COVID-19 Guidance for Medicaid Providers

Coverage and Billing Guidance

The following guidance documents are effective beginning with the State Disaster Emergency declared on March 7, 2020, and shall remain in effect until further notice or as noted.

  • New York State (NYS) Medicaid Policy and Billing Guidance for Reimbursement of COVID-19 Therapeutics Dispensing or Administration at Pharmacies - (Web) - (PDF) - 1.10.2022
  • New York State Medicaid Policy and Billing Guidance for Pharmacy Reimbursement of COVID-19 Oral Antivirals - (Web) - (PDF) - (Updated 7.20.2022)
  • New York State (NYS) Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage - (Web) - (PDF) - (Updated 2.8.2022)
  • New York State (NYS) Medicaid Fee-For-Service (FFS) Policy and Billing Guidance for COVID-19 Testing and Specimen Collection at Pharmacies - (Web) - (PDF) - 5.22.20 (Updated 12.16.21)
  • COVID-19 Vaccine Administration Billing Guidance for Managed Long-Term Care Members without Medicare Coverage - (Web) - (PDF) - Updated 2.3.2022
  • Guidance for Medicaid Pharmacies Regarding the End of the Declared Disaster Emergency in the State of New York over COVID-19 - (Web) - (PDF) - Updated 7.8.2021
    • Guidance for Medicaid Pharmacies Regarding the Declared Disaster Emergency in the State of New York over COVID-19 - (Web) - (PDF) - Updated 4.6.2020 (Effective July 9, 2021, in accordance with the end of the State Disaster Emergency declared on March 7, 2020 to fight COVID-19, this guidance has expired.)
    • *NEW* Please note: Facilities unable to confirm receipt of delivery of medications by signature, may alternatively provide confirmation by a phone call, text or email in accordance with state and federal laws, in lieu of providing a signature. Such confirmation should be documented and retrievable upon audit by the delivering provider. This alternative confirmation of receipt of medication deliveries to facilities will be in effect until further notice.

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  • NYS Medicaid Billing Guidance for Coronavirus (COVID-19) Testing in School Based Health Centers - (Web) - (PDF) - (3.10.22)
  • NYS Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines and Vaccine Counseling Provided by School Based Health Centers - (Web) - (PDF) - Updated 7.18.22
  • NYS Medicaid Billing Guidance for COVID-19 Testing and Specimen Collection and Therapeutics - (Web) - (PDF) (Updated 3.29.22)

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  • Medicaid Members are Exempt from Copayments for COVID-19-Related Treatment and Services - (Web) (November 2021 Medicaid Update)
  • Updated Coverage Criteria for COVID-19 Vaccine Counseling - (Web) (PDF) Updated 3.8.2022
  • Coverage Policy and Billing Guidance for the Administration of COVID 19 Vaccines - (Web) - (PDF) - Updated 7.18.22

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  • Comprehensive Telehealth Guidance June 2021 Special Edition - Telehealth (Web) or (PDF).
    • Frequently Asked Questions (FAQs) on Medicaid Telehealth Guidance during the Coronavirus Disease 2019 (COVID-19) State of Emergency - (Web) - (PDF) - Updated 5.1.2020
    • Webinar: New York State Medicaid Guidance Regarding Telehealth, Including Telephonic, Services During the COVID-19 Emergency - (Slides) - (Recording) - 5.5.2020
  • New York State Medicaid Program Launches Online Medicaid Provider Enrollment During COVID-19 Public Health Emergency - (Web) or (PDF) - 4.20.2020

For historical guidance, please go to the COVID-19 Special Edition Publications webpage.

  • COVID-19 Guidance Notices related to the extension of Medicaid coverage/suspension of disenrollments, the resumption of MMC comprehensive commercial TPHI, and MLTC involuntary disenrollments.
    • COVID-19 Extension of Medicaid Coverage - (Web) - (PDF) - 3.30.2020
    • COVID-19 Extension of Medicaid Coverage Dear MLTC Health Plan Administrator - (Web) - (PDF) - 4.3.2020
    • Third-Party Health Insurance (TPHI) Disenrollment to Resume - (Web) - (PDF) - 1.19.2021
    • Resumption of Certain MLTC Involuntary Disenrollments - (Web) - (PDF) - 8.12.2021
      • MLTC Involuntary Processing Schedule - (Web) - (PDF)
    • Resumption of Two Additional MLTC Involuntary Disenrollment Reasons - (Web) - (PDF) - 11.29.2021
      • Attachment I - 30 vs 90 day absence from MAP service area - (Web) - (PDF) - 11.29.2021
      • Attachment I - 30 vs 90 day absence from MAP service area - (Web) - (PDF) - revised 12.20.2021
      • Attachment I - 30 day absence from MAP service area - (Web) - (PDF) - revised 04.25.2022
      • 2022 MLTC Plan Processing Schedule Involuntary Disenrollments - (Web) - (PDF) - 11.29.2021
    • Resumption of Additional MLTC Involuntary Disenrollment Reason - 04.26.2022
      • 2022 MLTC Plan Processing Schedule Involuntary Disenrollments Revised - (PDF) 04.06.2022
      • Dear MLTC Health Plan Administrator Letter (PDF) 04.26.2022
      • May 20, 2022 Webinar Plan Involuntary Disenrollment No CBLTSS Training, Recording, and Transcript - 5.25.2022
  • COVID-19 HCBS Respite Guidance (Web) - (PDF) - April 8, 2020 (Updated 6.26.2020)
  • CMS APPROVED 1915c Children Waiver Appendix K Amendment for COVID-19 - (PDF) - 6.18.20
  • Questions and Answers Related to COVID-19 Guidance for Providing Adult Social Day Care (SDC) Services Telephonically (Web) - (PDF) - 5.16.2020
  • COVID-19 Guidance for Voluntary Plan of Care Schedule Change - (Web) - (PDF) - 4.23.2020
  • COVID-19 Guidance for Managed Care Organization Contracting and Surveillance Relief - (Web) - (PDF) - 4.8.20 (Effective June 25, 2021, in accordance with the end of the State Disaster Emergency declared on March 7, 2020 to fight COVID-19, this guidance has expired.)
  • Guidance on Providing Adult Social Day Care (SDC) Services Telephonically - (Web) - (PDF) - 4.7.2020
  • Guidance on Frequently Asked Questions (FAQ) from Non-Emergency Medical Transportation (NEMT) Providers - (Web) - (PDF) - 4.7.2020
  • Guidance on Suspended Health Plan Utilization Review Requirements (Web) - (PDF) - 4.3.2020 (Effective June 25, 2021, in accordance with the end of the State Disaster Emergency declared on March 7, 2020 to fight COVID-19, this guidance has expired.)
  • Guidance for 1915(c) HCBS Children´s Waiver for Children´s Health Homes and Children, Youth Evaluation Services (C-YES), HCBS Providers, and MMCP/HIV SNP - (Web) - (PDF) - 3.29.2020
  • COVID-19 Telephonic and Telehealth Services Available to Statewide Adult Day Health Care Program Services - (Web) - (PDF) 03.28.2020
  • Guidance on Medicaid Changes to Private Duty Nursing (PDN) Policy - (Web) - (PDF) - 3.28.2020
  • Guidance on Medicaid Changes to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy - (Web) - (PDF) - 3.28.2020
  • Guidance for Infection Control in NYS DOH Supportive Housing Programs in Response to COVID-19 (Web) - (PDF) - 3.27.2020
  • Guidance on Emergency Response to COVID-19 - (Web) - (PDF) - 3.5.2020
  • Guidance for Transportation Managers and Brokers - (Web) - (PDF) - 3.21.2020
  • Guidance for Facilitated Enrollment Agencies for the Aged, Blind and Disabled. - (Web) - (PDF) - 3.21.2020
  • Guidance for Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) 1915 (c) Medicaid Waiver Providers in Response to COVID-19 - (Web) - (PDF) - 3.20.2020
  • Guidance for Designated Children and Family Treatment and Support Services´ Providers - (Web) - (PDF) - 3.19.2020 Updated 6.10.2020
  • Guidance for the Authorization of Community-Based, Long-Term Services and Supports Covered by Medicaid in response to COVID-19 - (Web) - (PDF) - Updated 9.30.2021, (Rescission Effective 7.26.2021)
    • Letter of Rescission of Guidance for the Authorization of CBLTSS Covered by Medicaid in response to COVID-19 - (Web) - (PDF) - 7.26.2021 (Updated 2.8.2022)
  • Guidance issued by Centers for Medicare & Medicaid Services (CMS) to all Programs of All-Inclusive Care for the Elderly (PACE) Organizations (POs) in response to COVID-19 (PDF) - 3.17.2020
  • Immediate Temporary Suspension of Statewide Adult Day Health Care Program Services as a Response to COVID-19 - (PDF) - 3.17.2020
  • Guidance for Certified Home Health Agencies, Long Term Home Health Care Programs, Hospices, and Licensed Home Care Services Agencies Related to COVID-19 - (Web) - (PDF) - 3.14.2020
  • Guidance for Home and Community-Based Services (HCBS) Providers Serving Children/Youth Under the 1915(c) Children´s Waiver Related to COVID-19 - (Web) - (PDF) - 3.14.2020 Updated 6.10.2020
  • Guidance for Health Homes Serving Adults, Health Homes Serving Children/Youth, and Care Coordination Organization/Health Homes (CCO/HH) Related to COVID-19 - (Web) - (PDF) - 3.14.2020
  • Health Advisory: COVID-19 Cases in Nursing Homes and Adult Care Facilities - (PDF) - 3.13.2020
  • Webinar for NYS DOH Health Care Providers: Update on COVID-19 for NYS Healthcare Providers - 3.5.2020

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