As the U.S. population struggles to fight the rapid spread of COVID-19 across the nation, so too, are health plans scrambling to keep up with the changing environment through policy changes and the use of telehealth.
Executives at Policy Reporter, a medical policy tracking platform owned by TrialCard, say the company has alerted its healthcare clients to dozens of new and updated payer policies related to the virus over the past week or so.
The Families First Coronavirus Response Act (H.R.6201)—signed into law on March 18—requires most health plans to cover testing for the virus at no cost to members. As a result, many health plans are adopting “significant changes” to their rules for covering telehealth services, including waiving patient cost-sharing expenses and expanding access to telehealth services, according to Policy Reporter.
"Many smaller regional plans are following the lead of large national plans that have announced their intent to cover telehealth services in this manner,” says Scott Dulitz, chief strategy officer at TrialCard. “This includes all Blue Cross Blue Shield plans as well as Aetna, Anthem, and Humana.”
Aetna has announced it is waiving member costs for in-network hospital stays related to COVID-19 treatment through June 1 for at least 3.6 million of its members, Dulitz says.
Policy changes appear to be led by the Centers for Medicare & Medicaid Services (CMS). The agency announced March 17 that it had lifted many restrictions on the use of telehealth services for Medicare beneficiaries during the COVID-19 emergency, in addition to expanding its reimbursement policy to pay physicians for telehealth services at the same rate as an in-person visit—for all diagnoses.
CMS’s changes allow Medicare patients to receive telehealth services in all areas of the country and in all settings, including in their homes. In addition, CMS will not enforce a requirement that patients have an established relationship with the physician providing telehealth prior to the telehealth visit. And, physicians licensed in one state can provide services to Medicare beneficiaries in another state.
The Medicare telehealth policy changes are putting pressure on private plans to follow suit, according to Dulitz, who also anticipates commercial health plans to update policies for home health services, which allow patients to self-isolate.
According to Dulitz, more plans are publishing provider guidance on billing and coding for COVID-19-related procedures and diagnosis. The American Medical Association's (AMA) new billing code for COVID-19 testing—CPT 87635—is being adopted by plans quickly, with Blue Cross Blue Shield of Rhode Island, Blue Cross Blue Shield of Kansas, and United Healthcare among the most recent payers to publish guidance—including guidance on maximum billing frequency.
All 36 independently operated Blue Cross Blue Shield (BCBS) companies and the Blue Cross and Blue Shield Federal Employee Program announced on March 19 expanded coverage for telehealth services for 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully insured members and applies to in-network telehealth providers who are providing appropriate medical services, the association says.
BCBS companies are also waiving the need for prior authorization for COVID-19 diagnostic tests and they are covering the full costs of the tests for members if diagnosed with COVID-19, according to Scott Serota, BCBSA President and CEO. The policy changes also allow for increased access to prescription medications and nurse or provider hotlines.
“We are also advocating for physician and health system adoption of social distancing-encouraged capabilities such as video, chat and/or e-visits,” Serota says.
Vincent Nelson, MD, vice president of medical affairs and interim chief medical officer at BCBSA, says the association’s member companies “have made a system-wide commitment to ensure members can swiftly and smoothly access the right care in the right setting during the COVID-19 outbreak.”
“Our commitment is based on the experience we have handling previous international disease outbreaks including the Ebola virus, SARS and the Swine Flu, in which patient testing and treatment is done in close coordination with public health authorities and with financial support appropriate to a broad public health effort,” Nelson says.
Nelson did not say if the new policies will extend past 90 days, but he says that BCBS companies are “monitoring the outbreak closely” and will be reviewing telehealth coverage decisions, “as needed, to ensure that people have seamless access to the medical services they need.”
Blue Cross Blue Shield of Massachusetts (BCBSMA) has launched policies to ease administrative burdens for healthcare providers. The payer announced March 25 it has removed prior authorization requirements and moved to a notification-only requirement for inpatient levels of care, including acute; long-term acute; acute and subacute rehabilitation; and skilled nursing facility admissions. Medical necessity reviews will not be performed for inpatient levels of care through June 23, the health plan says.
BCBSMA says it will remove all referral and authorization requirements for outpatient care, if a member is being evaluated or treated for suspected or confirmed COVID-19. This applies to in- and out-of-network providers and also to face-to-face and telehealth/virtual/telephonic visits.
"We want to decrease the administrative burden on clinicians as they're faced with this unprecedented public health challenge," says Bruce Nash, MD, chief physician executive and senior vice president of health and medical management at BCBSMA. "These additional steps we've taken will support care teams in establishing an appropriate treatment plan for each patient, while preserving availability of necessary inpatient care for all patients."
Blue Shield of California (BSC) has announced that it will provide Teledoc virtual care at no cost to its members through May 31, including those members with individual, family and employer-sponsored plans that offer Teladoc.
Teladoc Health provides medical advice over smartphones or computers from physicians anytime from anywhere reducing the risk of infection and spread of disease, according to BSC.
Members enrolled in Blue Shield’s Trio, Tandem and Medicare Advantage plans, plus Blue Shield of California Promise Health Plan beneficiaries, already enjoy no out-of-pocket costs for Teladoc Health services, BSC says.
“As we continue to closely monitor the COVID-19 situation, we believe making telemedicine more readily available is the right thing to do,” says Terry Gilliland, MD, executive vice president at BSC. “It’s important that we reduce direct human contact as much as possible as we assess cases initially. We believe in testing outside of medical facilities—either with temporary facilities adjacent to existing healthcare facilities, or via drive through testing to help us reduce possible spread of the virus inside a medical facility.”
BSC also announced a new free digital tool to help its network hospitals triage patients. COVID-19 SERA can direct low-acuity cases to the appropriate medical settings and provide relevant information to patients affected by COVID-19 so that they can quickly receive medical care and help curb community transmission, according to BSC.
Patients can access the “COVID-19 Screener and Emergency Response Assistant” (COVID-19 SERA) via smartphone, tablet or computer on a participating hospital’s website. The tool can be customized for each health system’s emergency response plan, and it is updated in real-time with latest guidelines from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
The triage tool, developed by San Francisco-based GYANT, a provider of virtual triage and patient navigation services, can be implemented on a hospital’s website within 48 hours. BSC says it will cover the costs for its network hospitals to implement and update the tool, as well as for licensure to use the COVID-19 SERA system for three months during the pandemic.
“The tool provides relief to hospitals’ overburdened call centers and front-desk resources,” Gilliland says. “These are trying times for everyone and we believe this system can make a difference for hospitals as they do their best to provide medical care for patients.”
