Blue Cross & Blue Shield of Rhode Island

Provider conference call regarding COVID-19 pandemic.

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1-888-330-1716

and enter participant code 6540228

When asking questions in the chat, please ensure to drop down your question to everyone.

Blue Cross & Blue Shield of Rhode Island

Provider conference call regarding COVID-19 pandemic.

April 22, 2020

Dr. Matthew CollinsExecutive Vice President and Chief Medical Officer

AGENDA• Reminders Dr. Matthew Collins, Executive Vice President and

Chief Medical Officer

• Referral Requirement Update Dr. Collins

• Authorization Suspension Update Dr. Collins

• RI’s New Hotline for Buprenorphine Induction Dr. Collins

• Managing Mental Health Dr. Collins

• BCBS Association Updates: Clinical Taskforce Dr. Collins

• Claims Pend Update Mary Ellen Moskal, Director of Provider Relations

• Q & A Dr. Collins, Mary Ellen Moskal & Stef Vito, Manager, Provider Relations

COVID-19 Policy RemindersTelemedicine/Telehealth and Telephone Services – Temporary Policy – Effective 3/18/20 (“Policy”)

The Policy is in adherence with following state requirements, supplemented by additional steps taken by BCBSRI to provide its members with access to needed health care services during the pandemic;

State of Rhode Island “Fourth Supplemental Emergency Declaration –Expanding Access to Telemedicine Services”, Executive Order 20-06 issued March 18, 2020 &

State of Rhode Island Office of the Health Insurance Commissioner (OHIC) guidance Bulletin 2020-01 entitled “Emergency Telemedicine Measures to Address and Stop the Spread of COVID-19” issued on March 20, 2020.

The Policy Temporarily allows for;

• All clinically appropriate, medically necessary covered health services

to be provided through telemedicine/telehealth/telephone that are covered in the office

• Reimburses services at 100% of the in office allowable amount

• Waives cost-share (e.g. co-pays and/or deductibles and co-insurance)

Referral Requirement Update

• CMS has temporarily directed all Medicare Advantage plans to waive the referral requirement going back to 03/01/2020 during the COVID-19 crisis.

• This temporary waiver will be in place until further notice from BCBSRI.

• Any Medicare Advantage claims with dates of service of 03/01/2020 and after, where the claim is denying for no referral will be adjusted to pay.

• This does not pertain to Commercial accounts • Exception: The State of Rhode Island is the only group that has waived their referral

requirements for dates of services on or after March 16, 2020.

Authorization Suspension Update

• Effective for dates of service April 17, 2020 and until further notice, BCBSRI will be suspending prior authorization requirements for all products (including New England Health Plan members with a RI PCP) with the exception of Federal Employee Program (FEP) for the following:

• Urgent and emergent inpatient level of care (FEP only if COVID-19 related)• long term acute care• acute inpatient rehabilitation level of care• skilled nursing services

• Other services not listed above still require prior authorization. Please refer to our preauthorization page on bcbsri.com for the full guidance. https://www.bcbsri.com/providers/preauthorization

Rhode Island’s New Hotline for Buprenorphine Induction

• The Rhode Island Department of Health (RIDOH) and the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) are pleased to announce the launching of a new Buprenorphine Hotline for people with moderate to severe opioid use disorder (OUD).

• The Buprenorphine Hotline - 401-606-5456

• Offers 24-hour telehealth service access for patients who are seeking initiation of buprenorphine treatment.

• Hotline telehealth services are for new buprenorphine prescriptions only. Individuals who are currently being prescribed buprenorphine by a healthcare provider should follow up with their current buprenorphine prescriber for ongoing maintenance treatment.

Please refer to RIDOH’s recent Provider Advisories on telehealth and expanding Rhode Island’s buprenorphine prescribing capacity for more information

Managing Mental HealthThe AMA released two great articles this week• 6 ways to address physician stress during COVID-19 pandemic • Managing mental health during COVID-19

Both articles have been added to our COVID-19 page in our provider portal

Pediatric Psychiatry Resource Network (PediPRN)-- This telephonic consultation program encourages pediatric primary care providers (PPCPs) to consult with mental health specialists, thus improving access to and delivery of high-quality pediatric mental health services. The free service is offered to all PPCPs in Rhode Island. Pre-enrollment in PediPRN is encouraged. 401-432-1543https://www.lifespan.org/centers-services/pediatric-psychiatry-resource-network-pediprn

KIDS LINK — Kids Link is a behavioral health triage service and referral network. A program offered in collaboration with Gateway Healthcare, Lifespan, Hasbro Children's Hospital and Bradley Hospital, Kids’ Link RI is available 24 hours a day, seven days a week to help triage children and youth in need of mental health services and refer them to treatment providers. The free, confidential phone line connects parents and caregivers to an experienced clinician that can help them access children’s services in Rhode Island, and determine the best place to go for treatment and counseling. https://www.lifespan.org/centers-services/kids-link-ri 1-855-543-5465

