COVID-19 Provider Information

COVID-19 UPDATES FOR VIVIDA PROVIDERS

Important Funding Announcement

For all Medicaid and CHIP providers: The U.S. Department of Health and Human Services (HHS) has announced additional distributions from the Provider Relief Fund to eligible providers that participate in the Medicaid and Children’s Health Insurance Programs.

Copayments

During the current state of emergency related to COVID-19, Vivida Health is waiving co-payments for all services.

Early Prescription Refills

Vivida Health has lifted all limits on early prescription refills during the state of emergency for maintenance medications, except for controlled substances. The edits prohibiting early prescription refills will remain lifted for 60 days, in accordance with the Governor’s Executive Order #2020-52. This does not apply to controlled substances.

Telemedicine

This coding information is from the AHCA alert issued on 3/18/2020- Telemedicine Guidance for Medical and Behavioral Health Providers and 3/20/2020- Telemedicine Guidance for Therapy Services and Early Intervention Services.

Practitioners: The Agency covers physician, physician extenders (advanced practice registered nurses and physician assistants), and clinic providers (county health departments, federally qualified health centers, and rural health clinics) through telemedicine. Covered medical services include evaluation, diagnostic, and treatment recommendations for services included on the Agency’s practitioner fee schedule to the extent telemedicine is designated in the American Medical Association’s Current Procedural Terminology (i.e., national coding standards). All service components included in the procedure code must be completed in order to be reimbursed. The Agency reimburses services using telemedicine at the same rate detailed on the practitioner fee schedule. Providers must append the GT modifier to the procedure code in the fee-for-service delivery system.
Link to AHCA fee schedule: https://ahca.myflorida.com/Medicaid/review/Fee_Schedules.shtml

For certain evaluation and management services provided during the state of emergency period, the Agency is expanding telehealth to include store-and-forward and remote patient monitoring modalities rendered by licensed physicians and physician extenders (including those operating within a clinic) functioning within their scope of practice. The Agency will reimburse each service once per day per recipient, as medically necessary.

Updated Telemedicine Services and Codes:

Service Code Modifier Required
Store-and-forward G2010 CR
Telephone Communications-existing patients 99441
99442
99443
CR
CR
CR
Telephone Communications-New Patients 99441CG
99442CG
99443CG
CR
CR
CR

Therapy Services

Florida Medicaid will reimburse for evaluation, diagnostic, and treatment recommendations for services included on the respective therapy services fee schedule to the extent services can be delivered in a manner that is consistent with the standard of care and all service components designated in the American Medical Association’s Current Procedural Terminology and the Florida Medicaid coverage policy is provided. Providers must append the GT modifier to the procedure code in the fee-for-service delivery system.

Early Intervention Services

Florida Medicaid will reimburse for the delivery of early intervention sessions via telemedicine when performed by an eligible EIS provider (as defined in the Medicaid coverage policy) to provide family training designed to support the caregiver in the delivery of care. The provider must guide the caregiver in the implementation of certain components of the recipient’s individualized family support plan to promote carryover of treatment gains. Providers are required to ensure caregivers can perform the tasks. Services are covered, as described below:

Service Procedure Code Modifier Required Limits
Early Intervention Individual Session: Family Training T1027 SC GT Four 15 minute units per day

Provider Telemedicine Requirements (Applies to Therapy and EIS Providers) Providers using telemedicine as a modality to deliver services must comply with the following:

  • Ensure services are medically necessary and performed in accordance with the service specific policy and fee schedule.
  • The recipient (and their legal guardian) must be present for the duration of the service provided using telemedicine.
  • Telemedicine should not be used by a provider if it may result in any reduction to the quality of care or if the service delivered through this modality could adversely impact the recipient.
  • Documentation regarding the use of telemedicine must be included in the progress notes for each encounter with a recipient. All other documentation requirements for the service must be met as described in the coverage policy.
  • Providers must comply with the Health Insurance Portability and Accountability Act (HIPAA) when providing services; all equipment and means of communication transmission must be HIPAA compliant.
  • Providers must assure that the recipient has compatible equipment and the necessary connectivity in order to send and receive uninterrupted video. Telephone or electronic-based contact with a Florida Medicaid recipient without a video component is not permitted.

Additional EIS Provider Telemedicine Requirements Early intervention service providers using telemedicine as a modality to deliver services must also comply with the following:

  • Providers may only utilize telemedicine for existing recipients receiving EIS.
  • Telemedicine services cannot be provided if another EIS provider is in the home on the same date of service.

Prior Authorization

Effective May 5, 2020, Vivida Health waived prior authorization requirements and services limits (frequency, duration, and scope) for all behavioral health services (including targeted case management) until further notice to reduce any barriers to enrollees receiving care.

