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News & Press: Updates for Members

3/20/20 Updated Telehealth Policies by Insurer

Monday, March 23, 2020   (0 Comments)
Posted by: Kay Castillo
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The following serves as a resource guide when deciding how to best use telehealth for you and your clients. If you wish for more information or would like more updates, please contact Kay Castillo, kcastillo.naswnc@socialworkers.org. Note, consultation with staff is a members only benefit!

 

Aetna

Visit the Aetna website to learn more about their Telehealth opportunities for providers at: https://www.aetna.com/health-care-professionals.html

 

Aetna members can find more information on their insurance plans on the website. Additionally,

  • For the next 90 days, until June 4, 2020, Aetna will offer zero co-pay telemedicine visits – for any reason. Aetna members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices.
  • Cost sharing will be waived for all virtual visits through the Aetna-covered Teladoc® offerings and in-network providers delivering synchronous virtual care (live video-conferencing) for all Commercial plan designs.
  • Self-insured plan sponsors will be able to opt-out of this program at their discretion.

BlueCross BlueShield of North Carolina

Blue Cross NC will cover members’ cost for COVID-19 testing and will not require prior approval for COVID-19 testing. The company is also expanding virtual access to doctors and will waive early medication refill limits. These changes apply to fully insured, Medicare Advantage and Federal Employee Program members. Self-funded employer groups will be given the option to apply these changes to their employees’ plans.

For providers, Blue Cross NC has announced that “any service that would be covered with a face to face visit, will now be covered as a telehealth visit. Make sure to follow state regulatory guidelines (encryption etc).” Click here for Blue Cross NC’s telehealth policy

 

This policy does apply to therapy and medication management for MH/SUD. This policy decision is good until April 6. You should hold claims from 3/06 to 3/21 and submit them on March 21st, 2020.

 

Medicare

CMS issued new changes to their telehealth policy for Medicare beneficiaries on March 17.

Key Takeaways:

  • LCSWs can provide teletherapy to beneficiaries if the client is in their home.
  • They can also see new or existing patients.
  •  Telephone/audio only does not appear to be reimbursable; LCSWs must use a video conferencing platform.
  • HIPAA requirements are also eased.

For more on Medicare's telehealth policy:

NC Medicaid

NC Medicaid announced several policy changes around the use of telemedicine in response to COVID-19. These changes will enable Medicaid beneficiaries to continue to access the care they need.

 
Effective Monday, March 23, 2020, Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policies to better enable the delivery of remote care to Medicaid beneficiaries. In addition to telephone conversations and secure electronic messaging, the modifications will include the use of two-way real-time interactive audio and video to provide and support physical and behavioral health care when participants are in different physical locations.


Telehealth refers broadly to electronic and telecommunications technologies and services used to provide care and services at a distance. Telehealth encompasses a range of practices, including telemedicine and telepsychiatry, which use two-way, real-time interactive audio and video between provider and patient to deliver health care and behavioral health services, respectively. Virtual patient communication is another part of telehealth used to provide evaluation and consultation between provider and patient or between different providers.

Medicaid policy changes include:

  • Payment parity for approved services, meaning providers will be paid the same fee for a service regardless of whether it is provided in-office or via an approved technology platform;
  •  Expanding eligible telehealth technologies to any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers;
  • Expanding the types of provider that can provide telehealth to include clinical pharmacists, licensed clinical mental health counselors (LCMHCs), licensed marriage and family therapists (LMFTs), licensed clinical addiction specialists (LCASs), and licensed psychological associates (LPAs);
  • Expanding the list of eligible originating sites, which is where the patient may be located (e.g., health care facilities, community sites, the home) and distant sites, which is wherever the provider is located (Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs) are considered eligible distant sites); and
  • Eliminating the need for some prior authorizations and referrals.

These changes will be retroactive to March 10, 2020 and will remain in effect until the North Carolina State of Emergency is declared over or when this policy is rescinded, whichever comes first. Medicaid will continue to release telehealth policy provisions and will continue to evaluate this policy throughout the state of emergency period.

 

For more information, visit Special COVID-19 Medicaid Bulletin #9: Telehealth Providers – Clinical Policy Modification on the Medicaid website.

 

Additional telehealth details and guidance will be available online at www.medicaid.ncdhhs.gov/coronavirus.roviderarencouraged to review Medicaid information as it is updated

NC State Health Plan

The State Health Plan is following Blue Cross NC's policy for telehealth at this time. For more information click here.

 

Optum

Optum Behavioral Health is continually monitoring this situation and if any further modifications to our normal processes are necessary to accommodate individuals impacted by COVID-19 we will notify providers immediately. There is no Optum restriction on the Behavioral Health discipline for providing telehealth. To take advantage of the Optum Telehealth services, you must already be an Optum provider.

If providers are currently in network, with Optum, they can be reimbursed for providing telehealth services. All providers billing for this type of service will be reimbursed at the same rate they are currently contracted under.

Telephonic Care: For members or providers who do not have access to HIPAA-approved technology required to conduct a video-enabled virtual session, we will now accept telephonic sessions. More information on
Optum’s updates on telehealth services for members can be found
here.

Questions can be directed to Optum’s provider email, which is optum.nc.pr@optum.com

UnitedHealth Group, UnitedHealthcare and Optum are taking action to ensure health plan members and patients affected by COVID-19 have the support and resources they need.

Additional COVID-19 Telehealth Resources:

In order to make it easier for our members to receive appropriate behavioral health treatment during this challenging time, we are encouraging providers and members to observe social distancing, self or mandated quarantine rules as outlined by the CDC and use our video-enabled virtual visits platform, any HIPAA-approved telehealth technology or telephonic care as long as this method will effectively support the Behavioral Health needs of the individual.

 

You do not need to join our virtual visit network in order to be reimbursed for the telehealth services you provide our members. Please continue to use standard CPT codes and a Place of Service of 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely.


Current virtual visit Providers: Please continue to use standard CPT codes and a Place of Service of 02 for virtual visits to indicate the visit was conducted remotely. This will allow claims to process through auto-adjudication without creating manual work, ensuring timely reimbursement.

NEW virtual visit Providers: Optum Behavioral Health is expediting new virtual visits applications for providers to offer virtual care for members who cannot travel to an office visit. To join our network, providers must be currently a participating Optum provider, use HIPAA approved telehealth technology to deliver care and complete a virtual visits attestation form here.

Visit the Provider Express virtual visits Page: Click here for information regarding participating in or joining the Optum virtual visits network.

Emotional-Support Help Line is available to support anyone who may experiencing anxiety or stress following the recent developments around COVID-19. This free service can be reached at (866) 342-6892, 24 hours a day, seven days a week and is open to all. In addition, emotional-support resources and information are available online at liveandworkwell.com

United HealthCare

UnitedHealth Group COVID-19 response: Click here to review the UnitedHealth Group press release on its comprehensive response to provide members and patients with COVID-19 support and resources. For more information, click here.

Free access to telehealth:

We expanded access to telehealth to make it easier for you to connect with health care providers from the comfort and safety of your home. There are two ways to access telehealth services:

  • Schedule a free telehealth visit: Sign in to your health plan account to access your existing telehealth benefit. We are waiving member deductibles, copays and coinsurance for telehealth visits through our designated telehealth partners.
  • Talk to your health care provider about telehealth: For the next 90 days, telehealth access is expanded in response to COVID-19 to allow faster support and to reduce exposure to the virus. Your local medical provider may be able to provide a telehealth visit through live video-conferencing. We are waiving member deductibles, copays and coinsurance for COVID-19 related visits.

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