BCBS Association Updates: Clinical TaskforceCOVID-19 Serologic Testing Update Coding

•CPT codes were approved for the serology test at a special meeting at AMA on April 10

https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance

•Effective immediately

•86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

•86769: Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

BCBS Association Updates: Clinical TaskforceCOVID-19 Serologic Testing Update

Regulatory Status: Emergency Use Authorization (EUA)•Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status”•EUA pathway: Single test at this time: CellexqSARS-CoV-2 IgG/IgM Rapid Test https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd•EUA FDA Policy for LDTs: Sect IV-D: Commercial Manufacturer Development and Distribution and Laboratory Development and Use of Serology Tests:• Allows developers of serological tests to begin to market or use tests (without prior FDA review) once

appropriate evaluation for accuracy and reliable are performed• But does not require submission of data to FDA and must use disclaimers in labeling• Approximately 80 test developers have notified the FDA that they have serological tests available/offered for

use: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2?utm_campaign=2020-04-14%20New%20Information%20on%20Diagnostic%20Testing%20for%20SARS-CoV2&utm_medium=email&utm_source=Eloqua#offeringtests

•AMCs and State Public Health Labs may independently create serologic tests

BCBS Association Updates: Clinical TaskforceCOVID-19 Serologic Testing Update

Appropriate Use and Potential Clinical Utility

•To date there have been no consensus statements or formal guidelines issued by Federal entity or professional organizations •Highest valence issue: Potential for use to screen antibody positive/viral PCR negative persons to allow return to work (especially HCPs) and/or local changes in mitigation efforts.•Concerns arising regarding analytic validity (RT-PCR and serology/antibody) of testing.–Anecdotal reporting of false negative rates for both type of testing–Limited publication of completed EUA summaries–Specific focus on serology testing supplied without EUA•FDA clarification for emphasis: (4.7.20) https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-tests?utm_campaign=040720_PR_Coronavirus%20%28COVID-19%29%20Update%3A%20Serological%20Tests&utm_medium=email&utm_source=Eloqua

•FDA interagency voluntary program to address and verify error accuracy. https://www.fda.gov/media/136833/download–Congressional inquiry (4.9.20) to FDA regarding accuracy of COVID-19 testing.

BCBS Association Updates: Clinical Taskforce

Off-Label Prescribing: Anti-Malarials Update• Preprint study reports:

–US /NYU Langone(Chorin): Observational report (N=84) treated with OH-CQ+”Z” found 11% ∆QTc(> 500 ms)–Brazil (Barbo): RCThigh vs low dose CQin high risk patients stopped early due to ∆QTc and increased mortality (4.13.20)–France (Molina): Consecutive series (n=11) using OH-CQ+”Z” did not see evidence of viral load reduction in nasopharyngeal swabs (4.14.20)–France (Gautret): initial paper rejected for final publication

•Public reporting:–Sweden halts prescribing for COVID-19–FAA: "Chloroquine and hydroxychloroquine were both reviewed by the FAA Federal Air Surgeon when they entered the market and have long been considered generally incompatible for those performing safety related aviation duties,"

BCBS Association Updates: Clinical Taskforce

Off-label Drug Use Update

Off-label medication list•ivermectin•lopinavir/ritonavir•mefloquine•darunavir•Actemra•Kevzara

Ivermectin:•Human use:–Oral: intestinal strongyloidiasis and onchocerciasis–Topical: head lice and skin conditions such as rosacea•Veterinary use:–Heartworm treatment

https://www.fda.gov/animal-veterinary/product-safety-information/fda-letter-stakeholders-do-not-use-ivermectin-intended-animals-treatment-covid-19-humans

BCBS Association Updates: Clinical TaskforceCOVID-19 Drug Shortages: Current and Future Concerns

Ventilator Management and ICU Support•Induction and paralytic agents

–etomidate, propofol–cisatracurium, rocuronium

•Sedatives and opiates–dexmedetomidine–fentanyl citrate, morphine citrate–Midazolam

•Cardiopulmonary agents–Albuterol MDI –Norepinephrine, phenlyephrine

COVID-19 Drug Shortages: Current and Future ConcernsSources: FDA Drug Shortage Database, AHFS Drug Information

Claims Pend Update

Claim pends previously put in place for the following policies, have been removed as of Monday, 04/20/20.

1) TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of COVID-19

2) TEMPORARY Encounter for Determination of Need for COVID-19 Diagnostic Testing

We are currently in the process of identifying impacted claims that were processed prior to our policies being configured in our claims system. Once identified, adjustments will be initiated.

Q & AThank you for sending all of your questions prior to the

meeting!

Going forward, calls will be every Wednesday

Next Call:

Wednesday, 04/29 – 8:00am – 9:00am

If you would like to be added to the Provider Relations email blast list, please contact ProviderRelations@bcbsri.org to be added.

Thank you for attending! Stay Safe!