As COVID-19 cases continue to fall and states begin to rescind emergency restrictions, Harvard Pilgrim has updated our COVID-19 procedures and policies accordingly. Today, we revised our COVID-19 provider website to reflect the latest changes on cost-sharing and prior authorization policies, including:
- Cost-sharing for COVID-19 treatment: Effective for dates of service on or after Aug. 7, 2021, Harvard Pilgrim will resume cost share for COVID-19 treatment for members of our Maine, New Hampshire, and Connecticut commercial, Medicare Advantage, Medicare Supplement, and Medicare Enhance plans products. For members of Massachusetts plans, Harvard Pilgrim will continue to waive cost share for COVID-19 treatment until further notice. This applies for COVID-treatment provided by telemedicine as well as in-person treatment.
- Prior authorization for diagnosis and treatment of COVID-19: For diagnoses and treatments related to COVID-19 or for members suspected of contracting COVID-19:
- Members of Maine, New Hampshire and Connecticut plans: Prior authorization requirements will resume for members of Harvard Pilgrim’s commercial, Medicare Advantage, Medicare Supplement, and Medicare Enhance plans products, effective for dates of service on or after Aug. 7, 2021
- Members of Massachusetts plans: Prior authorization requirements will not be required until further notice. Notification will be required within 2 business days of the admission.
- Prior authorization for post-acute care [such as skilled nursing (SNF), long-term acute care (LTAC), inpatient rehab facilities, and home care]:
- MA commercial products: Effective for dates of service on or after Aug. 7, 2021, Harvard Pilgrim is resuming prior authorization requirements for post-acute care at non-hospital locations, such as skilled nursing (SNF), long-term acute care (LTAC), inpatient rehab facilities, and home care, including following an inpatient hospital admission.
- All other states and Medicare Advantage: Prior authorization was reinstated for dates of service beginning June 30, 2020.
- Hospice services: Standard prior authorization requirements for hospice services delivered in outpatient and post-acute care facilities were reinstated for dates of service on or after April 1, 2021 for all lines of business with the exception of Massachusetts members. Effective for dates of service on or after Aug. 7, 2021, prior authorization requirements will apply for Massachusetts members.
For complete information, please refer to the updated Provider COVID-19 webpage. We will continue to update our COVID-19 website as other changes occur.
Editor’s Note: This article was added to the June issue of Network Matters on Monday, June 7, 2021.
Director, Network Operations