Consistent with Phase 2 of Governor Ron DeSantis’ Plan for Florida’s Recovery, the following prior authorization requirements for the following Medicaid services that were previously waived in response to COVID-19 will be reinstated : Hospital services (including long-term care hospitals), Nursing facility services, Physician services, Advanced practice registered nursing services, Physician assistant services, Home health services, Ambulance transportation; and Durable medical equipment and supplies. This will be effective for dates of service on or after June 19, 2020, when prior authorization is required for these services. For inpatient hospital services, prior authorization requirements will be reinstated for admissions occurring on or after June 19, 2020. Behavioral Health Exception: Vivida Health will continue to waive prior authorization requirements and services limits (frequency and duration) for behavioral health services covered under the Medicaid program. This includes community behavioral health services, inpatient behavioral health services, and targeted case management services. Vivida Health will continue this flexibility until further notice.

Payment Provisions

Centers for Medicare and Medicaid Services issued a set of blanket waivers that states may utilize in response to COVID-19. The Agency for Health Care Administration has received authority for many of these waivers related to health care facilities and licensure requirements. The Agency is actively working to receive the federal authority needed for many of the items listed in this alert related to the Medicaid program.  The Agency will be issuing subsequent guidance related to additional flexibilities or service enhancements that will be enacted to ensure there is no disruption in care for Medicaid recipients in the event of workforce shortages or limitations in recipients seeking care in provider.

At Vivida Health we are updating policy and procedures to meet the State guidance and to support our providers.  Our website and resources are routinely updated with information available for your review.  The following information will help guide you through revised credentialing, administrative, claims and support services policies.  We are available to assist you regarding these changes by calling us at  1-844-243-5131 available Monday – Friday  8a – 7p EST.   You may also call your provider relations specialist directly or email providerrelations@vividahealth.com with any questions.

Submission instructions for providers

Includes provider enrollment requirements and waiver of non-applicable provider credentialing requirements Provider enrollment and waiver of non-applicable provider credentialing requirements:   To ensure adequacy of providers for treatment of members diagnosed with COVID-19 and under the Agency for Health Care Administration’s directive, Vivida Health will cover medically necessary services provided to recipients diagnosed with COVID-19, regardless of whether the provider is located in-state or out-of-state. To be reimbursed for services rendered to eligible Florida Medicaid recipients, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The provisional provider enrollment form is http://www.mymedicaid-florida.com

Claim Submission Requirements

Claim submission requirements remain largely the same with added diagnosis and laboratory testing codes available for COVID-19 related care as well as modifiers for telemedicine.  Please check this website for updates on additional information as the situation develops.

COVID-19 diagnosis codes

When submitting COVID-19 related claims, follow the appropriate CDC guidance on diagnosis coding for the date of service. The CDC has provided interim coding guidance on which ICD-10 diagnosis codes to report until a new code becomes effective April 1, 2020.

Interim code guidelines

Lab testing

Lab providers should use the newly created HCPCS codes when billing for COVID-19 testing. CMS created the following HCPCS codes for testing performed on or after Feb. 4, 2020:

HCPCS U0001: This code is used for the laboratory test developed by the CDC.
HCPCS U0002: This code is used for the laboratory test developed by entities other than the CDC.

Non-Urgent and Non-Emergent Services including Elective Procedures

In the State of Florida’s ongoing efforts to take necessary and appropriate actions to ensure the 2019 novel coronavirus (COVID-19) remains controlled and that there are essential resources (e.g., personal protective equipment, hospital beds, etc.) for use by health care professionals responding to this emergency, Governor Ron DeSantis issued Executive Order 20-72 on March 21, 2020 related to non-elective medical procedures. The executive order prohibits hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices from providing any medically unnecessary, non-urgent, or non-emergent procedure or surgery which, if delayed, will not place the patient’s health at risk. This includes non-essential elective medical procedures during the state of emergency. As a result, procedures that may have already been prior approved by the managed care plan must be postponed. In order to reduce the administrative burden for providers that already obtained approval for procedures postponed as a result of this executive order, the managed care plan will extend the approval period for affected authorizations for at least six months.

Discharge Planning

Although COVID-19 patients with mild symptoms may be managed in a lower level of care (e.g., home, long-term care facility, etc.), the decision to discharge to another setting must take into consideration the patient or the facility’s ability to adhere to the Centers for Disease Control’s (CDC) infection prevention and control recommendations, as well as the potential risk of secondary transmission to household members or other residents.

CDC – Test-based strategy.

  • Resolution of fever without the use of fever-reducing medications and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens)