Category: Awareness

Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage

Carenodes Health Enterprise
Office of the Executive

Dear Health Plan Representative,

Please see attached Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage.

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Thank you for your response. ✨

 

 

 

 

Carenodes Health Enterprise 

Office of the Executive 

 

Dear Health Plan Representative, 

 

 

Please see attached Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage.

 

 

 

 

 

 

February 25 , 2021

 

TO:  PAYER PARTNERS

 

 

RE:  DMHC All Plan Letter directing commercial full-service health plans and specialized health plans offering behavioral health services to demonstrate compliance with the amended California Mental Health Parity Act (SB 855, 2020).

 

On Jan. 5, the Department of Managed Health Care (DMHC) issued All Plan Letter (APL) 21-002 to all commercial full-service health plans and specialized health plans offering behavioral health services that are regulated by the department. The guidance is designed to ensure health plans comply with amendments made to Senate Bill (SB) 855 (Wiener, D-San Francisco), the mental health and substance use parity law that took effect on Jan. 1.   

 

SB 855 requires commercial health plans and insurers to provide full coverage for the treatment of all mental health conditions and substance use disorders. It also establishes specific standards for what constitutes medically necessary treatment and criteria for the use of clinical guidelines. The APL outlines filing and compliance requirements of plans, including revised policies and procedures to accommodate new coverage requirements and implementation procedures related to utilization review of covered benefits. 

 

In addition, the 2020-21 state budget approved strategies to strengthen enforcement of behavioral health parity laws, including focused investigations of commercial health plans regulated by DMHC. These investigations, which are expected to begin in the first quarter of 2021, will help DMHC further evaluate health plan compliance with parity and assess whether enrollees have consistent access to medically necessary behavioral health care services. 

 

 

 

 

Sincerely,

 

 

 

 

A Alex Yarijanian

Chief Executive Officer and Founder

 

 

 


Health Care Consumer Assistance

Department of Managed Health Care (DMHC) Help Center
Assistance with problems with health coverage and with health plan grievances and appeals.
www.Healthhelp.ca.gov 

 

California Department of Insurance
Assistance with health insurance problems for non-managed care plans
1-800-927-4357
www.insurance.ca.gov 

 

Health Consumer Alliance
Consumer assistance program to help people with low incomes get the health care they need.
1-888-804-3536
www.healthconsumer.org/

 

HICAP (California Health Insurance Counseling and Advocacy Program)
Information, counseling, and assistance for people who have or will soon have Medicare
1-800-434-0222
www.aging.ca.gov/hicap/

 

Medi–Cal Managed Care Ombudsman
Assistance for people enrolling in or changing Medi-Cal managed care plans
1-888-452-8609
www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx

 

 

 

 

 

3415 S Sepulveda Blvd #1000 | Los Angeles, California 90034 | 310-626-0149 | Hello@carenodes.co

American Healthcare Infrastructure Development Initiative 

 
 

 

Updates to UnitedHealthcare Cost-Share Waivers

To ensure members are able to access the care they need as the COVID-19 pandemic continues, UnitedHealthcare is expanding cost share waivers for our Medicare Advantage and Individual and Group Market health plans for certain services. Here’s a high-level

The following provides healthcare providers and patients with information surrounding cost-share (copays, etc.) and applicable policies as enacted by United Healthcare (UHC).

Not ALL patients covered by UHC are implicated — please read the line of business (Medicare, type of commercial insurance, etc.) before making potentially detrimental changes in your cost-share collections.

PRIMARY CARE PROVIDERS WITH UHC PATIENTS, NEW POLICIES APPLY TO YOU

To ensure members are able to access the care they need as the COVID-19 pandemic continues, UnitedHealthcare is expanding cost-share waivers for our Medicare Advantage and Individual and Group Market health plans for certain services. Here’s a high-level summary of the changes.

New! Medicare Advantage Primary Care
Care Oct. 1, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost share for Medicare

New! Medicare Advantage Primary Care
From Oct. 1, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost share for Medicare Advantage plan members for primary care professional services. This applies to in-network and covered out-of-network COVID-19 and non-COVID-19 visits, whether they are conducted in-office or via telehealth.

Telehealth Originating Site Requirements (no changes since 9/28/20)

Telehealth Originating Site Requirements (no changes since 9/28/20)

The updates to originating site requirements that we announced on Sept. 28, 2020 have not changed.

  • Individual and fully insured Group Market health plans:
    • For Individual and fully insured Group Market health plans, there are changes related to COVID-19 and non-COVID-19 telehealth visits, as well as for in- and out-of-network providers. You’ll also find state-specific rules, regulations and emergency periods on the State Provision Exception page. These may vary from federal regulations. If no state-specific exceptions apply, UnitedHealthcare guidelines will apply.
      • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020.* This means health care professionals can temporarily provide telehealth services by a live interactive audio-video or audio-only communications system for members at home or another location. For more details on telehealth billing guidance and provider type eligibility, visit UHCprovider.com/covid19.
      • COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ends Oct. 22, 2020. As of Oct. 23, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.*
      • Non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ended July 24, 2020. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.

