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Provider Coronavirus Information

Medicaid COVID Vaccine Information

Buckeye Health Plan follows guidance from Ohio Department of Medicaid


COVID-19 Vaccine Incentives - Providers and Members

Read a Special Message to providers from Steve Province, President and CEO and Dr. Brad Lucas, Chief Medical Officer. 

Member Incentive Flyer (PDF) - Download to share with your patients.

Text # Text Messages to Members

Ohio MCP Medicaid and MyCare members over 18: You can get a $50 incentive for getting your first COVID vaccine with valid ID! Now until August 15.  At your doctor’s office, local pharmacy or a community event near you. Visit COVIDVaxOnTheSpot.com to learn more!

 

Outbound call script

Greeting: Hello! This is Dr. xxxxx office calling with information about a $50 incentive for you!

Message:

Protect yourself, your family members and friends by getting the COVID-19 vaccine. Get back to doing the things you love together! The vaccine is your best defense against getting COVID-19. Medicaid and MyCare members over 18 will receive a $50 incentive for getting your first COVID-19 vaccination from now until August 15. Bring a valid ID.

Do you need help getting there? Transportation is FREE with Buckeye Health Plan. To schedule a ride, call 866.549.7289.  Visit COVIDVaxOnTheSpot.com for more information or press 1 to speak with Member Services for more information.

 

Email

Subject:  Get your first COVID-19 Vax and a $50 incentive!

Heading: Buckeye Medicaid and MyCare members over 18: Get your COVID-19 Vax on the Spot!

Call outs:

Get a $50 gift card on the spot!

No appointment needed!

FREE rides!

Body:

You will receive a $50 gift card for getting your first vaccination with valid ID.

Protect yourself, your family members and friends by getting the COVID-19 vaccine so we can all get back to doing the things we love together! The vaccine is your best defense.

Now until August 15

Need help getting to your vax? Transportation is FREE with Buckeye. To schedule a ride, call 866.549.7289. Stop in for a healthier Ohio and a healthier YOU!

Visit COVIDVAXontheSPOT.com for more information.

 

Social Media

GET YOUR COVID-19 VAX ON THE SPOT. Buckeye Health Plan Medicaid and MyCare members over 18 will receive a $50 gift card for getting their first vaccination with a valid ID. Buckeye can help get you there at no cost to you! Visit www.COVIDVAXontheSPOT.com to learn more!

 

Direct Mail - Front

Headline: Get your COVID-19 Vax on the Spot and a $50 incentive!

Subhead: Buckeye Health PlanMedicaid and MyCare members over 18: Get your free COVID -19 Vax on the Spot now until August 15.

Call outs:

  • Get a $50 gift card for your first vaccination!
  • No appointment needed!
  • FREE ride to get your vax!
  • Bring a valid ID.

 

Direct Mail - Back

Body: Buckeye Health Plan members!

You will receive a $50 incentive for getting your first COVID-19 vaccination.

Protect yourself, your family members and friends by getting the COVID-19 vaccine so we can all get back to doing the things we love together! The vaccine is your best defense.

Now until August 15

Need help getting there? Transportation is FREE with Buckeye. To schedule a ride, call 66.549.7289.

Visit COVIDVAXontheSPOT.com for more information.

 

COVID-19 Vaccination Member Incentive FAQs

 

Q. Am I eligible for a gift card?

A. The cards are available to Medicaid and MyCare Ohio members 18 and older who receive their first vaccination shot between June 15 and Aug. 15, 2021.

 

Q. Where can I spend the gift card?

A. The retailers will vary depending on which health plan is involved.

 

Q. I got my shot before June 15. Why am I not eligible for a gift card?

A. That is great that you already received your COVID-19 vaccine. Thank you for doing your part to protect your loved ones and communities. This incentive is part of a special summer campaign to help achieve the state’s commitment to protect OH Medicaid and MyCare Ohio members from COVID-19. Unfortunately, people who were vaccinated prior to June 15 are not eligible for the gift cards. Should these rules change at any time, Ohio’s Medicaid Managed Care Plans will share new details accordingly.

 

Q. If I take a gift card, am I still eligible for other rewards I’ve heard about?

A. The health plans aren’t involved with other reward plans and don’t set the rules for them.

 

Q. Why should I get the COVID-19 vaccine?

A. The only way to stop the Coronavirus from increasing its spread again is for as many people as possible to be vaccinated so that they can’t contract the virus.

 

Q. Does it work?

A. Yes. All the vaccines approved for use in the U.S. have been extensively tested and shown to be more than 90% effective in preventing severe cases of COVID-19.

 

Q. Are there any side effects?

A. Yes, but in most people, they are mild: soreness at the spot where you were injected or mild flu-like symptoms.

 

Q. Who can get it, and what does it cost?

A. Vaccines have been granted emergency authorization approval by the FDA for anyone age 12 and older. For those age 12-15, only the Pfizer vaccine can be administered.  The vaccine is free to everyone in the U.S.

 

Q. Lots of people who contracted COVID-19 didn’t get sick at all. Why is the vaccine so important?

A. If you contract the Coronavirus, even if you don’t feel sick, you could be spreading the virus to other people, who could get sick and even die. The only way to stop the spread is to make as many people as possible immune to the virus so that it can’t spread.

 

Q. Shouldn’t I be concerned about some of the bad things I’ve heard about the vaccine?

A. There are many myths going around — untrue statements about the vaccine. Here are the facts:

  • The vaccine will NOT make you infertile
  • Development of the vaccine was NOT rushed and it is NOT untested. Scientists had been working on this type of vaccine technology for many years. An extraordinary effort after the pandemic hit enabled the development and testing to be completed quickly.
  • Getting the vaccine WON’T give you COVID-19 or cause you to test positive for the disease.
  • The vaccine is SAFE for women who are pregnant and/or breastfeeding.
  • The vaccine is proving to be EFFECTIVE against new variants of the virus that have arisen.
     

