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Health Net Provider Alerts

3/24/20

COVID-19 (Coronavirus)

Questions and Answers for Health Net of California Network Providers

20-334b

Updated 4/1/20 – The following sections were added and/or updated with additional guidance and information:

  • Request For Solutions: $5.9M In Grants For Telehealth Capacity Solutions (Deadline: 12pm PT, April 7, 2020)
Request For Solutions: $5.9M In Grants For Telehealth Capacity Solutions (Deadline: 12pm PT, April 7, 2020)

Health Net is committed to protecting the delivery system for California's most vulnerable populations, especially those who serve the Medi-Cal community. In response to the COVID-19 pandemic, Health Net will provide one-time funding to California safety net clinics, Federally Qualified Health Centers, and independent provider practices to help build telehealth capacity and capability.

Health Net expects to award approximately 47 grants, with a maximum grant amount of $125,000 per award.

Telehealth Capacity

Telehealth funds are offered to assist with virtual visits between patients and providers. Telehealth is a service requirement in response to COVID-19, and we recognize Medi-Cal providers may need assistance to meet this requirement. Funds provided will be directed toward those providers who have limited and/or no telehealth infrastructure, and may also support the build out and/or significant expansion of current telehealth capacity.

Telehealth and Telephonic Infrastructure

  • Hardware, such as laptops, land lines and cell phones
  • Software
  • Licensing and vendor fees for telehealth programs and/or apps

Internet Services

  • Internet connectivity and/or browser set up
  • Monthly service or coverage fees

General Support

  • Training
  • Technical Assistance
  • Unanticipated operational, staffing and/or transitional costs associated with establishing and/or expanding telehealth visits

Telepsychiatry Infrastructure and Services

To increase prevention and intervention efforts for patients with mental health and/or substance use conditions

  • Telepsychiatry capability and capacity to sustain and/or expand access
  • Support training and/or team-based mental health modalities

Eligibility

  • To be eligible for COVID-19: Emergency Response Support, the applicant must be organized as one of the following:
    • Federally Qualified Health Center, Rural Health Center, Indian Health Center, 330 Look Alike Health Center, or community clinic
    • Independent Provider Practice with at least a 30% Medi-Cal patient mix and/or located in a Health Professional Shortage Area
  • Geographic Area: Safety Net Clinics and FQHCs operating in non-County Organized Health System (COHS) are eligible to apply
  • Must be able to document financial distress on current and/or future healthcare delivery operations
  • It is required that an applicant's telehealth solution or vendor have a billing process in place for telehealth, and have the capacity to collect and submit encounter data or claims data. Notwithstanding the Notification of Enforcement Discretion issued by the HHS Office of Civil Rights during the COVID-19 emergency response and telehealth services, it is strongly recommended the telehealth solution or vendor must meet HIPAA and related state privacy rules.

Request Specifications

Application

Please complete the online application found here: http://healthnet.smartsimple.com

Proposal Cover Letter

Please attach a letter on the organization's letterhead that includes, at a minimum:

  • The legal name of the organization
  • The organization's street address as listed in the application
  • Signature and date signed by the chief executive of the organization
  • Brief description of proposed program, including name of telehealth vendor/platform and requested funding amount

IRS Form W-9

Please provide a signed copy. The form for your fiscal agent will suffice if applicable.

Financial Report

Please provide a copy of your organization's most recent financial report, (such as YTD Budget Statement), that demonstrates financial distress for current and/or future healthcare delivery operations due to COVID-19. Please limit the report to five pages or less.

Accounts Payable ACH Form (for electronic deposit)

Payments will be electronically deposited into your organization's designated bank account through ACH. An ACH payment remittance advice will be delivered via the email address specified on the form. The form is to be completed by the requesting organization and must contain the signature of a company authorized individual. A link to download the form is provided in the application.

