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COVID-19 vaccine communications
As COVID-19 vaccine distribution and administration accelerate across our state and nation, we are providing a few updates for you to share with your patients. First, there remain many myths and questions circulating in the community, and we want to ensure our customers and members have the facts about safe and effective vaccines. Addressing vaccine myths and providing the facts to instill confidence is critical to our shared success. We are joining our parent organization, Mass General Brigham, in supporting a critical state campaign, Trust the Facts. Get the Vax campaign, to educate the public and our members on the safety and efficacy of the COVID 19 vaccine.
In addition to vaccine safety, our vaccine communications tie in access, equity, and ongoing prevention as the phased approach outlined by the state continues to move forward. To remind members 75 and older to make their vaccine appointments, we are currently using proactive phone outreach. We are also sending individual text message to members 65 and older as well as those with two or more co-morbidities. Next, we’ll be sending target letters guided by vaccine phases.
We will continue to update you with the latest information as it becomes available.
In this issue:
- COVID-19 vaccine communications
- SPEAK UP Champions—implicit and explicit racial bias education
- Allies HMO
- New guidelines
- Reminder: ACCESS Law contraception coverage
- Revised and new medical policies
- My Care Family- new letter for EMR
- CPT code updates
- Drug code updates
SPEAK UP Champions—implicit and explicit racial bias education
A Black woman is 3 to 4 times more likely to die of pregnancy-related complications than a white woman. Research shows that inequities in outcomes are primarily due to differences in how women are treated within the health care setting based on race. The SPEAK UP Champions© Implicit and Explicit Racial Bias education is 8 hours of live virtual interactive learning that outlines quality improvement strategies to support individuals and groups with dismantling racism, providing quality equitable care, and reducing health disparities. To learn more about how you can SPEAK UP later this month on March 23 + 25, visit perinatalqi.org/page/speakup
Introducing Allies HMO
Powered by the Newton-Wellesley Hospital Community Plus Network
Our Allies HMO plans are designed to make high-quality care more affordable and accessible. Allies Choice is a Merged Market offering that leverages the Newton-Wellesley Hospital Community Plus Tiered HMO Network to deliver a value-based experience. Members will receive care at a top community hospital and get support from health navigators who ensure quicker access to care. They'll also have access to Boston's leading academic and specialty hospitals when needed.
Learn more at allwayshealthpartners.org/allies
New guidelines
MRI-guided focused ultrasound thalamotomy
As of February 1, 2021, AllWays Health Partners has published new guidelines to determine medical necessity for MRI-guided Focused Ultrasound Thalamotomy (MRgFUS, MRIgFUS, MR-FU) to treat the neurological conditions of Parkinson disease and essential tremor. The guidelines are called “MRI-guided Focused Ultrasound Thalamotomy (Custom) – AWH”.
To access this criteria, providers should log in to AllWays Health Partners’ provider website at allwaysprovider.org and click the InterQual® Criteria Lookup link under the Resources Menu.
Determining medical necessity for electric tumor treating fields therapy
As of March 1, 2021, AllWays Health Partners has published new guidelines to determine medical necessity for electric tumor treating fields therapy (ETTFs) (e.g. Optune™ device) to treat supratentorial glioblastoma multiforme (GBM). The guidelines are called “Tumor Treating Fields (Custom) – AWH”. To access these criteria, providers should log in to AllWays Health Partners’ provider website at allwaysprovider.org and click the InterQual® Criteria Lookup link under the Resources Menu.”
Per DOI requirements, AllWays Health Partners will be reinstating prior authorization requirements for in-patient hospital admissions on March, 31, 2021.
The provider should notify us within 48 hours of admission and submit an update a minimum of every 5 days to support discharge planning.
For more information about our policies during the pandemic, visit our COVID-19 FAQ for providers.
My Care Family—new letter for patients’ EMR
In order to comply with a Mass Health requirement to have the results of the Health-Related Social Needs Screening (HRSN) documented in the EMR, we’re sending the following letter to My Care Family PCPs who are not part of GLFHC. GLFHC has its own documentation process for their patients. Be on the lookout this month for additional communication with a formalized copy of the letter below:
Reminder for providers
Please be advised, Massachusetts law permits individuals with fully-insured commercial health plan coverage to fill a 12-month supply of prescription contraceptives. This applies to our My Care Family (Medicaid) members.
Coverage under Chapter 120 of the Acts of 2017, An Act Relative to Advancing Contraceptive Coverage and Economic Security in Our State, provides that coverage shall be required for:
“Prescription contraceptives intended to last (A) for not more than a 3-month period for the first time the prescription contraceptive is dispensed to the covered person; and (B) for not more than a 12-month period for any subsequent dispensing of the same prescription, which may be dispensed all at once or over the course of the 12-month period, regardless of whether the covered person was enrolled in a plan or policy under this chapter at the time the prescription contraceptive was first dispensed; provided, however, that the insured may not fill more than one 12-month prescription in a single dispensing per plan year.”
Revised medical policy updates
You can find the updated policies here but below is a summary:
New medical policy updates
New medical policy, Radiofrequency Ablation to Treat Uterine Fibroids, has been posted to allwayshealthpartners.org with an 3/1/2021 effective date.
CPT Code Updates
As a reminder to our network the following services are not reimbursable for My Care Family Plan:
As a reminder to our network the following dental services are not covered for Commercial and ASO plans; Redirect to MassHealth for My Care Family Plans:
As a reminder to our network the following dental service is redirect to MassHealth for My Care Family Plans:
The following previously not covered for Commercial and ASO plans are now covered with prior authorization for Commercial and ASO plans; Not covered for My Care Family Plans:
Drug Code Updates
The following drug(s) previously considered not covered experimental/investigational are now covered under the medical benefit; no prior authorization required:
The following drug(s) previously considered not covered experimental/investigational are now covered under the medical benefit; prior authorization required:
The following drug(s) previously covered without prior authorization now covered with prior authorization under the medical benefit:
