Health Net Provider Alerts

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the additional distributions from the Provider Relief Fund to eligible Medicaid and Children's Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens.

For additional information, visit HHS.

What is Health Net doing to mitigate risk to its operations?

As the COVID-19 situation escalates, we have taken the necessary steps to ensure the health of our employees so they can continue to perform their important work, and protect our business operations through actions such as implementing work from home policies where possible, providing enabling technology and limiting travel.

These and other measures further reinforce existing contingency plans Health Net has in place to preserve operations, provide our employees with the resources they need to stay safe, and support the health and well-being of our members during this critical time.

While this pandemic is unprecedented within Health Net's history, we are prepared for this challenge through our long-standing business continuity plans that safeguard the integrity of our operations.

As we have experienced in recent years as a result of seasonal wildfires and other natural disasters, Health Net regularly reviews and updates its emergency business continuity protocols. As part of these efforts, we continue to measure and refine our call center, utilization management and claims processing operations. We are doing everything we can during the nationally declared emergency for COVID-19 to support ongoing operations. In particular:

• Health Net's Provider Network Management (PNM) and Provider Relations personnel remain available to providers, with no current impact in their ability to assist with provider issues.
  • However, on-site meetings are being replaced with telephonic and other forms of support.
• Our key operational units will continue to provide updates to PNM leadership if and when challenges arise.
• Visit Health Net Alerts: COVID-19 to view regular provider updates.

Does Health Net allow access to telehealth services to increase access to care? And what is the reimbursement rate?

To limit members' risk of COVID-19 infection, Health Net encourages use of telehealth to deliver care when medically appropriate and capable through telehealth modalities for covered services.

Commercial and Medi-Cal members - During the course of this declaration of emergency Health Net's coverage for telehealth services will be temporarily expanded in accordance with regulatory requirements, and will be reimbursed whether the telehealth service is delivered via audio/video technology or via audio-only technology (when deemed medically appropriate for the patient's medical condition).

• Federally Qualified Health Centers (FQHCs), Regional Health Centers (RHCs), and Indian Health Service (IHS) Clinics - During the course of this declaration of emergency Health Net's Medi-Cal coverage for telehealth services will follow guidelines released by the Department of Health Care Services (DHCS), which includes virtual/telephonic visits consistent with in person visits. Additionally, virtual/telephonic visits provided pursuant to this guidance are eligible for prospective payment system (PPS) rates, or all-inclusive rate (AIR), as applicable, and as communicated by DHCS via email to all Managed Care Plans on April 6, 2020.

Medicare and MMP/Cal MediConnect members - During the course of this declaration of emergency Health Net's coverage for telehealth services will follow guidance released by CMS, which includes telecommunications involving audio and video technology and audio only technology.

Applicable to all lines of business:

• During the public emergency period, Health Net will reimburse fee-for-service providers the same contracted rate, whether service is provided in person or through telehealth technology.
• Services that cannot be appropriately delivered remotely are not eligible for telehealth coverage and reimbursement.
• Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above. Claims processing risk will follow the in-person location place of service where the service would have been delivered in lieu of telehealth.

In addition to telehealth services offered through our network of providers, Health Net has expanded access to telehealth services through third parties. Updated information on those vendor arrangements can be found in the Telehealth Vendors and Other Resources Supporting Your Primary Services section below or at Health Net Alerts: COVID-19.

What are the guidelines for telehealth services specific to risk adjustment?

For Medicare, providers should follow the guidance in the communication from the Centers for Medicare and Medicaid Services (CMS) dated April 10, 2020, regarding the Applicability of diagnoses from telehealth services for risk adjustment.

• Applicability of diagnoses from telehealth services for risk adjustment (PDF)

How do I bill for telehealth services during this declaration of emergency period?

For commercial and Medi-Cal

• Use appropriate American Medical Association (AMA) CPT and HCPCS codes most descriptive for the service delivered
• For Medi-Cal:
  • Use Place of Service code 02 (Telehealth) – excluding FQHC/RHCs
  • Use appropriate modifiers, when applicable – excluding FQHC/RHCs
    • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
    • Modifier GQ (Asynchronous store and forward telecommunications systems)
• For Commercial:
  • Use the normal Place of Service code (11, 23, etc.) – excluding FQHC/RHCs
  • Use appropriate modifiers – excluding FQHC/RHCs
    • Modifier 95 (Synchronous, interactive audio and telecommunications systems), OR
    • Modifier GQ (Asynchronous store and forward telecommunications systems)

The same amount of reimbursement will be provided for a service rendered via telephone as they would if the service is rendered via video provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member.

Updated Medi-Cal telehealth billing guidance, as well as information regarding FQHC telehealth coverage and billing guidance details, can be found at:

• Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19) (PDF)
• California Department of Health Care Services | Medi-Cal & Telehealth
• California Department of Health Care Services | COVID-19 Guidance for Telehealth and Virtual/Telephonic Communications

For Medicare and Cal MediConnect

• Providers should bill and will be reimbursed for Medicare and Cal MediConnect telehealth services as required by CMS
• Use the normal Place of Service code (11, 23, etc.) with the appropriate telehealth modifiers, as identified by CMS

Updated CMS guidance for telehealth coverage can be found at:

• Center for Medicare and Medicaid Services (CMS)
• Telehealth.HHS.GOV

Examples of benefits or services not appropriate for telehealth delivery:

• Benefits or services that are performed in an operating room or while the patient is under anesthesia
• Benefits or services that require direct visualization or instrumentation of bodily structures
• Benefits or services that involve sampling of tissue or insertion/removal of medical device
• Benefits or services that otherwise require the in-person presence of the patient for any reason

What do I do if my commercial or Medicare telehealth claim did not price at full rate parity for the CPT code?

During the course of this declaration of emergency, commercial and Medicare telehealth claims need to reflect the normal POS (11, 23, etc.) and the applicable telehealth modifier for the claim to price at parity.

Claims for such CPT codes previously billed with POS 02 must be re-billed as corrected claims in order to receive rate parity.

Updated 7/29/20 Are there member cost shares for commercial and Medicare network provider telehealth services?

For commercial network provider telehealth services starting March 17, 2020, covered telehealth services will be offered at zero member cost share. Health Net will update this website's information prior to the telehealth cost share waivers expiring. When the telehealth cost share waiver expires, members will continue to retain telehealth benefits included in their Health Net coverage contract or policy, as well as any temporary telehealth benefit coverage mandated during the emergency period.

For Medicare network provider telehealth services delivered March 17 through December 31, 2020, covered telehealth services will be offered at zero member cost share.

This applies to:

• All diagnosis codes, not just COVID-19 related diagnosis codes
• Telehealth claims paid by Health Net and telehealth services covered and provided by capitated physician groups and IPAs.
• Exceptions:
  • Cost sharing payable by the secondary Medi-Cal payor for Health Net dual eligible Medicare plans will continue to be that payor's responsibility through normal coordination of benefits.

Capitated Physician Groups/IPAs:

Capitated physician groups or IPAs are required to support, cover and enable telehealth services and to abide by regulatory requirements for coverage and payment of telehealth services as outlined above, including the waiver of member cost share. Waived cost shares for capitated physician groups' or IPAs' paid telehealth services will be reimbursed by the health plan. Details regarding the process for capitated telehealth services to receive reimbursement for waived member cost shares will be released at a later date.

What is Health Net's strategy to support telehealth services for providers and members?

Health Net is committed to supporting your relationship with your patients. We continuously encourage members to first take advantage of the telehealth services provided by their primary care provider before considering Health Net's contracted vendors.

What additional support does Health Net provide to enhance access to care for my patients?

Health Net offers many solutions to enhance access to care for your patients. These solutions supplement, but do not replace, the personal care you provide to your patients. Examples include:

• The Nurse Advice Line – Available to members 24 hours a day at 1-800-893-5597 (TTY 711).
• myStrength (tailored wellness resources to help members with mental health challenges). If a member needs emergent or routine treatment services, call MHN at 1-888-327-0010 or mystrength.com.
• Health Net Community Connect (Aunt Bertha) – A free online search service, allows members to find free and low cost social services.
• Heal – On demand doctor house calls is now offering telemedicine visits. Members can schedule care through Heal online or by calling 1-844-644-4325 from 8 a.m. to 8 p.m., 7 days a week.
  • Available for commercial members only

Does Health Net have a list of recommended telehealth platforms for providers?