Key Dates

  • Proposal Release March 31, 2020
  • Proposal Due April 7, 2020, noon PST
Health Net's Business Continuity Plan

What is Health Net doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols. As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations. In particular:

  • Health Net's Provider Network Management (PNM) and Provider Relations personnel remain available to providers, with no current impact in their ability to assist with provider issues.
    • However, on-site meetings are being replaced with telephonic and other forms of support.
  • Our key operational units will continue to provide updates to PNM leadership if and when challenges arise.
  • We have created the following website link, "Health Net Alerts: COVID-19" on provider.healthnet.com to provide regular updates.
Telehealth

Will Health Net allow access to telehealth services to increase access to care? And what is the reimbursement rate?

To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for all services.

During the course of this declaration of emergency for Commercial and Medi-Cal members, Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

During the course of this declaration of emergency for Medicare and MMP/Cal MediConnect members, Health Net's coverage for telehealth services will follow guidance released by CMS which includes telecommunications involving both audio and video technology (with the only exception being for "virtual check-ins," which is defined in the CMS fact sheet available in the online link immediately below).

Medicare Telemedicine Health Care Provider Fact Sheet

  • Health Net will reimburse fee-for-service providers the same contracted rate, whether service is provided in person or through telehealth technology.
  • Services that cannot be appropriately delivered remotely are not eligible for telehealth coverage and reimbursement.
  • Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above.

In addition to telehealth services offered through our network of providers, Health Net is diligently working to offer expanded access to telehealth services through third parties. We will provide updated information on vendor arrangements once available.

Additional details on telehealth billing and coverage requirements for commercial, Medicare and Medi-Cal products will soon be posted to the Health Net Alerts: COVID-19 link on provider.healthnet.com.

COVID-19 Testing and Screening Billing Information

What billing codes should be used to bill for COVID-19 testing?

The following guidance can be used to bill for COVID-19 testing.

Starting April 1st, 2020, providers performing the COVID-19 test can begin billing Health Net for services that occurred after February 4, 2020, using the following newly created HCPCS and CPT codes:

  • HCPCS U0001 – For CDC developed tests only: 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPCS U0002 – For all other commercially available tests: 2019-nCoV Real-Time RT-PCR Diagnostic Panel. (It is not yet clear if the Centers for Medicare & Medicaid Services (CMS) will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.)
  • CPT 87635 - Effective March 13, 2020 (the industry standard for reporting of novel coronavirus tests across the nation's health care system).

All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived across all products.

  • Health Net will absorb the costs for waived copayments for COVID-19 screening and testing to support our network providers.
  • Waivers for cost-sharing responsibility DO NOT apply to members receiving treatment and care resulting from their diagnosis of COVID-19.

In addition to cost-share requirements, authorization requirements will be waived for any claim that is received with these specified codes.

Providers may bill these codes regardless of provider type or contracting status.

What diagnosis codes should be used to bill for services related to COVID-19 screening and testing?

For complete and up-to-date diagnosis coding for COVID-19, visit the NCHS website.

The following diagnosis codes can be used to bill for screening and testing services related to COVID-19.

  • Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases.
  • Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out.

Is there more information available on COVID-19 billing?

For additional information on coding, refer to the following links from the American Medical Association (AMA):

What is the deadline to file claims?

The deadline to file claims for providers impacted by COVID-19 will be extended to 90 calendar days beyond standard filing timelines or the timeline in your Health Net Provider Participation Agreement (PPA). This also applies to Medi-Cal late filing penalties.

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Screening and Testing

Is Health Net requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Participating Physician Groups (PPGs) delegated by Health Net to authorize services related to COVID-19 screening and testing are required to ensure members receive the care they need as quickly as possible by not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Is Health Net waiving cost-share requirements for screening and testing?

Health Net covers screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

Where is COVID-19 testing available?

LabCorp, Quest Diagnostics™ and Bio Reference are currently offering testing for COVID-19. Providers are encouraged to visit the following sites for more information on registration and specimen collection requirements:

  • LabCorp – Physicians who send laboratory testing to LabCorp, will require an active account. Please contact LabCorp at 1-800-859-6046 and speak to a customer service representative to set up account.
  • Quest Diagnostics – website or call 1-866-697-8378. Providers can open an account here.
  • BioReference – Providers do not need to sign up. Tests can be sent through courier or FedEx depending on area. Providers can open an account or contact BioReference via telephone at 1-833-684-0508 or 1-800-229-5227.

Testing can be ordered only by physicians or other authorized health care providers.

  • Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

The Lab Patient Service Centers will not be collecting specimens for COVID-19 testing. DO NOT refer patients to Lab Patient Service Centers. Please contact specific labs for instructions for specimen collection and transport, and to obtain specimen collection supplies.

Providers can also refer members for testing to their county's public health department.

What are the screening and testing guidelines for COVID-19?

Refer to the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/coronavirus/2019-ncov/downloads/priority-testing-patients.pdf for updated guidelines for testing patients suspected of having the COVID-19 infection.

On March 19, 2020, the state of California launched a coronavirus awareness website. This site provides the following testing recommendations:

California is expanding the coronavirus testing capacity daily.

Currently, testing is being prioritized for people who:

  • Have the coronavirus symptoms AND
  • Have one of these risk factors:
    • Have had contact with a person who has tested positive for COVID-19, OR
    • Are health care providers or work with vulnerable populations (such as a long term care facility), OR
    • Traveled to an affected country in the past 14 days, OR
    • Are over age 60, have a compromised immune system or have serious chronic medical conditions
Prescription Information

How do members obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

Coping Assistance for Members

Is coping assistance offered to members impacted by COVID-19?

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Reporting COVID-19 Impacts to Offices and Facilities

What if my office or facility is impacted by COVID-19?

If your office or facility is impacted by COVID-19 and this affects your ability or capacity to provide services and access to members, please contact your provider network regional representative immediately. If you are affiliated with a participating physician group or IPA (PPG), please contact your PPG immediately. Health Net contracted PPGs must notify their Health Net designated network representative of any changes in access to their provider panel.

Websites with Information and Guidance on COVID-19

Where can I obtain the latest information and guidance on COVID-19?

To obtain the latest updates and guidance on assisting patients and when to take action, visit provider.healthnet.com where you will see a link to Health Net Alerts: COVID-19 in the yellow bar. You can also visit the websites below for more information about COVID-19 and the latest guidance from public health officials:

Additional Information, Requirments and Guidance

  • All participating providers must continue to provide health care services and perform delegated functions. However, the CDC, CMS and other health authorities recommend delaying elective inpatient and outpatient surgical and procedural cases. The delay of elective surgeries or other non-urgent procedures during this time is allowed and is recommended by CMS. The referring or treating provider must have determined and noted in the relevant record that when considering COVID-19 implications during this public health emergency period, a longer waiting time will not have a detrimental impact on the health of the member.
  • Telehealth services during this emergency period may be used to determine medical necessity for someone to come into the office, emergency room or urgent care center. Refer to the TELEHEALTH section above for more information.
  • For Commercial and Medi-Cal, where mailing hard-copy notices to members and providers as required by law is delayed due to personnel shortages and/or safety precautions enacted, please contact the member or provider electronically or by telephone. If the provider or PPG, as the case may be, does not have personnel available to mail hard-copy information, it is sufficient to communicate with members and providers electronically and/or by telephone, so long as a log or record of such communications is maintained. (Note: CMS has not yet communicated a similar relaxation of its regulatory requirements for Medicare Advantage.)
  • Health care workers, including those supporting healthcare operations, are considered essential workers and are exempt from the "stay at home," "shelter in place," and "shelter at home" recommendations and orders recently announced.

3/17/20

Provider Update


3/7/20

Health Net Assisting Members in California During State of Emergency

In response to Gov. Gavin Newsom's declared state of emergency, Health Net, LLC wants to help ensure everyone is informed about what they can do to help protect themselves from the coronavirus (COVID-19).


3/5/20

What you need to know about COVID-19 (updated, 3/20/20)

Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. Though the risk of getting COVID-19 in the U.S. is low, learn how you can help keep yourself and others healthy.

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Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.


Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.


No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

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