FEDERAL GUIDANCE
CENTERS FOR MEDICARE AND MEDICAID SERVICES
Catastrophic plans currently include coverage for diagnosis and treatment of COVID-19 subject to certain limitations. HHS will not take enforcement against any issuer that amends its catastrophic plans to provide pre-deductible coverage for services associated with the diagnosis and/or treatment of COVID-19. HHS encourages states to take a similar enforcement approach and would not consider a state to have failed to substantially enforce section 1302(e) of the PPACA if it takes such an approach.
Re-prioritizes scheduled program audits of Medicare Part C and D and PACE programs until further notice. CMS will continue oversight but will temporarily shift oversight activities to prioritizing the investigation and resolution of: Instances of non-compliance where health and/or safety of beneficiaries are at serious risk (ex. lack of access to critically needed health services or prescription drugs).
Allows Medicare Advantage Plans to waive or reduce cost-sharing and for the expansion of telehealth services beyond those included in their approved 2020 benefits. Allows Part D Plans to relax their refill-too-soon edits. Allows Part D sponsors to provide maximum extended day supply to affected enrollees. Permits Plan D sponsors to relax any plan imposed policies that may discourage certain methods of delivery. Pauses audit reviews including prior authorizations. Re-prioritizes schedule program audits. Removes requirements relating to data reports and surveys. Provides for extensions to file an appeal (Medicare Part D Independent Review Entities). Allows waiver of requirements for timeliness for requests for additional information to adjudicate appeals (Medicare Part D Independent Review Entity). Allows the process of an appeal with incomplete Appointment of Representation forms. Allows for the process of requests for appeal that don't meet the required elements. Allows for the flexibility in the appeals process as if good cause requirements are satisfied.
Relating to CMS Section 1135 Waiver of Authority; blanket waivers, Medicaid and special waivers.
Provides for regulatory changes that provide more flexibility for the healthcare system to respond to COVID-19, includes changes to telehealth and Part D requirements.
CONGRESS
In addition to other health care related provisions, this Act increases Medicare telehealth flexibility, requires health plans to cover qualifying COVID-19 preventive services, and requires Medicare Prescription Drug Plans and MA-PD Plans to allow fills and refills of covered Part D drugs for up to a 3-month supply.
OFFICE FOR CIVIL RIGHTS
COVID-19 and HIPAA: Bulletin issued by OCR on 2/3/2020 provides information regarding protected health information under the HIPAA Privacy Rule during a public health emergency.
In order to ensure that healthcare providers can serve patients, including those who cannot or should not leave their homes during this emergency, OCR announced on March 17, 2020, that it will exercise its enforcement discretion and will not impose penalties for HIPAA violations against health care providers that in good faith provide telehealth using non-public facing audio or video communication products, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. This exercise of enforcement discretion applies regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
OCR also issued guidance on when the HIPAA Privacy Rule permits a covered entity to disclose the protected health information of an individual who has been infected with, or exposed to, COVID-19, with law enforcement, paramedics, other first responders, and public health authorities without the individual’s authorization.
STATE GUIDANCE
ALASKA
Division of Insurance
The Division expects insurers to provide early refills or replacements of lost or damaged medications; allow emergency supplies or refills without applying additional authorization requirements; allow consumers access to necessary prescriptions from a local retail pharmacy even if it is normally provided by mail order without penalty; and insurers may require opioids be obtained using the standard process. The Division will provide an update on these requirements by 4/30/20.
Health Insurers are asked to identify and remove barriers to testing and treatment for COVID-19.
Extends deadlines for external healthcare reviews in 3 AAC 28.958 - 3 AAC 28.964; The Division, Insurers and Independent Review organizations will need to process requests for Standard External Healthcare review cooperatively to meet an extended deadline of 75 days. All Expedited External Healthcare Reviews will be processed to completion in no more than 5 working days. Experimental and Investigational Healthcare Reviews will be extended to a 30-day deadline.
This bulletin supersedes Bulletin 20-04 and makes the following revisions or additions: effective March 20, 2020, respiratory panel test are no longer subject to the zero cost-sharing requirement; under IRS Notice 2020-15, high deductible health plans will not lose that status if they cover the cost of testing for COVID-19 before plan deductibles have been met; issuers shall not impose prior authorization or other medical management techniques for COVID-19 testing products, items and services. In addition to early refills referenced in Bulletin 20-03, insurers are required to: waive cost-sharing for testing for respiratory syncytial virus (RSV), influenza, and COVID-19 and are asked to waive cost-sharing for the related office/urgent care/ER visit for in and out-of-network providers, facilities, and labs. Insured are asked to review and ensure their telehealth programs are robust and can meet increased demand.
Requires that insurers suspend deadlines for claim filing and appeals; urges insurers to implement fully electronic claims processes; urges insurers to provide flexibility and coverage; requires private insurer services that can be provided via telehealth be covered; requires coverage of off-formulary prescriptions if there is no formulary drug available to treat a covered condition; expects insurers to minimize prior authorization requirements; reminds insurers about reporting fraud and abuse.
Advises insurers, authorized to write health insurance in this state, and registered third-party administrators, that certain utilization review and notification requirements should be suspended until June 1, 2020. Requires insurers to pay claims for covered services at alternate sites due to COVID-19. Covers suspension of concurrent review for inpatient hospital services; suspension of retrospective review for inpatient and outpatient services and emergency services and payment of claims; suspension of preauthorization requirements for post-acute placements; waiver of credentialing by location for payers; immediate payment of claims and audits of hospital payments and over-payment recovery; applicability to Third-Party Administrators of Self-Funded Plans.
ALABAMA
DEPARTMENT OF INSURANCE
Health carriers should review and ensure telehealth programs are robust and able to meet any increased demand; verify networks are adequate; provide access to out-of-network providers at the in-network cost-sharing; preauthorization requirements should not be used as a barrier to treatment for COVID-19 and utilization review and appeal processes for services should be expedited when medically appropriate; in the event immunization becomes available for COVID-19, AL DOI requests that health carriers immediately cover the immunization at no cost-sharing for all covered members; ACCESS TO PRESCRIPTION DRUGS: Health carriers are asked, where appropriate, to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured's health, life, or ability to regain maximum function or if the insured is undergoing a current course of treatment using a non-formulary prescription drug; provide information on steps taken in response to bulletin to Yada Horace, Insurance Analyst.
In accordance with the March 19, 2020 DHS memo
insurance companies, underwriters, producers (agents & brokers), related insurance claims, agency services, and related financial services are deemed essential services and operations and allowed to operate. Insurance company employees should seek to work remotely or behind closed doors and follow all CDC guidelines.
ARIZONA
DEPARTMENT OF INSURANCE
Requires insurers to: cover testing for COVID-19 regardless of network status; waive cost-sharing requirements related to COVID-19 testing; cover telemedicine at lower cost sharing than in office services; prohibits price gouging in relation to COVID-19 diagnosis and treatment related services.