Q. Is vaccination making a difference?

A. Yes. Numbers of new COVID-19 cases have dropped sharply. A study at Cleveland Clinic showed that 99.7% of people who had to be hospitalized for COVID-19 since January 1, 2021 were either unvaccinated or only partially vaccinated,


Increase in Administrative Fee for COVID-19 Vaccines

See our Provider Alerts page.


All Ohio Medicaid and MyCare members age 18 and older who receive their first dose of the COVID-19 vaccine between June 15, 2021 and September 15, 2021 will receive a $100 incentive!

Visit COVIDVaxOnTheSpot.com for details about vaccine events near you! 


Nursing Facility COVID-19 Tool Kit

Buckeye Health Plan is providing our nursing facilities resources to consider when engaging members during the COVID-19 pandemic. Providers are encouraged to consider expanding their existing processes to incorporate strategies or initiatives as appropriate. Nursing Facility Tool Kit PDF.


FDA and CDC Lift Recommended Pause on Johnson & Johnson (Janssen) COVID-19 Vaccine Use Following Thorough Safety Review

Following a thorough safety review, including two meetings of the CDC’s Advisory Committee on Immunization Practices, the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention have determined that the recommended pause regarding the use of the Janssen (Johnson & Johnson) COVID-19 Vaccine in the U.S. should be lifted and use of the vaccine should resume.

The pause was recommended after reports of six cases of a rare and severe type of blood clot in individuals following administration of the Janssen COVID-19 Vaccine. During the pause, medical and scientific teams at the FDA and CDC examined available data to assess the risk of thrombosis involving the cerebral venous sinuses, or CVST (large blood vessels in the brain), and other sites in the body (including but not limited to the large blood vessels of the abdomen and the veins of the legs) along with thrombocytopenia, or low blood platelet counts. The teams at FDA and CDC also conducted extensive outreach to providers and clinicians to ensure they were made aware of the potential for these adverse events and could properly manage and recognize these events due to the unique treatment required for these blood clots and low platelets, also known as thrombosis-thrombocytopenia syndrome (TTS).

The two agencies have determined the following:

  • Use of the Janssen COVID-19 Vaccine should be resumed in the United States.
  • The FDA and CDC have confidence that this vaccine is safe and effective in preventing COVID-19.
  • The FDA has determined that the available data show that the vaccine’s known and potential benefits outweigh its known and potential risks in individuals 18 years of age and older.
  • At this time, the available data suggest that the chance of TTS occurring is very low, but the FDA and CDC will remain vigilant in continuing to investigate this risk.
  • Health care providers administering the vaccine and vaccine recipients or caregivers should review the  Janssen COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) (PDF) and Fact Sheet for Recipients and Caregivers (PDF), which have been revised to include information about the risk of this syndrome, which has occurred in a very small number of people who have received the Janssen COVID-19 Vaccine.

CDC’s independent Advisory Committee on Immunization Practices met today to discuss the latest data on TTS, hearing from the vaccine manufacturer Janssen and the COVID-19 Vaccine Safety Technical (VaST) Subgroup, as well as a risk benefit analysis. ACIP is committed to be vigilant and responsive to additional information that could impact the risk benefit analysis of any of these vaccines. Vaccine safety monitoring will continue and any new information about TTS will be brought to ACIP as needed.

“Safety is our top priority. This pause was an example of our extensive safety monitoring working as they were designed to work—identifying even these small number of cases. We’ve lifted the pause based on the FDA and CDC’s review of all available data and in consultation with medical experts and based on recommendations from the CDC’s Advisory Committee on Immunization Practices. We have concluded that the known and potential benefits of the Janssen COVID-19 Vaccine outweigh its known and potential risks in individuals 18 years of age and older. We are confident that this vaccine continues to meet our standards for safety, effectiveness and quality. We recommend people with questions about which vaccine is right for them have those discussions with their health care provider,” said Janet Woodcock, M.D., Acting FDA Commissioner.

“Above all else, health and safety are at the forefront of our decisions,” said CDC Director Dr. Rochelle P. Walensky. “Our vaccine safety systems are working. We identified exceptionally rare events – out of millions of doses of the Janssen COVID-19 administered – and we paused to examine them more carefully. As we always do, we will continue to watch all signals closely as more Americans are vaccinated. I continue to be encouraged by the growing body of real-world evidence that the authorized COVID-19 vaccines are safe and effective, and they protect people from disease, hospitalization, and death. I urge anyone with questions about the COVID-19 vaccines to speak with their healthcare provider or local public health department.”

Assessment of Available Data

Medical and scientific teams at the FDA and CDC reviewed several sources of information and data related to the Janssen COVID-19 Vaccine to reach today’s decision.

Specifically, the agencies assessed reports submitted to the Vaccine Adverse Event Reporting System (VAERS) reviewed the medical literature and considered the information from global regulatory partners about thrombosis with thrombocytopenia that have been reported following use of a similar, yet not identical, COVID-19 vaccine using a virus from the adenovirus family that has been modified to contain the gene for making a protein from SARS-CoV-2.

Update on Adverse Events

On April 13, the FDA and CDC announced that, out of more than 6.8 million doses administered, six reports of a rare and severe type of blood clot combined with low blood platelet levels occurring in people after receiving the Janssen COVID-19 Vaccine had been reported to VAERS. In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia).

Today, the agencies can confirm that a total of 15 cases of TTS have been reported to VAERS, including the original six reported cases. All of these cases occurred in women between the ages of 18 and 59, with a median age of 37 years. Reports indicated symptom onset between 6 and 15 days after vaccination.

Monitoring for Safety Will Continue

The surveillance systems that are in place to monitor the safety of COVID-19 vaccines authorized for emergency use are working, as demonstrated by both agencies’ quick work to identify and investigate these rare, but serious adverse events. The FDA and CDC will continue with these efforts to closely monitor the safety of these vaccines.

Reports of adverse events following vaccination can be made to the Vaccine Adverse Event Reporting System.

