March 26, 2020
Third federal stimulus bill. House Resolution 748, the Coronavirus Aid, Relief, and Economic Security Act, passed the US Senate unanimously today and awaits action in the the House of Representatives tomorrow. The 880-page bill contains $2 trillion of various relief measures, including a $100 billion pot of money to help cover health care providers' costs of responding to COVID-19. There are a number of other relevant provisions in the legislation. We will provide more detail after it is finalized.
Latest COVID-19 material for ID/DD services and supports providers. The Department of Developmental Disabilities (DODD) released a number of guidance documents this evening including additional guidance on service authorizations for waiver services, behavior supports and rights restrictions, and non-medical transportation services. DODD also published information about Medicaid telehealth rule changes. On the last topic, former DODD Director John Martin contacted OHCA and asked us to inform members about StationMD, a company that specializes in telehealth emergency services for people with developmental disabilities. Please see their website if you are interested in learning more.
In addition, DODD released guidance on Bureau of Criminal Identification and Investigation and Federal Bureau of Investigation criminal record checks that allows a provider to employ an applicant as long as the background check is initiated within 10 calendar days. Currently, it is difficult to find a location that is open to perform fingerprinting. The Attorney General’s Office suggests calling ahead before traveling to a WebCheck location. If one is unavailable, the DODD guidance includes instructions for self-fingerprinting.
Palmetto extends RAP deadline. Palmetto GBA announced that per Centers of Medicare and Medicaid Services authorization, they extended the auto-cancel timeframe for Requests for Anticipated Payment (RAPs) by 90 days from the paid date of the RAP, retroactive to March 1, 2020. Please review this information and share it with your staff.
ODH guidance documents. The Department of Health (ODH) released on the Enhanced Information Dissemination and Collection system a large set of guidance documents that synthesize ODH orders and Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention guidelines. These materials also are available on the OHCA COVID-19 web page.
Revised hospital transfer document includes AL. AHCA revised its guidelines on accepting hospital transfers during the COVID-19 pandemic to include assisted living communities as well as SNFs. These guidelines are not officially sanctioned in Ohio - none on this topic are - but are good advice for members.
Medical directors: OMDA is here to help. OHCA participated on a call with several key members of the Ohio Medical Directors Association (OMDA). In addition to discussing key issues such as admissions from the hospital, the OMDA members asked us to let our members know that if their medical directors feel disconnected from relevant information about COVID-19, they can consult the OMDA website and are welcome to participate on the weekly calls.
Managed care companies waive prior authorization. From March 25 to April 24, 2020, Aetna Medicare and Aetna Commercial waived initial prior authorization requirements for SNF admissions. The SNF still needs to notify Aetna of admission within 24 hours and to send medical records for concurrent review within three days of initial admission. Medical records can be uploaded directly to Availity or Navinet or sent via fax to 833-596-0339.
Effective March 16, Anthem removed prior authorization requirements for SNFs for the next 90 days to assist hospitals in managing possible capacity issues. SNFs should continue to notify Anthem of admissions to verify eligibility and benefits for all members before rendering services and to assist with ensuring timely payments. This waiver applies to members of all lines of business, as well as self-insured plan members.
Effective March 17, 2020, Paramount allowed for immediate, 3-day presumptive admissions from a hospital to a SNF as long as new presumptive admission criteria are met. Paramount uses the Presumptive Admission Diagnosis List and/or the Therapy Evaluation Skilled Nursing Pre-certification form to assess each patient. If you use the Therapy Evaluation Skilled Nursing Pre-certification form, please reference the Skilled Nursing Presumptive Admission workflow.
Cigna also allows direct SNF or SNF/acute rehab transfer without authorization. Concurrent review will begin the next business day with no retroactive denials. SNFs must notify Cigna of the admission, and level of care and medical necessity reviews still apply. Cigna's COVID-19 Interim Billing Guidance for Providers is posted to the CignaforHCP.com homepage.