ARKANSAS
DEPARTMENT OF INSURANCE
Directs all insurers and other regulated entities to provide it with the appropriate email address the company has designated to field consumer contacts during this health emergency. Carriers should forward their consumer contact email address to [email protected] as soon as possible; the commissioner advises all insurers and other regulated industries that they must continue to adjust claims as expeditiously as possible during this emergency in compliance with the provisions of AID Rule 43; the Department is hereby issuing a sixty (60) day moratorium on the cancellation/non-renewal of insurance policies for the non-payment of premiums for Arkansans diagnosed with/positively tested for COVID-19.
Requires all health insurance carriers offering health insurance plan, including short-term limited-duration insurance plans, to comply with reimbursement requirements for healthcare services provided through telemedicine.
Department directs PBMs and health insurance carriers to suspend random audits, including, but not limited to in-person or "desk" audits of pharmacies for 60 days but does not apply to cases where fraud is suspected.
Directs PBMs and health insurance carriers to suspend consumer signature requirement.
CALIFORNIA
DEPARTMENT OF HEALTH CARE SERVICES
Reminder to MCPs of existing contractual requirements; MCPs should work with their contracted providers to use telehealth services to deliver care when medically appropriate; In the event of a shortage of any particular prescription drug, MCPs should waive prior authorization and/or step therapy requirements if the member’s prescribing provider recommends the member take a different drug to treat the member’s condition.
HCS reminds Medi-Cal pharmacy providers of the following existing Medi-Cal FFS pharmacy policies: 100-day supply; 6 Rx limit; utilization management; emergency supply of medications; early refills; prior authorizations; mail order.
Letter specifying Section 1135 flexibilities.
Allows DEA-waivered prescribers the ability to prescribe buprenorphine without an in-person visit during the COVID-19 public health emergency. Relates to HIPPA regulations regarding communication technologies and telemedicine/telehealth. Provides information relating to The California Telehealth Resource Center; delivery of medication for patients who cannot leave home; patient consent to receive telehealth services.
Information relative to CMS March 23, 2020 approval letter for Section 1135 flexibilities.
DHCS issues guidance relative to the temporary suspension of Medi-Cal FFS PA requirements under California’s approved Medicaid State Plan (State Plan) for certain benefits, as well as extension of existing PAs.
Encourages: the expansion of telehealth services; expedited/removal of pre-authorization or pre-certification review requirements if applicable; waiving cost sharing; allows for 90 day refill on maintenance prescriptions; suspension of drug refill limitations; waive delivery charges for home delivery of prescriptions.
CALIFORNIA
DEPARTMENT OF INSURANCE
Department strongly encourages steps be taken to maintain ability to process and pay insurance claims and provide other required consumer services for insureds in a reasonable and timely manner.
In response to Governor Newsom’s
Executive Order (N-33-20)
, the recent guidance provided by several California public health officials, and the recent guidance from the U.S. Department of Homeland Security, Commissioner Lara encourages insurers and other licensees of the Department to use their discretion to determine whether critical insurance functions can be performed during the pendency of the COVID-19. Commissioner Lara also encourages all insurance businesses to continue to provide as many core insurance functions as possible during the COVID-19 pandemic while balancing the protection of the health or safety of their employees and other workers.
CDI expects health insurers will provide increased access to health care services through telehealth by: including the use of all available and appropriate modes of telehealth delivery (e.g., synchronous video and telephone-based service delivery); immediately implement reimbursement rates for telehealth that mirror payment rates for an equivalent office visit; removing barriers to access; providing access to medically appropriate care from a qualified provider.
COLORADO
DIVISION OF INSURANCE
The Division is directing carriers to conduct an outreach and education campaign to remind individuals of their telehealth coverage options. In addition, the Division is directing carriers to provide telehealth services to cover COVID-19-related in-network telehealth services at no cost share, including co-pays, deductibles, and coinsurance that would normally apply to the telehealth visit. The Division will be issuing an emergency regulation formalizing this directive; To the extent consistent with clinical guidelines, the Division is directing carriers to cover an additional one-time early refill of any necessary prescriptions to ensure individuals have access to their necessary medications should they need to limit close contact with others. Carriers shall not apply a different cost-sharing amount to an early fill of a prescription due to concerns about COVID-19 but does not apply to prescription drugs with a high likelihood of abuse, such as opioids. The Division will be issuing an emergency regulation formalizing this directive and is directing carriers to ensure that coverage is provided for COVID-19 testing without the requirement that consumers pay co-pays, deductibles or co-insurance.
Carriers shall provide coverage for COVID-19-related in-network telehealth services with no cost share for the covered person. Carriers shall cover at least one (1) additional early refill of all necessary prescriptions to ensure that the covered person has access to necessary medications (1) Carriers shall not apply a different cost-sharing amount for an early refill of a prescription, and (2) this does not apply to prescription drugs with a high likelihood of abuse, such as opioids; covered testing for COVID-19 provided with no cost share and related testing requirements.
CONNECTICUT
INSURANCE DEPARTMENT
Encourages the following: waive cost-sharing for COVID-19 testing; devote resources to consumer inquiries; verify provider networks are prepared to handle potential increases; permit testing and treatment for COVID-19 out-of-network and provide on in-network basis; authorize payment to pharmacies for 90 day supply of maintenance prescription medications; not to apply penalties for failure to provide notice relating to testing or treatment of COVID-19. Upon notification by the Insurance Commissioner, health insurers, health care centers, and any preferred provider networks or pharmacy benefit managers acting on their behalf, are encouraged to extend the time limits for providers, enrollees, certificate holders and insureds to submit claims for the testing or treatment of COVID-19. Health insurers and health care centers are requested to provide information to the Department on the steps being taken in response to the items in this bulletin.
DELAWARE
DEPARTMENT OF INSURANCE
Restates existing requirements for testing, telemedicine and telehealth, network adequacy and access to out-of-network services; timely utilization review; immunizations; prescription drugs (department expects insurers to provide for early refills or replacements of lost or damaged medications and to allow emergency refills without applying additional authorization requirements; may obtain prescriptions from local pharmacy even if prescription supply is normally provided by mail order without penalty); inpatient hospital, emergency and ambulatory patient services; surprise medical bills. Department encourages all carriers to: waive patient cost sharing; increase communications and provide accurate information; update contingency plans.
Requests carriers to do the following: suspend cancellations and nonrenewal due to nonpayment of premium; fully reimburse providers for telehealth visits; allow out-of-state providers to provide telemedicine services to a Delaware resident if they hold an active license in another jurisdiction; ensure Delaware residents do not need to be in Delaware at the time telehealth services are provided; waive all pre-authorization requirements for testing and treatment of confirmed or suspected COVID-19 patients; ensure no enforcement action under catastrophic health coverage plans.
Provides that communication with enrollees may be via electronic or telephonic means as long as a log or record of the communications are maintained.
