Cost Sharing Updates

Update Regarding MetroPlusHealth Member Cost Sharing for Laboratory Tests to Diagnose COVID-19, Provider Visits To Diagnose COVID-19, and All Telehealth Services During the COVID-19 Emergency

Please be advised that the New York State Department of Financial Services (DFS), the New York State Department of Health, and the federal government are directing payers to waive patient copayments, coinsurance, and deductibles for certain testing and treatment due to the COVID-19 emergency.

Commercial Health Insurance, Medicaid, Medicaid Managed Care, Child Health Plus, and the Essential Plan

The New York State Department of Financial Services (DFS) and the New York State Department of Health (DOH) have waived patient copayments, coinsurance, and deductibles for in-network laboratory tests, in-network provider visits, and visits at the emergency department of a hospital to diagnose COVID-19 effective March 13, 2020 for 90 days during the state of emergency. In addition, the Departments have also waived patient copayments, coinsurance, and deductibles for all covered telehealth services effective March 16, 2020 for 90 days during the state of emergency.The waivers apply to commercial health insurance coverage, Medicaid, Medicaid Managed Care, Child Health Plus, and the Essential Plan. Providers should not collect the copayment, coinsurance, or deductible from the patient, and, to the extent possible, notify the health plan that they have waived cost sharing.  Instead, the health plan will reimburse the provider directly. For more information see the following resources.

• DFS regulation to waive cost-sharing for laboratory tests and visits to diagnose COVID-19.
• DFS regulation to waive cost-sharing for telehealth.
• DFS Circular Letter on telehealth coverage.
• DFS Q&A on telehealth coverage.
• DOH  Comprehensive Telehealth guidance for Medicaid providers.
• New York State Office of Mental Health guidance.
• New York State Office of Addiction Services and Supports:
  • Letter to providers March 9, 2020 – waives and modifies certain tele-practice regulations.
  • Letter to providers March 17, 2020 – regarding provider attestation.
  • Teleconference waiver update I (issued March 13, 2020).
  • Teleconference waiver update II (issued March 18, 2020).

Medicare

The federal government has passed legislation providing that during the emergency period, Medicare will pay the entire cost, and no deductible will be applied, for any medical visit that results in an order for, or the administration of, a test for COVID-19 or that relates to an evaluation to determine whether such test is needed. Since Medicare is requiring this for their enrollees, MetroPlusHealth will also follow these same guidelines for our Medicare Advantage products.

Please contact MetroPlusHealth at 1-800-303-9626 with any questions you may have.