Medicaid HMOs Must Allow Harvey Victims to Receive Care Out-of-Network

Medicaid managed care organizations (MCOs) must allow patients who have been displaced by Hurricane Harvey to receive out-of-network care for nonemergency services, the Texas Health and Human Services Commission (HHSC) said.

“This direction pertains specifically to providers who deliver Medicaid or CHIP-covered services to members with a permanent residence in a FEMA-declared disaster county from Aug. 25, 2017, until the emergency declaration has been rescinded,” HHSC said in a statement. “The direction applies to all Medicaid or CHIP-covered services, including nursing facility add-on services.”

MCOs always must allow emergency services to be provided out of network.

TMA also has requested an extension of the Medicaid claims filing deadline beyond 95 days. An extension will be granted, officials have confirmed, but no details have yet been provided.

HHSC and the state’s largest health plans already have posted some changes and guidance on policies related to Hurricane Harvey recovery.

The Texas Department of Insurance also has suggested health insurers and HMOs waive common out-of-network penalties and restrictions on health insurance — including the need to obtain prior authorizations — for people seeking medical or dental care in counties that have been declared a disaster area

In addition, certain Medicare enrollment screening requirements have been suspended for physicians, health care providers, and suppliers who are assisting with Hurricane Harvey recovery in Texas and Louisiana.

More information on Hurricane Harvey recovery can be found in TMA's Disaster Preparedness & Response Resource Center or by contacting the TMA Knowledge Center at knowledge[at]texmed[dot]org or by calling (800) 880-7955 or (512) 370-1544.

Action Special, Sept. 12, 2017


Last Updated On

April 27, 2018