DISTRICT OF COLUMBIA
DEPARTMENT OF INSURANCE
Requires carriers to: make screening, testing, treatment and vaccinations or immunizations available without prior authorization or cost sharing; cost sharing for telehealth shall not exceed that of an in-person appointment; expand coverage of telehealth and review telehealth programs to meet demand; requires Commissioner approval of cancellation or non-renewal of any health plan; allow early refills; remove mail order restrictions; make subsitutions available in the event of a shortage; conduct utilization review and appeals swiftly; requires notice be given to providers and enrollees regarding response to COVID-19. Requests providers to accept highest in-network reimbursement and prohibits overcharging by out of network providers.
FLORIDA
OFFICE OF INSURANCE REGULATION
Reminder to health insurers, HMOs and other health entities of Section 252.358 of Florida Statutes, which allows for early prescription refills due to the Governor's recent Executive Order declaring a State of Emergency.
OIR will not consider certain actions to be violations if applied in a nondiscriminatory manner; OIR is granting a 30-day extension for the filing of May 1 annual statements for HMOs, Administrators, continuing care providers and MEWAs; OIR will accept electronic signatures and notarizations on documents to be filed through 5/1/20.
GEORGIA
INSURANCE AND SAFETY FIRE COMMISSIONER
Department is asking health insurers to take the following immediate measures: consider options to reduce potential barriers of cost-sharing for testing and treatment of COVID-19; review internal processes and procedures to ensure they are prepared and to provide insureds with information and timely access to all medically necessary covered health care services; inform insureds of available benefits and make all necessary and useful information available on websites and staff nurse-help lines; remove cost barriers to testing; ensure telehealth programs with participating provides will be able to meet increased demand; verify network adequacy and access to out-of-network services; make expedited formulary exceptions and allow temporary use of out-of-network pharmacies at the in-network level in the event of a medication shortage at network pharmacies. The Department asks health insurers to provide information on the steps being taken in response to this Directive.
HAWAII
INSURANCE DIVISION
Reminds licensees of online renewal abilities. Strongly encourages early renewals up to 90 days prior to expiration. The Department is still accepting applications, renewals and activations via USPS or UPS.
Encourages insurers to work with insureds to ensure coverage continues, policies do not lapse and refrain from cancelling or non-renewing policies due to non-payment and grant grace period for premiums payments; provide structured payment plan for those late on premium payments; waive late fees and penalties.
ILLINOIS
DEPARTMENT OF INSURANCE
Includes information on balance billing and surprise bills; cost-sharing; prescription drug supply (the Department encourages temporary use of out-of-network pharmacies at the in-network coverage level in the event of medication shortages); denials or termination of coverage; travel insurance; communications with enrollees.
Provides overview of telehealth requirements; requires coverage of telehealth services by in-network providers providing covered services. Allows insurers to set reasonable requirements and parameters for telehealth services.
GOVERNOR
Expands telehealth services. Requires health insurance issuers to cover the costs of all Telehealth Services rendered by in-network providers. Health insurance issuers shall not impose utilization review requirements that are unnecessary, duplicative, or unwarranted, nor impose treatment limitations that are more stringent than services rendered in-person and shall not impose any prior authorization requirements. Health insurance issuers shall not impose any cost-sharing for Telehealth Services provided by in-network providers except under "high-deductible health plan" coverage unless it is deemed "preventive care" (the IRS has recognized that services for testing, treatment, and any potential vaccination for COVID-19 fall within the scope of "preventive care"). Telehealth Services may be provided regardless of whether or not the in-network provider was originally established in any designated telehealth network. Suspends statutory limitations pursuant to Section 5 of Illinois' Mental Health and Developmental Disabilities Confidentiality Act, 740 ILCS 110/5 regarding records and written consent and restricts the use of public facing applications (Facebook Live, Twitch, Tik Tok, etc.).
IOWA
INSURANCE DIVISION
Encourages the use of telehealth services. Requires all health carriers to reimburse for telehealth services on the same rate and basis as an in-person visit. Directs health carriers to eliminate barriers to audio-only telephone transmission requirements for reimbursement and to allow the use of telephones, audio/video, secure text messaging, email or other means for the furnishing of telehealth services. Encouraged to increase access to telehealth services; health carriers shall not limit telehealth services to only patients with COVID-19; health carriers shall not limit, deny or reduce coverage for reimbursement for a covered health care service delivered via telehealth; encourages the removal of cost-sharing or other barriers to the use of telehealth in self-funded employer based plans.
KENTUCKY
Department of Insurance
Requires insurers to: waive all prior authorization requirements and cost sharing for services related to COVID-19; allow access to out of network services; notification to all contracted providers regarding waiver of prior authorization and cost sharing; provide information relating to coverage of COVID-19 accessible on insurer's website; allows for early prescription refills.
The Department waives the requirements of KRS 304.17A-005(47)(c) and will not impose penalties for noncompliance in connection with the good faith provision of telehealth using such non-public facing audio or video communication products.
LOUISIANA
DEPARTMENT OF INSURANCE
Applies to HMOs, MCOs, PPOs, PBMs, and TPAs and all other entities licensed by the LA DOI. Orders health insurance issuers to waive all cost-sharing including copayments, coinsurance and deductibles for screening and testing for COVID-19; waive any prior authorization requirements or restrictions for screening and testing for COVID-19 and timely response to requests for treatment of COVID-19; verify provider networks are adequate, including access to out-of-network services; provide notice to contracted providers regarding waiver of cost-sharing and prior authorization requirements and communicate to insureds; allow prescription refills even prescription recently filled (does not apply to opioids and similar drugs restricted to 7-day prescriptions); suspends all precertification or step-therapy procedures (30 day supply); suspends provisions in LA Insurance Code which place restrictions on replacement prescriptions pertaining to mail order prescriptions; allows mail order prescriptions to be mailed to alternate address if requested by insured; waive all restrictions relative to out-of-network access to pharmacy services or prescriptions; reminds health insurance issuers to comply with utilization review decision timelines; restatement of authority to enforce sanctions for violations.
Applies to HMOs, MCOs, PPOs, PBMs, and TPAs and all other entities licensed by the LA DOI. Order waives geographic accessibility requirements of La. R.S. 22:1019.2 except for those issuers which do not comply with all provisions of this Rule. Issuers shall waive: any limitation on the use of audio-only telephonic consultations for telemedicine, including the use of personal devices; any coverage limitations restricting telemedicine access to providers included within a plan's telemedicine network; any requirement that the patient and provider have a prior relationship in order to have services delivered through telemedicine. All health insurance issuers shall evaluate differences in cost-sharing responsibilities for their insureds seeking in-network and non-network care and take steps to ensure that patients are not subject to unreasonable cost sharing due to access limitations.
Rule regarding premiums, continuation of health coverage, claims payment, and physician credentialing.
MAINE
BUREAU OF INSURANCE
The following emergency measures are effective for all carriers: make all medically necessary screening and testing for COVID-19 available with no deductible, copayment or other cost sharing or prior authorization; immediately cover vaccines and associated costs for COVID-19 without cost sharing; continued coverage of emergency services with network-level cost-sharing regardless of the status of the emergency provider and prior authorization may not be required for emergency services; ensure out-of-network cost-sharing at in-network level and protect patients from surprise billing; review telehealth programs to verify adequacy and continue to provide telehealth services with parity; make substitutions of medications available when necessary at not greater cost and without prior authorization or step therapy requirements; allow one-time refills of prescriptions except for classes subject to misuse; prioritize the timely delivery of medically necessary health services to enrollees for all care and conduct utilization review and appeal processes as expeditiously as possible; provide accurate and prompt information carriers must provide clear and prominent notice that they are waiving cost-sharing for medically necessary screening and testing for COVID-19, guidance on how enrollees can access such care, and notice that they are permitting early prescription refills. This notice must be posted prominently on the carrier’s Web site, provided to all customer service personnel and all nurse help-lines and similar programs, and communicated to all network providers and facilities. Carriers shall provide the Bureau with copies of all notices.
For the duration of this emergency, health carriers shall not refuse to pay claims submitted by providers credentialed within a health care organization but not at that health care organization’s location where the service was provided or at a location not in that health care organization. A carrier may establish reasonable notice requirements if a provider is reassigned to a different location in the same or another health care organization. However, there must be a reconciliation process to ensure that claims submitted by or on behalf of credentialed providers will not be denied indefinitely on the ground that the provider’s credentials are not valid at the location where the service was provided.
Carriers must also provide parity in coverage for other clinically appropriate remote delivery of medically necessary health care services, including office visits conducted by non-public-facing telephone communication methods that have audio-only or audio-video capability, to the extent that the provider is permitted by law to provide such services. All carriers are further ordered to ensure that rates of payment to in-network providers for services delivered via telehealth and other remote modalities are not lower than the rates of payment established by the carrier for services delivered in person, and to notify providers for any instructions necessary to facilitate billing for such remote services.
MARYLAND
INSURANCE ADMINISTRATION
Carriers are required to waive any time restrictions on refills and authorize payment to pharmacies for at least a 30-day supply (copays and deductibles may apply to refills according to contract/policy); carriers are urged to communicate COVID-19 information to members, review provider panels to ensure reasonable access, and plan for granting out-of-network referrals (including entering into agreements with out-of-network providers to prevent balance billing). Commissioner will promulgate emergency regulations to require health carriers to: waive cost-sharing (copays, coinsurance and deductibles) for diagnosis, testing, vaccinations, experimental treatment, evaluate use of out-of-network provider to provide testing; limit prior authorization requirements for testing; treat an adverse decision on a request for coverage of diagnostic services for COVID-19 as an emergency case for which an expedited grievance procedure is required under Maryland Code. Carriers are asked to: remove cost barriers to testing; encourage telehealth services by all members; consider treatment of COVID-19 an emergency case for purposes of expediting a review of an adverse decision.
Encouraging licensees to utilize remote claim handling technologies to the greatest extent possible; on-site claim handling activities should be in accordance with social distancing protocols published by the CDC and MD DOH; prompt payment of known claim obligations should be top priority.
MASSACHUSETTS
DIVISION OF INSURANCE
The Division expects Carriers to do the following: establish dedicated help lines to respond to Coronavirus calls; promote tele-health options including removal of applicable cost-sharing; relax prior approval requirements and procedures for testing or treatment of Coronavirus; relax out-of-network requirements and procedures when access to urgent testing or treatment is unavailable from in-network providers; forego cost-sharing (copayments, deductibles, or coinsurance) for medically necessary Coronavirus testing, counseling, vaccinations and treatment; review all relevant medical necessity criteria and develop appropriate exceptions in cases where insureds are at significant risk of contracting dangerous viruses such as the Coronavirus.
Group Insurance Commission and Carriers are: required to allow all in-network providers to deliver clinically appropriate, medically necessary covered services to members via telehealth and shall not impose specific requirements of technologies used; ensure payments for telehealth services are not lower than rates for traditional methods and shall notify providers of billing instructions for telehealth services; required to cover without cost-sharing (copays, deductibles or coinsurance) medically necessary treatment via telehealth for COVID-19 at in-network providers; shall not impose prior authorization requirements on medically necessary treatment delivered via telehealth related to COVID-19 at in-network providers.
The Division expects Carriers to communicate prevention, testing and treatment options to covered persons; when delivered via telehealth by in-network providers (modifies Bulletin 2020-02) forego any prior authorization requirements and any cost-sharing (deductibles, coinsurance or copayments) for medically necessary Coronavirus treatment in accordance with DPH and CDC guidelines; permit all in-network providers to deliver clinically appropriate, medically necessary covered health services via telehealth without imposing specific requirements on technologies used [bulletin includes standards for medically necessary care via telehealth contained in All-Provider Bulletin 289]; communicate with in-network providers regarding reimbursement and claims submission for services provided via telehealth; reimburse services delivered via telehealth at least at the rate of reimbursement of in-person methods; Carriers to communicate Division's expectations with self-insured employer plan clients.
Division expects all necessary steps be taken to assist in protecting the public health and that of Massachusetts pharmacy staff and expects Carriers to: work with networks to ensure signature requirements are not in place for in-person prescription receipts, member-pharmacist counseling requirements, etc.; waive signature requirements for in-home prescription deliveries (with exception for federal signature requirements for controlled substances; ensure that there are not impediments to mailing prescriptions to members; allow for early refills for maintenance drugs (other than federally controlled substances); establish prior authorization systems (to be used by Carriers or PBMs) for Chloroquine and Hydroxychloroquine to include: (1.) for prescriptions related to malaria or to rheumatologic or dermatologic conditions, Carriers/PBMs should continue to fill prescriptions under the current prescribed limits, including in some cases 90-day supplies as they currently exist; (2.) for prescriptions related to COVID-19, Carriers/PBMs should limit the quantity of prescriptions for Chloroquine and Hydroxychloroquine at the point-of-sale to a 14-day supply or less in their discretion and any subsequent fills above that initial supply should be made subject to prior plan approval; (3.) Carrier should explain how a provider can contact the plan for fills beyond the initial fill; (4.) once a prescription has received a prior authorization for the amounts beyond the initial fill, the Carrier should follow its normal review for refilling Chloroquine and Hydroxychloroquine; (5.) if the prescriptions are used for non-COVID-19 diagnoses, Carriers/PBMs will collect the applicable cost-sharing amount as set forth in the member's policy and if the FDA declares these medications "approved therapies" for COVID-19, then Carriers/PBMs will collect cost-sharing in accordance with Bulletin 2020-02. Carriers acting as administrators for employment -sponsored non-insured health benefit plans are encouraged to take steps that are consistent with this Bulletin.
Division expects Massachusetts Carriers to make appropriate information available via consumer phone service lines, on their websites and via direct communications regarding COVID-19 to include testing, telehealth, coverage benefits; appeal and grievance processes; etc.
