Neighborhood waives prior authorizations for all behavioral health and inpatient medical services

All copays, deductibles and co-insurance fees have been waived for all COVID-19 treatment

April 6, 2020 (Smithfield, RI) – Neighborhood Health Plan of Rhode Island (Neighborhood), a not-for-profit health plan that serves approximately one in five Rhode Islanders, announced, effective April 1, it is waiving requirements for health care providers to seek prior authorizations for all behavioral health and all inpatient medical services regardless of whether they are COVID-19 related or not.

As of March 18, Neighborhood began waiving prior authorizations and all members’ out-of-pocket fees for treatment related to COVID-19, including copays, deductibles and co-insurance. Likewise, Neighborhood expanded its telemedicine policies to include phone-only with no prior authorization or cost sharing fees. It is also allowing for early prescription refills.

“As our health care providers on the front lines of the coronavirus pandemic ready for the surge of sick patients, Neighborhood is seeking ways to make it easier for doctors to make decisions quickly about their patients’ treatment,” said Chief Medical Officer Marylou Buyse. “We understand that it will be critically important for health care providers to triage all levels of care in order to address the needs of the community during this rapidly evolving public health crisis.”

No prior authorizations are required to admit patients for treatment regardless of diagnosis for all levels of behavioral health services, and for medical and surgical inpatient services. Neighborhood will request less burdensome notifications to track and serve members admitted to behavioral health and medical inpatient facilities. 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. Neighborhood still requires prior authorizations for medical outpatient services and prescription drugs, but is continuing to assess provider and member ease of access during this state of emergency.

“Additionally, these changes in prior authorization policies allow us to redeploy our utilization management team to proactively contact our members who are managing other health conditions to ensure they have access to the resources they need, such as food and medications,” added Buyse.

The outreach by case managers will help Neighborhood identify who needs these resources and identify any other gaps in services. As the primary health plan for Rhode Island’s most vulnerable populations, Neighborhood is partnering with Rhode Island Food Bank and Meals on Wheels of Rhode Island to secure food sources for its members with a focus on Providence, Central Falls, Woonsocket and Pawtucket, where most of its members live. Additionally, it has earmarked funds to be used to address other areas of need as they are identified, in particular for the state’s community health centers.

These changes are in place for all Neighborhood health plans which include Medicaid eligible children, adults and families; Medicare-Medicaid dual-eligible adults; and individuals, families and small businesses who purchased their health insurance through HealthSource RI, the state’s health exchange.

More information on temporary policy changes is available for members and providers on Neighborhood’s COVID-19 Update page at