Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
MassHealth
Managed Care Entity Bulletin 21
March 2020
TO: All Managed Care Entities Participating in MassHealth
FROM: Daniel Tsai, Assistant Secretary for MassHealth [signature of Daniel Tsai]
RE: Coverage and Reimbursement for Services Related to Coronavirus Disease 2019 (COVID-19)
Background
MassHealth's mission is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainably and equitably promote health, well-being, independence and quality of life. In support of that mission, MassHealth provides broad coverage of medically necessary health care services to its members. In light of the state of emergency declared in the Commonwealth due to the 2019 novel Coronavirus (COVID-19) outbreak, MassHealth is introducing additional flexibilities for coverage and billing related to COVID-19, as further described in this bulletin.
This bulletin contains MassHealth's expectations for Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care Plans, Senior Care Organizations (SCOs) and the MassHealth Behavioral Health Vendor (referred to here collectively as "managed care plans") related to communications, payment, coverage, and billing for services related to COVID-19. Additionally, Primary Care Accountable Care Organizations (Primary Care ACOs) are expected to follow the "Communication with Enrollees regarding Coronavirus and COVID-19" guidance set forth below. MassHealth providers serving members enrolled in MassHealth fee-for-service, the Primary Care Clinician Plan, and Primary Care ACOs and should refer to the All Provider Bulletin 288. Program of All-inclusive Care for the Elderly (PACE) organizations should follow the guidance set forth in this bulletin and in All Provider Bulletin 288 when delivering services to MassHealth members.
As set forth in this bulletin, and as further directed by the Massachusetts Executive Office of Health and Human Services (EOHHS), managed care plans must take all necessary steps to enable their enrollees to obtain medically necessary and appropriate testing and treatment that will help fight the spread of this disease.
EOHHS is coordinating with federal and local partners to respond to COVID-19. As this situation evolves, EOHHS may issue additional guidance on this topic as informed and directed by the Massachusetts Department of Public Health (DPH) and the federal Centers for Disease Control and Prevention (CDC).
This bulletin shall remain effective for the duration of the state of emergency declared via Executive Order No. 591. The text of Executive Order No. 591 is available here.
Communication with Enrollees regarding Coronavirus and COVID-19
Managed care plans and Primary Care ACOs must communicate prevention, testing, and treatment options to their enrollees in accordance with guidelines from the Massachusetts DPH and the CDC. Information must include guidelines regarding how and when to contact your local board of health or health care provider. Managed care plans and Primary Care ACOs should provide proposed communications and informational materials to MassHealth for review prior to issuance.
Managed care plans and Primary Care ACOs must also establish call center resources to respond to all calls about COVID-19 and keep members aware of their available benefits, including for screening, testing and treatment, and phone numbers that members can call for additional help.
Utilization Management Related to COVID-19
In alignment with the guidance issued by the Massachusetts Division of Insurance, managed care plans (including those not licensed through DOI) are expected to take the all necessary steps to minimize the barriers to prompt testing and treatment for COVID-19. This includes, but is not limited to:
• Relaxing referral and prior approval requirements and procedures so that members can get timely medically necessary testing or treatment, in accordance with DPH and CDC guidelines, if they are at risk of contracting the Coronavirus; and
• Relaxing out-of-network requirements and procedures when access to urgent testing or treatment, in accordance with DPH and CDC requirements, is unavailable from in-network providers.
Coverage and Payment Policies
Managed care plans must cover testing, treatment, and prevention of COVID-19 in at least the same amount, duration and scope as covered by MassHealth through its fee-for-service program. Coverage must include:
• Diagnostic laboratory services performed by laboratories and health care facilities that have obtained appropriate approval to test individuals for COVID-19;
• Telehealth and certain telephonic services as means by which members may access all clinically appropriate, medically necessary covered services;
• Home visits;
• COVID-19 quarantine in a hospital as administrative or observation days; and
• Drugs, including 90-day supplies and early refills of covered drugs.
In addition, managed care plans must not impose any referral requirements for testing or treatment related to COVID-19.
For specific information regarding MassHealth coverage of COVID-19 testing, treatment, and prevention, including specific coding and payment policies, please refer to All Provider Bulletin 288. Managed care plans should conform their coverage policies to match those set forth in that bulletin, as may be updated from time to time.
Claims Procedures
Managed care plans should add Healthcare Common Procedure Coding System (HCPCS) codes in accordance with CMS as they become available. (https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests).
Additional Information:
For the latest MA-specific information, visit the following link: https://www.mass.gov/resource/information-on-the-outbreak-of-coronavirus-disease-2019-covid-19.
The latest Centers for Disease Control and Prevention (CDC) guidance for health care professionals is available at the following link: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html.
MassHealth Website
This bulletin is available on the MassHealth Provider Bulletins web page.
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Questions
If you have any questions about the information in this bulletin, please contact the MassHealth Customer Service Center at (800) 841-2900, email your inquiry to providersupport@mahealth.net, or fax your inquiry to (617) 988-8974.