Additional Resources:

 

This is an official CDC HEALTH ALERT

Distributed via the CDC Health Alert Network

April 13, 2021, 1:00 PM ET  

CDCHAN-00442

Cases of Cerebral Venous Sinus Thrombosis with Thrombocytopenia after Receipt of the Johnson & Johnson COVID-19 Vaccine  Summary

As of April 12, 2021, approximately 6.85 million doses of the Johnson & Johnson (J&J) COVID-19 vaccine (Janssen) have been administered in the United States. The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) are reviewing data involving six U.S. cases of a rare type of blood clot in individuals after receiving the J&J COVID-19 vaccine that were reported to the Vaccine Adverse Events Reporting System (VAERS). In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). All six cases occurred among women aged 18–48 years. The interval from vaccine receipt to symptom onset ranged from 6–13 days. One patient died. Providers should maintain a high index of suspension for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received the J&J COVID-19 vaccine. When these specific type of blood clots are observed following J&J COVID-19 vaccination, treatment is different from the treatment that might typically be administered for blood clots. Based on studies conducted among the patients diagnosed with immune thrombotic thrombocytopenia after the AstraZeneca COVID-19 vaccine in Europe, the pathogenesis of these rare and unusual adverse events after vaccination may be associated with platelet-activating antibodies against platelet factor-4 (PF4), a type of protein. Usually, the anticoagulant drug called heparin is used to treat blood clots. In this setting, the use of heparin may be harmful, and alternative treatments need to be given.

CDC will convene an emergency meeting of the Advisory Committee on Immunization Practices (ACIP) on Wednesday, April 14, 2021, to further review these cases and assess potential implications on vaccine policy. FDA will review that analysis as it also investigates these cases. Until that process is complete, CDC and FDA are recommending a pause in the use of the J&J COVID-19 vaccine out of an abundance of caution. The purpose of this Health Alert is, in part, to ensure that the healthcare provider community is aware of the potential for these adverse events and can provide proper management due to the unique treatment required with this type of blood clot.

Background

VAERS is a national passive surveillance system jointly managed by CDC and FDA that monitors adverse events after vaccinations. The six patients (after 6.85 million vaccine doses administered) described in these VAERS reports came to attention in the latter half of March and early April of 2021 and developed symptoms a median of 9 days (range = 6–13 days) after receiving the J&J COVID-19 vaccine. Initial presenting symptoms were notable for headache in five of six patients, and back pain in the sixth who subsequently developed a headache. One patient also had abdominal pain, nausea, and vomiting. Four developed focal neurological symptoms (focal weakness, aphasia, visual disturbance) prompting presentation for emergency care. The median days from vaccination to hospital admission was 15 days (range = 10–17 days). All were eventually diagnosed with CVST by intracranial imaging; two patients were also diagnosed with splanchnic* and portal vein thrombosis. Unusual for patients presenting with thrombotic events, all six patients showed evidence of thrombocytopenia (<150,000 platelets per microliter of blood), consistent with a condition known as thrombotic thrombocytopenia, with platelet nadir counts ranging from 10,000 to 127,000 during their hospitalizations. Four patients developed intraparenchymal brain hemorrhage and one subsequently died. All data presented in this HAN are preliminary and investigations of these VAERS reports are ongoing. The Clinical Immunization Safety Assessment (CISA) project which includes experts in infectious disease and hematology are also reviewing these cases. To date, VAERS has received no reports of CVST with thrombocytopenia among persons who received either of the two mRNA-based COVID-19 vaccines.

These reports following the J&J COVID-19 vaccine are similar to reports of thrombotic events with thrombocytopenia after receipt of the AstraZeneca COVID-19 vaccine in Europe. Both vaccines contain replication-incompetent adenoviral vectors (human [Ad26.COV2.S] for J&J and chimpanzee [ChAdOx1] for AstraZeneca) that encode the spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. Based on studies conducted among the patients diagnosed with immune thrombotic thrombocytopenia after the AstraZeneca COVID-19 vaccine in Europe, the pathogenesis of these rare and unusual adverse events may be associated with platelet-activating antibodies against platelet factor 4 (PF4). Anti-PF4, also known as heparin-PF4 antibody, can induce thrombotic thrombocytopenia in a small percentage of persons exposed to heparin. However, none of the cases reported from Europe had recent heparin exposure. As with heparin-induced thrombocytopenia, the administration of the anticoagulant heparin should be avoided in patients with potential vaccine-associated immune thrombotic thrombocytopenia (VITT), unless heparin-induced thrombocytopenia (HIT) testing is negative. Non-heparin anticoagulants and high-dose intravenous immune globulin should be considered in treatment of patients who present with immune-mediated thrombotic events with thrombocytopenia after J&J COVID-19 vaccination. Consultation with hematology specialists is strongly recommended.

* The term 'splanchnic circulation' describes the blood flow to the abdominal gastrointestinal organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine.

Recommendations For Clinicians

  1. Pause the use of the J&J COVID-19 vaccine until the ACIP is able to further review these CVST cases in the context of thrombocytopenia and assess their potential significance.
  2. Maintain a high index of suspension for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received the J&J COVID-19 vaccine, including severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, petechiae (tiny red spots on the skin), or new or easy bruising. Obtain platelet counts and screen for evidence of immune thrombotic thrombocytopenia.
  3. In patients with a thrombotic event and thrombocytopenia after the J&J COVID-19 vaccine, evaluate initially with a screening PF4 enzyme-linked immunosorbent (ELISA) assay as would be performed for autoimmune HIT. Consultation with a hematologist is strongly recommended.
  4. Do not treat patients with thrombotic events and thrombocytopenia following receipt of J&J COVID-19 vaccine with heparin, unless HIT testing is negative.
  5. If HIT testing is positive or unable to be performed in patient with thrombotic events and thrombocytopenia following receipt of J&J COVID-19 vaccine, non-heparin anticoagulants and high-dose intravenous immune globulin should be strongly considered.
  6. Report adverse events to VAERS, including serious and life-threatening adverse events and deaths in patients following receipt of COVID-19 vaccines as required under the Emergency Use Authorizations for COVID-19 vaccines.

For Public Health

  1. Pause the use of the J&J COVID-19 vaccine in public health clinics until the ACIP is able to further review these CVST cases in the context of thrombocytopenia and assess their potential significance.
  2. Encourage healthcare providers and the public to report all serious and life-threatening adverse events and deaths following receipt of COVID-19 vaccines to VAERS as required under the EUAs for COVID-19 vaccines.
  3. Disseminate this alert to healthcare providers in your jurisdictions.

For the Public

  1. If you have received the J&J COVID-19 vaccine and develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination, contact your healthcare provider, or seek medical care.
  2. Report adverse events following receipt of any COVID-19 vaccine to VAERS.
  3. If you are scheduled to receive the J&J vaccine, please contact your healthcare provider, vaccination location, or clinic to learn about additional vaccine availability.

For More Information

 

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.COVID-19 Update: Johnson & Johnson Vaccine

Ohio Governor Mike DeWine and Lt. Governor Jon Husted provided an update on Ohio's vaccination plans following the decision to pause the administration of the Johnson and Johnson (Janssen) vaccine. 

The majority of the Ohio's Johnson and Johnson doses were directed to mass vaccination clinics and to 63 public and private 4-year colleges and universities, most of which have already completed their student vaccinations. 

Of the mass vaccination clinics and college/university clinics that did plan to offer the Johnson and Johnson vaccine this week, most will proceed with their clinics by offering either the Pfizer or Moderna vaccine.  A total of eight sites will not offer any vaccines this week as the health community works to recognize, report, and manage any adverse events related to the Johnson and Johnson vaccine. 

There are many other local providers with open appointments for the Pfizer or Moderna vaccine. Visit gettheshot.coronavirus.ohio.gov to look for open appointments.

Approximately 6.8 million people have received the Johnson and Johnson vaccine in the U.S. 264,311 of those vaccinations were administered in Ohio.

Ohio Advises Temporary Pause for Johnson & Johnson COVID-19 Vaccine

As of April 13, 2021, Governor Mike DeWine, Ohio Department of Health Director Stephanie McCloud, and Ohio Department of Health Chief Medical Officer Bruce Vanderhoff, M.D., are advising all Ohio vaccine providers to temporarily pause using the Johnson and Johnson (Janssen) vaccine. 

This is in response to a statement by the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) recommending a pause following extremely rare blood-clotting events of six people in the U.S. after receiving the vaccine. The cases have occurred in women between 18 and 48 and the reactions have taken place within 6-13 days after receiving the vaccine. More than 6.85 million Johnson & Johnson vaccine doses have been administered in the U.S. as of April 12 (264,311 of those in Ohio).

People who have received the Johnson & Johnson vaccine and develop severe headaches, abdominal pain, leg pains or shortness of breath within three weeks after vaccination should contact their healthcare provider or seek medical attention. Providers should report all adverse events following any vaccination to the Vaccine Adverse Events Reporting System (VAERS).

We will continue to keep this page up-to-date. You can also visit Medicaid’s COVID page  or the CDC’s COVID-19 Resource website for the latest information about the vaccines.


The Latest Information from the Ohio Vaccine Preparedness Office

Weekly Update Topics May 11, 2021 (PDF)

  • FDA/CDC Updates
  • Webinar - Best Practices for Vaccinating Children
  • New Resources
  • Bringing the Vaccine to Neighborhoods
  • Talking Points

Weekly Update Topics April 23, 2021 (PDF)

  • Johnson and Johnson (Janssen) vaccine update
  • Best Practices
  • Equity Pop-Up Clinics
  • Cleveland mass vaccination clinic to offer first doeses
  • New PSA's to share
  • Talking Points

Weekly Update Topics March 18, 2021 (PDF)

  • New groups eligible for vaccination
  • New Vaccine Management Solution scheduling
  • Mass vaccination sites
  • Talking Points

See archive below.

COVID-19 Vaccination Workgroup Handout - March 3, 2021 (PDF)

  • Latest on all three vaccines:
    • Pfizer-BioNtech
    • Moderna
    • Johnson and Johnson-Janssen
  • How the Janssen vaccine works and key features
  • Vaccines at a Glance
  • Nusing Home Guidelines

Weekly Update Topics March 11, 2021 (PDF)

  • New groups eligible for vaccination
  • New Vaccine Management Solution is live
  • Mass vaccination sites
  • New CDC Guidelines for fully vaccinated individuals
  • Talking Points

Weekly Update Topics February 27, 2021 (PDF)

  • Possible vaccine shipment delays due to severe weather
  • Pfizer vaccine quantities update
  • VMS 411 sessions to be held on Wednesdays and Fridays at 3:00 p.m.
  • COVID-19 Vaccine Town Halls start Monday, February 22, 2021
  • Reminder: medical disorders group began February 15, 2021
  • Talking Points

Weekly Update Topics 2-8-21 (PDF)

  • Ohio launching new Vaccine Management Solution (VMS)
  • Process announced for medical disorders group beginning February 15
  • Save the Date: Ohio's COVID-19 Vaccine Town Halls
  • Ohio administers more than 1 million doses of COVID-19 vaccine
  • Updated Target Population/Occupation Checklists
  • Johnson & Johnson has submitted EUA application
  • Talking Points

Weekly Update February 4, 2021 PDF

  • Where those with disabilities should go to schedule vaccines
  • K-12 School Staff Vaccination Program underway
  • Do not hold back second doses from first-dose shipments of vaccine
  • Acceptable forms of identification
  • Talking Points

Weekly Update January 25, 2021 PDF

  • CDC has updated clinical guidance
  • Resources available for working with patients with disabilities
  • New VaxText resource
  • Continue proper reporting
  • Submit information for statewide Vaccine Provider Location searches
  • No vaccine should be wasted
  • Correction from last week's update
  • Talking Points

Weekly Update January 20, 2021 PDF

  • Submit information for statewide Vaccine Provider Location search
  • Phase 1B begins
  • Vaccinations for those with qualifying medical conditions
  • Vaccine allocation
  • Expectation to immediately vaccinate
  • Vaccinating vaccinators
  • Talking  Points

COVID Champions

Ohio has over 700 providers across all 88 counties to ensure access close to home and Buckeye has partnerships with Federally Qualified Health Centers and nursing homes, as well as personalized outreach to members add up to Ohio COVID Champions (PDF)


ODH Town Hall Information

Ohio’s COVID-19 Vaccine Town Halls begin Feb. 22 Whether you hear myths on social media, at work, or from friends or family, there is a lot of dangerous misinformation out there about COVID-19 vaccines.

The truth is that COVID-19 vaccines are safe, effective, and rigorously tested. Ohio’s COVID-19 Vaccine Town Halls are designed to help you sift through the myths and learn where you can find reliable, trustworthy information about COVID-19 vaccines.

You’ve got questions, and the upcoming Town Halls will give you answers. Hear from medical experts, community leaders, and public health professionals.

Watch livestreams at the following dates and times:

  • Monday, Feb. 22, 6:30 p.m. – African American Ohioans 
  • Tuesday, Feb. 23, 6:30 p.m. – Hispanic/Latino Ohioans
  • Monday, March 1, 6:30 p.m. – Asian American and Pacific Islander Ohioans
  • Tuesday, March 2, 6:30 p.m. – Rural Ohioans 

How to watch: Watch live or on-demand after the event:

Watch later on TV: Watch later on the Ohio Channel. Find the date and time, and your local channel by checking with your PBS station or television provider.

Learn more about Townhalls 


Billing Information

  • See the latest updates on COVID-Billing Guidelines that includes the new Johnson & Johnson vaccine.  ODM Vaccine Billing Guidelines  

  • NOTE: Per ODM, CMS has increased the administration payment rates for the COVID-19 vaccines to $37.98 for each dose (the initial and subsequent doses) effective, March 15, 2021. The vaccine rate will remain $0.01 throughout the public health emergency.

  • ODM will complete systems work this week to increase the administration rates for 0001A, 0002A, 0011A, 0012A, and 0031A. The new rates effective 03/15/2021 will be reflected on the upcoming Provider-Administered Pharmaceuticals fee schedule.

  • BH MITS Bits with information on COVID-19 Vaccine Administration Billing Guidance (PDF). Should you have questions or comments, please submit them to BH-Enroll@medicaid.ohio.gov.

Medicare and Ambetter COVID-19 Information


TEMPORARY MEDICARE PLAN WAIVERS EXPIRING FOR APPLICABLE COVID-19 TREATMENT AND TELEHEALTH SERVICES ON JUNE 1, 2021

As we continue to address the COVID-19 pandemic, we want to update you on important changes for our Medicare plans. Last year, we instituted temporary member cost share liability and prior authorization waivers for select services to ensure critical care could be quickly delivered to our members during a time of heightened need. On June 1, 2021, these temporary waivers will expire and our members’ Medicare plan benefits will be reinstated for the following services:

COVID-19 Treatment Related Services

  • COVID-19 treatment related services (those billed with a confirmed ICD-10 diagnosis code) will continue to be eligible for coverage at this time, in accordance with the member’s plan benefits.
  • Beginning June 1, 2021, prior authorization will be required for COVID-19 treatment related services in accordance with CMS guidance and plan benefits.
  • Providers should also resume collecting Medicare member liability at the point of service for applicable treatment related services on June 1, 2021 onward.

Telehealth Services

  • Any services that can be delivered virtually will continue to be eligible for telehealth coverage at this time.
  • Beginning June 1, 2021, prior authorization requirements will be reinstated for applicable services delivered via telehealth.
  • Providers should also resume collecting Medicare member liability at the point of service for all telehealth services on June 1, 2021 onward, in accordance with the member’s plan benefits.
  • Providers should reflect telehealth care on their claim form by following standard telehealth billing protocols in their state.
  • For further coding guidance for telehealth services, we recommend following what is being published by:

Prior authorization requirements and member cost share liability (copayments, coinsurance and/or deductible cost share amounts) will continue to be waived for COVID-19 testing, screening services and vaccinations.

We are working in close partnership with state, local and federal authorities to serve and protect our members and communities during the COVID-19 pandemic, including ensuring that our providers have relevant and up-to-date information. We value your partnership during these unprecedented times.

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

THE CENTERS FOR MEDICARE AND MEDICAID (CMS) RELEASE AN Interim Final Rule Addressing COVID-19 Vaccine Coverage

Ambetter from Buckeye Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have begun to publish guidance for providers.  Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

  • Ambetter from Buckeye Health Plan will configure its systems to properly adjudicate COVID-19 vaccine-related claims, both for the vaccine and its administration
  • Member liability will be $0
  • Non-participating provider pre-auth requirements will be waived
  • Provider reimbursement rates and emergency use authorizations (EUA) are all still pending and we will update you as that information becomes available

The American Medical Association (AMA) has published updates to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). The code set will continue to be updated as additional vaccines receive EUA approval by the U.S. Food & Drug Administration (FDA).

The following codes have been published as of December 21, 2020. However, they will not be billable until the specific vaccine receives official EUA approval.

