COVID-19 FAQs and Provider Bulletins

Community Health Plan of Washington Information on COVID-19

 

Provider Bulletin: May 21, 2020  

Dear Provider:

We are providing the latest information for you regarding your work with CHPW around COVID-19. Please share this information with your clinical and administrative staff, as needed. 

We’ll continue to update you as this response evolves. As information is changing rapidly, please defer to the most recent communication.

For Previous Bulletins and a complete list of FAQs, click here.

CHPW is ready to partner with you in any ways we can be of assistance. You are not alone... Please reach out to us if you think of anything.

UPDATED INFORMATION (as of 5/21/2020. Information is subject to change)

The information in this section reflects new or revised information since the last dated bulletin.

Behavioral Health

Is the state still collecting information about behavioral health provider needs regarding telehealth?

Yes. The Behavioral Health Institute has developed a survey for behavioral health providers to determine telehealth support and training needs.  The survey is intended for mental health, substance use, and recovery providers across a variety of organizations and disciplines.  The survey closes this Friday- May 22.  CHPW encourages providers to fill it out.

Are there psychiatric consultation resources available for providers who are treating more complex patients?

Yes, the University of Washington has several resources available to support providers with behavioral health treatment.

  •  The UW Psychiatry Consultation Line (PCL) helps prescribing providers in Washington seeking clinical advice regarding patients (18+) with mental health and/or substance use disorders. The free service is available 8 a.m.-5 p.m., Monday-Friday. Starting July 1, 2020, coverage for this line will be available 24/7.
  • PAL for Moms – Psychiatric consultation for perinatal patients. Call 877-725-4666 (PAL4MOM) Monday-Friday 8 a.m..-5 p.m.
  • PAL (Seattle Children’s) – Psychiatric consultation for children and adolescents for primary care providers (doctors, nurse practitioners and physician assistants). Call 866-599-7257 Monday - Friday, 8 a.m. to 5 p.m.

Behavioral Health Treatment Agencies should have received the “2020 Behavioral Health Provider Survey” from the Health Care Authority.  This survey invitation was sent out by mail and email from the HCA.  CHPW is encouraging providers to complete this survey as it helps to identify statewide needs for behavioral health services.


Where can I find information on support provided to the behavioral health workforce?

Health Management Associates hosted a webinar on May 18th on “Supporting the Behavioral Health Workforce During the COVID-19 Response.” The recording is available for viewing.  


Telemedicine

Are there any resources available for members receiving services via telehealth?

Yes. HCA has developed a Telehealth Tips for Individuals Factsheet. This is one pager describes some tips and tricks to engaging and getting the most out of members' telehealth visits.

My clinic is providing a telehealth option to provide care, but the member I work with doesn’t have access to a telephone or broadband. How are we addressing this gap?

CHPW Medicaid members qualify for the Lifeline program. The FCC has removed barriers to members accessing phones in their program, “Keep Americans Connected.” This initiative ensures that Americans do not lose their broadband or telephone connectivity as a result of these exceptional circumstances.

Additionally, Washington State Department of Commerce has set up approximately 300 drive-in Wi-Fi hotspots across the state.  A map of locations can be found here.

 

PROVIDER RESOURCES

HCA

WASHINGTON DEPT. OF HEALTH

CMS

 

MISCELLANEOUS

 

PREVIOUS PROVIDER BULLETINS

FAQs from May 7, 2020

Medicaid Billing

How do I bill CHPW for services I perform for members who are not in the office, during COVID-19?

There are actually three ways you can bill:

  • Traditional Telehealth Services: Use in-office service codes with modifier 95 or GT, and POS 02 or 12, even though you might not actually qualify for the requirements. In this case you get paid at the CPT code level (or capitated depending on your CHPW contract) as you would if the member were in the office. This counts in your encounter data too.
  • Phone Calls, regardless of who initiates: Use CPT codes 98966-98968, 99421-99423, 99441-99443, 99446, 99451, and HCPCs code G2012, with the CR modifier for Medicaid and CS for Medicare. CHPW increased the rates to be equal to the evaluation and management correlated code.
  • Bill as you would if the member were in the office. No change in billing and the same for reimbursement, but note in the charts where the service was actually performed.

