Coronavirus Update

Effective April 1, 2020, prior authorization is not required for any behavioral health service.  In addition, prior authorization requirements will no longer be required for inpatient medical and surgical services, regardless of diagnosis. These waivers apply to both in-network and out-of-network providers, and Neighborhood will re-evaluate this temporary change in policy on April 30.

*Note: Neighborhood will still require prior authorization for medical outpatient services and prescription drugs.  See the grid at the end of this communication for detailed information on what is currently in and out of scope for this temporary policy.

Behavioral Health

Requests for prior authorization from Optum will no longer be required for the following services when the admission date (including transfer date) occurs within the effective date of this policy (4/1/2020 through 4/30/2020):

• Inpatient
• Partial hospital
• Intensive outpatient
• Outpatient
• Residential substance abuse disorder treatment

Optum will still require notification for all admissions and transfers, as that is the current process today. For the most current information, Behavioral Health providers should contact OPTUM Provider Express.

Medical Care

Requests for prior authorization from Neighborhood will no longer be required for the following inpatient services when the admission date (including transfer date) occurs within the effective date of this policy (4/1/2020 through 4/30/2020):

• Inpatient acute care level of care determinations
• Skilled Nursing Facilities
• Inpatient Rehabilitation
• Long Term Care Facilities

Neighborhood will require notification for all admissions and transfers to track and serve members admitted to inpatient facilities, as that is the current process. Notification of admission or transfer can be faxed directly to Utilization Management (UM) Department. The fax number is 1-401-459-6023.

All member cost share for behavioral healthcare services are waived under the new expanded telemedicine/telephone-only payment policy. In office visits are BAU.

Effective April 1, 2020 Neighborhood and our DME partner DMEnsion/Integra  are temporarily allowing 90-day benefit exceptions, in select cases, for Automatic Blood Pressure Monitors and Electronic Scales, ensuring  the most at-risk members are able to receive services they need to remain comfortable in their homes.

Effective 4/1/2020 through 6/30/2020, the following services will not require authorization when prescribed by a physician for the listed diagnoses. Please note a prescription is still required.

Neighborhood Benefit Exception for Automatic Blood Pressure Monitors and Electronic Scales

On behalf of Neighborhood and DMEnsion/Integra, we are grateful for our DMEPOS providers on the front lines.  We acknowledge that the COVID-19 pandemic is having an impact on the health of family members, friends, the businesses on which we rely, and the global economy. Our thoughts are with those affected in this unprecedented time.  Please contact the DMEnsion Benefit Management Customer Service team, servicing Neighborhood providers at 866-205-2122 with any questions.

automatic blood pressure monitors and Electronic Scales

Neighborhood is grateful for healthcare professionals willing to obtain an emergency medical license in Rhode Island to help during the COVID-19 crisis. Neighborhood has developed a process for credentialing and re-credentialing providers during this state of emergency. The process aligns with the RIDOH for licensing providers who meet the criteria outlined in the regulations, to practice during the COVID-19 crisis. Neighborhood’s Credentialing Department is continuously monitoring changes published by the RIDOH and CMS to best address network needs.

Prior authorization is not required for services under the Temporary COVID-19 Telemedicine/Telephone-only Services payment policy, however, we expect our provider community to practice in good faith and use their professional judgement related to services that can be provided through the expanded temporary policy.

Neighborhood expanded its existing payment policy for telemedicine services temporarily during the COVID-19 pandemic.  The payment policy is not limited to telephone only.  Neighborhood encourages all providers to use HIPAA-compliant technology when available, but recognizes in some cases this may ne be possible.  If using alternative options, Neighborhood requests that providers implement reasonable HIPAA safeguards.  For more information, please visit: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf

Effective March 18, 2020, the CDC announced an off-cycle code set update for the diagnosis COVID-19. Effective April 1, 2020, providers should use diagnosis code U07.1, COVID-19. For more information, go to: https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf

Yes, dispensing pharmacists will be able to enter overrides at the pharmacy at point of sale. The guidelines below have been put in place to allow for medication access, but to also prevent situations like stockpiling. Pharmacies should call their help desk if they experience any issues processing prescriptions.

