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OSMO COVID-19 Resources Week as of April 15, 2020

4/15/2020

Dear OSMO Members and Colleagues,


IMPORTANT: This information is provided for informational purposes only, please go to the source documents for the most up-to-date information.

 

Centers for Medicare & Medicaid Services (CMS)

CMS webpage Coronavirus (COVID-19) Partner Toolkit Includes links to information and resources on COVID-19 from several government departments and includes information for clinicians, health plans, health care consumers, Medicare beneficiaries, caregivers and more at: https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit.


Centers for Disease Control (CDC)

Latest updates and information on COVID-19 is available at: https://www.cdc.gov/coronavirus/2019-ncov/index.html. Information for healthcare professionals can be found at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html.


Oregon Medical Association (OMA)

Monitor the OMA COVID-19 webpage for recent updates, resources and information at:
https://www.theoma.org/OMA/Learn-content/Public-Health-Library/COVID-19-Coronavirus.aspx?hkey=990ff86c-fcb2-4f34-bdc2-b0ed7820220a&WebsiteKey=b30aea32-d5ed-4217-a8ef-4342cfefc729.


American Society of Clinical Oncology (ASCO)

ASCO maintains a web page of information and resources on COVID-19 including patient care information, provider and practice information, government, reimbursement and regulatory updates and an electronic form to submit COVID-19 questions to ASCO. Access these resources at: https://www.asco.org/asco-coronavirus-information


The Society of Surgical Oncology (SSO)

The SSO website contains resources for many surgical oncology specialties which can be useful advice for dealing with delaying surgery, guidelines for triage of cancer surgery patients, managing COVID-19 in surgical systems and more.

Access SSO’s website at: https://www.surgonc.org/resources/covid-19-resources/


American Society for Radiation Oncology (ASTRO)The ASTRO COVID-19 Recommendations to Radiation Oncology Practices includes COVID-19 Clinical Guidance, COVID-19 FAQs, a sample Patient Communication – COVID letter. Access this information at: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information


Oregon Health Authority (OHA)

OHA maintains a webpage with resources on COVID-19 for Oregon Health Plan partners that includes operational and billing information for Oregon Health Plan (Medicaid) providers and coordinated care organizations. Access the OHA COVID-19 webpage at:

https://www.oregon.gov/OHA/HSD/OHP/Pages/COVID-19.aspx


OHA Healthcare Provider COVID-19 Videoconferences

OHA will continue to host twice-weekly information sessions for healthcare providers on Tuesdays (OHA Webinar) from 12-1 p.m. and Thursdays (Project ECHO) from 12-1:15 p.m. and will reassess for further needs as they move forward. You can submit questions for OHA when you join the webinar. 


Join the webinar here:
https://join-noam.broadcast.skype.com/dhsoha.state.or.us/ba2697ad2f8440efbbbd226d40e9ac06

An archive video of the OHA’s Tuesday, March 24 provider teleconference is available at: https://www.youtube.com/watch?time_continue=3&v=YEfMpxwlZis&feature=emb_logo.



Oregon Health Insurance Marketplace


Individuals who have experienced a recent life change may be eligible to sign up for health coverage at Oregon’s Health Insurance Marketplace at: https://healthcare.oregon.gov/Pages/index.aspx

Office of the Insurance Commissioner OR

The Office of the Insurance Commissioner, OR State maintains COVID-19 information, resources and FAQs for consumers, providers, and insurers & regulated entities at: https://dfr.oregon.gov/Pages/index.aspx.

Association for Community Cancer Centers (ACCC)

ACCC maintains a webpage with updated information on COVID-19 and includes links to information and resources from the Centers for Disease Control (CDC), Centers for Medicare & Medicaid Services (CMS) the Food and Drug Administration (FDA) as well as patient advocacy foundations. 

https://www.accc-cancer.org/home/news-media/coronavirus-response

TELEHEALTH SERVICES RESOURCES & INFORMATION

 

From the Oregon Health Authority (OHA)

OHA is expanding coverage of telehealth and telephone services in light of the COVID-19 outbreak. Access the Oregon Health Plan coverage of telephone/telemedicine/telehealth services updated April 6, 2020 here: https://www.oregon.gov/oha/HSD/OHP/Pages/COVID-19.aspx.

From the American Medical Association (AMA)The AMA maintains updated information on telemedicine including: a quick guide, policy, coding and payment, practice implementation and other helpful resources on telemedicine: 

https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice

 

From the Department of Health and Human Services (HHS)


On March 20, 2020, the HHS Office for Civil Rights (OCR) announced that it is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). Covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA.


The notice from HHS, which includes examples of technology that may be used by providers, can be accessed here: 

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

 

Medicare Telemedicine Health Care Provider Fact Sheet:
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

 

From the New England Journal of Medicine (NEJM)

The NEJM hosts a collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary on their website at: https://www.nejm.org/coronavirus?query=main_nav_lg

 

From the American College of Physicians (ACP)

 

The ACP website https://www.acponline.org includes a COVID-19 Practice Management Toolkit, information and resources on telehealth coding and billing, and a tutorial Telemedicine: A Practical Guide for Incorporation into your Practice – access this tutorial at: https://assets.acponline.org/telemedicine/scormcontent/?&_ga=2.50834473.1228759002.1584542301-395527866.1580950498#/

 

 

From the Community Oncology Alliance (COA)


COA’s webpage for COVID-19 Practice Resources and Protocols contains many links to resources and information and tools for the oncology practice including COA’s webpage for COVID-19 Practice Resources and Protocols contains many links to helpful information including a very helpful Medicare Telehealth Cheat Sheet: https://communityoncology.org/wp-content/uploads/2020/03/MedicareTelehealthGuideFinal031820.pdf

 

Access the COA COVID-19 resources here:

https://communityoncology.org/coronavirus-covid-19-practice-resources-and-protocols/

 


POLICY UPDATES FROM PRIVATE PAYORS – EXPANDED TELEHEALTH SERVICES & MORE

Note: please go directly to the payor’s website for the most up-to-date information.

 

From Regence BlueCross BlueShield of Oregon – Updated April 7, 2020

Regence BC/BS of Oregon has announced temporary updates to telehealth to expand medical and behavioral health telehealth services. In their announcement they provide the following information:


Telehealth expansion


We are temporarily expanding medical and behavioral health telehealth services. This expansion will remain in effect through each state’s emergency declaration. 

Telehealth services can be provided if: 

 Pulsara offers a free, HIPAA-compliant, video-enabled platform: https://www.pulsara.com

  • The services: 
    • Are safely and effectively delivered via telehealth 
    • Meet the code definition that is billed when provided via telehealth 
    • Meet existing coverage criteria, including pre-authorization requirements and medical necessity 

Member benefits and provider reimbursement 

  • The visits are considered the same as in-person visits and are paid at the same rate as in-person visits. 
  • The member’s copay, coinsurance and deductible will apply to telehealth services, if applicable. 
  • We will cover the telehealth visit related to COVID-19 testing at no member cost share for our Individual, group (including ASO group) and Medicare Advantage members. See below for information about coverage for COVID-19 testing. 
  • For claims to process correctly and for you to receive reimbursement consistent with an in-office visit, the place of service (POS) must be either POS 11, intensive outpatient (IOP) or partial hospitalization (PHP). The GT modifier will indicate that the services were rendered via telehealth.
    • Note: The location of the service does not need to be in an office. However, claims must be submitted using the instructions above to be paid at the same rate as an in-person visit. 
  • Claims can be submitted for dates of service beginning on March 19, 2020. 
  • Note: We will continue to cover the medical and behavioral health codes, as outlined in our Virtual Care (Administrative #132) reimbursement policy. Claims submitted following the guidelines in this policy will be paid as they have been.
     

BCBS FEP telehealth expansion
In-network providers can provide telehealth services to Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) members. View the BCBS FEP telehealth expansion information at: https://www.regence.com/provider/library/whats-new/fep-telehealth.


TriWest telehealth expansion
TriWest has determined that providers who wish to use virtual or phone visits to treat patients and provide continued care while staying in compliance with the Centers for Disease Control and Prevention (CDC) guidelines may do so, as long as the provider has an authorization on file first. View TriWest’s Community Providers COVID-19 page for more information at: https://www.triwest.com/en/provider/news--updates/community-providers-covid-19-resource-page/.


For more information on Regence BC/BS Covid-19 updates and resources go to: https://www.regence.com/provider/library/whats-new/covid-19

Credentialing

 

Temporary providers and expedited credentialing

During this health emergency, we are allowing an exception to our Locum tenens policy and expediting credentialing to help meet emerging demands for health care providers and to ensure that our members have access to care. 

 

Locum tenens
We are making the following exceptions to our Locum tenens policy to allow a provider to identify and authorize care for his or her patients by another provider, during this pandemic: 

  • The use of a locum tenens provider by a participating provider has been expanded to 180 days during this emergency. 
  • A locum tenens can have a valid license in a different state than the one in which they are practicing in. 

For more information on the temporary locum tenens policy: https://www.regence.com/provider/contracting-credentialing/locum-tenens

 

Expedited credentialing
If your practice has been directly impacted by COVID-19, please: 

  • Complete the credentialing application. 
  • Contact Provider Relations to request expedited credentialing. 
  • Note: This process does not apply to routine requests. 

For more information on expedited credentialing: https://www.regence.com/provider/contracting-credentialing/credentialing

 

Pharmacy pre-authorizations
All pharmacy pre-authorizations that are due to expire between March 23, 2020, and June 30, 2020, will be extended six months from the current expiration date to alleviate work by providers’ offices. Members will be notified via letter that their pre-authorization has been extended with the new expiration date. We will evaluate any pre-authorizations that expire after this period at a later date. 

 

Early prescription medication refills
We are allowing for an extended supply of medications:

 

Line of business

Extended supply of medications coverage

Home-delivery options

Commercial members (with the exception of a few self-funded groups)

Allowing for a 90-day refill on medications used for chronic conditions, such as multiple sclerosis, diabetes, asthma and heart disease

Members can order home-delivery prescriptions through the AllianceRx Walgreens Prime website at:https://www.alliancerxwp.com or by calling 1 (844) 765-2894.

Medicare Advantage members who have medical and pharmacy benefits

Allowing for a 100-day refill on medications used for chronic conditions, such as multiple sclerosis, diabetes, asthma and heart disease

Members can order home-delivery prescriptions through the Postal Prescription Services website at:https://www.ppsrx.com/signIn

Members who have a Medicare Part D prescription drug plan

Allowing for a 90-day refill on medications used for chronic conditions, such as multiple sclerosis, diabetes, asthma and heart disease.

Members can order home-delivery prescriptions through the Postal Prescription Services website at:https://www.ppsrx.com/signIn.

 

Note: Some drugs are not eligible for extended day supply, including controlled substances and certain specialty drugs. Drugs listed on our formularies in the Narcotics and section marked SP are not eligible for an extended supply.


Note
: BCBS FEP members: 

  • Can receive early medication refills for 30-day prescription maintenance medications 
  • Have access to a 90-day mail order benefit for prescription medications 
  • Do not have a cost share for prescriptions for up to a 14-day supply

 

For more information on Regence BC/BS Covid-19 updates and resources go to: https://www.regence.com/provider/library/whats-new/covid-19

 

From UnitedHealthcare – Updated April 5, 2020:

COVID-19 Telehealth Services


Starting March 18, 2020, UnitedHealthcare expanded our policies around telehealth services for Medicare Advantage, Medicaid, and Individual and Group Market health plan members. In addition, effective from March 31, 2020 until June 18, 2020, we will also waive cost sharing for in-network telehealth visits for medical, outpatient behavioral and PT/OT/ST, with opt-in available for self-funded employers.


Expanded Provider Telehealth Access

UnitedHealthcare is waiving the Centers for Medicare and Medicaid’s (CMS) originating site restriction and audio-video requirement for Medicare Advantage, Medicaid, and Individual and Group Market health plan members from March 18, 2020 until June 18, 2020. Eligible care providers can bill for telehealth services performed using interactive audio-video or audio-only, except in the cases where we have explicitly denoted the need for interactive audio/video, such as with PT/OT/ST, while a patient is at home.

NEW! Cost Share Waived for In-Network Telehealth Services 

We will also waive cost sharing for in-network telehealth services for medical, outpatient behavioral and PT/OT/ST services from March 31, 2020 until June 18, 2020 for Medicare Advantage, Medicaid, and Individual and fully insured Group Market health plan with opt-in available for self-funded employers.

 

For medical and outpatient behavioral telehealth visits, providers can utilize both interactive audio/video and audio-only.

 

Cost sharing will be waived for in-network telehealth visits. According to plan benefits, out-of-network providers also qualify for telehealth and member benefit and cost sharing will apply, if applicable.

NEW! Expanded List of Services for Telehealth and Virtual Check-Ins.

From March 30, 2020 until June 18, 2020, UnitedHealthcare has expanded the services that can be covered using telehealth, as well as through a Virtual Check-In for Medicare Advantage, Medicaid, and Individual and Group Market health plan members. A list of reimbursable codes that can be used during the waiver period can be found under the Billing Guidance section of Telehealth or Virtual Check-Ins.

 

Link to UnitedHealthcare's telehealth services update: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services.html


Learn more about UnitedHealthcare's response to COVID-19 at: https://www.uhc.com/health-and-wellness/health-topics/covid-19.

 

From Aetna and CVS Health:

  • If you request testing related to COVID-19, we’ll waive your Aetna patient’s cost sharing.
  • Aetna Commercial patients pay $0 for covered telemedicine visits until June 4, 2020.
  • Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members, so they can receive the care they need from you without leaving their homes. With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video. 
  • Aetna is offering its Medicare Advantage brief virtual check-in and remote evaluation benefits to all Aetna Commercial members and waiving the co-pay. 
  • Care packages will be sent to Aetna patients diagnosed with COVID-19. Through Aetna’s Healing Better program, Aetna Commercial and Medicare Advantage members will receive CVS items to help relieve symptoms as well as personal and household cleaning supplies to help keep others in the home protected from potential exposure. Call the number on your Aetna patient’s ID card to register a recently diagnosed patient. 
  • Patients won’t have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.
  • We’re waiving early refill limits on 30-day prescription maintenance medications for all Commercial members with pharmacy benefits administered through CVS Caremark.
  • Aetna Medicare members may request early refills on 90-day prescription maintenance medications at retail or mail pharmacies if needed. For drugs on a specialty tier, we’re waiving early refill limits for a 30-day supply.
  • Through existing care management programs, Aetna will proactively reach out to your patients who are most at-risk for COVID-19.

Read the latest updates and information at:
https://www.aetna.com/health-care-professionals/provider-education-manuals/covid19-letter.html


From Health Net Oregon:
In order to ensure that all Health Net members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

Effective immediately, the policies we are implementing include:

 

  • Continuation of zero-member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through June 30, 2020
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care**

 

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services.
**Providers should follow state and federal guidelines regarding performance of telehealth services including permitted modalities.
Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state.

 

Health Net Oregon notice on expanded telehealth services: https://www.healthnetoregon.com/newsroom/covid19-telehealth-guidance.html

 

From PacificSource:

PacificSource has expanded coverage to allow most provider types to bill appropriate E/M services that can be performed in real time via telehealth. PacificSource reimburses for telehealth services as if the service was done in the clinic setting (for services appropriate for telehealth delivery).

 

PacificSource is suspending prior authorization (PA) and referral requirements related to medical necessity for care rendered March 27 through June 30 for services included on the Prior Authorization Grid. To determine if a service formerly required preauthorization, consult our Prior Authorization Grid (https://authgrid.pacificsource.com/).

 

Prior authorizations are still required for all benefit coverage exceptions. One way this can be identified is by using LineFinder. LineFinder is an online tool to assist providers in determining what is covered by OHP. OHP generally updates the information quarterly. (https://intouch.pacificsource.com/LineFinder).

 

PacificSource has extended most prescription and medical drug prior authorizations that expire between now and June 30 an additional 90 days. New CMS and state regulations will be incorporated into our processes as released. New requests will follow standard prior authorization procedures for medical and prescription drugs.

 

For more information and to access the PacificSource documents on their COVID-19 Provider Relief Plan go to: https://www.pacificsource.com/providers/

 

 

 

IMPORTANT: This information is provided for informational purposes only, please go to the source documents for the most up-to-date information.

 

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