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:

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:

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

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: Prior authorization requirements are reinstated for dates of services on or after July 15, 2021 and service limits have been reinstated for dates of service on or after July 1, 2021.

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 [email protected] with any questions.

Claim Submission Requirements

Claim submission requirements remain largely the same with added diagnosis, vaccine product, administration codes, and laboratory testing codes which are 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. You may visit https://vividahealth.com/claims-and-billing-2021/ for additional claim submission instructions.

COVID-19 State of Emergency: Vaccine Administration

The managed care plan will reimburse Medicaid-enrolled providers for the administration of the COVID-19 vaccine, for any place of service, and without regard to whether such services are provided by a participating or nonparticipating provider:

• Physicians and physician extenders, including those practicing in a County Health Department, Federally Qualified Health Center, or Rural Health Clinic.
• Pharmacies for COVID-19 vaccine administration rendered by a pharmacist.

Effective March 15, 2021, the plan will cover the vaccine administration at the rates in the following chart.

PHYSICIANS AND PHYSICIAN EXTENDERS: COVID-19 VACCINE ADMINISTRATION CODES AND RATES

Billing Code	NDC	CPT Description	Labeler Name	Physician Rate	Extender Rate
91300	59267100001 59267100002 59267100003	SARSCOV2 VAC 30MCG/0.3ML IM	Pfizer	$                  –	$                 –
0001A		ADM SARSCOV2 30MCG/0.3ML 1ST	Pfizer	$             40.00	$            32.00
0002A		ADM SARSCOV2 30MCG/0.3ML 2ND	Pfizer	$             40.00	$            32.00
91301	80777027310 80777027399	SARSCOV2 VAC 100MCG/0.5ML IM	Moderna	$                  –	$                 –
0011A		ADM SARSCOV2 100MCG/0.5ML 1ST	Moderna	$             40.00	$            32.00
0012A		ADM SARSCOV2 100MCG/0.5ML 2ND	Moderna	$          40.00	$          32.00
91303	59676058005	SARSCOV2 VAC AD26 .5ML IM	Johnson & Johnson (Janssen)	$             –	$            –
0031A		ADM SARSCOV2 VAC AD26 .5ML	Johnson & Johnson (Janssen)	$          40.00	$          32.00

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)