CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

COVID-19 Emergency Administrative Protocols for New Hampshire Medicaid

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Temporary administrative, prior authorization, equipment, claims, and prescription-drug protocols for covered services provided to New Hampshire Medicaid members during the COVID-19 Public Health State of Emergency. Applies to Medicaid fee-for-service, participating managed care organizations, enrolled providers, and providers authorized through Executive Order #15.

Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyCOVID-19 Emergency Administrative Protocols for New Hampshire Medicaid

Policy CodePolicy N/A

Change TypeTemporary emergency administrative protocols

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit prior authorization for covered telehealth services, but ensure the practitioner is eligible to bill and acts within scope of practice.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

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CurrentNew Hampshire Department of Health and Human ServicesPolicy N/A

COVID-19 Emergency Administrative Protocols for New Hampshire Medicaid

Customize your policy alerts

Sign up for all New Hampshire Department of Health and Human Services policy alerts

Know when New Hampshire Department of Health and Human Services releases new policies or updates existing guidance.

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Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyCOVID-19 Emergency Administrative Protocols for New Hampshire Medicaid

Policy CodePolicy N/A

Change TypeTemporary emergency administrative protocols

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit prior authorization for covered telehealth services, but ensure the practitioner is eligible to bill and acts within scope of practice.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Emergency Coverage Protocols

Physical and behavioral health services

Physical and behavioral health services are subject to the following COVID-19 emergency administrative protocols.

ALL of the following

Covered telehealth service
Prior authorization is not required
Practitioner must be eligible to bill for the service
Practitioner must act within the practitioner's scope of practice

ALL of the following

Care-transition admission, including coordination of a member redirected to an alternative setting
Prior authorization is temporarily waived
Notify the applicable payer when required to support identification of care-management needs; notification is not required for NH Medicaid Fee-for-Service

ALL of the following

EPSDT service not specifically listed as a State Plan benefit
Prior authorization remains required

ALL of the following

Physical health service, including routine or specialty care visits and excluding prescriptions
Backdated prior authorization requests may be submitted when necessary
The payer may conduct concurrent or retrospective review within 60 days of the rendered service date

ALL of the following

Other physical health service, including PT, OT, ST, out-of-network services, imaging, or surgical procedures, excluding prescriptions
Backdated prior authorization requests and concurrent or retrospective review within 60 days of the rendered service date are permitted
Otherwise follow payer standard operating procedures

ALL of the following

Behavioral health service excluding prescriptions
Use payer standard operating procedures

ALL of the following

Inpatient admission
Use payer standard operating procedures

DME/POS and equipment

DME, prosthetics, orthotics, supplies, equipment, and related claims are subject to the following emergency flexibilities and requirements.

ALL of the following

Oxygen equipment or supplies for a confirmed COVID-positive member
Prior authorization is temporarily waived
Proof of delivery is required via text, email, photograph, or confirmed shipment receipt from a third-party carrier

ALL of the following

Oxygen equipment or supplies for a member who is not confirmed COVID-positive
Relaxed prior authorization procedures permit backdated requests and concurrent or retrospective review within 60 days of the rendered service date

Prescription drugs

Prescription coverage and refill protocols apply during the State of Emergency.

ALL of the following

Generic non-controlled behavioral-health drug
Prior authorization is waived

ALL of the following

Currently prescribed drug with prior authorization expiring during the State of Emergency
Prior authorization is extended for 90 days
Drugs prescribed for a specific course of treatment are excluded, including certain treatments such as Hepatitis treatment

Timing and Filing Parameters

Concurrent or retrospective prior authorization review window

Review typeConcurrent or retrospective prior authorization review

Review windowWithin 60 days of the rendered service date

Applicable servicesSpecified physical health services, other physical health services, oxygen equipment and supplies, and home sleep studies and CPAP devices

DME/POS order extension

Order typeMedical DME/POS orders expiring during the State of Emergency

Extension30 days

Exclusion

Operational Instructions for Providers

Prior Authorization

Telehealth Services

NH Medicaid Payers do not require prior authorization for covered telehealth services. Practitioners may not bill for services outside their scope of practice.

Applies to covered telehealth services.
Practitioners must remain within their authorized scope of practice.

Note

Care Management Support

Payers and providers shall use standard operating procedures for care management support, including follow-up and care-transition coordination. Support may be informed by analysis of medical and pharmacy claims and Admission/Discharge/Transfer (ADT) reports.

