Summary of Health Plan Waivers and Policies in COVID-19 Era

Center for Managed Care | April 09, 2020 | by Nicole Fallon

LeadingAge has summarized some of the key temporary policies that some of the large national Medicare Advantage plans have adopted during the COVID-19 crisis covering COVID-19 related coverages and waivers, prior authorization waivers, claims processing relief, and telehealth issues.

While CMS has been making changes to Medicare fee-for-services policies such as waiving 3-day stay requirements for SNF stay and extending some SNF stays beyond the 100 days,  managed care plans, such as Medicare Advantage and Special Needs Plans, are not required to adopt these same policies. The result is these new temporary policy changes vary widely and change frequently among these plans.

On March 10, 2020, CMS gave Medicare Advantage plans additional flexibility and also new requirements in light of the declared COVID-19 national emergency. Many, if not most, plans appear to be waiving cost sharing for COVID-19 testing and sometimes the related treatment, and are adopting policies to encourage and expand telehealth services. However, other plans are going further and mirroring some of the Medicare FFS changes including waiving prior authorizations for hospital or SNF admissions.

Some of these changes potentially allow PAC providers to forgo prior authorizations for services or receive reimbursement for services without a 3-day hospital stay. In other cases, these changes mean that providers are to no longer collect co-payments, co-insurance for certain services for which they previously would have billed the plan member. Therefore, it is important to know the policies of the plans with which your organization contracts to ensure you can be reimbursed and are taking advantage of new flexibilities that can help protect the frail older adults your organization serves. It is also important to note that these policies are changing daily.

The America Health Insurance Plans (AHIP) has been compiling the policies, approaches and other activities that their member plans are undertaking related to the COVID-19 crisis.  LeadingAge has pulled together a summary of the temporary policies (as of April 8, 2020) of some of the larger, national plans -- United Health, Aeta/CVS, Humana, Kaiser Permanente, the Blue Cross Blue Shield Association plans and Anthem -- for reference. Within the summary, we have included links to these plans' COVID-19 pages. You are strongly encouraged to go to the provided websites for further details and up-to-date policies. For local and state plans, members may be able to find information on the AHIP site where it has published a more comprehensive list that includes many local plans (listed alphabetically).

Keep in mind, that policies are constantly being reexamined, supplemented and revised. Members are encouraged to regularly consult the provider portals of or directly contact the Medicare Advantage (and Medicaid managed care) plans with which they contract for changes.  In addition, when accepting an enrollee of a non-contracted plan, there may be special circumstances under which you may be able to be paid or accept these admissions during the COVID-19 national emergency that would not otherwise be available. For these individuals, LeadingAge members should contact the plan directly and/or consult its COVID-19 resources web pages for further details.

Additional Resources

Sign up for and engage in our COVID-19 and/or Managed Care Member Communities for updates on this topic and other related issues, and to seek input from your peers on the issues of the day. To get started, visit Community.LeadingAge.org to create or log into your My LeadingAge account.