Payment Allowances and Effective Dates for COVID-19 Vaccines and Treatment during the Public Health Emergency:

Code Short Descriptor Vaccine/Procedure Name Payment Allowance Effective Date Age limit
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer-Biontech Covid-19 Vaccine $0.01 12/11/2020 16 and older
0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer-Biontech Covid-19 Vaccine Administration – First Dose $16.94 12/11/2020 16 and older
0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose $28.39 12/11/2020 16 and older
91301 SARSCOV2 VAC 100MCG/0.5ML IM Moderna Covid-19 Vaccine $0.01 12/18/2020 18 and older
0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna Covid-19 Vaccine Administration – First Dose $16.94 12/18/2020 18 and older
0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna Covid-19 Vaccine Administration – Second Dose $28.39 12/18/2020 18 and older
Q0239 bamlanivimab-xxxx Injection, bamlanivimab, 700 mg $0.01 11/9/2020 N/ A
M0239 bamlanivimab-xxxx infusion Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring $309.60 11/9/2020 N/A

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Ambetter from Buckeye Health Plan covers, please contact Provider Services at 877.687.1189.

UPDATED PROVIDER BILLING GUIDANCE FOR COVID-19 VACCINE, TESTING, SCREENING & TREATMENT SERVICES

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19. The following guidance can be used to bill for services related to COVID-19 vaccinations, testing, screening and treatment services. This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For additional information and guidance on COVID-19 billing and coding, please visit the resource centers of the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA).  

COVID-19 Vaccines

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for claims billed with the new COVID-19 vaccine codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. This includes non-participating providers.
  • Per CMS guidance, all Medicare claims for the COVID-19 vaccine and its administration must be billed directly to Original Medicare fee-for-service (FFS).
  • All Medicare claims related to the COVID-19 vaccine codes will be denied, with direction to submit directly to Medicare FFS for payment.
  • The following codes have been published as of February 22, 2021. NOTE: Vaccines will not be billable until the specific vaccine receives official EUA approval. Currently approved vaccines are denoted by their effective date below.
Codes published as of February 22, 2021

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Effective Date

91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer

Pfizer-BioNTech Covid-19 Vaccine

12/11/2020

0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer

Pfizer-BioNTech Covid-19 Vaccine

Administration – First Dose

12/11/2020

0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND

Pfizer

Pfizer-BioNTech Covid-19 Vaccine

Administration – Second Dose

12/11/2020

91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

12/18/2020

0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna

Moderna Covid-19 Vaccine

Administration – First Dose

12/18/2020

0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna

Moderna Covid-19 Vaccine

Administration – Second Dose

12/18/2020

91303

SARSCOV2 VAC

AD26 .5ML IM

Janssen

Janssen Covid-19 Vaccine

2/22/2021

0031A

ADM SARSCOV2 VAC

AD26 .5ML

Janssen

Janssen Covid-19 Vaccine Administration

2/22/2021

  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 vaccine payments.

COVID-19 Testing Services

  • Providers performing the COVID-19 test can bill us for testing services that occurred after February 4, 2020, using the following newly created HCPCS codes:
    • HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
    • HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
    • CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
    • PLA 0202U - Effective May 20, 2020. Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.

Please note:  It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.

  • These codes should not be used for serologic tests that detect COVID-19 antibodies.
  • 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.
  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 testing services payments.

COVID-19 Antigen Testing Services

  • Providers performing COVID-19 antigen tests can bill us for testing services that occurred after June 25, 2020, using the following HCPCS codes:
    • 87426 - Infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg SARS-CoV, SARA-CoV-2 (COVID-19).
    • 0223U - Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected
    • 0224U - Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19) includes titer(s), when performed (Do not report 0224U in conjunction with 86769).
  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the above COVID-19 antibody testing codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. This includes non-participating providers.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 antigen testing services payments.

High-Throughput Technology Testing Services

  • Providers performing high production COVID-19 diagnostic testing via high-throughput technology can bill us for testing services that occurred after February 4, 2020, using the following newly created HCPCS codes:
    • HCPCS U0003 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
    • Please note: U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies.
    • HCPCS U0004 -2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
    • Please note: U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
  • Neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these codes to indicate high production testing.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 high-throughput technology services payments.

COVID-19 Specimen Transfers

  • For specimen transfer related claims, the following codes can be used:
    • G2023 - Spec Clct for SARS-COV-2 COVID 19 ANY SPEC SRC
    • G2024 - SP CLCT SARS-COV2 COVID19 FRM SNF/LAB ANY SPEC
    • C9803 - Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. This is effective for services provided on or after March 1, 2020.
  • Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.
  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 specimen transfer payments.

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.
  • If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:
    • Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
    • Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation
  • This applies to services that occurred as of February 4, 2020.
  • Providers billing with these codes will not be limited by provider type.
  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 screening service payments.

 

COVID-19 Treatment Services

  • For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:
    • U07.1 – 2019-nCov Confirmed by Lab Testing
  • We will waive member cost sharing for COVID-19 treatment for all members for dates of service through May 31, 2021.
  • For dates of service June 1, 2021 and onward, providers should collect Medicare and Marketplace member cost share (copayment, coinsurance and/or deductible amounts) at the point of service.
  • Prior authorization requirements will continue to be waived for COVID-19 treatment services.

COVID-19 Monoclonal Antibody Infusion Services

  • All Marketplace and Medicaid member cost share (copayment, coinsurance and/or deductible amounts) will be waived for claims billed with the new COVID-19 monoclonal antibody infusion services codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes. This includes non-participating providers.
  • Per CMS guidance, all Medicare claims for monoclonal antibody infusion services must be billed directly to Original Medicare fee-for-service (FFS).
  • Medicare claims related to the monoclonal antibody infusion codes will be denied, with direction to submit directly to Medicare FFS for payment.
  • CMS has identified the following specific code(s) for the monoclonal antibody product and specific administration code(s) for Medicare payment:
    • Eli Lilly and Company’s Antibody Bamlanivimab (LY-CoV555), EUA effective November 9, 2020
      • Q0239 - Injection, bamlanivimab-xxxx, 700 mg
      • M0239 - Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitorin
    • Regeneron’s Antibody Casirvimab and Imdevimab (REGN10933 and REGN10987), EUA effective November 21, 2020
      • Q0243 – Injection, casirvimab and imdevimab, 2400 mg
      • M0243 – Intravenous infusion, casirvimab and imdevimab, includes infusion and post-administration monitoring
  • We will employ the reimbursement rates established by CMS and our state regulators in accordance with provider contract terms for COVID-19 monoclonal antibody infusion service payments.

TALKING TO YOUR PATIENTS ABOUT The COVID-19 VACCINE: How you can engage and inform in a meaningful way

As COVID-19 vaccines are approved and distributed, providers will be a key part in its adoption and administration to the American public. Patients look to their healthcare professionals for medical guidance and assurance, and while much is still unknown, you can start laying the groundwork now for when the vaccines are available. As your partners in healthcare, we want to share some tips for effectively setting expectations and addressing questions from your patients.

Start COVID-19 Vaccine Conversations Early

Even before you are able to offer COVID-19 vaccinations, consider including the topic in your conversations with patients. This will give you the opportunity to set expectations about vaccine availability, including if/when you might recommend vaccination for them, and learn about any concerns they have.

Engage in Effective COVID-19 Vaccine Conversations

Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

Start with empathy and understanding.

  • Acknowledge the disruption COVID-19 has caused in all our lives.
  • Provide an opportunity to recognize common concerns that can be addressed by a vaccine.

Assume patients will want to be vaccinated but may not know when to expect it.

  • Consider providing the following general information to patients about the timeline for COVID-19 vaccines:
  • Limited COVID-19 vaccine doses may be available in 2020.
  • It is anticipated that vaccine supply will increase substantially in 2021.
  • The goal is for everyone to be able to easily get a COVID-19 vaccine as soon as large quantities are available. However, not everyone will be able to get vaccinated right away.
  • Encourage patients to continue taking steps to protect themselves from COVID-19 and let them know how you plan to share updates about vaccine availability.

Give your strong recommendation.

  • Let your patients know if you plan to recommend COVID-19 vaccination for them.
  • Share the importance of COVID-19 vaccines to protect patients’ health as well as the health of those around them.
  • Talk about your personal plans to get a COVID-19 vaccine.
  • Reassure your patients that the vaccine is safe.

Listen to and respond to questions.

  • If a patient has concerns or questions, this doesn’t mean they won’t accept a COVID-19 vaccine. Sometimes patients want your answers to their questions.
  • Your willingness to listen to their concerns will play a major role in building trust in you and your recommendation. Make it clear that you understand they have questions, and that you want to answer them, so they feel confident in choosing to get vaccinated.
  • Seek to understand patient/caregiver concerns and provide information they need in a way they can understand it (see Q&A below).

Keep the conversation open.

  • After answering their questions, let your patients know that you are open to continuing the conversation and answering any additional questions they may have.
  • Encourage patients to take at least one action like:
  • Scheduling another appointment.
  • Reading any additional information you provide them about COVID-19 vaccination.
  • Encourage others to get their COVID-19 vaccine when available.
  • Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.

Answering Patient Questions about the Vaccine

Your patients will likely have a lot of questions about the vaccine, and as their healthcare provider, they will turn to you for answers.

Q: Can I make an appointment with you to be vaccinated? If not, why? Do I have to go to a pharmacy to receive the vaccine?

A: Pharmacies are generally the most convenient locations to individuals and they also have great expertise in administering vaccines. While many providers anticipate to have the vaccine in their office later on, for now we recommend patients visit their local pharmacy. The website www.vaccinefinder.org  can help them locate the closest location with current inventory.

Q: Why are some people getting the vaccine before others? Why can’t I get mine yet?

A: Initially, there will be a limited number of vaccines available.  Because of the limited supply, some groups are recommended to get the vaccine first:

  • Phase 1A will include residents and employees of nursing homes and long-term care facilities.  They are recommended to get the vaccine first, as they are deemed highly vulnerable.  Long-term care facilities account for a high percentage of the deaths from COVID-19 (40%).
  • Additional phases are being developed by federal and state governments.  This will address first-responders, essential workers, older adults and people more at risk for either contracting the virus or becoming seriously ill with the virus.

Q: How do we really know if COVID-19 vaccines are safe? 

A: The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials. It only authorizes emergency vaccine use when the expected vaccine benefits outweigh potential risks.

  • The Advisory Committee on Immunization Practices (ACIP) reviews all safety data before recommending any COVID-19 vaccine for use.
  • FDA and CDC will continue to monitor the safety of COVID-19 vaccines to make sure even very rare side effects are identified.

Q: Is the vaccine that helpful? I heard getting COVID-19 gives you better and longer immunity than the protection a vaccine can give. Can it actually make my illness worse if I do end up getting COVID-19? 

A: Explain the potential serious risk COVID-19 infection poses to them and their loved ones if they get the illness or spread it to others.

  • Remind them of the potential for long-term health issues after recovery from COVID-19 disease, especially for those who have chronic conditions, are older, or have weakened immune systems.
  • Explain that scientists are still learning more about the virus that causes COVID-19. And it is not known whether getting COVID-19 disease will protect everyone against getting it again, or, if it does, how long that protection might last. Therefore getting a vaccine is a safer choice.
  • Some vaccines are more effective than the natural illness; it is not clear whether natural illness or vaccination will provide more effective immunity in this case.
  • Early information indicates that COVID-19 vaccination may reduce the severity of illness, as well as the incidence of illness. As we learn more about the efficacy of the vaccine, we will also learn more about potential long-term protection it may bring.
  • Describe how the vaccine was tested in large clinical trials and what is currently known about its safety and effectiveness.
  • Be transparent that the vaccine is not a perfect fix. Patients will still need to practice other precautions like wearing a mask, social distancing, handwashing and other hygiene measures until public health officials say otherwise.

Q: I heard I need 2 vaccines. Why? I don’t want to come back for a second vaccine.

A: Two vaccines are needed to provide the best protection against COVID-19.

