Update on Reimbursement for Non-Risk Criteria for COVID-19 and CHIP Copay Waiver

Date: April 11, 2025

Attention: Providers

HHSC’s Non-Risk Payments COVID-19 reimbursement will end August 31, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to update you on COVID-19 reimbursement information.

Consistent with the Centers for Medicare and Medicaid Services (CMS) guidance and the elimination of certain pandemic-related HCPCS codes, the Texas Health and Human Services Commission (HHSC) has added and removed vaccine administration and drug treatment codes from the Non-Risk payment process for both COVID-19 and CHIP copayment reimbursement criteria.
HHSC previously moved COVID-19 costs into the managed care organizations (MCO) capitation rates effective for dates of service on or after September 1, 2023. HHSC’s Non-Risk Payment (NRP) COVID-19 reimbursement will end August 31, 2025.
As stated in the May 28, 2024, MCO notice, “Reinstatement of CHIP Co-pays for COVID-19 Vaccines, Treatment, and Testing Services”, HHSC reinstated co-pays for CHIP COVID-19 vaccines, treatment and testing services on October 1, 2024. HHSC’s Non-Risk CHIP co-pay will end September 30, 2026.

Background: In response to the COVID-19 public health emergency and the guidance provided by CMS, the Texas HHSC is making Non-Risk payments (NRP) to reimburse MCOs or TCHP for COVID-19 related services.

How this impacts providers: HHSC has updated the below listed resources with new criteria and clarifications. Descriptions of these updates can be found in the document titled “Updates to Attachments on Reimbursement for Non-Risk Criteria for COVID-19 and CHIP Copay Waiver” available by clicking here.

Please note within Attachments, all items underlined are new criteria and clarifications that have been added.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.