Includes members with COVID-related exposures and all other members.
Coordinate follow-up and care transitions using available claims and ADT information.

Unsupported block type: prior_auth

Defined Payers and Providers

NH Medicaid Payers

Collective termNH Medicaid Payers

Fee-for-ServiceNew Hampshire Medicaid Fee-for-Service (FFS)

Participating managed care organizationsAmeriHealth Caritas New Hampshire, NH Healthy Families, and Well Sense Health Plan

Covered providers

Covered servicesMedicaid-covered services

Enrolled provider scopeNH Medicaid-enrolled providers participating with FFS and/or one or more managed care organizations

Additional provider scope

Policy Summary

PayerNew Hampshire Department of Health and Human Services

PolicyCOVID-19 Emergency Administrative Protocols for New Hampshire Medicaid

Policy CodePolicy N/A

Change TypeTemporary emergency administrative protocols

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit prior authorization for covered telehealth services, but ensure the practitioner is eligible to bill and acts within scope of practice.

SourceLink

On This Page

ALL of the following

Covered monitoring device
Prior authorization is waived for certain devices, including blood-pressure cuffs and monitors; home blood-glucose monitors, batteries, lancets, and test strips; and scales
Extended quantity limits may be permitted based on member health risk and vendor recommendations
Proof of delivery is required via text, email, photograph, or confirmed shipment receipt from a third-party carrier

ALL of the following

Medical DME/POS order expires during the State of Emergency
A 30-day extension is granted
Expired pharmacy orders are not eligible for the extension

ALL of the following

Home sleep study or CPAP device during the State of Emergency
May be provided subject to retrospective medical-necessity review within 60 days of the rendered service date

ALL of the following

DME/POS service during an inpatient stay
Place-of-service edits are waived
Proof of delivery is required via text, email, photograph, or confirmed shipment receipt from a third-party carrier

ALL of the following

DME/POS claim
Timely claim filing is extended to 180 days from the date of service

ALL of the following

Assistive-technology fitting
Remote telehealth technology may be used whenever practical
Remote technology is generally not appropriate when complex equipment measurement, such as wheelchair measurement, is required

ALL of the following

DME order from a nonparticipating or out-of-network provider
The order is permitted
The rendering provider must have at least a temporary State license

ALL of the following

Medical supply refill supported by a provider order
Early fill is permitted for a maximum 30-day supply

ALL of the following

Refill request for a Schedule II-IV controlled substance
Review each request for clinical appropriateness because of the high risk of overdose in the context of the opioid epidemic
Consider the CDC recommendation that members have a 14-day supply on hand during the State of Emergency

ALL of the following

Refill request for a non-controlled substance or a Schedule V controlled substance
A one-time early-refill override is permitted for current prescriptions

Timely claim filing extension

Filing requirementTimely filing of claims

Extended period180 days from the date of service (DOS)

Applicable claimsDME/POS claims

Retrospective medical-necessity review for home sleep studies and CPAP

ServicesHome sleep studies and CPAP devices

Review typeRetrospective medical-necessity review

Review timingWithin 60 days of the rendered service date

Prescription prior authorization extension

Extension period90 days

Applicable prescriptionsCurrently prescribed drugs whose prior authorizations expire during the State of Emergency

ExclusionCertain drugs prescribed for a specific course of treatment, such as Hepatitis treatment, are excluded

Early medical-supply fill

Refill typeEarly fills of medical supplies

Maximum supplyMaximum 30-day supply

RequirementA provider's order is required

CDC-referenced controlled-substance supply

Controlled substancesSchedules II-IV

Clinical reviewReview each refill request for clinical appropriateness because of the high risk of overdose

CDC-referenced supply14-day supply on hand during the State of Emergency

Prior Authorization

EPSDT Services

NH Medicaid Payers require prior authorization for EPSDT services that are not specifically listed as a State Plan benefit.

Obtain prior authorization for services outside the specifically listed State Plan benefits.
Applies to confirmed COVID-positive members and all other members.

Prior Authorization

Physical Health Services

For physical health services, excluding prescriptions, NH Medicaid Payers have relaxed prior authorization timelines to permit backdated requests and concurrent or retrospective review within 60 days of the rendered service date.

Examples include routine and specialty care visits.
Contact the Medicaid Payer for more information.
Applies to confirmed COVID-positive members.

Prior Authorization

Other Physical Health Services

For other physical health services, excluding prescriptions, payers and providers shall use standard operating procedures. NH Medicaid Payers have relaxed prior authorization requirements to permit backdated requests and concurrent or retrospective review within 60 days of the rendered service date.

Examples include PT/OT/ST, out-of-network services, imaging, and surgical procedures.
Contact the Medicaid Payer for more information.
Applies to all other members and confirmed COVID-positive members.

Note

Behavioral Health and Inpatient Services

Payers and providers shall use standard operating procedures for behavioral health services, excluding prescriptions, and for inpatient admissions.

Applies to behavioral health services for COVID-positive members and all other members.
Applies to inpatient admissions for all other members.

Prior Authorization

Oxygen Equipment and Supplies

NH Medicaid Payers temporarily waive prior authorization for oxygen equipment and supplies for confirmed COVID-positive members. Proof of delivery remains required.

Acceptable proof of delivery includes a text, email, photograph, or confirmed shipment receipt from a third-party carrier.
For all other members, relaxed prior authorization procedures allow backdated requests and concurrent or retrospective review within 60 days of the rendered service date.
Contact the Medicaid Payer for more information.

Prior Authorization

Monitoring Devices and Quantities

Prior authorization is waived for certain covered monitoring devices, and extended quantities may be permitted based on member health risk and vendor recommendations. Proof of delivery is required.

Examples include blood pressure cuffs and monitors; home blood glucose monitors, batteries, lancets, and test strips; and scales.
Acceptable proof of delivery includes a text, email, photograph, or confirmed shipment receipt from a third-party carrier.
Contact the Medicaid Payer for more information.

Billing Rule

Expired DME/POS Orders

NH Medicaid Payers grant a 30-day extension for medical DME/POS orders that expire during the State of Emergency period. Expired pharmacy orders are not eligible for extension.

The extension applies to medical DME/POS orders only.
Do not extend expired pharmacy orders.

Documentation Required

Sleep Studies and CPAP

NH Medicaid Payers grant home sleep studies and CPAP devices during the State of Emergency period, subject to retrospective medical-necessity review within 60 days of the rendered service date.

Applies to confirmed COVID-positive members and all other members.
Ensure records support retrospective medical-necessity review.

Billing Rule

DME/POS Inpatient Service Edits

NH Medicaid Payers waive place-of-service edits for DME/POS services during inpatient stays. Proof of delivery remains required.

Acceptable proof of delivery includes a text, email, photograph, or confirmed shipment receipt from a third-party carrier.
Applies to confirmed COVID-positive members and all other members.

Note

Assistive-Technology Fittings

NH Medicaid Payers authorize assistive-technology fittings through remote telehealth technology whenever practical. Remote technology is generally not appropriate when equipment measurement is required for complex fittings.

Complex fittings may include wheelchair fittings.
Use remote telehealth when practical, but arrange an appropriate in-person process when accurate complex measurements are required.

Documentation Required

Nonparticipating and Out-of-Network DME Orders

NH Medicaid Payers permit nonparticipating and out-of-network providers to order durable medical equipment. Rendering providers must minimally hold a temporary State license.

The ordering provider may be nonparticipating or out of network.
Verify that the rendering provider has at least a temporary State license.

Prior Authorization

Early Medical-Supply Refills

NH Medicaid Payers permit early fills of medical supplies for a maximum supply period of 30 days when supported by a provider's order.

Obtain and retain the provider's order.
The maximum early-fill period is 30 days.

Prior Authorization

Covered Prescription Prior Authorization

During the State of Emergency period, NH Medicaid Payers waive prior authorization for generic non-controlled behavioral health drugs and for Actemra® and Kevzara®. They extend current prescription prior authorizations for 90 days when they are scheduled to expire during the Emergency period, subject to exclusions for certain drugs used for a specific course of treatment.

Drug safety edits remain in place.
The 90-day extension excludes certain drugs for a specific course of treatment, such as Hepatitis treatments.
Contact the Medicaid payer for more information.

Documentation Required

Prescription Refill Overrides

For covered prescription refills, review each controlled-substance request for clinical appropriateness because of the high risk of overdose associated with the opioid epidemic. Consider the CDC recommendation to have a 14-day supply on hand during the current State of Emergency.

Controlled substances in Schedules II-IV require clinical review.
Non-controlled substances and Schedule V controlled substances may receive a one-time early refill override for current prescriptions.
Contact the Medicaid payer for more information.