  • The first vaccine primes the immune system and helps recognize the virus. The second vaccine strengthens the immune response.
  • The two doses are given a few weeks apart (e.g. 21 or 28 days depending on vaccine type). Explain the dosing options available in your office and advise the patient that they can set up an appointment before they leave to come back for a second dose.
  • Provide members with a vaccination record card to ensure that they know when they received their first vaccine, what type of vaccine they received, and when they need to come back and receive their second vaccine.
  • Direct them to their insurance health plan to set up non-emergency transportation, if applicable.

Q: Will the shot hurt? Can it cause you to get sick? I don’t want to get the vaccine because it will give me COVID.

A: List the most common side effects from vaccination are and how severe they may be (e.g. fever, headache, body aches, cold symptoms). Emphasize that a fever could be a potential side effect and when to seek medical care.

  • Symptoms will typically go away on their own within a week. Let them know when they should seek medical care if their symptoms don’t go away.
  • Explain that the vaccine cannot give someone COVID-19 as the vaccine does not contain a live coronavirus.
  • Explain that side effects are a sign that the immune system is effectively working.

Q: Do I have to pay for my vaccines?

A: No! The vaccine will be at no cost to patients. They will not have to pay for either dose of the COVID-19 vaccine.

Follow Vaccine Updates from Trusted Sources of Truth

The Centers for Disease Control (CDC)

National Institutes of Health (NIH)

The Centers for Medicare and Medicaid (CMS)

The American Medical Association (AMA)

Post- Acute Care Prior Authorization Changes

Update March 5, 2021 for Buckeye Medicaid, MyCare, Medicare and Ambetter members.

Since issuing the November 2020 memo, Ohio has seen a decrease in both the number of COVID-19 cases and the number of hospitalizations due to COVID-19. As such, we are resuming prior authorizations and/or pre-certifications for long-term acute care facilities, inpatient rehabilitation facilities and skilled nursing facility admissions effective April 1, 2021.  

Updated November 18, 2020 for Buckeye Medicaid, MyCare, Medicare and Ambetter members.

To reduce barriers to care and reduce administrative burden for providers caring for our Buckeye Medicaid, MyCare, Medicare and Ambetter members, we have made the following changes to our prior authorization policies:

  1. Prior authorization requirements for long term acute care facilities (LTAC), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF hospital) are being waived.  Upon admission to your facility, please contact Buckeye Health Plan as you do today to allow for determination of appropriate level of care and to continue concurrent stay review to assist with discharge planning activities to ensure safe transitions to next the level of care including:
    • Ensuring member are transferred to appropriate level of care
    • Adding services for member home care needs
    • Expediting referrals to participating providers
    • Ensuring all plans are in place before the member discharge

      NOTE:  Non-Par facilities: please accept 100% of Medicaid Fee Schedule and No Single Case Agreement will be required.
       
  2. We will extend authorizations for elective hospital services and surgical procedures for up to six months when treatments, procedures or services have been postponed.

Contact by phone:  866-246-4359

Fax: SN/Rehab/LTAC requests 866-529-0291 / Elective and /or scheduled admits 866-529-0290

 

On October 5, 2020, HHS Secretary Alex Azar renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through January 21, 2021.

With this renewal the various testing, screening, billing, and telehealth coverages that were implemented in response to the COVID-19 Public Health Emergency earlier this year will be extended to Buckeye Health Plan members through late January, until the PHE is either terminated or extended again.  This extension does not affect coverages that had already been made effective through December 31, 2020.

In accordance with this extension, Buckeye Health Plan has updated the General Guidance for COVID-19 Testing, Screening, and Treatment document, as well as the COVID-19 Telehealth Guidance for Providers documents posted on our website.

If you have any questions about this extension or the covered benefits impacted by it, please contact Provider Services at 866-296-8731.

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 indefinitely for dates of service beginning March 9, 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). This document was updated on July 17, 2020

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.

CMS has new COVID-19 ICD-10 procedure codes that will be effective date on 8/1/2020. Please refer to the ICD-10 MS-DRGs Version 37.2 (PDF).

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.

The COVID-19 global pandemic has created unprecedented changes to our lives and healthcare systems. While we continue to connect our members to COVID-19 services, we wanted to reach out to our provider partners on how we can work together to better support their care needs.

As a primary care physician (PCP), you are at the heart of our members’ healthcare. They trust and rely on you to help them access appropriate, affordable, coordinated care from the right providers, at the right time. If you refer our members to an out-of-network provider – or send their test specimens to a non-participating laboratory – they could be responsible for the out-of-network charges according to their benefits. These costs can quickly add up, especially for patients who do not have out-of-network benefits.

You can help your patients avoid this and keep their medical costs down by referring them to providers within their Buckeye Health Plan network, as denoted on their Member ID card. Understanding it can sometimes be challenging to navigate multiple payor networks to connect patients to appropriate in-network providers and facilities, we want to share two easy methods for you to access this information quickly:

Thank you for your continued partnership during this time of heightened concern. If you have any questions regarding our networks, please contact Provider Services at 1-866-296-8731.

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

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

September 2020 Update: Retrospective Reviews have been postponed until further notice by the Ohio Department of Medicaid (ODM) to ensure that barriers are removed for providers that care for our members. 

Buckeye Health Plan is currently analyzing claims that paid without authorization during the time that the Ohio Department of Medicaid Emergency Amendment “S” was in effect (March 9- June 30, 2020). 

Beginning July 1, 2020, BHP will perform retrospective medical necessity reviews of claims paid without authorization from March 9-June 30, 2020, following this schedule:
 

Dates Steps
July 1-31, 2020
  1. Identify inpatient claims paid without authorization and share with respective providers.

August 1-31, 2020

  1. Requests for medical records of identified inpatient claims.
  2. Identify outpatient claims paid without authorization and share with respective providers.

September 1 – November 1, 2020  

  1. Requests for medical records of identified outpatient claims.
  2. BHP review of identified inpatient claims and recoupment requests, as required.

November 1, 2020 – June 2021

  1. BHP review of identified outpatient claims and recoupment requests, as required.