These are for the duration of the COVID-19 crisis. CHPW is following billing guidelines for COVID-19 that are consistent with the HCA and CMS guidelines for Medicaid and Medicare.  These guidelines may change or expand, so please refer to these authorities  for the most current information.

Medicare Billing

On April 30, CMS made additional changes to its telehealth rules.  Below are a few highlights, but please refer to the press release for additional information and changes.  FQHCs, please refer to this MLN Matters bulletin for the latest changes for FQHCs. 

  • Audio-Only: CMS is broadening the list of services that can be conducted by audio-only telephone to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits.  The payments are retroactive to March 1, 2020.  You can see a full list of Telehealth services and which ones can be provided via audio-only technology here
  • Telephone E/M: CMS is adding telephone evaluation and management services to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.  FQHCs can also bill for telephone E/M services (99441-99443), although the MLN bulletin directs that when furnishing services via telehealth that are not FQHC qualifying visits, FQHCs should hold these claims until July 1, 2020, and then bill them with HCPCS code G2025.
  • Additional Telehealth Providers: CMS is expanding the types of clinical practitioners that can furnish Medicare telehealth services, including physical therapists, occupational therapists, and speech language pathologists.
  • CMS Process for Rules: CMS is changing its process during the emergency to add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible. This will speed up the process of adding services.  This means that CMS doesn’t have to go through a formal rulemaking process to expand the list of telehealth services.   

The Center for Connected Health Policy tracks and summarizes policy changes related to telehealth and COVID-19 that can be referenced as well.  They have created fact sheets to easily review these changes on their website.

Behavioral Health

Is the state collecting information about behavioral health provider needs regarding telehealth?

Yes. The Behavioral Health Institute, has developed a survey for behavioral health providers to determine telehealth support and training needs.  The survey is intended for mental health, substance use and recovery providers across a variety of organizations and disciplines.  The survey closes on May 22, 2020.  CHPW encourages providers to fill out this survey.    

Are there resources available to support SUD and Recovery Support Providers with telemedicine?

Yes.  A compilation of resources from SAMHSA, Addiction Technology Transfer Center, Telehealth Resource Centers and other organizations, “Telehealth Learning Series for SUD Tx and Recovery Support Providers” is one resource that may be helpful for providers.

Funding Support

Is there any federal funding being provided to our state?

Yes, the Federal Emergency Management Agency (FEMA) has $720,000 for the State of Washington for qualifying services including non-congregate sheltering, emergency protective measures, and emergency medical care. To find out more information and register for the FEMA funding, visit Washington Emergency Management Division (EMD).
 

Telemedicine

Are there recommended resources around behavioral health and telehealth?

The Behavioral Health Institute has launched a website to coordinate resources across the state for the delivery of behavioral health services via telehealth technology.  Resources include regular trainings as well as resources related to technology, clinical care, billing and legal topics.

Is there guidance available related to Best Practices and resources for Medicaid Telehealth?

Yes.  HCA has revised their Apple Health (Medicaid) telemedicine and telehealth brief to include an overview of policy, guidance, resources and best practices for conducting telehealth services.  
 

Pharmacy

Does CHPW cover continuous glucose monitoring devices for Medicaid members?

Yes. Continuous glucose monitoring devices have traditionally been covered under our medical benefit and under our RX benefit for Medicare. Recently we decided to add continuous glucose monitoring to our pharmacy benefit for Medicaid. The criteria for approval match our medical criteria and is in alignment with the Medicaid Health Technology Assessment guidance. Such devices include Dexcom and FreeStyle Libre.

FAQs from 4/28/2020

Medicaid Billing

Registration is open for the HCA webinar on telehealth billing and policy on Thursday, April 30, at 12 PM.  The webinar will:

  • Provide an overview of telehealth for Apple Health (Medicaid)
  • Discuss billing and policy
  • Discuss tools you can use
  • Answer questions that may be concerning you

Is texting a reimbursable service?

Yes.  Texting activities are covered as a Virtual Visit (G2012) when billed with the CR modifier.  Reference the HCA clinical billing guidelines for additional details.  

Are there additional incentives for delivering telehealth outside of regular business hours?

Yes.  The HCA released add-on billing codes for telehealth services outside of regular business hours.  These can be billed in addition to the evaluation and management codes. Reference the HCA guidelines and COVID-19 fee schedule for rates.

billing chart

Are there billing guidelines for School-Based Health Services? (CORRECTION FROM PREVIOUS BULLETIN)

Yes.  The HCA has developed an FAQ for School-Based Health Services that is updated periodically. 

Children’s Behavioral Health

Are there resources for pediatric providers to support the increased need for behavioral health during COVID-19?

Yes.  The Washington Chapter of the American Academy of Pediatrics (WCAAP) CHPW is hosting a Rapid Behavioral Health Education series for primary care providers who care for children, which CHPW is co-sponsoring.  This training series offers effective behavioral health interventions via telemedicine, tailored to the unique and challenging contexts children and families are experiencing right now. 

Every two weeks from April 30-June 11, participants will watch two 15-minute training videos, at a time convenient to you, on specific clinical content and then join a live facilitated 60-minute discussion sharing what you have learned with other participants, case examples and what help or additional supports you need.  Recordings will be available following the live events and any provider can register here.

Telemedicine

Registration is open for the HCA webinar on Telehealth billing and policy on Thursday, April 30, at 12 PM.  The webinar will:

  • Provide an overview of telehealth for Apple Health (Medicaid)
  • Discuss billing and policy
  • Discuss tools you can use
  • Answer questions that may be concerning you

Our organization has been having success with telehealth. Is there an opportunity to share these stories?

Yes.  The HCA created hcacommunications@hca.wa.gov to send telehealth success stories. CHPW would also like to hear about success stories; please send these to provider.relations@chpw.org.

Is there support to expand broadband to improve access to telehealth?

Yes.  The FCC has released “The Healthcare Connect Fund Program” to support expansion of broadband access.  OCHIN is supporting providers interested in applying for these funds.  

Are there recommended resources around behavioral health and telehealth?

The Behavioral Health Institute has launched a website to coordinate resources across the state for the delivery of behavioral health services via telehealth technology.  Resources include regular trainings as well as resources related to technology, clinical care, billing and legal topics.

Is there additional information about the platforms available to support COVID-19 screening?

Yes.  The HCA has posted a recording for the webinar on the mobile EHR platform that enables patient screening and triage outside of a typical health care setting.  This is compatible with the Epic Systems and leverages OCHIN technology. 

Financial Assistance

Are there programs available for cash assistance for Washingtonians?

Yes.  On April 17, DSHS developed an emergency cash assistance program. This cash assistance is available to Washington residents regardless of citizenship status, and does not require applicants to provide a Social Security number. Eligible households will receive their Disaster Cash Assistance Program benefits for one month in a 12-month period during an emergency. The benefit amount depends on household size, income and need, ranging from a maximum of $363 for a single person to a maximum of $1,121 for a household of eight or more people. 

 

FAQs from 4/20/2020

Medicaid Billing

Are there billing guidelines for School-Based Health Centers?

Yes.  The HCA has developed an FAQ for School-Based Health Centers that is updated periodically. 

Medicare Billing

Is CHPW waiving cost-share for COVID-19 testing?

Yes. During the COVID-19 outbreak, CHPW is waiving Medicare member cost-sharing (copays, deductibles and coinsurance) for covered services for COVID-19 related tests and treatments. This applies regardless of where services take place including, but not limited to, telehealth, primary care physician visits, specialty physician visits, hospital stays, labs, home health, and ambulance services.

Telemedicine & Behavioral Health

Northwest Mental Health Technology Transfer Center and the Behavioral Health Training, Workforce and Policy Innovation Center of the BHI are partnering to present an 8-session telehealth learning series for behavioral health providers across the continuum of behavioral health care in Washington State in response to COVID-19.

The webinar series will meet twice weekly for four weeks and will address a variety of topics related to telehealth, including operational and administrative issues (such as billing), equipment and technology requirements, and strategies to provide effective clinical care.  

