For Providers

Michigan COVID-19 Information

Aetna Better Health of Michigan is adopting temporary changes in its prior authorization protocols for inpatient admissions. This will help health care facilities reduce administrative burdens on the health care system during the national COVID-19 pandemic. Please see the attachments for more information.

Attachment 1

Attachment 2

Prior authorization is not needed for respiration equipment (i.e. ventilators, suction catheters, and oxygen). Quantity limits on these items do not apply

Prior authorization is not needed for medical supplies (i.e. diabetic strips, adult diapers, incontinence supplies, enteral formulas) delivered to members’ homes. Quantity limits on these items do not apply

Certain surgical masks (HCPCS A4928, 20 per unit), hand sanitizer (A9286), and patient gowns (E1399) are covered

The use of telemedicine is recommended to meet Affordable Care Act (ACA) face-to-face requirements

Refer to the Centers for Disease Control (CDC) COVID-19 Personal Protection Equipment guidelines

For more information, please see bulletin MSA 20-14.

Pharmacies are allowed to provide an emergency refill for those not able to visit their doctor (excludes control substances)

Pharmacies may fill prescriptions early (excludes controlled substances)

Pharmacies may dispense prescriptions for up to 90 days

For more information, please see bulletin L 20-20

The following services are covered for members diagnosed with COVID-19:

 

Practitioner visits and services, including home visits and telemedicine services

Clinical diagnostic laboratory tests and diagnostic imaging

Prescribed drugs

Vaccines

Medical supplies and equipment

Inpatient and outpatient hospital services

Long-term services and supports

Other ancillary and medically necessary Medicaid-covered services, as appropriate

For more information, please see bulletin L 20-16.

All codes on the telemedicine database will be allowed for the service delivery method telephonic (audio) only. When reporting these services via telephone the appropriate Current Procedural Terminology Healthcare Common Procedure Coding System (CPT/HCPCS) code (as represented on the current telemedicine databased), Place of Service 02-Telehealth and the GT-interactive modifies must be used. Also, “services provided via telephone” must be included in the remarks section. For Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) please use the GT modified and the remarks section as indicated in this addendum.

 

For more information, please see bulletin MSA 20-13.

You can find information about COVID-19 in Michigan, including testing sites HERE.

 

 

During this time, providers may use telephonic, telemedicine and video technology commonly available on smart phones for program functions that require in-person communication as long as they meet Health Insurance Portability and Accountability Act (HIPAA) compliance standards and the beneficiary or legal representative consents to the method. This does not include personal care services, home health, or other services designed to support Activities of Daily Living. 

For more information, please see bulletin MSA 20-12.

In order to provide the isolation or create capacity to effectively respond to the COVID-19 conditions, nursing facilities may use any or all of the following options:

 

Medicaid residents may be placed in a Medicare-certified bed without submitting a request for Medicaid bed certification. A request would be submitted after the Emergency Order (2020-04, COVID-19) ends, with retroactive effective dates

Nursing facilities with a non-available bed plan may use those beds without prior approval. The non-available bed plan will be negated effective the date of the date any of the non-available beds were used. The provider must notify MDHHS Long Term Care Reimbursement and Rate Setting Section in writing within 30 days of the use of non-available beds. Failure to do so will render the non-available bed plan negated to the original effective date.

Resident rooms that were converted for other purposes can be reconverted to resident use.

A single room can be converted to a semi-private room if it is large enough to allow for proper care procedures.

If a facility determines that the most effective was to control the spread of the virus is to group residents who test positive or isolate residents, the facility may move residents independent of the distinct part requirements.

For more information, please see bulletin MSA 20-16.

MDHHS is relaxing current Medicaid policy to allow the transfer of beneficiaries to lower acuity facilities in an effort to free hospital resources for incoming COVID-19 cases. Hospitals wishing to initiate transfers to another facility must continue to obtain a Prior Authorization Certification Evaluation Review (PACER) through the state’s designated Admissions and Certification Review Contractor (ACRC) and maintain documentation of medical justification for the transfer. Interfacility hospital transfers to lower acuity facilities via ambulance transports will be allowed in an effort to free hospital resources for incoming COVID-19 cases. 

For more information, please see bulletin MSA 20-18.

Click the link for information on COVID-19 

 At Aetna Better Health of Michigan, we see our providers as our allies in providing high-quality health care services to a vulnerable population. We are a Medicare-Medicaid plan for dual-eligible members ages 21 and over. We know our providers strive to deliver the best care possible. For that reason, we hope you’ll take advantage of all the resources we can provide for you.

One-stop shop

Because we manage both Medicare and Medicaid coverage, we’re pleased to offer you the benefits of working with a single point of contact and billing for your Medicare-Medicaid patients. We take care of it all, including medical, dental, vision and mental health benefits. That makes it easy on our members too.

As one of our network providers, you play a most important role in getting the word out about our services. We look forward to helping coordinate care for your Medicare-Medicaid patients. We also provide our members with access to important health care services and programs. We make sure these are convenient for both members and providers.