• The coding will enable dispensing pharmacists to enter a submission clarification code (SCC13) at the pharmacy to bypass the refill-too-soon (RTS) rejections.
• Medicaid and Exchange plans that have a maximum day supply (DS) of 30 at retail will be able to obtain up to three, 30 days supply early fills.
  • Members will have a maximum of 3 fills within a 90-day window. Members can request all 3 fills at once, but they would have to wait another 90 days to obtain the SSC13 RTS benefit again. Please note that consecutive filling is at the discretion of the dispensing pharmacist. For example, if there is limited inventory of medications at that pharmacy, the pharmacist may not be able to dispense all 3 fills at once.
  • **Controlled substances and Specialty medications are excluded**
• Exchange plans that have a maximum day supply of 90 at retail will be able to obtain a 1-time 90 DS early refill.
  • **Controlled substances and Specialty medications are excluded**
• MMP plans have early refill benefits, but no restriction on number of fills at this time.

Neighborhood’s retro authorization procedure were revised and shared with providers in December 2019.

This revised policy included extenuating circumstances in which Neighborhood’s Utilization Management (UM) department will accept requests up to 14 days from the date of service. Given the current pandemic, the “Not Enough Time” situation would certainly apply and the UM staff has been made aware.

Neighborhood will waive the cost of the diagnostic testing and treatment for COVID-19. Neighborhood has developed a Temporary COVID-19 Testing Services payment policy for billing diagnostic testing services related to COVID-19. We are currently developing a payment policy for guidance on how to bill for COVID-19 related treatment.

Neighborhood does cover telehealth (telemedicine) services per Neighborhood’s Telemedicine Services Payment Policy.

• In addition, Neighborhood is actively engaged with our behavioral health partner, Optum, to assess their capacity for virtual patient visits (formerly known as telemental health). Through Optum’s live and work well provider directory, members can access virtual visit providers and in some cases, schedule an appointment with them online.  Providers can learn how to become a telemental health/virtual visit provider and access up-to-date information on Optum’s Provider Express portal, at: https://www.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/vv-tmh.html

• Optum updates their network providers via Provider Express and this includes information about billing for telemedicine visits.  Providers can visit Provider Express for up-to-date information or contact their respective Network Provider Relations Representative with any questions.

Per the Office of the Health Insurance Commission (OHIC) and the Rhode Island Medicaid Program, where applicable, Neighborhood has implemented a Temporary COVID-19 Triage Services Provided Via Telephone Only payment policy to support coverage of telephonic triage for COVID-19.

For Neighborhood’s Commercial members, cost-sharing will be waived.

Neighborhood does not require referrals for any service.

For the safety of Neighborhood staff, our members, and our community, Neighborhood closed its office to visitors, effective March 23, 2020. As a company, Neighborhood has engaged our emergency response team to activate protocols that aim to minimize disruption to daily business operations that impact members and providers. Neighborhood members and providers can still reach us during normal business hours.

Any suspected cases of COVID-19 should be reported to Rhode Island Department of Health (RIDOH) immediately. For any questions and to report cases, please call the RIDOH Center for Acute Infectious Disease Epidemiology at 401-222-2577 during business hours (Monday – Friday, 8:30 a.m. – 4:30 p.m.) or 401-276-8046 after hours. RIDOH also has a dedicated email address for healthcare providers: RIDOH.ProviderQuestions@health.ri.gov

Neighborhood is actively engaged with the Rhode Island Department of Health (RIDOH) and other regulatory agencies.  In addition, Neighborhood is:

• Educating members on steps they can take to prepare and stay healthy.
• Directing members to CALL their provider if they exhibit symptoms.
• Creating a web page, offering information from the Centers for Disease Control and Prevention (CDC) and RIDOH, including the local COVID-19 Info Line 401-222-8022 (available Monday through Friday, 8:30 a.m. to 4:30 p.m.) and email: RIDOH.COVID19Questions@health.ri.gov
• Continuously monitoring COVID-19 developments and assessing whether emergency preparedness plans and modifications to plan practices need to be implemented.