COVID-19 Updates from Major Payers

WASHINGTON, D.C. (April 3, 2020)—Humana shared policy changes for health care providers and suppliers to help facilitate patient care during the COVID-19 outbreak. The policies include:

• Humana is now covering short-term home oxygen usage for members with a COVID-19-related diagnosis.
• To support social distancing, DME vendors should waive the signature-at-delivery requirement for DME-delivered to members with a COVID-19-related diagnosis (as noted at the bottom of this page).
• Waiving all out-of-pocket medical costs (copays, coinsurance and deductibles) related to covered treatment for COVID-19 for enrollees of individual and Group Medicare Advantage plans, fully insured commercial members, Medicare Supplement, and Medicaid.
• Additional guidance and flexibilities with use of telehealth for physician office visits.
• Effective April 1, Humana will suspend all medical records requests for pre-and post-paid claim review processes for individual and Group Medicare Advantage, Commercial Group, and Medicaid and will release any claims currently under medical record review as of April 1 and issue payment to providers. Please note that Humana has stated they may request medical records retrospectively once the suspension is lifted. AAHomecare will discuss concerns of retrospective reviews of all claims during this COVID-19 crisis.

The changes follow strong outreach from AAHomecare and other industry stakeholders on many of these issues; the association will continue to work with leaders at Humana to help maintain strong patient access to HME during the pandemic.

More details can be found in Humana’s April 2 announcement and on their COVID-19 provider website.

Anthem Shares COVID-19 Policy Updates

Anthem also released new guidance that includes:

• Suspending select prior authorization requirements to allow providers to focus on caring for patients diagnosed with COVID-19. This includes suspension of prior authorization requirements for patient transfers, prior authorization requirements for skilled nursing facilities, and suspension of prior authorization requirements for the use of medical equipment critical to COVID-19 treatment.
• Temporarily adjusting the approach to monitoring claims and audits.

See Anthem’s update here. AAHomecare’s payer relations staff is meeting with Anthem today to get clarification on these changes and advocate for further policy adjustments.

AAHomecare Continues Outreach to Major Commercial Payers & Shares Federal Policy Changes

In addition to the association’s discussions with Humana and Anthem, AAHomecare’s payer relations team has reached out to senior staff at Aetna, Anthem, BCBS Association, BCBS of Michigan, Blue Shield of CA, CareCentrix, Centene, Healthnet, HighMark BCBS, Kaiser, and United HealthCare and is setting up calls/meetings to advocate for policies that will allow DME suppliers to effectively serve more patients and reduce hospital burdens.

AAHomecare has shared an update on provisions in the COVID-19 Interim Final Rule (IFR) and other CMS guidance released earlier this week with these commercial payers, highlighting these policy changes from and asking that payers adopt similar measures:

• CMS will not enforce clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) (including articles). Enforcement of these clinical indications for coverage will resume once the COVID-19 emergency has ended.
• Waiving Proof of Delivery Requirements
• Waiving Prior Authorizations
• Suspension of audit activity

See AAHomecare’s new letter to commercial payers here.

The new letter follows last week’s joint industry letter to commercial payers spearheaded by AAHomecare. The letter, endorsed by more than 150 suppliers and other HME stakeholders, shared 18 recommendations to help HME suppliers better respond to the COVID-19 emergency.

Contact Laura Williard at [email protected] for more information.

Additional Guidance/Resources from Commercial Payers

Here is a rundown of additional information available from commercial payers the association has reached out to.

UnitedHealthcare had previously put out a bulletin on prior authorization for post-acute care, but this update clarifies that their changes do not apply to DME. We are actively following up to get DME relief from UHC as well. See also their COVID-19 information page.

Centene has announced that they are waiving cost-share related costs for Medicare, Medicaid, and marketplace members for COVID-19 related treatment and removing authorizations for COVID-19 related treatment. We will be verifying if this is DME-related. This resource page is available for those wishing to learn more about the company.

BCBS Association is expanding telehealth for the next 90 days and waiving cost sharing for diagnosis, testing, and treatment of covered services for COVID-19 patients—see their announcement.

Aetna has developed a COVID-19 provider page—no information directly related to DME currently noted.

AAHomecare will continue to reach out to these and other major payers to clarify their guidance and advocate for policy recommendations.