Please check this NYS Medicaid billing guidance for COVID-19 testing and specimen collection at pharmacies.

Effective March 6, 2020, in accordance with CMS guidance, use of telehealth services during COVID-19 is permitted.

VNSNY CHOICE Total (HMO D-SNP) will expand eligibility coverage of telehealth services for CHOICE Total members. This applies to covered services including those provided by primary care doctors, specialists, therapists, and mental health professionals.

While the information below provides billing-related guidance, VNSNY CHOICE Total expects Providers to check the CMS and NYSDOH websites frequently for the latest guidance.

Coding Information
CHOICE Total is prepared to accept claims for telehealth services that are consistent with previous announcements when modifiers 95 or GT are appended to CPT or HCPCS codes that ordinarily describe face-to-face services, including but not limited to:

• Professional services related to diagnosis or treatment of COVID-19
• Routine care
•  Therapy
• Mental Health care through our partner Beacon Health

During the current public health emergency, reimbursement for our CHOICE Total members will include services under CMS guidance when provided by our in-network providers using interactive audio and video telecommunications system that permits real-time interactive communication; alternative technologies commonly available on smartphones, tablets, and/or other devices as listed below:

• Telehealth Services (Both synchronous audio and visual required)
• Online Patient Portal Communication (Patient-initiated virtual check-ins)

For Telehealth services rendered, the provider should bill as follows:

• Use CMS designated place of service (POS) ‘02’.
• Use CMS designated CPT telehealth modifier ‘95’ with any place of service, or ‘GT’ to the appropriate embed link to these procedure codes. NOTE: This list of services is furnished by the current CMS guidelines and subject to updates and changes by CMS.
• Follow current coding guidelines set forth by the American Medical Assistance, Current Procedural Terminology Professional Edition and associated publications and services.

Important links for Medicare Providers:

• CMS Fact Sheet on Medicare Telemedicine
• CMS Frequently Asked Questions on Telehealth
•  Waiver or Modification of Requirements Under Section 1135 of the SSA
•  CMS Provider-Specific Telehealth Fact Sheet NYS DOH Guidance for Medicaid Telehealth
•  CHOICE eblast on Medicaid Telehealth during the COVID-19 Emergency, sent 3/27
• NYS DOH Medicaid Guidance for Providers
• See Medicaid Telehealth FAQs

Behavioral Health
During this national public health emergency, our partner Beacon Health is issuing new policies to serve our members and ensure access to care.

Please visit www.beaconhealthoptions.com/coronavirus for the latest updates.

For questions related to coverage and billing at VNSNY CHOICE Health Plans, please call your dedicated Provider Relations representative.

Or call VNSNY CHOICE Provider Services toll free: 1-866-783-0222. TTY for the hearing impaired: 711.

Effective March 1, 2020, in accordance with published New York State Department of Health (NYS DOH) Medicaid Guidance, all VNSNY CHOICE Health Plans—CHOICE MLTC, CHOICE Total (HMO D-SNP), and SelectHealth—will expand eligibility for coverage of telehealth services to all members.

In line with this guidance, CHOICE will reimburse providers for telephonic assessment, monitoring, and evaluation and management services provided to members where face-to-face visits may not be recommended and it is appropriate for the member to be evaluated and managed by telephone.

Telehealth is the use of electronic information and communication technologies (computer, smartphone or tablet) to deliver health care to patients at a distance.

For purposes of the State of Emergency, this definition is expanded to include telephone conversations.

Medicaid covered services provided via telehealth include:

•  assessment
•  diagnosis
•  consultation
•  treatment
•  education
• care management and/or self-management

This applies to all contracted providers serving members under VNSNY CHOICE Health Plans. All telephonic encounters documented as appropriate by the provider would be considered medically necessary for payment purposes.

All other requirements in delivery of these services otherwise apply.

For more information about how to bill or code for telehealth services, please see this telephonic reimbursement overview from the DOH.

Behavioral Health
During this national public health emergency, our partner Beacon Health is issuing new policies to serve our members and ensure access to care.

Please visit www.beaconhealthoptions.com/coronavirus for the latest updates.

Access to Telehealth Equipment and Digital Services
If you have patients who are VNSNY CHOICE Health Plan Members who need WiFi, data coverage and/or a cell phone, please see the DOH’s Medicaid Guidance on Telehealth from March 23.