Medicare Advantage:

  • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020. Any originating site requirements that apply under Original Medicare are temporarily waived, so that telehealth services provided through live interactive audio-video can be billed for members at home or another location.
  • COVID-19 and non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access is extended through the national public health emergency period, currently scheduled to end Oct. 22, 2020.*
Medicare Advantage COVID-19 Treatment

Cost share waivers (copay, coinsurance and deductible) for COVID-19 testing and testing-related visits are extended through Dec. 31, 2020 for our Medicare Advantage health plans. This applies to in-network and covered out-of-network COVID-19 treatment.

COVID-19 Treatment

Individual and Group Market health plans:

Cost share waivers (copay, coinsurance and deductible) for in-network COVID-19 treatment are extended through Dec. 31, 2020. Out-of-network cost share waivers will end Oct. 22, 2020. Implementation for self-funded customers may vary.

Medicare Advantage:

Cost share waivers (copay, coinsurance and deductible) for COVID-19 treatment are extended through Dec. 31, 2020. This applies to in-network and covered out-of-network COVID-19 treatment.

COVID-19 and non-COVID-19 out-of-network telehealth visits:
  • Individual and fully insured Group Market health plans: For Individual and fully insured Group Market health plans, there are changes related to COVID-19 and non-COVID-19 telehealth visits, as well as for in- and out-of-network providers. You’ll also find state-specific rules, regulations and emergency periods on the State Provision Exception page. These may vary from federal regulations. If no state-specific exceptions apply, UnitedHealthcare guidelines will apply.
  • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020.* This means health care professionals can temporarily provide telehealth services by a live interactive audio-video or audio-only communications system for members at home or another location. For more details on telehealth billing guidance and provider type eligibility, visit UHCprovider.com/covid19.
  • COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ends Oct. 22, 2020. As of Oct. 23, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.*
  • Non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access for out-of-network providers ended July 24, 2020. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s telehealth reimbursement policy.

Medicare Advantage:

  • COVID-19 and non-COVID-19 in-network telehealth visits: The expansion of telehealth access is extended through Dec. 31, 2020. Any originating site requirements that apply under Original Medicare are temporarily waived, so that telehealth services provided through live interactive audio-video can be billed for members at home or another location.
  • COVID-19 and non-COVID-19 out-of-network telehealth visits: The expansion of telehealth access is extended through the national public health emergency period, currently scheduled to end Oct. 22, 2020.*

Mental Health Awareness: Men Don’t Cry

A livestream discussion to raise awareness of minority mental health. The conversation took a turn for the expected level of viewer engagement.

Mental Health is Health

Dr. Godwin Orkeh and Alex Yarijanian discuss Covid-19 and the discrepancies in access to mental health care among minority groups, including the disenfranchised, uninsured, and underinsured.

Dr. Orkeh also sheds light on the difference between equity vs. equality, the providers’ index of suspicion, health-seeking behavior among men, and the stigma associated with Covid-19.

View the full discussion here.

Dr. Godwin ORKEH JR
Physician, experienced Medical Director, Public Health Officer and Quality Improvement Officer, with interest in International Health and Development. A key interest of his is the interplay of culture, language and its effects (labels), and the political and socio-economic factors that influence health-seeking behavior in the population.

Alex Yarijanian
CEO and founder of Carenodes, Alex is a longtime healthcare administrator, who marked his career by managing 28 safety net clinics across CA and TX, to 14 hospitals, over 50 skilled nursing facilities, to a national health plan. He is presently engaged in an effort to expand access to healthcare services, based on equity, and true to Parity between medical and mental health services.

Orchestrated by Carenodes Networks

Mental Health… Matters?

It’s not just the police. What are we doing to make the world a better place?

It just so happens that July is designated as Minority Mental Health Month in the US.

As a leader in this industry, a ‘minority’ person, and someone who has to grapple with the same stigma our patient populations experience — not being hetero aware of such a designation myself, is telling of the extent to which the topic has been on the back burner (systemically).

As a leader representing a large behavioral health group in CALIFORNIA (Insight Choices), I have a personal and professional duty to do my part in leveling inequities.

As such, we have galvanized a grassroots initiative and presently we have payers, providers, and technology companies engaged.

Our coalition understands that racism undermines mental health. Therefore, we are committed to anti-racism in all that we do. This means that we pledge to work against individual racism, interpersonal racism, and institutional racism in all their forms.

We are concerned that our fellow Americans in majestic parts of this nation which also happen to be rural and are subjected to these inequities.

We are concerned that men are shamed for mental illness. We are concerned that mothers in need of mental healthcare marginalized and judged.

More and more people are starting to speak up about the unique mental health needs of this country’s diverse communities. From health care disparities that have become more apparent during COVID-19 to highlighting the need for culturally competent mental health care providers, these conversations contribute to raising awareness around critical issues.

We are strong alone, but unstoppable together. Would you pls share what activities, initiatives, and other engagement efforts you’ve implemented. If you and or your organization would love to engage but, with limited bandwidth and strained resources, has not had the opportunity to engage, pls let us know.

Reach out using the form below: