide family education trainings to two families at once.

Are the ratios for staff to children with DD in group settings going to go back to what they were when the PHE ends?

Yes. They will return to one staff per six children.

As a provider for a child with DD who use HCBS benefits can I continue to use a previous-years physical to qualify them for benefits when the PHE ends?

No. After the PHE ends, the child will need a new exam to qualify for benefits.

Developmental Disabilities Waiver - Documentation

Can a participant accessing Adult or Children’s DD services continue to sign their person-centered service plans and other required documents electronically when the PHE ends?

Medicaid is updating their electronic signature policy and will provide information as soon as it is complete. 

Aged and Disabled Waiver/Personal Care Services (PCS)

General Provider Guidance

Refer to updated Medicaid Information Releases for Personal Assistance Agencies related to specific guidance. 

Can participants receiving A&D waiver and/or Personal Care Services (PCS) continue signing their PCS plans and other required documents electronically when the PHE ends?

Medicaid is updating their electronic signature policy and will provide information as soon as it is complete. 

Will I continue receiving payment rate increases for A&D Waiver adult day health services when the PHE ends?

No. The rate increase tied to the PHE will no longer be available. However, Adult Day Health received a permanent rate increase effective July 1, 2022. For additional information see information release MA22-09.

Can we continue using telehealth for monitoring & compliance activities to A&D Waiver participants when the PHE ends?

Yes, for six-months after the PHE ends. After that it will transition back to in-person services.

Can I continue to be employed as a paid caregiver for my child or spouse when the PHE ends?

Idaho Medicaid continues to explore this issue with our federal partners.

Inpatient Hospital Providers

Can private rooms be provided without documentation for medical necessity when the PHE ends?

No. At the end of the PHE the state will resume normal operations.

As a critical access hospital can I continue providing telehealth with other larger hospitals when the PHE ends?

No. This will be discontinued at the end of the PHE.

Telehealth

Can we continue using telehealth for monitoring & compliance activities to A&D Waiver participants when the PHE ends?

Yes, for six-months after the PHE ends. After that it will transition back to on-site visits.

Can I continue to provide telehealth services to my DD participants when the PHE ends?

Yes, if services can be provided safely and effectively.

As a critical access hospital can I continue to provide telehealth services with other larger hospitals when the PHE ends?

No. This will be discontinued at the end of the PHE.

As a Medicaid provider can I continue using the phone to meet with my Medicaid participants when the PHE ends?

Yes, with modifications. We will publish updated policy on this in the future. Until then, you may utilize audio-only telehealth where it is safe, effective, and appropriate.

Can I continue providing care without establishing a face-to-face relationship prior to a telehealth meeting when the PHE ends?

Yes, with modifications. We will publish updated policy on this in the future. Until then, you may continue utilizing this flexibility.

As a Medicaid provider can I continue delivering services in alternate locations other than my office when the PHE ends?

Yes, if services can be provided safely and effectively. Please follow all documentation and service requirements, including accurately identifying the location of the participant.

As a non-licensed Medicaid provider can I continue delivering services via telehealth when the PHE ends?

The state is still evaluating this.