Please check the following resources with guidance for New York Medicaid providers.

• The New York State Department of Health (DOH) posts guidance and resources here.
•  DOH also has a Coronavirus Provider Information Page.
•  The 2020 DOH Medicaid Updates, including COVID-19 special editions, are posted here.
• DOH has published the following contact information for Providers:
  • Questions about COVID-19 can be directed to ipc@health.ny.gov or the toll-free call center at 888-364-3065.
  • Questions about guidance relating to COVID-19 may be sent to OMCMail@health.ny.gov.
• You can find Medicaid guidance from CMS on their Medicaid.gov Disaster Page.

Please check the following resources with guidance for Medicare providers.

• CMS posts COVID-19 guidance on its Current Emergencies page.
• You can also find information in the CMS newsroom.

During this national public health emergency, Beacon is issuing new policies to serve our members and ensure access to care.

Please visit https://www.beaconhealthoptions.com/coronavirus for the latest updates.

As you are most likely aware, in late 2019, a new coronavirus was identified as the cause of an outbreak of acute respiratory illness (COVID-19) in Wuhan, China. Since then, an increasing number of COVID-19 cases have been reported in other countries, including the United States, and now in New York State. The purpose of this guidance is to instruct providers to develop and implement strategies for COVID-19 preparedness that ensures timely member access to all relevant information and needed health care services.

Additional guidance will be forthcoming as testing capabilities are expanded and other information becomes available. An emergency declaration may require changes to this guidance. At this time, providers’ COVID-19 preparedness strategies should include, at a minimum, the following components:

An emergency preparedness plan:
Review and update your internal emergency preparedness plan to ensure infrastructure stability and business continuity so that members’ care is uninterrupted in the event of the further spread of COVID-19 in New York. 

Proper Aide and Member guidance and education:
Home Health agencies must implement processes to provide information and resources to Aides on how to protect themselves and minimize transmission of the virus and help members understand how and when to access services for COVID-19 care. Any member-related questions should be addressed with their VNSNY CHOICE Care Manager.
If an emergency is declared, this information could change or be added to. We will keep you informed as we learn more. Thank you for your attention and action on this important matter.

The Department of Health provides public health information and guidance, here:
https://www.health.ny.gov/diseases/communicable/coronavirus, and has implemented a Novel Coronavirus Hotline at 1-888-364-3065.

The Centers for Disease Control’s website offers up to date information at: https://www.cdc.gov/coronavirus/2019-ncov/index.html. 

If you have any questions, please contact omcmail@health.ny.gov.

The following guidance is effective until the official Declared Disaster Emergency in the State of New York over COVID-19 has ended. Where practicable, practitioners and pharmacists should use these procedures for individuals in quarantine or those who have been identified by the CDC as being at a higher risk for developing serious illness from COVID-19.

90 Day Supplies & Medication Delivery
VNSNY CHOICE Total and SelectHealth will cover up to a 90-day supply for most prescription maintenance medications with a valid 90-day supply prescription. Pharmacists will be required to enter appropriate override codes and to document the Declared Disaster Emergency in the State of New York within the pharmacy’s processing system. Pharmacies that choose to provide delivery to individuals quarantined may confirm receipt of the medications by the member through a phone call, text or email, in lieu of getting a signature.

Transfers
If a CHOICE member has had a prescription filled from a pharmacy that is inaccessible or if traveling to that pharmacy is not feasible, the member can obtain a new prescription/fiscal order from the prescriber or a refill of the prescription can be transferred to another in-network pharmacy (where allowed by law).

Early Refills
CHOICE will allow early refills for members in need of medications due to quarantine or outbreak at the provider’s discretion. Please contact the member’s pharmacy. The pharmacy will be required to enter appropriate override codes and to document the Declared Disaster Emergency in the State of New York within the pharmacy’s processing system.

Quantity Supply, Prior Authorization, and Step Therapy
CHOICE will allow overrides for quantity limits, prior authorizations and step therapy edits at the provider’s discretion. Pharmacists will be required to enter appropriate override codes and to document the Declared Disaster Emergency in the State of New York within the pharmacy’s processing system.