Webinars are held on:

  • Wednesdays from 2 - 3pm PT
  • Fridays from 11am - 12pm PT

For more information on the training series - Click Here.

Upcoming sessions:

  • Wednesday, April 22, 2-3pm PT -- Training #1:  Telehealth Nuts & Bolts Kick-Off -- Register here
  • Friday, April 24, 11am-12pm PT -- Training #2:  Telehealth:  Myths and Facts You Need to Know -- Register here

Pharmacy

Are signatures still required to fill prescriptions for Medicaid members?

No.  The HCA is temporarily removing the requirement to obtain a signature from the Medicaid client or the client’s designee upon receipt of pharmacy products dispensed and delivered directly to a client.

Are regular Pharmacy updates occurring?

Yes.  The April Pharmacy Preferred Newsletter can be accessed on the CHPW website.

 

FAQs from 4/13/2020

OIC Fraud Alert

The Office for  Civil Rights (OCR) has shared that an individual posing as an OCR Investigator has contacted HIPAA-covered entities in an attempt to obtain protected health information (PHI). The individual identifies themselves on the telephone as an OCR investigator, but does not provide an OCR complaint transaction number or any other verifiable information relating to an OCR investigation.

Provider organizations can take action to verify that someone is an OCR investigator by asking for the investigator’s email address, which will end in @hhs.gov, and asking for a confirming email from the OCR investigator’s hhs.gov email address.

Suspected incidents of individuals posing as federal law enforcement should be reported to the HHS OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477) or https://oig.hhs.gov/fraud/report-fraud/.

Medicare Billing

Will CHPW be adopting the CS modifier released by CMS for COVID billing?

Yes.  Providers should use the CS modifier for Medicare and continue to use the CR modifier for Medicaid.

Is CHPW waiving cost-share for COVID-19 testing?

Yes.

Telemedicine/Telehealth

Are there any platforms available to support COVID-19 screening?

Yes.  The HCA is promoting a mobile EHR platform enabling patient screening and triage outside of a typical health care setting that’s compatible with Epic Systems and leveraging OCHIN technology.  

Are there opportunities for providers to access equipment to support telemedicine?

Yes.  HCA is loaning laptops to medical providers, behavioral health providers, and recovery-based organizations who do not have access to a laptop (or the resources to obtain one) for the purposes of offering their services through telehealth.

Are there options available for providers and members for low-cost or free WiFi and internet?

Yes.  A number of telecom companies are expanding resources for people at this time.  Check with your local provider and reference some additional options below:

Audits

Is CHPW accommodating providers regarding audits, per CMS guidance released on March 30?

Yes.  CHPW has paused retrieval of medical records for audits, per CMS guidelines.  CHPW is continuing with the HEDIS audit as it is still required by HCA and NCQA at this time; however, we are limiting our requests to providers by retrieving charts electronically where possible in consideration of COVID for this as well as for claims audits.

Behavioral Health

Is there specific guidance for ABA providers and COVID?

Yes. CHPW is following the HCA guidance for ABA Providers.

Are there resources to support behavioral health providers during this time?

Yes. HCA's Division of Behavioral Health and Recovery (DBHR) will host a weekly webinar for providers of mental health, substance use, and problem gambling services. 

The agenda will be developed each Monday based on what we know about COVID-19, and its relationship to prevention, treatment, and recovery support services. Representatives from the Department of Health and SAMHSA will join the call when they can.

Providers will have the opportunity to ask questions and share strategies with one another. For more information and to register, click here.

Maternal & Child Health

Is CHPW providing any additional support for high-risk OB members during COVID?

Yes. CHPW will cover the costs of automatic blood pressure cuffs for high-risk OB members that can be delivered to the member’s home to help support them during this time.  Further, CHPW allows for telemedicine, when appropriate, to care for these members. Members who qualify as high risk include those with elevated blood pressure in pregnancy, pregnancy-induced hypertension, or pre-eclampsia.

To order this equipment, submit an authorization request using the exception to rule request form and include: member demographics, ordering provider information, the code of the item requested (A4670 for automatic BP Cuffs), and the associated diagnosis. Howards Medical Supply should be indicated in the “Service Provided By” section.

Is CHPW providing any additional support for high-risk infants during COVID?

Yes. CHPW will cover the costs of an infant scales for high-risk infants that will be delivered to the member’s home to help support them during this time. Further, CHPW allows for telemedicine when appropriate to care for these members. Members that qualify as high risk include those with poor weight gain, failure to thrive, prematurity.

To order this equipment, submit an authorization request using the exception to rule request form and include: member demographics, ordering provider information, indicate the code of the item requested (E1399 for infant scale), and the associated diagnosis. Howards Medical Supply should be indicated in the “Service Provided By” section.

Where can I find resources for ensuring contraceptive access for patients during the pandemic?

Upstream USA, a national leader in promoting contraceptive access, and a partner of CHPW, has launched a webpage for health centers with the latest information regarding contraceptive care during COVID-19. This includes guidelines on counseling, stocking, and leveraging telehealth for contraceptive care, as well as the following toolkits:

Further, pharmacists have a critical role to play in ensuring continued contraceptive access:

CHPW Member Information

Are there resources for families to support them through this time?

Yes.  Start Talking Now is offering virtual sessions for parents, caregivers, and families.  Events can be found on the Start Talking Now Facebook page and others are listed below.

  • Topic: Supporting your child’s emotional and behavioral needs during COVID-19 (in English)
    Presenter: Carol Good, University of Washington
    Date and time: April 15, 1 p.m.-2 p.m.
    Register here.
  • Topic: Family management and resiliency (in English)
    Presenter: AnaMaria Diaz Martinez, Washington State University Extension
    Date and time: April 16,  4:30 p.m.-5:30 p.m.
    Registration coming soon.
  • Topic: Family management and resiliency (in Spanish)
    Presenter: AnaMaria Diaz Martinez, Washington State University Extension
    Date and time: April 17,  4:30 p.m.-5:30 p.m.
    Registration coming soon.

Are there changes to Medicaid member eligibility during COVID?

There have been changes to the eligibility, as found here: https://www.hca.wa.gov/assets/free-or-low-cost/apple-health-eligibility-covid-19-faq.pdf

FAQs from 3/30/2020

HCA COVID-19 Information

Are there specific contacts at the HCA for provider concerns related to COVID-19?

Yes. In addition to the HCA COVID-19 Information page, HCA has developed 2 email boxes to directly respond to the following concerns:

CHPW Electronic Payment

Does CHPW provide an option for electronic payment if our staff works remotely?

Yes.  With the developing COVID-19 situation in the United States, we strongly encourage you at this time to consider enrolling in ACH electronic payments. This will allow us to issue payments in a timely manner, avoiding delays and disruptions.

We are pleased to continue our business relationship with you in this uncertain time. Please fill out the  Vendor ACH Enrollment form and return to accounts.payable@chpw.org.

Medicaid Billing

Can non-physician providers be reimbursed for telephone calls to patients?

Yes. Non-physicians can bill the existing (pre COVID-19) phone call codes. They range from 98966 to 98968, depending on time. They should consult the CPT guidance for the most appropriate code.  They can also bill their usual codes with the telehealth modifiers and place of service and be paid what they would have been paid if the member was seen in the normal place of service.

Telemedicine/Telehealth

Are there additional resources for my practice to develop a telemedicine program?

The Northwest Regional Telehealth Resource Center (NRTRC) provides technical assistance in developing Telehealth networks and applications to serve rural and underserved communities.  They have also developed a couple resources specifically designed for COVID program development.

Provider Credentialing

Does HCA have a new process to support CHPW’s rapid credentialing process?

Yes.  Providers should send the following information to the HCA at Providerenrollment@HCA.wa.gov:

To back-date providers for changes to their effective dates:

  • The desired effective date
  • their NPI,
  • provider name, and
  • identify this as a priority request due to the COVID-19 situation

To prioritize applications:

  • the NPI of the application submitted
  • provider name,
  • desired effective date and
  • identify this as a priority request due to the COVID-19 situation


Behavioral Health

Is there specific guidance for Behavioral Health providers to track the billing and care delivery changes related to COVID-19?

Yes.  The HCA has released guidance for behavioral health billing guide that will be updated as changes are made.  Providers should bookmark this page and review periodically.


CHPW Member Information

What are the CHPW Member options for pharmacy delivery?

CHPW has temporarily expanded home delivery options for medications for CHPW members. For compete information, click here.

Medicaid:

1. Walgreens Express
2. Walmart's Home Delivery Service
3. Mail order from select CHCs

If a member has been assigned to Healthpoint or Yakima Valley Farm Workers Clinic and get your care there, you can request home delivery of your prescriptions.

Medicare:

1. Express Scripts Pharmacy Delivery
2. CVS
3. Walgreens Express
4. Mail order from select CHCs

If you have been assigned to Healthpoint or Yakima Valley Farm Workers Clinic and get your care there, you can request home delivery of your prescriptions.

Will CHPW be sending preventive care reminders and outreach to members during the emergency?

No. CHPW is temporarily suspending member reminders and outreach for preventive care services.  This includes programs such as Member Birthday Cards, which reminds parents to schedule well-child visits. We will resume preventive care reminders and outreach efforts when primary care providers resume scheduling for preventive services.

FAQs from 3/20/2020

Utilization Management

Has CHPW changed Authorization processes to respond to the COVID emergency?

Yes.  CHPW is working to accommodate providers as much as possible to facilitate care for our members.  The following temporary changes have been put in place effective March 20, 2020.

  • Durable Medical Equipment: CHPW will approve any DME needed for discharge from an inpatient setting. DME that is rental will be approved for 10 days initially. Non-custom items for purchase (such as bath aids) are included, but this does not include custom DME items for purchase (such as a power wheelchair). Notification can be sent after discharge and will be approved. The DME must be a benefit under the Medicaid or Medicare program for which the member is eligible.
  • SNF/LTAC/Inpatient Rehab: CHPW will approve a minimum of 10 days for any SNF/LTAC/Inpatient Rehab stay needed to discharge a member from an acute inpatient setting. Notification can be sent after discharge and will be approved.
  • Hospital Transfers: All hospital lateral transfers can occur without approval of CHPW. As long as the member’s continued inpatient admission is medically necessary, facilities can transfer a CHPW member to another accepting facility. The accepting facility still needs to send notification to CHPW when they are admitted.
  • Home Health and Respiratory Care: CHPW is temporarily removing the requirement for prior authorization for the following services: Home Health, Ventilators, and CPAP/Bi-PAP. Prior authorization is not required for any respiratory supplies at this time. While prior authorization will not be required, it is requested that notification be sent to us as soon as possible that the service is being provided so we can support care coordination for our members requiring these services.
  • Prior Authorization: For all services that require prior authorization, CHPW will temporarily allow retro authorization requests.

Telemedicine

Provider Credentialing

Will CHPW allow providers licensed out of the state to join our practice to deliver covered services?
Yes. CHPW is following the HHS 1135 Waiver and will be reimbursing for all providers operating in the scope of their license.   Please notify CHPW at provider.credentialing@chpw.org if temporary or out of state providers will be joining your practice on a permanent basis.   

Behavioral Health

Care for Immigrants & Refugees

On 3/16/20, the HCA filed an Emergency Rule to expand coverage of the Alien Emergency Medical (AEM) program to include testing and treatment for COVID-19 in any office, mobile, or non-hospital based setting. 

  • AEM covers adults (age 19+) who:
    • have a qualifying emergency medical condition, and
    • would otherwise be eligible for Medicaid but do not meet the citizenship or immigration status requirements for Medicaid, including qualified immigrants who have not met the 5-year bar.   
  • AEM is a state-funded Medicaid program and is excluded from the public benefits considered under the new “Public Charge” rule.
     

FAQs from 3/18/2020

Medicaid Billing

Are there any changes to billing in response to COVID?
Review the HCA’s frequently asked questions about COVID-19 clinical policy and billing. CHPW has modified our systems to accommodate these new billing codes and requirements.

Please note, when billing the telephone and online digital evaluation and management codes, you will need to include modifier CR.

Is G2012 (Virtual Visit) available for Medicaid?
Yes. The referenced HCA guideline clarifies that this is now allowable for Medicaid as well as Medicare Advantage.

