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Below you will find important news and updates about COVID-19. Below the newsroom, you will find FAQs. For the most up to date MDHHS letters, policies and bulletins, click here.
HAP is here, for businesses during this unprecedented and uncertain time. Our COVID-19 business resource page offers information about recent legislation, available resources and answers to questions about your HAP plan.
HAP is waiving member cost-sharing for treatment of COVID-19, which includes deductibles, copays and co-insurance associated with treatment for the virus.
This cost-sharing waiver is for inpatient or outpatient treatment from an in-network provider. This waiver has been extended and is for services rendered through December 31, 2020.
This waiver applies to all fully insured large and small employer groups, Medicare Advantage, Medigap, individual, Medicaid and MI Health Link members.
Self-insured employer group customers control their own health benefits and HAP is working with these customers to determine how they will cover treatment costs. We will advise employees of self-funded employer groups to confirm cost-sharing when seeking services.
Telehealth is defined as real time audio/visual visit. Virtual visit is defined as a phone visit. with provider. CMS guidelines have changed due to COVID-19; therefore, if a provider can do any kind of HIPAA compliant video or audio call such as FaceTime or Skype, that is considered a telehealth visit.
We are waiving cost-sharing for telehealth services through the end of the year. All cost-sharing is waived for HAP’s individual, fully-insured employer group, Medicare, Medicaid and MI Health Link members using telehealth services through December 31, 2020, even if the service is not related to COVID-19.
Self-insured employer group customers control their own health benefits, and HAP is working with its self-insured customers to determine how they will cover telehealth services.
Yes, wellness visits (G0438 and G0439) are covered when provided via telehealth. Please refer to our Benefit Administration Manual for the Telemedicine, Telehealth & Virtual Care Services policy. The policy also contains links to CMS resources for codes.
Preventive visits (99381-9939) are not covered via telehealth, consistent with CMS guidelines. These service codes include expectations or aspects of care that are not feasible by audio/visual telemedicine technology (listening to breath sounds, heart sounds, palpitation of the abdomen, etc.). We’re reevaluating if this could be covered in the future.
Yes. Please refer to our Benefit Administration Manual for the Telemedicine, Telehealth & Virtual Care Services policy for more information. Applies to all Medicare Advantage, HAP/AHL Commercial and Individual product members. HAP Empowered Medicaid members continue to follow MDHHS directives.
Yes. Please refer to our Benefit Administration Manual for the Autism Spectrum Disorders, Evaluation and Treatment policy for coverage criteria.
HAP will not require hospitals to submit prior authorization for admissions to skilled nursing facilities. Instead, skilled nursing facilities can communicate directly with hospitals and accept HAP members. SNFs need to submit the clinical information below within three business days of the admission date.
Yes. We’ve extended effective dates of existing and new pre-service authorizations to 365 days; 180 days now for high-tech imaging, sleep studies and ZOLL LifeVests.
Yes. We’ve removed authorizations for out of plan/out of network services for all Medicare, MMP and DSNP. No PCP referrals required for HAP Primary Choice Medicare (HMO) and HAP Choice Medicare (HMO) plans.
Yes. Referrals are not required for HAP Primary Choice Medicare (HMO) plans, HAP Choice Medicare (HMO) plans, tiered network plans. This is effective March 10 through end of State declared emergency.
Yes. We cover all medically necessary covered Medicare Advantage plan benefits provided at non-contracted providers. The provider must participate with original Medicare. This is effective March 10 through end of State declared emergency
HAP is waiving appeals timelines during the emergency timeframe.
We pay claims quickly and have experienced no operational barriers to our work. Additionally, we’re providing cash flow relief by expediting our 2019 Best Practice payments. We’re evaluating other opportunities for financial relief.
Monthly premium changes for individual members and small group customers
HAP will decrease monthly premiums by 5 percent through the end of the year. These decreases will be reflected in monthly premium bills beginning July 1 and will be in effect through December 2020.
Copay changes for Medicare Advantage members
HAP will waive copays and co-insurance for all in-person primary care visits and behavioral health visits through the end of the year. In addition, HAP will waive all member cost-sharing for telehealth visits for its Medicare Advantage members through the end of the year. This means that HAP Medicare Advantage members will not be charged any copays, deductibles or co-insurance for telehealth visits made through December 31, 2020, even if it is unrelated to COVID-19.
