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Provider Coronavirus Information

To reduce administrative burdens for providers caring for our Buckeye Medicaid and MyCare-Ohio (MMP) members, we have made the following changes to our prior authorization policies.

  1. All existing prior authorizations are extended for six months from renewal or expiration date.
    • Buckeye will honor any previously approved prior authorization for a treatment, procedure, or service for up to six months when the treatment, procedure,  or service has been postponed, which includes both waiver services and nursing facility care.
  2. The Ohio Department of Medicaid has updated prior authorization guidelines. Effective July 1, 2020, all medical prior authorizations requirements will resume. These updates will be accurately reflected in the Buckeye Health Plan Secure Provider Portal.

In order to ensure that all of our 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 9, 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.

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people. 

Please refer to ODM's website for the full Telehealth Billing Guidelines During COVID-19 State of Emergency (PDF).

Buckeye Health Plan is working to quickly address and support screening, testing and treatment for COVID-19, and is closely following guidance from the Centers for Medicare and Medicaid Services (CMS). As of April 1, 2020, the following guidance can be used to bill for services related to the screening and treatment of COVID-19.

COVID-19 Screening Services

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for COVID-19 screening visits and if billed alongside a COVID-19 testing code.
  • This applies to services that occurred as of February 4, 2020.

As a reminder, only those services associated with screening and/or treatment for COVID-19 will be eligible for prior authorization and member liability waivers.  For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply.

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. Coding and modifier information for the expansion of telehealth benefits are available in the ODM Billing Guidance document. Access to this and other key documents around COVID-19 can be found on ODM's website.    

In addition, below is specific Buckeye Health Plan guidance.

COVID-19 Testing Services

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.  
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.
  • Adjudication of claims is currently planned for the first week of April 2020.

Medicare Reimbursement Rates for COVID-19 Testing Services for All Provider Types*

We are complying with the rates published on 3/12/20 by CMS:

  • U0001 = $35.91
  • U0002 = $51.31

Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.

Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

Buckeye Health Plan can assist FQHC providers with receiving PPE (mask, gloves, gowns, hand sanitizer).

Tara Bires - TBires@centene.com is the facilitator of these request and can assist you with getting supplies to the FQHCs.

To assist our providers in accessing the multiple funding streams available, the Business Development team is developing a page on the Centene website that will:

  • Provide access  to the SBA loan application
  • Help providers understand available funding opportunities (SBA and grant funding)
  • Connect them with a member of the Business Development team that can assist in completing required applications.

You will find more details around the CARES Act (financial assistance and relief) and the EIDL and PPP loans available on our Centene site.

Buckeye’s Pharmacy team is working to increase member access to medications where appropriate for COVID-19.

  1. Increase member access to medications where appropriate for COVID-19:
    • Refill too soon over rides
    • Quality limit over rides
    • Prior authorization over rides
    • Exception: Refill too soon override NOT allowed for opioids.
  2. Over-the-counter (OTC) medications may be covered through the Medicaid pharmacy benefit without a prescription.
  3. 90-day supply for medications along with HIV and Transplant medications
  4. Delivery of medications with no additional charge to member. Below is a list of some of the major chains that participate in this effort:
    • CVS
    • Walgreens
    • Exactcare Pharmacy

The Centers for Medicare & Medicaid Services (CMS) have released guidance for implementing several provisions included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Buckeye Health Plan will be following this guidance as we adjudicate Medicare claims for applicable COVID-19 inpatient treatment services.

The CARES Act provides for a 20% increase to the inpatient prospective payment system (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. The increase will be applied to claims that include the applicable COVID-19 ICD-10-CM diagnosis code and meet the date of service requirements, as follows:

For discharges with the diagnosis codes above, [HEALTH PLAN] will follow the Medicare billing guidance published by CMS (PDF). Inpatient claims for these COVID-19 discharges that have already been received will be automatically reprocessed to reflect the payment increase.

This guidance is in response to the COVID-19 pandemic and may be retired at a future date.

Sources:

The Centers for Medicare and Medicaid (CMS)

The Centers for Disease Control (CDC)

Allwell from Buckeye Health Plan EXTENDS $0 MEMBER LIABILITY FOR Primary Care, Behavioral Health, and Telehealth SERVICES for Remainder of 2020

Since March, Allwell from Buckeye Health Plan has waived pre-authorizations, co-pays, and other costs related to COVID-19 testing, screening and medically necessary treatment. We also have waived prescription refill limits, and members are able to refill prescriptions prior to their refill date during this crisis.

As seniors face increased social and economic barriers to care amid the pandemic, we are now offering a number of expanded benefits to help our eligible Medicare Advantage members address issues such as out-of-pocket medical costs, food insecurity, and medication assistance.

Effective July 1, 2020, expanded benefits will include:

  • $0 Member Liability Extension: We are waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits and are extending telehealth cost share waivers for all telehealth visits—primary care, specialty, and behavioral health—for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states.
  • Extended Meal Benefits Members eligible for meal benefits due to a chronic condition or recent discharge may receive an additional 14 meals delivered to their home at no cost.
  • Increased Annual Wellness Visit Incentives – Members may be eligible for an increased incentive for completing their Annual Wellness Visits, a benefit offered at no cost to the member.
  • Additional Over-The-Counter (OTC) Benefits – Plans with an OTC benefit may now receive additional allowance dollars in monthly or quarterly increments, adding up to as much as $150 for the remainder of 2020, depending on plan.
  • Access to WellCare’s Community Connections Help Line – The Community Connections Help Line – a toll-free line provided by our partners at WellCare and available to anyone in need – is staffed by peer coaches and support specialists who can refer individuals and caregivers in need to a database of more than half a million social services in local communities across the country. By calling the line at 1-866-775-2192, members can also receive help coordinating of the expanded meal program benefits, OTC allowances, and annual wellness visit incentives via the line.

Beginning July 1, 2020, providers should waive the member liability for the eligible primary and behavioral health care claims at the point of service, and forego the collection of the member cost share. This is a benefit change for our members and our claims system will be configured to administer these adjusted benefits. We recognize that providers have different reimbursement/accounting arrangements with us, and the costs associated with this benefit change will follow the accounting processes as outlined in the provider’s contract with Allwell from Buckeye Health Plan. For services rendered to Medicare members with state benefits, providers should continue to collect that member cost share from their State Medicaid Agency as per usual.

There are many additional resources for information around COVID-19, coding for expanded telehealth services and other Ohio-specific information from the Ohio Department of Medicaid:

ODM links

OAC rules for OhioMHAS and ODM

CMS (Medicare) links

CMS Telehealth Guidelines for Medicare