MICHIGAN
DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES
In-person business operations to abide by all applicable conditions in Executive Order 2020-21 (social distancing, etc.) and all claims must continue to be processed and paid in a timely manner; entities and persons regulated by DIFS must continue to comply with all statutory and regulatory deadlines and requirements unless expressly waived or modified by the Director.
Requires coverage of a 30-day up to 60-day early refill of prescription drugs to allow for up to a 90 day supply regardless of whether the pharmacy is mail order or in person.
MINNESOTA
DEPARTMENT OF COMMERCE
Commissioner requests: health carriers eliminate all cost sharing relating to services for COVID-19; health plans limit of eliminate cost sharing for in network providers; health plans to ease prior authorization or pre-certification requirements; requires health plans to verify network adequacy and ensure they are adequate to handle increase utilization; health carriers should allow for out of network care; expansion of telemedicine services and remove any barriers to use telemedicine; coverage of one time early prescription refills; encourages self-insured plans to follow these guidelines.
MISSISSIPPI
INSURANCE DEPARTMENT
Commissioner of Insurance directs insurers to adopt procedures that will encourage policyholders to use telemedicine and suspends certain limitations applicable to telemedicine found in Miss. Code Ann. § 83-9-351.
MISSOURI
DEPARTMENT OF COMMERCE AND INSURANCE
Waives requirement that providers be licensed in the State of Missouri in order to provide care via telehealth.
Provides accommodations for submitting required filings through 5/15/20.
Requires: waive cost sharing related to COVID-19 services; review telehealth programs with participating providers and ensure ability to meet increased demand; review of network adequacy and ensure ability to meet increased demand; allow for out of network providers consistent with in network cost sharing; requires health carriers to be prepared to expedite utilization review and appeal processes; requires coverage of COVID-19 vaccination at no cost sharing for all memebers when applicable; allow for expedited formulary exceptions when necessary; requests health carriers submit information in relation to steps taken to comply with this order to Any Hoyt, Health Insurance Counsel [email protected]
GOVERNOR
Temporarily suspends statutory and regulatory requirements, including requirements relating to telemedicine and pharmacology for telemedicine.
NEBRASKA
DEPARTMENT OF INSURANCE
Nebraska nor CMS will take an enforcement action against an insurer if they amend their catastrophic policies to provide pre-deductible coverage for services associate with the diagnosis and/or treatment of COVID-19.
Health care providers are not required to obtain a patient's signature on a written agreement prior to providing telehealth services; insurance claims for telehealth will not be denied solely based on the of lack of a signed written statement.
NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY, DIVISION OF INSURANCE
Health insurers shall: not impose an out-of-pocket cost COVID-19 testing or for office visits, urgent care center visits or emergency room visits if the purpose is COVID-19 testing; shall cover the costs of COVID-19 immunization as one becomes available; provide coverage for off-formulary prescription drugs if formulary drugs are unavailable.
NEW HAMPSHIRE
INSURANCE COMMISSIONER
Health carriers shall: provide members with access to information medically necessary covered health care services including on websites and nurse help lines; provide the Department at [email protected] any member facing communications carriers develop; provider coverage to testing before the application of any deductible and without cost-sharing, including office visits, urgent care visits and emergency services for the purpose of testing; cover out-of-network provider testing if in-network providers are unavailable; suspend prior authorization requirements for testing; cover testing regardless of site or location if it has all necessary approvals; cover telemedicine visits and make sure telemedicine programs can meet increased demand; ensure sufficient provider networks and provide access to out-of-network providers at in-network cost sharing if in-network providers are unavailable; minimize prior authorization requirements and expedite utilization review and appeals processes; permit insureds to obtain a one-time refill of covered prescription medications before the expiration of the waiting period and permit 90-day supply of maintenance medications, except opioids and certain other classes of drugs may be limited.
NEW JERSEY
DEPARTMENT OF BANKING AND INSURANCE
The Department is advising all carriers to refrain from imposing cost-sharing for any emergency room, office, urgent care visit or lab testing (in-network or out-of-network) when the purpose is to be tested for COVID-19 to expeditiously notify contracted providers. The Department also advises carries to take the following actions: keep consumers informed; ensure network adequacy and access to out-of-network services; provide timely utilization management to include not using preauthorization requirements as a barrier to treatment for COVID-19 and be prepared to expedite UR and appeal processes for services related to COVID-19 when medically appropriate; provide telehealth medical advice and treatment; cover costs if immunization becomes available; expand access to prescription drugs and to provide coverage for prescriptions to treat COVID-19 at a preferred level of cost-sharing; ensure emergency care in hospital facilities at in-network cost-sharing even if hospital is out-of-network or overseas and to not require preauthorization prior to seeking emergency care -- including ambulance service; and reminds carriers of requirements re medical bills for inadvertent out-of-network services.
The Department is requiring carriers to verify telehealth network adequacy; grant requested in-plan exceptions for out-of-network telehealth providers if network telehealth providers are not available; cover without cost-sharing healthcare services or supplies delivered or obtained via telehealth; update policies to include reimbursement for telehealth in any manner including telephone and make this information available on website or by other manners; reimburse providers and establish requirements not more restrictive than those for in-person services; ensure rates of payment for telehealth are not lower than services delivered via traditional (in-person) methods; notify providers of instructions to facilitate billing for telehealth; may not impose any restriction on the reimbursement for telehealth or telemedicine that requires that the provider who is delivering the services be licensed in a particular state, so long as the provider is in compliance with P.L. 2020, c.3 and c.4 and this guidance; not impose prior authorization requirements on medically-necessary treatment delivered via telehealth.
The Department is temporarily requiring external appeals be submitted to the Department by email to [email protected]; providing a temporary, modified External Appeal Application form; suspending the $25 filing fee.
NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
OSI urges all health insurers to at a minimum take the following steps: provide members and providers with information on COVID-19; ensure use of new COVID-19 billing codes; encourage telehealth services; ensure utilization review, prior authorization, care and case management and emergency care policies and procedures are in accord with CDC guidelines and do not present barriers to testing or treatment; ensure one-time refill of prescriptions prior to normal refill period; "take action to...waive patient cost sharing."
All insurers listed to provide every NM insured, participant, member, beneficiary or certificate holder the notice listed in this order. The notice must be mailed or e-mailed to each required recipient no later than 5 pm on March 20, 2020.
Declares presumptively unreasonable and prohibits any cost sharing requirement for the provision of health care services for COVID-19, pneumonia, influenza, or any disease or condition which is the cause of, or the subject of, a public health emergency.
Orders every healthcare insurer to furnish the following information and data: verification of whether it will waive all cost sharing relating to COVID-19 testing and treatment; verification of standards for utilization review, prior authorization, care management, case management and emergency care policies and procedures; copy of notice sent to insurer's members and providers that provides information on COVID-19 (include when, how sent and total number of members/providers on distribution list); copy of referral, consultation or cost-sharing guidelines provided to help-desk or help-line providers; verification of the date billing system will be able to process COVID-19 billing codes; report of number of claims processed related to COVID-19; copies of COVID-19 specific staff training materials. All responsive information and data to be provided through a notarized affidavit by an authorized officer of each health care insurer and provided to the Superintendent no later than the close of business on March 23, 2020 and to continue on a weekly basis at close of business each Friday electronically to: [email protected].
