Reinstatement of CHIP Co-pays for Medical Office Visits

Date: March 20, 2023

Attention: All Providers

Effective Date: May 12, 2023

Call to action: In response to the COVID-19 public health emergency (PHE), the Health and Human Services Commission (HHSC) waived co-pays for Children’s Health Insurance Program (CHIP) medical office visits beginning March 13, 2020. HHSC will reinstate co-pays for CHIP medical office visits on May 12, 2023, because the federal PHE ends on May 11, 2023. The reinstatement of medical office visit co-pays does not apply to:

COVID-19-related office visits for COVID-19 vaccines (and the administration of such vaccine)
Testing, and treatment, including preventative therapies and treatment of post-COVID conditions (long-haul COVID-19)
Treatment of health conditions that may seriously complicate the treatment of COVID-19 during the period when a beneficiary is diagnosed with or is presumed to have COVID-19 as required by the American Rescue Plan Act of 2021.
Mental health and substance use disorder outpatient office visits. Co-pays have been permanently removed for mental health and substance use disorder outpatient office visits to comply with federal regulations.

How this impacts providers: TCHP will continue to not require co-pays for COVID-19-related office visits and follow all processes as described below through May 11, 2023. TCHP will reimburse providers the full rate for the service, including what would have been paid by the member through cost-sharing.

For CHIP medical office visits scheduled on or after May 12, 2023, you may begin collecting co-pays. CHIP co-pays that members must pay are determined based on their income. CHIP co-pays do not apply to Native Americans, Alaska Natives, CHIP Perinate and CHIP Perinatal newborn members.

Next steps for providers:

Providers must submit a completed template invoice with signed attestation for all office visit copayments not collected from members. The attestation must be submitted to TCHP by email to tchpfinance@texaschildrens.org and the deadline for receipt is June 30, 2023.
TCHP has thirty (30) calendar days to pay the invoice received from a provider.
In the situation that a provider has already collected a CHIP copay, a refund to the Member must be made before submitting to TCHP for reimbursement.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org
For access to all provider alerts, log into:

www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers