Coronavirus
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Coronavirus disease (COVID-19) was identified in 2019 as an emerging illness. In the past few years, we've gained a great deal of knowledge about treatment options, how the virus works, and the total impact of the illness. New information, obtained daily, will further inform the risk assessment, treatment options and next steps.
Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023
Earlier this year, the Biden Administration announced that the federal Public Health Emergency (PHE) related to the COVID-19 pandemic will end on May 11, 2023.
During the PHE, we followed guidance from the Centers for Medicaid & Medicare Services (CMS) and instituted temporary waivers for select services. This action ensured that critical care could be quickly delivered to our members during a time of heightened need. Beginning May 12, 2023, these temporary waivers will expire, and our members’ Medicare plan benefits will be reinstated for some services.
Temporary Commercial Waivers Expiring for Applicable COVID-19 Treatment and Telehealth Services on July 1, 2021
As we continue to address the COVID-19 pandemic, we want to update you on important changes for our Commercial 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 July 1, 2021, these temporary waivers will expire and our members’ Commercial 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 July 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 Commercial member liability at the point of service for applicable treatment related services on July 1, 2021 onward.
All Telehealth Services
- Any services that are not otherwise restricted and can be delivered virtually will continue to be eligible for telehealth coverage at this time.
- Providers should resume collecting Commercial member liability at the point of service on July 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 at this time.
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.
Temporary Medicare Plan Waivers Expiring for Applicable COVID-19 Treatment and Telehealth Services on July 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 July 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 July 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 July 1, 2021 onward.
Telehealth Services
- Any services that are not otherwise restricted and can be delivered virtually will continue to be eligible for telehealth coverage at this time.
- Beginning July 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 July 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.
COVID-19 Public Health Emergency Extended by Federal Government in to 2022
The HHS Secretary has renewed the COVID-19 Public Health Emergency. This extends flexibilities and funding tied to the public health emergency (PHE) to continue through April 2022.
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 Health Net members through late January, until the PHE is either terminated or extended again.
In accordance with this extension, Health Net has updated its information and guidance for COVID-19-related information posted on this page.
If you have any questions about this extension or the covered benefits impacted by it, please contact Provider Services at 1-888-802-7001 (TTY: 711) for Health Net Commercial or 1-888-445-8913 (TTY: 711) for Medicare Advantage.
Please note, the dates for the COVID-19 Federal Public Health Emergency extension may or may not align with Oregon regulatory requirements or guidance.
Guidance:
- Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.
- However, be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
- Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
- Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
- Refer to the CDC’s criteria for a patient under investigation for COVID-19. Notify local and/or state health departments in the event of a patient under investigation for COVID-19. Maintain a log of all health care personnel who provide care to a patient under investigation.
- Monitor and manage ill and exposed healthcare personnel.
- Safely triage and manage patients with respiratory illness, including COVID-19. Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.
Take Action:
- Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
- Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
- Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
- Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
- Be familiar with the intended scope of available testing and recommendations from the FDA.