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COVID-19 State and Private Payer Policies
Last updated 4/9/2021
Many payers, both public and private, have adjusted many rules related to payment, prior authorization, cost sharing, and enrollment. This CMS Summary provides information about all the flexibilities during the COVID-19 public health emergency.
CDC is encouraging communities, including 1st responders, healthcare “providers,” and health systems to offer telehealth. The federal government is requesting private payers to cover telehealth for COVID-19 as a way to minimize the spread of the virus in the community and clinical settings. Please note that changes in payer policies are changing from day to day, so be sure and check the policies of your practice’s most common payers.
State-by-state Policy Changes Due to COVID-19 Public Health Emergency
Many states have issued their own public health emergencies, resulting in changes to Medicaid, private payer, and licensure for telehealth.
- The Center for Connected Health Policy (CCHP) has two toolkits that track COVID-19 Telehealth Coverage Policies and COVID-19 Related State Actions, which include Medicaid clarification, waivers, and telehealth guidance, prescription and consent waivers, private payer requirements, and cross-state licensing.
- The Alliance for Connected Care also has created an easy to read chart showing state changes to licensure, coverage, and other changes.
In addition to those payers listed in the above CCHP resource, we provide links to supplemental information as we become aware of them:
- For a full listing of all blanket waivers and flexibilities related to provider enrollment, telehealth, 1135 waivers, and other changes resulting from the COVID-19 public health emergency, go here.
- CMS has issued revised guidance regarding additional flexibilities specific to FQHCs and RHCs (revised April 30).
- Physician assistants, nurse practitioners, and clinical nurse specialists can now certify the need for home health services and order services. These changes are permanent, and retroactive to March 1, 2020.
- Private Payers: See this chart summarizing recent policy announcements by some of the major insurance companies regarding testing, cost sharing, prescriptions, and provider enrollment. (Revised 4/9/2021)
- America’s Health Insurance Plans (AHIP) has put together a list of COVID-19 related announcements from individual health plans.
- California – The state of California has directed all health plans to reimburse providers at the same rate, whether a service is provided in-person or through telehealth, including video and telephone, and with the same level of cost-sharing as if provided in-person. They have also created a special enrollment period for Californians who wish to enroll in the California Health Benefits Exchange, Covered California.