All insurers listed to provide every NM insured, participant, member, or certificate holder the notice listed in this order. The notice must be mailed or e-mailed to each required recipient no later than 6 pm on March 27, 2020; verification of compliance to be provided to the Superintendent by each insurer no later than 6 pm on March 27, 2020 (via email to [email protected]); notice to also be sent to every person authorized to market the policies or plan subject to this Amended Order and to all prospective purchasers.
Directs all insurers to remove barriers to telemedicine services and reminds insurers of current requirements regarding prior authorizations, rates for telemedicine services and mental health parity provisions of state law. LOD to MCOs detailing requirements for telehealth and other services will be posted on HSD and OSI website. OCR announced that it will waive potential penalties for HIPAA violations against providers using everyday communication technologies during the COVID-19 emergency.
Requesting all insurance companies providing insurance coverage in New Mexico to refrain from cancelling or non-renewing policies of businesses and individuals or provide grace payments. Requesting that all insurance agents, brokers and other licensees who accept premium payments on behalf of insurers to make online payments available.
Regarding member notices.
Discusses closure of non-essential businesses including the 100% closure of all call centers situated in New Mexico.
Requesting TPAs encourage, assist, and respond to the state's efforts to meet obligations due to access/responsibility for much of the information required by the Superintendent's office.
NEW YORK
DEPARTMENT OF HEALTH
Updated guidance on telehealth.
DEPARTMENT OF FINANCIAL SERVICES
Insurers must cover telehealth services during the state of emergency with no copayments, coinsurance or annual deductibles for in-network services when such services would have been covered if delivered in-person, including mental health services delivered by telephone.
Issuers shall: keep consumers informed via websites and nurse help lines; waive cost-sharing for COVID-19 testing at in-network provider office visits, urgent care visits, and emergency room visits; provide out-of-network testing at no cost if in-network providers are unable to test; emergency regulations will ensure no cost-sharing for COVID-19 testing; cover telehealth visits and ensure providers are able to meet increased demand; provide access to out-of-network providers at the in-network cost sharing if in-network is unavailable; ensure timely utilization review and expedite utilization review and appeal processes if medically appropriate; cover COVID-19 vaccine, if available, at no cost to all persons for whom it is recommended by the CDC (includes grandfathered plans); provide access to non-formulary prescription drugs through a standard and expedited formulary exception process (standard requests notified by phone within 72 hours) (expedited requests notified by phone within 24 hours) with written notice of adverse benefit determination within 3 business days of receipt of the request; cover inpatient hospital services without pre-authorization and without lifetime and annual limits; cover emergency services without the insured incurring greater out-of-pocket costs for out-of-network services than for in-network; prohibit ambulance services from charging or seeking reimbursement from the insured for any amount except deductible, copayment and coinsurance; cover insureds who receive surprise bills as defined in Financial Services Law § 603(h).
NORTH CAROLINA
DEPARTMENT OF INSURANCE
All health benefit plans, State Health Plan for Teachers and State Employees and any optional plans or programs and other stand-alone prescription medication plans licensed by the department are reminded of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Insurers are requested to identify and remove barriers to testing and treatment for COVID-19 and to take the following immediate measures: review internal processes and operations to ensure that they are prepared to address COVID-19; provide accurate and timely information and make information available on their websites and staff nurse-help lines accordingly; ensure telehealth programs are robust; verify network adequacy and access to out-of-network services; waive prior authorization for COVID-19 diagnostic tests and covered services for insureds if diagnosed with COVID-19 and cover medically necessary tests for COVID-19 at no cost to insured; make expedited formulary exceptions if an insured diagnosed with COVID-19 is suffering from a health condition that may seriously jeopardize the insured's health, life or ability to regain maximum function or if the insured is undergoing a current course of treatment using a non-formulary prescription drug that is intended to lessen symptoms or the duration of the virus and insurers are encouraged to make expedited formulary exceptions if there is a shortage of a formulary drug; provide information on the steps they are taking in response to this advisory at the department's request. Insurers shall file a letter detailing any changes to their policies related to diagnosing or treating COVID-19 and the Department will expedite the review of any COVID-19 changes; insurers cannot raise premiums to provide these additional benefits.
Regarding stay of proof-of-loss requirements and premium and debt deferrals; entities that are subject to North Carolina’s External Review Law, NCGS 58-50 Part 4, shall allow consumers, whose requests may have been impacted by the disaster, additional time for their requests to be received and reviewed. Additionally, for cases that have been accepted and additional information is being submitted, the timeframes for receiving this information will also be extended.
GOVERNOR
Directs NCDHHS and NC DOI to work with health insurance plans to identify burdens for testing for COVID-19 and access to prescription drugs and telehealth services to reduce cost-sharing to zero for all medically necessary screening and testing for COVID-19. Waives statutory requirements under N.C. Gen. Stat. § 108A-54.2 (procedures for changing medical policy).
NORTH DAKOTA
INSURANCE DEPARTMENT
The Department is asking health carriers to take measures relating to the following: review preparedness; communicate with insureds and make information available on websites and staff nurse-help lines; waive cost-sharing (copays, deductibles and coinsurance) for testing, in-network provider office visits, urgent care visits and ER visits when testing for COVID-19 (waiving cost-shares may be done on a retrospective case-by-case basis upon confirmed COVID-19 diagnosis); review telehealth programs for adequacy and comply with N.D.C.C. § 26.1-36-09.15; verify network adequacy and access to out-of-network services at in-network cost-sharing; waive prior authorization requirements associated with COVID-19 testing or treatment; immediately cover immunization at no cost sharing as it becomes available; make expedited formulary exceptions where appropriate; requesting out-of-network providers and facilities accept the highest of carrier's in-network reimbursement as it relates to testing and treatment of COVID-19; required coverage of risks relating to COVID-19 for travel insurance policies.
The Department urges: extension of premium payments and deadlines; extension for cancellations; extension of proof of loss deadlines; waivers of limitations regarding use of out-of-network providers; relaxing time limitations to allow for early prescription renewals; relaxing prescription drug formulary limitations to ensure access due to potential drug shortages or access issues; waiver of fees, penalties or other charges relating to inability to pay premiums; allowing employers to remove/reduce probationary periods for new employees to allow access to health insurance sooner; development of payment plan options for consumers and businesses facing financial hardship.
Consistent with recent guidance issued by CMS, health benefit plans that offer telehealth services must relax guidelines under HIPPA and provides specific codes to be used for telehealth services.
