COVID-19 news & updates
May 22, 2020
MCCFL is receiving information from many of the insurance plans regarding prior authorization processes and other updates related to COVID-19. We will continue to provide this information via email communication, however, for the most recent information, we are recommending you visit the health plan's website or call their provider line. We will also be placing the communications from the health plans that can be accessed by visiting https://client.mccfl.us/public/ under the tools and resources tab in the Coronavirus folder. As best practice we still suggest you initiate authorization process, prior to admission. Please note that unless specified, out of network status still applies to some of their requirements, please read carefully.
We would also like to point out all notices and links state that the provider is still at risk of denial or non-payment of services if the admission was not deemed medically necessary or otherwise meet level of care criteria. There is the potential of being audited for medical necessity.
Below are the individual plan directives; please be sure to follow directions from your corporate teams.
Aetna
No information regarding changes to prior authorization and SNF stays at this time. Information regarding post SNF medications and coverage for those directly affected by COVID -19.
Update: 3.27.2020
Effective 3.25.2020 for a period of 30 days Aetna is temporarily making changes to the requirement for prior authorizations for post acute care facilities including SNF's. Initial pre-certification/prior authorization for admission to SNF is being waived for all Commercial and Medicare Advantage Plans. SNF's will be required to notify Aetna of the admission within 24 hours of admission either through Availity, or by calling Aetna directly. SNF's are also required to send medical records for concurrent review within three days of the initial admit. Medical records can be uploaded directly to Availity, or sent to Aetna by fax. Be sure to include patient name, and member ID on your fax cover sheet. Please note: there has been no clarification as to whether or not this applies to both in and out of network providers.
Update: 5.8.2020
Aetna is resuming our standard prior authorization protocols for inpatient admissions effective May 7, 2020 


AvMed
(This applies to Florida ONLY)
No information regarding changes to prior authorization and SNF stays at this time. Auth is still required.

 BayCare
(This applies to Florida ONLY)
Effective March 24, 2020 BayCare Plus Medicare Advantage has temporarily waived the prior authorization requirement for admission to SNF, ARU, and LTACH levels of care. Baycare is requiring notification by the facility that the member is being admitted to and clinical documentation, supporting the reason for transfer. Baycare will follow normal concurrent review process and will continue to follow our members for discharge planning needs. Notification of admission can be submitted by phone or fax. Please note: this only applies to in-work providers, out of network providers should seek authorizations.
Update: 4.17.2020
Baycare is now waiving authorization for both in and out of network providers.

CarePlus
(This applies to Florida ONLY)
No information regarding changes for SNF stay or prior authorization at this time. CarePlus is allowing telehealth/telemedicine visits for all their members, and are waiving out-of-pocket costs for the next 90 days for telehealth. CarePlus is also allowing early refills on prescription medicines so our members can prepare for extended supply needs and extra 30 or 90 day supply as appropriate.
Update: 4.17.2020
CarePlus is expanding this suspension to include suspending nearly all authorization requirements for in-network providers for Medicare-covered services. This applies to inpatient (acute and post-acute), outpatient and all par referrals for CarePlus benefit plans. This continues to apply to both in-network and out-of-network providers when the member has a COVID-19-related diagnosis
Otherwise, for non-COVID-19-related diagnosis, out-of-network providers must continue to follow authorization and referral requirements and submit authorizations requests per CarePlus’ policy.
Update: 5.22.2020
CarePlus is resuming our standard prior authorization protocols for inpatient admissions effective May 18, 2020.
Cigna
Effective March 23,2020 Cigna will waive prior authorizations for the transfer of its non-COVID-19 customers from acute inpatient hospitals to in-network LTACHs. In place of prior authorizations, Cigna will require notification from the LTACH on the next business day following the transfer. Cigna has also waived prior authorizations for the transfer of its patients to other in-network subacute facilities including, skilled nursing facilities and acute rehab centers. This policy will remain in place through May 31,2020 and applies to Cigna commercial and Medicare Advantage plans.

Florida Blue
(This applies to Florida ONLY)
No information regarding changes for SNF stay or prior authorization at this time. At this point they are offering Teledoc virtual visits to Medicare Advantage Members. Florida Blue is providing early access to 30-day prescription refills of medications (consistent to the member's benefit plan).
Update: 3.31.2020
Florida Blue Medicare, Commercial, and Affordable Care Act is waiving prior authorization requirements for patients being transferred from inpatient acute hospital settings to post-acute care facilities for 90 days from March 20th. Post-acute care facilities are still required to notify CareCentrix of FloridaBlue Medicare members of an admission by the end of the next calendar day. This timely notification and review is still required to determine medical necessity of continued stay and ensure Florida Blue can assist with discharge planning for its members. Please see the attached for further details on Commercial and Affordable Care Act members.

Freedom Health & Optimum HealthCare
(This applies to Florida ONLY)
No information regarding changes to prior authorization and SNF stays at this time. At this time Freedom has stated they are only giving authorization to in-network providers.
Update: 4.17.2020
As of April 6, 2020, Freedom Health and Optimum Healthcare is removing prior
authorization requirements for inpatient transfers to lower levels of care for the next 90 days to
assist hospitals in managing possible capacity issues. Providers must continue admission
notification to Freedom Health and Optimum Healthcare in an effort to verify eligibility and
benefits for all members prior to rendering services and to assist with ensuring timely
payments. Concurrent review for discharge planning will continue unless required to change by federal or state directive. Please note for out of network providers you will have to seek out a letter of agreement.
Clarification: 4.24.2020
Freedom clarified saying this only applies when a hospital system has been recognized as having a high volume of Covid-19 cases and bed availability is needed please note this is being handled on case by case. Freedom is asking providers to continue with the ‘normal authorization process’ as best as you possibly can. They still have staff working during the day and after-hours, who can provide authorizations.

Humana
Pre-authorization requirements have been removed in many cases:
  • For SNF services, it is business as usual continue to follow current process.
  • Medicaid waivers are being handled on an individual state basis; please visit the Medicaid website for state guidelines.
  • Humana is allowing early refills on prescription medicines so our members can prepare for extended supply needs - an extra 30 or 90- days supply as appropriate.
Update: 4.01.2020
Previously, Humana suspended authorization requirements on COVID-related diagnoses, excluding post-discharge, for both in-network and out-of-network providers. Humana is expanding the prior authorization suspension to include suspending nearly all authorization requirements for in-network providers. This applies to inpatient, outpatient, and all par referrals for all product lines offered by Humana. This continues to apply to both in-network and out-of network providers when the member has a COVID-related diagnosis notification of admission is highly recommended via Availity.
This only to COVID-19 diagnosed members with Humana otherwise follow normal admission/authorization process.
Update: 5.22.2020
Humana is resuming our standard prior authorization protocols for inpatient admissions effective May 22, 2020.
Medica
(This applies to Florida ONLY)
The following temporary changes apply for all Medica members and are effective from April 2, 2020, through May 31, 2020, dates of service. We are suspending prior authorization requirements to a post-acute care setting, so no prior authorization is needed for admission to the following facilities:
  • Acute inpatient rehabilitation (AIR)
  • Skilled nursing facilities (SNFs)
  • Home health care
Consistent with existing policy, the admitting provider should continue to notify Medica within 48 hours, and length-of-stay reviews still apply , including denials for days that exceed an approved length. Concurrent review will also continue.

Medicaid - AHCA
(This applies to Florida ONLY)
The Agency has lifted prior authorization for certain critical services for all Medicaid recipients and has lifted prior authorization for all services if the recipient is diagnosed with COVID-19. Please refer to the guidance published by the Agency on March 18th for a list of service categories where the prior authorization requirement has been lifted .
Clarification: 5.8.2020
Prior Auths: on or after March 1, 2020 through the termination of the emergency declaration for at least 90 days and up to 180 days (up to the last day of the emergency period under Section 1135(e) of the Act), for beneficiaries with a permanent residence in the geographic area of the public health emergency declared by the Secretary.
PASRR Level 2 exceptions were only in place for 30 days from the date initiated.  

Molina
In response to the COVID-19 Coronavirus, Molina Healthcare of Florida will be implementing the following measure:
Prior Authorization Requirements
In compliance with State Policy, Prior Authorization requirements will be lifted for Medically Necessary services provided by: Hospitals, Home Health Agencies, DME and suppliers, Physicians, ARNPs, PAs, SNF's, and Long Term Acute Care Hospitals for all members, under all lines of business until further notice. Prior Authorization requirements will be lifted for all medically necessary services related to the evaluation and treatment of COVID-19 provided by ALL providers, under all lines of business until further notice.
Referral requirement to participating specialists will also be lifted.
Update: 4.10.2020
Molina has clarified that the authorization process for Medicare Advantage and Commercial plans remains intact and prior authorizations are still required; the previous update was an error and the authorization process only applied to Medicaid/MMA patients until .

Preferred Care Partners
Preferred Care Partners is working to reduce administrative work for health care providers. Through May 31, 2020, providers will not need to do a prior authorization to move members to a different post-acute setting (i.e., long-term acute facilities, inpatient rehabilitation, skilled nursing facility or home health care). The admitting provider simply notifies us within 48 hours of the move.

Simply
Simply is waiving initial authorization, this provision is applicable to all managed care plan enrollees. Please note: there has been no clarification as to whether or not this applies to both in and out of network providers.
Update:4.24.2020
This applies to both in and out of network providers for 90 days from March 17th.

Staywell Medicaid
(This applies to Florida ONLY)
Prior authorization
To reduce administrative burden on key providers that are on the frontline serving that populations most impacted by COVID-19, Staywell is waiving initial and ongoing prior authorization requirements for medically necessary SNF's, Home Health, DME and supplies.
Staywell is waiving prior authorization requirements for all services (except pharmacy services) necessary to appropriately evaluate and treat members diagnosed with COVID-19. Please refer to official diagnosis coding guidelines that have been published by the CDC.
Update: 3.31.2020
Staywell has lifted the authorization process but technically are still requiring that an authorization be registered in their system for claims to process. Currently, Staywell is approving all SNF authorization requests that come across, so there will not be a delay. They are requiring an authorization be in place for tracking continuity of care concerns and processing of claims. Please read the below link, page ‘COVID19 Payment exception process”.  

Sunshine
Sunshine is waiving Prior authorization for all members for these services: medically necessary hospital services, physician services, advanced practice registered nursing services, physician assistant services, home health services, skilled nursing facilities, long term acute care hospital and durable medical equipment and
supplies.

United Healthcare
The following provisions are effective March 24, 2020:
  • Suspension of Prior Authorization requirements to a post-acute care setting through May 31,2020
  • Waiving prior authorization for admissions to: long-term care acute facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF).
  • Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer and penalties still apply.
  • Length of stay reviews still apply, including denials for days that exceed approved length.
  • Discharges to home health will not require prior authorization.
The admitting provider must notify United Healthcare within 48 hours of transfer or penalties still apply.
This applies to in or out of network SNFs; out of network SNF will still be considered out of network unless a GAP request is initiated due to lack of providers in an area.
Please see the link below for additional details.

WellMed
The provisions listed below are effective immediately and will remain in effect until May 31, 2020.
Skilled Nursing Facilities:
  • Consistent with existing policy, the admitting provider must notify within 48 hours.
  • WellMed will automatically approve initial requests for all SNF providers and automatically approve up to 5 days for per diem facilities
  • Maintain and review of subsequent days
  • Waive qualifying hospital stay requirement
  • Waive new benefit period requirement to renew SNF coverage when benefits are exhausted.
  • Please contact your market WellMed Inpatient Case Manager for discharge planning needs.
  • All prior authorizations requirements are suspended through May 31, 2020 for Home Health Agencies
  • DME: Lost, destroyed, irreparably damaged, or otherwise rendered unusable - waive replacement requirements such that the face-to-face requirement, a new physician's order, and new medical necessity documentation are not required.
WellMed reserves the right to update these provisions based on continued developments related to the State of Emergency for COVID-19 and direction from any applicable regulatory agency.
A Message from our President:

Dear Valued Clients,

MCCFL is working diligently on updates as related to the Covid-19 Crisis. We are gathering updates from the health plans as they are released to be able to provide you with the most recent information. Please note these updates and changes are very fluid and can change daily. It is best practice for out of network providers to check with the health plan for each referral to determine their current processes as they could vary based on type of product and benefits.  On March 25 th , 2020, President Trump declared that a major disaster exists in the State of Florida. Florida Disaster Declaration This additional declaration will most likely change the way the managed care organizations operate and how they will apply their rules regarding network operations. We are anticipating updates from the plans regarding this declaration. Medicare Advantage plans do have special requirements they must follow when such situations arise, please follow this link to review. CMS March 10, 2020
MCCFL is here to assist you and your staff with any managed care needs or questions that arise. Please do not hesitate to reach out to your Managed Care Liaison or any of our staff. We wish you and yours the best in these uncertain times. 

Destiny Quinones, BSW
President 
COVID-19
All of these articles can be found on our portal at MCCFL under tools. We will keep you abreast of this as it pertains to Managed Care.