HAP will follow the Centers for Medicare and Medicaid Services and restrict sequestration temporarily beginning May 1, 2020. Per CMS, section 3709 of the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), temporarily suspends sequestration of Medicare programs between May 1, 2020 and December 31, 2020, which we will refer to as the “sequestration suspension period.”
HAP is offering free in-home medication delivery service to ensure our members have adequate drug supply on hand. The delivery cost is free for members to get medications sent to their homes through Pharmacy Advantage. HAP members can request all their drugs from Pharmacy Advantage. This service is available for all of our HAP members - Medicare, Medicaid, Dual Medicare/Medicaid, and Commercial population.
HAP will reimburse members for prescriptions obtained from out of network pharmacies when the member cannot reasonably obtain medications from in network pharmacies
HAP will follow the MDHHS and CMS guidance below.
DME suppliers can use provider’s documentation of COVID-19 rationale for O2 equipment with a qualifying oxygen sat. DME script can be written for up to 60 days if medically necessary from date of discharge. Discretion of provider to determine allowable timeframe. After prescription expires, the patient will require a reevaluation.
COVID-19 diagnosis with a qualifying oxygen sat. qualifies for up to first 60 days or length of script and then patient needs to be re-evaluated. DME supplier should check at 30 days to assess if patient requires oxygen beyond the initial 30 days or when patient no longer needs oxygen any longer. Use new diagnosis code U07.1, COVID-19, effective from April 1, 2020. Use CDC codes for COVID-19 conditions before the new COVID-19 code is available.
HAP will follow CMS billing rules for refills which allows to process well in advance. This will minimize unintended consequence of DME shortages due to stockpiling. DME can be delivered as early as 10 calendar days earlier than refill date which HAP follows for Medicare, Medicaid and Commercial.
HAP will follow CMS and MDHHS guidelines for member cost share which at this time does not include the scope of DME and supplies. HAP will continue to assess the environment for additional changes.
HAP will follow MDHHS and CMS guidance below.
Bulletin MSA 20-14: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Providers, Hospitals, Physicians, Pharmacies, Medicaid Health Plans (MHPs), Integrated Care Organizations (ICOs)
Start Date: March 26, 2020
End Date: 30 days following the termination of the Governor’s Declaration of a State Emergency Order (2020-04, COVID-19) or the first of the following month, whichever is later
Applies to: MMP, Medicaid, HMP, CSHCS
Excludes: Commercial and Medicare
Here are the guidelines from the MDHHS:
COVID-19 Emergency Declaration Health Care Provider Fact Sheet (3/13/2020)
Start date: March 13, 2020
End date: Continue up to the termination of the Governor’s Declaration of a State Emergency Order
Applies to: Medicare, MMP, DSNP, Commercial
Excludes: Medicaid, ASO
Here are the guideline from CMS:
For Durable Medical Equipment Where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable:
HAP will continue to assess the situation and revise policies as needed or if government rulings require changes.
Below is an outline of the ways we’ve communicated.
We’ve posted the following information on hap.org:
We’ve sent direct mail to members about in-home prescription delivery
We’ve called members at highest risk of food insecurity and social isolation. Actions range from assessing care management needs to offering free meals for up to two weeks. This will be offered through the State declared emergency.
Employers have access to the online information available for members, as well as the following specific employer information hap.org:
Providers have access to the online information available for members, as well as the following specific provider information hap.org:
We’ve worked directly with our pharmacies on early medication refills and prescription home deliveries.
To ensure accurate claims payment, please follow the guidelines below when billing for COVID-19 related services and telehealth services during the Public Health Emergency (PHE).
HAP has aligned its billing requirements for telehealth services with the Centers for Medicare and Medicaid Services.
All guidelines above are applicable to all HAP and HAP Empowered lines of business.
We are working to enhance our systems based on the recent regulatory changes that have been published. If you believe a claim requires review, please follow HAP’s appeals process.
Welcome to HAP Empowered! During this webinar, you’ll:
Get to know your Medicaid plan.
Learn how to get the most out of your coverage.
Get real answers to all your questions! We’ll teach you about how Medicare works and give you tips and ideas to make sure you’re ready to go on day
Individual and family plans
Ready to join?
Alliance Health and Life Insurance Company
Self-funded / ASO
(800) 868-9885 TTY: 711
HAP Senior Plus®
(800) 801-1770 TTY: 711
HAP Senior Plus® (PPO)
(888) 658-2536 TTY: 711
Alliance Medicare Supplement:
(800) 873-7526 TTY: 711