OHIO
DEPARTMENT OF INSURANCE
Issuers of major medical policies must: have help-lines and customer service representatives available to assist consumers with coverage questions related to COVID-19; cover emergency services without preauthorization and at the same cost-sharing level as if in-network; cover out-of-network emergency services without balance billing; properly evaluate the appropriateness of applying utilization management techniques. Issuers are encouraged to adopt telemedicine services under which issuers are prohibited from excluding coverage simply because it is via telemedicine; such services must be covered the same as in-person services. Issuers must: expedite appeal and external review for adverse benefit determinations; provide access to out-of-network providers at in-network cost-sharing level if network is inadequate; provide access to a standard and expedited formulary exceptions process for non-formulary drugs and allow insureds to access prescription drugs beyond the typical supply limit, with exceptions for controlled substances.
Third party administrators, including PBMs, health insurance companies and other entities licensed pursuant to Ohio insurance law must suspend pharmacy audits during the state of emergency.
Insurers must cover emergency services related to testing and treatment for COVID-19 without preauthorization and at the same cost-sharing level as if provided in-network; must provided benefits with respect to an emergency service in an amount at least equal to the greatest of the amount negotiated with in-network providers, the amount calculated using the same method the plan generally uses to determine payments for out-of-network services, or the amount that would be paid under Medicare; must ensure coverage for out-of-network emergency services without balance billing.
OKLAHOMA
INSURANCE DEPARTMENT
Health carriers providing coverage to Oklahoma residents should: review processes to ensure readiness to provide insureds information and timely access to medically necessary covered services; inform insureds of available benefits specifically related to telemedicine, and make information available on websites and nurse help lines; waive cost-sharing for COVID-19 tests, in-network provider visits and urgent care visits related to COVID-19; waive telehealth copayments and reimburse provider for copayment; make exceptions to provide access to out-of-network providers at the in-network cost, if necessary; adhere to utilization review timelines and be prepared to expedite utilization review and appeal processes related to COVID-19; make expedited formulary exceptions where necessary; refrain from cancelling coverage for any person diagnosed with COVID-19 who is unable to return to work or maintain coverage for 90 days and extend the grace period to 60 days for nonpayment of premiums; waive insured signature requirements where pharmacist notes COVID-19 or substantially similar language; and allow a 60 day supply of maintenance drugs.
OREGON
DEPARTMENT OF CONSUMER AND BUSINESS SERVICES; OREGON HEALTH AUTHORITY
Health plans shall: cover telehealth services delivered by in-network providers; examine reimbursement rates for telehealth to ensure adequacy; ensure cost-sharing requirements for telehealth are no greater than in-person rates; promptly communicate telehealth information to members and provider networks; examine provider networks to ensure robust telehealth services are available; ensure use of telehealth for behavioral health services; eliminate barriers to providing medically and clinically appropriate care via telehealth.
PENNSYLVANIA
INSURANCE DEPARTMENT
Health insurers are urged to review processes to ensure preparedness, including providing enrollees with accurate information and access to medically necessary covered service and timely responses to inquiries about coverage. COVID-19 testing should be covered without prior authorization and cost sharing requirements. Insurers are asked to waive cost-sharing for in-network provider office visits, urgent care visits and emergency services related to COVID-19. Enrollees should be assisted with accessing in-network or publicly funded services to avoid balance billing and surprise balance bills; insurers should work to avoid imposing costs on insureds for out-of-network services. Insurers are encouraged to provide coverage of costs related to telehealth services and meet increased demand for same. Provider network adequacy must be verified and if insufficient, out-of-network services must be covered as if in-network. Pre-authorization requirements should be eased and utilization review and appeal processes should be expedited. Expedited formulary exceptions and use of out-of-network pharmacies should be considered; refills should be covered to maintain a 30-day supply even if refill is not scheduled (excludes opioids); medication synchronization should be implemented. Insurers should coordinate with self-funded employers. Insurers should provide information to DOI about steps they are taking in response to this Bulletin.
RHODE ISLAND
HEALTH INSURANCE COMMISSIONER AND MEDICAID PROGRAM
Health insurers shall: update telemedicine policies to include primary and behavioral health providers; require that plan-contracted out of state telemedicine providers follow CDC and RIDOH instructions for services provided to RI residents; ensure COVID-19 testing without prior authorization and cost-sharing; ensure coverage for advance prescription refills and medical supplies for a 30-day supply or 90-day supply for maintenance medications, and cover refills even if prior to the refill date; remove/reduce barriers to services including prior authorization and specialist referrals; provide COVID-19 vaccination if available with no cost-sharing; consider stream-lined access to non-formulary drugs if needed; continually assess provider network adequacy and provide out-of-network provider access at in-network cost sharing if necessary; allow out-of-network emergent care, alternative facilities, telephonic and telemedicine services, out-of-network pharmacies, if necessary; provide timely information to OHIC and Rhode Island Medicaid on steps taken in compliance with these instructions.
Carriers shall: cover telemedicine services if covered under the health benefit plan; permit in-network providers to deliver medically necessary covered services via telemedicine; not create or enforce any telemedicine coverage requirements or limitations based on the site of either the provider or patient; refrain from specifying the types of technologies used to deliver telemedicine services; present clear communication materials to providers about how to submit claims for telemedicine reimbursement.
SOUTH CAROLINA
DEPARTMENT OF INSURANCE
Director of Insurance expects the insurance industry to: extend premium, non-renewal or cancellation deadlines and waive fees, penalties or other charges; extension of proof of loss deadlines; waivers of limitations relating to use of out-of-network providers; relaxing time limitations to allow for early prescription refills; relaxing prescription drug formulary limitations to ensure access to prescription drugs resulting from drug shortage or access; increase access to medical care via telehealth.
SOUTH DAKOTA
DEPARTMENT OF LABOR AND REGULATION
Health carriers must: cover COVID-19 testing, office visits, urgent care and emergency room visits at no cost; waive or expedite preauthorization for treatment and testing, and utilization review and appeal processes; expand telemedicine services and waive cost-sharing for same; allow early refills on maintenance prescriptions without additional authorization requirements; allow access to out-of-network providers at in-network cost sharing; make reasonable accommodation for premium payments before cancellation, including extending grace periods, and refrain from cancelling coverage for anyone diagnosed with COVID-19; and assist in consumer challenges by refraining from balance billing out-of-network insureds and expand acceptance of insurance coverage by joining additional networks.
TENNESSEE
DEPARTMENT OF COMMERCE AND INSURANCE
Requests health carriers providing coverage through health benefit plans to: review internal processes and operations for preparedness and provision of information and timely access for covered services; inform insured of available benefits on websites and nurse help lines, and quickly respond to inquiries; waive cost sharing for COVID-19 testing, provider office visits, in-network urgent care, and emergency room visits; cover telehealth services; make exceptions for out-of-network providers at in-network cost-sharing; expedite utilization review and appeal processes and waive preauthorization requirements; cover COVID-19 immunization if one becomes available without cost-sharing; make expedited formulary exceptions; and provide information to Insurance Department on steps taken in response to this Bulletin and report requests for COVID-19 testing.
TEXAS
DEPARTMENT OF INSURANCE
Request to waive costs associated with testing and telemedicine visits for the diagnosis of COVID-19. Also asks insurers and HMOs to waive co-payments, co-insurance and deductibles for COVID-19 testing; waive penalties, restrictions and claims denials for out-of-network services; waive requirements for pre-authorization, referrals, notification of hospital admission or medical necessity reviews; allow extra time for filing of provider claims; and authorize 90-day prescription refills.
Providers that cannot meet the claim submission deadline under State prompt payment laws must notify the Department of Insurance at [email protected]. Upon return to normal business operations, provider must send TDI a certification of catastrophic event within 10 days which includes a sworn affidavit identifying the specific nature and dates of the event and the length of the interruption. A valid certification tolls the claim submission deadline for the same length of time identified in the certification. Failure to timely submit a valid certification may forfeit right to payment.
Established prior authorization approvals must be extended for 90 days, excluding controlled substances, with payment for an additional one-time 90 day supply of a covered drug. Co-payments, coinsurance or cost sharing for drugs dispensed out-of-network must be billed at in-network rates if no reasonably available in-network pharmacy is available; enrollees may be required to use mail-order or in-network pharmacies if they can timely dispense and are not more than 30 miles one way. Alternative drugs must be made available on-formulary or in the same tier, and without prior authorization, if the preferred drug is unavailable. Signature of enrollee at point of delivery must be waived unless otherwise required by law. Plan may not refuse or reduce payment for a drug on grounds that it was delivered by a local pharmacy but plan is not responsible for delivery fees.
VERMONT
DEPARTMENT OF FINANCIAL REGULATION
Insurers are: encouraged to expand scope of services for delivery through telephone or telemedicine; requested to limit deductibles, co-payments or co-insurance for services provided by telephone to those for in-person consultations; urged to reimburse providers for brief screening calls and remote evaluations of recorded video or images without imposing cost-sharing on members.
Insurers are required to cover at least a 30-day supply of medication available for refill, with the exception of narcotics and specialty medication; a larger supply is encouraged. Insurers are encouraged to offer home delivery services and expand mail-order pharmacy services. Retail pharmacies must be permitted to fill prescriptions at the same manner and level of reimbursement as mail-order pharmacies. Patient signature is waived for COVID-19 prescriptions.
UTAH
INSURANCE DEPARTMENT
Department asks for the following immediate measures: provide access to accurate information through direct communications and on website; remove barriers by waiving cost-sharing (co-pays, deductibles and coinsurance) for testing, in-network provider office, urgent care, telehealth, and ER visits when purpose of such visit is to be tested for COVID-19; review and ensure telehealth provider network is robust; verify provider networks are adequate, including offering access to out-of-network services and to make exceptions to access to out-of-network providers at in-network cost sharing; waive prior authorizations or precertification associated with COVID-19 testing or treatment; allow insureds to obtain one-time refills of prescriptions before a scheduled refill date; out-of-network providers and facilities to accept the highest in-network reimbursement and hold harmless insureds who receive surprise medical bills relating to testing and treatment of COVID-19.
WASHINGTON
OFFICE OF THE INSURANCE COMMISSIONER
Regulated Entities shall: allow in-network providers to use non-HIPAA compliant telehealth and communication platforms to provide patient care under certain circumstances; cover without cost-sharing diagnostic test panels for influenza A & B, norovirus and other coronaviruses, and respiratory syncytial virus (RSV) when billed in conjunction with a COVID-19 related diagnosis code; cover provider visits at various approved sites; with exceptions for qualified health plans purchased by individuals receiving an advanced premium tax credit through the Health Benefit Exchange, allow a grace period of no less than 60 days for payment of premiums.
Health carriers must cover COVID-19 testing for enrollees who meet the CDC criteria for testing as determined by the provider before the application of any deductible and with no cost-sharing. Enrollees shall be allowed to obtain a one-time refill of covered prescriptions before the expiration of the waiting period. All prior authorization requirements for covered diagnostic testing and treatment of COVID-19 must be suspended. If provider network is inadequate, allow enrollees to obtain out of network services at no greater cost than if in-network.
WEST VIRGINIA
OFFICE OF THE INSURANCE COMMISSIONER
Commissioner asks insurer to: provide accurate information and consider revisions to streamline responses and benefits for insureds; make necessary and useful information available on websites and staff nurse-help lines accordingly; waive cost-sharing and reduce or eliminate barriers to testing for COVID-19; waive cost sharing for in-network provider office, urgent care and ER visits; review telehealth programs to meet increased demand; provide access to out-of-network provider at in-network cost-sharing in certain situations; not to use preauthorization requirements as a barrier to access necessary treatment for COVID-19 and be prepared to expedite UR and appeal processes for services related to COVID-19 when medically appropriate: cover future immunization for COVID-19 with no cost-sharing; where appropriate, to make expedited formulary exceptions if the insured is suffering from a health condition that may seriously jeopardize the insured’s health, life, or ability to regain maximum function or if the insured is undergoing a current course of treatment using a non-formulary prescription drug; provide info on steps insurers are taking in response to bulletin to Erin Hunter, [email protected].
Commissioner requests health insurer to immediately review their telehealth services in anticipation of the signing of West Virginia House Bill 4003 re new telehealth requirements.
Insurers shall provide response describing plans of preparedness to manage the risk of disruption to operations and the financial risk arising from COVID-19.
Commissioner requires insurers to: cover additional one-time early refill of necessary prescriptions and 90-day supply refill for maintenance medications without applying a different cost-sharing amount; make formulary exceptions for health conditions that may seriously jeopardize health, life or ability to regain max function or if insured is undergoing a current course of treatment using non-formulary drug; encourage, but not require, the use of mail-order and allow access to mail-order prescriptions from local retail pharmacy. Commissioner urges insurers to allow temporary use of out-of-network pharmacies at the in-network benefit level of coverage in the event of medication shortages.
Provides for new telehealth requirements.
WISCONSIN
OFFICE OF THE COMMISSIONER OF INSURANCE
Health Plan Issuers are asked to waive any cost sharing for COVID-19 lab and radiology tests and for provider, urgent care, hospital and emergency room visits for COVID-19 purposes. Plans should review telehealth policies and ensure programs are robust; they should verify the adequacy of their provider networks, including developing a plan to make exceptions to provide access to out-of-network providers. Plans should expedite prior authorization requests to the extent possible, expedite formulary exceptions, be flexible on prescription supply and refill limits, and cover, without cost-sharing, a vaccine if one becomes available. They must also be prepared to expedite grievance and appeal processes for COVID-19 related services. Insurers are asked to make all necessary and useful information available on their websites and staff nurse help lines and to notify providers, help-line staff and customer service personnel of policies regarding COVID-19.
WYOMING
INSURANCE DEPARTMENT
Health insurers should: waive in-network and out-of-network cost-sharing for testing for respiratory syncytial virus (RSV), influenza, respiratory panel test, and COVID-19 and any associated office, urgent care or emergency room, facility and lab visits; provide access to telehealth services that are able to meet increased demand; provide COVID-19 coverage plan to Department of Insurance ([email protected]) no later than March 18, 2020.
