COVID-19 Guidance for Medicaid Providers
Coverage and Billing Guidance
New York State Medicaid coverage of Coronavirus Disease 2019 related services have been updated following the expirations of provisions in the American Rescue Plan Act of 2021 (ARPA) and the Public Readiness and Emergency Preparedness (PREP) Act. Please refer to the September 2024 Updates to New York State Medicaid Coverage of Coronavirus Disease 2019 Services Special Edition issue of the Medicaid Update, for current COVID-19 billing and coverage guidance.
Pharmacy Specific
- New York State Medicaid Coverage Policy of COVID-19 Oral Antivirals - (Web) - (PDF) - Guidance Expires 9.30.2024, updated guidance will be published soon in a Medicaid Update.
- Medicaid Coverage for the 2023-2024 COVID-19 Vaccines for Pharmacy Providers Not Enrolled in the Vaccines for Children (VFC) Program - (Web) - (PDF) - See important update regarding the 2024-2025 vaccine season.
- New York State (NYS) Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage - (Web) - (PDF) - Guidance Expires 9/30/2024, see New York State Medicaid Pharmacy Policy for Coronavirus Disease 2019 Testing
- Medicaid Pharmacy Coverage Policy and Billing Guidance for the 2023-2024 COVID-19 Vaccines - (Web) - (PDF) - Guidance updated and replaced, see NYRx, the New York State Medicaid Pharmacy Program Pharmacists as Immunizers Fact Sheet
- New York State (NYS) Medicaid Fee-for-Service (FFS) Policy and Billing Guidance for COVID-19 Point-of-Service Testing at Pharmacies - (Web) - (PDF) - Guidance Expires 9/30/2024, see New York State Medicaid Pharmacy Policy for Coronavirus Disease 2019 Testing
Medical Specific
Both Medical and Pharmacy
Medicaid Update Special Editions
- 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.
Other Guidance
- 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
- 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 - (Web) - (PDF) - 04.06.2022
- Dear MLTC Health Plan Administrator Letter - (Web) - (PDF) - 04.26.2022
- May 20, 2022 Webinar Plan Involuntary Disenrollment No CBLTSS Training, Recording, and Transcript - 5.25.2022
- Presentation (PDF)
- Recording (YouTube)
- Transcript - (Web) - (PDF)
- 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
- Webinar Recording (youtube.com)
- Presentation Slides (PDF)
