CurrentConnecticut Insurance DepartmentPolicy IC-39

Coronavirus (COVID-19) Outbreak and Testing

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Guidance for Connecticut health insurers and health care centers on COVID-19 testing and treatment access, cost-sharing, telehealth, network access, prescription supplies, utilization review, claims deadlines, consumer communications, and reporting.

Policy Summary

PayerConnecticut Insurance Department

PolicyCoronavirus (COVID-19) Outbreak and Testing

Policy CodePolicy N/A

Change TypeAdministrative and operational guidance

Effective DateMarch 9, 2020

Next Review DateN/A

Key ActionWaive cost-sharing for COVID-19 laboratory testing and qualifying in-network testing visits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

8Operational response areas addressed

90 daysMaintenance prescription supply

0COVID-19 testing cost-sharing

ConnecticutJurisdiction

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CurrentConnecticut Insurance DepartmentPolicy IC-39

Coronavirus (COVID-19) Outbreak and Testing

Customize your policy alerts

Sign up for Connecticut Insurance Department Policy IC-39 alerts

Get alerted when Policy IC-39 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerConnecticut Insurance Department

PolicyCoronavirus (COVID-19) Outbreak and Testing

Policy CodePolicy N/A

Change TypeAdministrative and operational guidance

Effective DateMarch 9, 2020

Next Review DateN/A

Key ActionWaive cost-sharing for COVID-19 laboratory testing and qualifying in-network testing visits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

8Operational response areas addressed

90 daysMaintenance prescription supply

0COVID-19 testing cost-sharing

ConnecticutJurisdiction

COVID-19 Testing and Treatment Access

Health insurers and health care centers are encouraged to provide the following COVID-19 testing and treatment access accommodations:

ALL of the following accommodations

Waive cost-sharing for COVID-19 laboratory tests.
Waive cost-sharing for an in-network provider office visit, urgent care visit, or emergency room visit when the purpose of the visit is to be tested for COVID-19.
Offer and waive cost-sharing for medical advice and treatment of COVID-19 provided through telehealth services.
When in-network availability is unreasonable with regard to time and distance, permit enrollees, certificate holders, and insureds to obtain COVID-19 testing and treatment out-of-network and provide coverage on the same basis as in-network services.
Cost-sharing for out-of-network COVID-19 testing is also encouraged to be waived pursuant to the cost-sharing accommodation above.

Administrative Accommodations

Health insurers, health care centers, preferred provider networks, and pharmacy benefit managers acting on their behalf are encouraged to provide the following administrative accommodations related to COVID-19 testing and treatment:

ALL of the following accommodations

Authorize payment to pharmacies for a ninety (90) day supply of maintenance prescription medications for individuals.
Subject to applicable state or federal law and monitoring by the Department of Consumer Protection related to controlled substances.
Do not apply penalties for an enrollee's, certificate holder's, or insured's failure to provide notice otherwise required under utilization review requirements when the individual has sought testing or treatment for COVID-19.
Upon notification by the Insurance Commissioner, extend the time limits for providers, enrollees, certificate holders, and insureds to submit claims for COVID-19 testing or treatment.

Operational Response Actions

Billing Rule

Waive cost-sharing for COVID-19 testing

Waive any cost-sharing related to COVID-19 laboratory tests and to an in-network provider office visit, urgent care visit, or emergency room visit when the purpose of the visit is COVID-19 testing.

Billing Rule

Support no-cost COVID-19 telehealth

Offer medical advice and treatment for COVID-19 through telehealth services and waive the associated cost-sharing.

Note

Inform consumers and streamline responses

Inform enrollees, certificate holders, and insureds about available benefits, respond quickly to consumer inquiries, and consider revisions needed to streamline responses and benefits.

Documentation Required

Prepare provider networks

Verify that provider networks are adequately prepared to handle a potential increase in health care service needs, including offering access to out-of-network services where appropriate and required.

Prior Authorization

Permit equivalent out-of-network coverage

When in-network availability is unreasonable with regard to time and distance, permit COVID-19 testing and treatment out of network and provide coverage on the same basis as in-network services.

Billing Rule

Authorize 90-day maintenance medication supplies

Authorize payment to pharmacies for a ninety (90) day supply of maintenance prescription medications, except as otherwise indicated under state or federal law and subject to monitoring related to controlled substances.

Denial Risk

Suspend utilization review notice penalties

Do not apply penalties for failure to provide notice otherwise required under utilization review requirements when an enrollee, certificate holder, or insured has sought testing or treatment for COVID-19.

Billing Rule

Extend COVID-19 claim filing deadlines

Upon notification by the Insurance Commissioner, extend the time limits for providers, enrollees, certificate holders, and insureds to submit claims for COVID-19 testing or treatment.

Documentation Required

Report response activities to the Department

Provide the Department with information on the steps being taken in response to the bulletin items. Information may be sent to cid.lh@ct.gov.

Coronavirus (COVID-19) Outbreak and Testing

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Coronavirus (COVID-19) Outbreak and Testing

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COVID-19 Coverage and Administrative Accommodations

Operational Response Actions