Texas gets more flexibility for Medicaid care

Texas has new flexibility in administering Medicaid care while the state grapples to respond to COVID-19.

The Center for Medicaid and Medicare (CMS) on Monday approved the Section 1135 Medicaid waiver submitted March 25 by the Texas Health and Human Services Commission.

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“These flexibilities ensure that care capacity is expanded for Texans who utilized Medicaid services, even as the state responds to COVID-19,” Texas Governor Greg Abbott said.

Flexibilities granted under the waiver include:

  • Extension of prior authorizations: For enrollees who have an existing prior authorization, CMS approves the state extending a prior authorization approved on or after March 1.
  • Suspension of Level 1 or Level II PASRR assessments: All new nursing facility admissions may be treated as an exempted hospital discharge for 30 days. After 30 days, new admissions with a mental illness or intellectual disability should be reviewed as soon as resources are available.
  • Fair hearing and appeals: CMS approves the extension of fair hearings up to 120 days (from 90 days) and Texas may choose to allow up to 90 days for an enrollee to file an appeal.