Beginning around May 1, Texas Medicaid and CHIP once again will make mosquito repellent a covered benefit for certain patients to help combat the Zika virus.
The Texas Health and Human Services Commission (HHSC) will offer the mosquito repellent benefit for Zika prevention in 2017 for pregnant women, females aged 10-55, and males aged 14 and older. Compared with last year, the 2017 benefit adds males, at TMA's request, and also increases the age for covered females from 45 to 55. The benefit will be available to eligible individuals through the Medicaid, Medicaid managed care, CHIP, CHIP-Perinatal, Children with Special Health Care Needs (CSHCN), Healthy Texas Women (HTW), and Family Planning programs.
Agency officials say:
- The benefit will end on Dec. 31, 2017.
- Individuals can receive one can per prescription fill with up to two cans per month.
- The standing order, which was in place for last year's benefit, will be available again for the 2017 benefit. The standing order is only available for eligible clients in Medicaid, CHIP, and HTW. The standing order allows pharmacies to fill prescriptions for repellent without contacting the client's physician or other health care provider. Patients can go directly to the pharmacy and present their YourTexasBenefits card to obtain the repellent.
- Family Planning program clients can obtain the repellent directly from their clinics.
- Only CSHCN clients will need a prescription from their physician or provider to obtain the benefit.
HHSC also released new guidelines for billing for Zika testing. (See "State Calls for More Zika Testing in South Texas" for the latest testing recommendations.)
States are waiting for the Centers for Medicare & Medicaid Services (CMS) to issue a specific Zika testing code. Until then, Texas Medicaid will continue to cover three general lab procedure codes that may be appropriate to use when submitting claims for Zika testing: 87798, 87799, and 86790.
A Zika specific modifier is currently in development. The agency will issue instructions to attach the new modifier to one of the recommended codes so that those procedures can be tracked as Zika tests. Medicaid will not require prior authorization for Zika testing. There is no Medicaid rate specific to Zika testing; payments will be made at the rates associated with the codes shown above.
On Wednesday, April 12, TMA conducted its second Tele-Town Hall Meeting on Zika. About 450 Texas physicians joined John Hellerstedt, MD, the Department of State Health Services (DSHS) executive commissioner; David Lakey, MD, former DSHS commissioner and current chair of the TMA Council on Science and Public Health; and other experts in the hour-long call.
Topics included an update on the state's Zika preparedness planning, a briefing on reported Texas Zika cases, and the latest on Zika testing.
If you missed the event or want to review the material covered, check out the recording on TMA's Infectious Disease Resource page.
Action, April 17, 2017