Current State of Emergency Due to Covid
HHS Secretary Xavier Becarra renewed the Public Health Emergency due to COVID-19 on July 19th. We have taken the following steps to ensure our members have access to their services:
- Allowing Part A/B and Supplemental Part C plan benefits to be furnished at specified non-contracted facilities at Medicare certified facilities as per 42 CFR 422.201(b)(3)
- Temporarily reduce plan-approved out-of-network cost sharing to in-network cost sharing amounts
- Waive in full, requirement for gatekeeper referrals where applicable.
- Waive the 30-day notification requirement to our members as long as all the changes (such as reduction of cost-sharing and waiving authorization benefit the member.
- Consistent with 42 CFR 423.124(a), ensure our members have adequate access to covered Part D drugs dispensed at out-of-network pharmacies when those members cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy
- Lift the ‘refill-too-soon edits
- Allow members to obtain the maximum extended day supply, if requested and available at the time of refill.