Will there be any delays in processing claims?
CHPW has strong work-from-home capabilities, and is not currently experiencing, nor expecting any delays in claims processing. We work to strengthen these capabilities daily to ensure we can handle the increase in claim volume.

Telemedicine

Will telemedicine services be reimbursed during the COVID response?
CHPW will allow telephone and telehealth for any covered service by any qualified provider operating within the scope of their license.

Do I need to use a HIPAA-compliant platform?
No. The HHS Office for Civil Rights (OCR) announced on March 17, 2020, that it will waive potential HIPAA penalties for good faith use of telehealth during the nationwide public health emergency due to COVID-19.  This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.  There is not yet clarity related to services covered by 42 CFR Part 2. We’ll update you when there is additional information is available. 

Provider Credentialing

Is CHPW able to accommodate rapid credentialing of temporary providers?
Yes.  CHPW has an expedited process in place for credentialing temporary providers.  In addition to the agreement with CHPW, providers need a Core Provider Agreement (CPA) with the HCA.  When completing application for a CPA, providers will need to ask for a retro-effective date for the date that the provider started treating Medicaid members to accommodate HCA timelines for processing applications.  Contact provider.credentialing@chpw.org for additional questions and include “Rapid Credentialing Temporary Provider” in the subject line.

Utilization Management

Will CHPW allow a telemedicine visit to meet the requirement for a face-to-face visit for billing of Durable Medical Equipment? 
Yes.  CHPW will accept telemedicine or telephone visits by the provider as a replacement for the face-to-face requirement for a renewal of an already approved DME, such as CPAP.  Reference the CMS Guidelines for additional information.  

Will Prior Authorization (PA) be extended for longer approval dates?  
Yes. All pre-service authorization or inpatient elective procedures that are approved in 2020, will have the date range of the authorization officially extended until at least 12/31/2020.  There is no need to get updated authorization letters or request an extension.

Effective 3/17/2020 we will start authorizing these services with the extended approval date ranges. However, the member can have the service until the end of the year for any existing authorization in place for any date in 2020.

  Below are some important additional notes on this change:   

1)    For any service that has a date range of 12 months (some injectable medications, DME, etc.), those services will continue to be authorized for 12 months.

2)    For Behavioral Health and Medical inpatient acute admissions, there is no change to how those are entered or how the extensions are processed. The date ranges for these services remain the same. In addition, Behavioral Health Partial Hospital Program authorizations will not change.

3)    All other requests (pre-service outpatient authorizations and elective Inpatient procedures), are typically authorized for anywhere from 3-6 months depending on the service. All of these authorizations that originated in 2020 are now approved until 12/31/2020 regardless of the date on the authorization in Jiva.

4)    The unit limits on the authorization still apply. Example: A PT authorization approved for 12 units from 2/1/2020 until 5/1/2020 is now approved for 12 units from 2/1/2020 to 12/31/2020. If the member has been able to receive their 12 units and continue their care, then any additional services would require a new authorization.

Do I need to get a second authorization for in home ABA treatment for a patient currently in Day Treatment to prevent the transmission of COVID?
If you have an authorization for Day Treatment (H2020), you can bill for ABA services (97151-97157) during the time period of the Day Treatment authorization.  A second authorization is not required.

FAQs from 3/13/2020

PROVIDER WEBINARS:

HCA's Division of Behavioral Health and Recovery (DBHR) will host a COVID-19 related weekly webinar for providers of mental health, substance use, and problem gambling services on Tuesdays from 12-1 PM from March 17-April 1. Here is the registration link.

The National Consortium of Telehealth Resource Centers free webinar on Telehealth and COVID-19 on Thursday, March 19 at 11 AM. Here is the registration link.

Will CHPW pay for COVID-19 testing?
Yes, codes have been developed and CHPW is now using them. For CHPW members, we will process these codes based on the published HCA and CMS reimbursement rates.

Health care providers who need to test patients meeting CDC criteria for testing for novel coronavirus using the Centers for Disease Control and Prevention (CDC) 2019

Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for the cost of the test using HCPCS code U0001. CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). 

Will Prior Authorizations be required for Home Health services?
No. CHPW is temporarily removing prior authorization requirements for home health services to support expedited transition coordination for members leaving an acute setting needed in response to increased demand for inpatient services. Home health services can be coordinated and start immediately without prior written approval from CHPW.

TELEMEDICINE

Medicare

Will CHPW cover any other types of virtual/remote patient interactions?
Yes. During the COVID 19 emergency period, CHPW will cover E/M services provided via telephone (CPT 99441 – 99443). Providers billing for these services for CHPW Medicare Advantage members should follow the same rules and process that applies for CHPW Apple Health members. Please note that CHPW is only able to cover these services during the COVID 19 emergency period, based on guidance from CMS. CHPW will notify providers of any changes

Medicaid

What about E&M services delivered via telephone (voice only)?
CPT 99441-99443 are available for telephone visits. Note that these cannot be billed if the patient is seen within 24 hours or next available urgent visit appointment of the phone call. Reference page 47 of the HCA Physician-Services Billing Guide for additional information. We are working to update and validate our systems for how to bill and how we will pay for telemedicine visits and will share that information early next week.

Will telemedicine services for Medicaid for behavioral health be reimbursed?
Yes, telemedicine services delivered with audio/video technology or store and forward (sharing electronic records) are billable for approved Medicaid services. This is currently available for established patients receiving services under the SERI Guide, but behavioral health intakes are currently are not billable as telemedicine services. We are awaiting HCA guidance on this.

The current version of the HCA Physician Billing Guide indicates the rules for telehealth/telemedicine billing, starting on page 85. This includes definitions, allowable locations for clients and required code modifiers.

Will telemedicine services for Medicaid for physical health be reimbursed?
Yes, telemedicine services delivered with audio/video technology or store and forward (sharing electronic records) are billable for approved Medicaid services. The current version of the HCA Physician Billing Guide indicates the rules for telehealth/telemedicine billing, starting on page 85. This includes definitions, allowable locations for clients and required code modifiers. Note that services can be delivered in a patient’s home or any location determined appropriate by the individual receiving service.

Does telemedicine require prior authorization?
Telemedicine alone does not require prior authorization. However, services that do require a prior authorization would continue to do so. Refer to the list of prior authorizations on the CHPW website.

Does CHPW require additional credentialing or privileging for delivering care via telemedicine?
It may, depending on the provider. If your organization is utilizing providers external to your organization to deliver telemedicine services this will require additional credentialing and privileging to be reimbursable. For internal providers to your organization, please reference your internal processes and procedures or contact credentialing@chpw.org.

Will my malpractice insurance cover telemedicine?
Providers should check to make sure that it is included, especially if delivering care in the home is new to the organization.

Do providers need additional training for delivering care via telemedicine?
Training is not required to report to CHPW, but you may develop internal procedures to ensure consistency in delivering care in this modality. You might also consider a formal approval process that requires this training before delivering services to support the billing process, like documentation standards and care delivery expectations. 

Can a physical exam be provided over telemedicine?
Yes, some levels of physical exam can be delivered via telemedicine without special technology including visual exam, temperature taken by patient, blood pressure, blood sugar or other measures that can be provided by the patient in their home. This can be combined with history, assessment and plan to complete a billable visit.

Do I need special documentation for visit delivered by telemedicine?
Yes, since the patient is receiving care remotely and you will be billing for a remote encounter, you need to identify the visit as such. You may do this by using a simple phrase at the end of your documentation that  should include the location of the patient and provider and anyone else present during the encounter. Other documentation of the encounter should be similar to a regular face-to-face encounter.

What technology can be used to deliver telemedicine?
There are many HIPAA-compliant platforms available with the capacity to deliver care with audio/video care technology. Some examples are Zoom for Healthcare, Skype for Business, Clocktree and doxy.me. Providers delivering telemedicine services are still responsible for compliance with applicable Privacy and Security Rules (i.e., HIPAA). 

Are there additional Telemedicine Resources?
The following are reputable organizations in telehealth that have a variety of resources for operational implementation:

Northwest Regional Telehealth Resource Center
Washington State Telehealth Collaborative – contains resources for implementing telehealth