Health Net has researched a variety of telehealth platforms that optimize the availability of telehealth capabilities to our providers. These platforms accommodate most medical conditions, including COVID-19, and allow for a compliant way to administer health care services to your patients.

Health Net is not affiliated with, and does not endorse, any of the solution platforms represented below. Health Net has reviewed these platforms and summarized their capabilities on behalf of our providers, but we do not have any direct experience with any of these platforms and we cannot guarantee their performance. Your decision to utilize any of these platforms is based on your individual sole discretion as it relates to the needs of your individual practice.

Below is a summary of telehealth platforms you may find helpful in selecting a solution that best meets your practice needs.

What additional telehealth options are available to my patients?

Health Net offers additional telehealth services to enhance access to care for your patients. These services supplement, but do not replace, the personal care you provide to your patients. Health Net is contracted with Babylon Health (excludes Medicare and Cal MediConnect) and Teladoc^® (excludes Medi-Cal).

What support will Babylon Health provide to me if my patients use them?

Babylon Health supports the primary care physician (PCP) and their relationship with their patient. Babylon services include:

• Visit summaries sent to the PCP for close communication and continuity of care.
• Referring patients back to the assigned PCP for follow up appointments.
• Prescribing of non-scheduled, non-lifestyle medications.
• Ordering of and follow up on basic ancillary testing for immediate treatment of the medical condition.
• Direct communication back to the member's PCP about clinical assessments that include a recommendation for a referral for advanced imaging, such as CT, MRI or referral to a specialist.
  • The PCP, who best knows the member and their clinical needs, then decides whether such referral is required and, if so, directs the patient to the most appropriate resource.
• Availability of the member's medical records through the Babylon Health app.

What support will Teladoc provide to me if my patients use them?

Teladoc supports the PCP and their relationship with their patient. Teladoc services include:

• Visit summaries sent to the PCP for close communication and continuity of care, at the member's request.
• Referring patients back to the assigned PCP for follow-up appointments.
• Prescribing of non-scheduled, non-lifestyle medications.
• Availability of the member's medical records through the Teledoc app.

What billing codes should be used to bill for COVID-19 testing?

Starting April 1, 2020, fee-for-service providers performing the COVID-19 test can begin billing Health Net for services that are Health Net's responsibility for dates of service February 4, 2020 and after, using the following newly created HCPCS and CPT codes:

• HCPCS U0001 – For CDC developed tests only: 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
• HCPCS U0002 – For all other commercially available tests: 2019-nCoV Real-Time RT-PCR Diagnostic Panel. (It is not yet clear if the Centers for Medicare & Medicaid Services (CMS) will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.)
• CPT 87635 – (effective 3/13/2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. The industry standard for reporting of novel coronavirus tests across the nation's health care system.
• HCPCS U0003 – (effective 4/14/2020): Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. U0003 should identify tests that would otherwise be identified by CPT code U0001 but for being performed with these high throughput technologies.
• HCPCS U0004 – (effective 4/14/2020): 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies.
• CPT 0202U – (effective 5/20/2020): Infectious disease (bacterial or viral respiratory tract infection), pathogen specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.

Effective for dates of service April 10, 2020, and continuing during the course of this declaration of emergency, Health Net benefit plans cover medically necessary FDA approved serologic (antibody) testing ordered by physicians or other authorized health care providers, using AMA approved CPT codes and based on CDC guidance for appropriate use of FDA approved or authorized (Emergency Use Authorization, EUA) antibody tests. Additional clinical guidelines for serologic testing coverage may be communicated at a later date.

Fee-for-service (FFS) providers performing medically necessary FDA approved COVID-19 antibody tests can bill Health Net for services that are Health Net's responsibility for payment, using the following CPT codes:

• CPT 86318 (Medi-Cal only) Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (eg, reagent strip); (EXISTING PARENT CODE NOT SPECIFIC TO COVID 19)
• CPT 86328 (All products) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), (Coronavirus disease [COVID-19]), (For severe acute respiratory syndrome, coronavirus 2 [SARS-CoV-2] [Coronavirus, disease {COVID-19}] antibody testing using multiple-step method, use 86769)
• CPT 86769 (All products) Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (For severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease {COVID-19}] antibody testing using single step method, use 86328)

CDC Antibody Testing Guidance

All member cost-share requirements (copayment, coinsurance and/or deductible amounts) related to the screening and testing for COVID-19 will be waived across all products.

• Health Net will absorb the costs for waived copayments for COVID-19 screening and testing to support our network providers.

In addition to cost-share requirements, authorization requirements will be waived for any claim that is received with these specified codes.

What diagnosis codes should be used to bill for services related to COVID-19 screening and testing?

For complete and up-to-date diagnosis coding for COVID-19, visit the CDC National Center for Health Statistics website.

The following diagnosis codes can be used to bill for screening and testing services related to COVID-19.

• Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases.
• Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out.

Is there more information available on COVID-19 billing?

For additional information on coding, refer to the following links from the American Medical Association (AMA):

• Special coding advice during COVID-19 public health emergency (PDF)
• CPT reporting for COVID-19 Testing (PDF)

What is the deadline to file claims?

The deadline to file commercial and Medi-Cal claims for dates of service March 5, 2020 through the end of the public emergency period, for providers impacted by COVID-19, will be extended to 90 calendar days beyond standard filing timelines or the timeline in your Health Net Provider Participation Agreement (PPA). This also applies to Medi-Cal late filing penalties.

The deadline to file Medicare claims for dates of service March 5, 2020 through July 25, 2020, for providers impacted by COVID-19, will be extended to 90 calendar days beyond standard filing timelines or the timeline in your Health Net Provider Participation Agreement (PPA).

Can providers balance bill members for fees related to screening and testing for COVID-19?

Balance billing is strictly prohibited by state and federal law and Health Net's PPA. Providers may not bill members for any fees related to screening and testing for COVID-19.

Is Health Net requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing?

Health Net is not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Participating Physician Groups (PPGs) delegated by Health Net to authorize services related to COVID-19 screening and testing are required to ensure members receive the care they need as quickly as possible by not requiring prior authorization, precertification, prior notification, or step therapy protocols for COVID-19 screening and testing services at this time.

Is Health Net waiving cost-share requirements for screening and testing?

Health Net benefit plans cover screening and testing for COVID-19. Health Net is waiving all member cost-sharing requirements including, but not limited to, copayments, deductibles, or coinsurance for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.

• Exception:
  • Cost sharing payable by the secondary Medi-Cal payor for Health Net dual eligible Medicare plans will continue to be that payor's responsibility through normal coordination of benefits.

Waived cost share for capitated physician groups' or IPAs' paid screening/testing services will be reimbursed by the health plan. Details regarding the process for capitated services to receive reimbursement for waived member cost shares will be released at a later date.

Where is COVID-19 testing available?

LabCorp, Quest Diagnostics™ and Bio Reference and several commercial and hospital based laboratories are currently offering testing for COVID-19. Providers are encouraged to visit the following sites for more information on registration and specimen collection requirements:

• LabCorp – Physicians who send laboratory testing to LabCorp, will require an active account. Please contact LabCorp at 1-800-859-6046 and speak to a customer service representative to set up account.
• Quest Diagnostics – website or call 1-866-697-8378. Providers can open an account.
• BioReference – Providers do not need to sign up. Tests can be sent through courier or FedEx depending on area. Providers can open an account or contact BioReference via telephone at 1-833-684-0508 or 1-800-229-5227.
• Twenty-two public health labs in California are testing samples for COVID-19. Providers can refer members for testing to their county's public health department. Additional information can also be found at the California Department of Public Health.
• Providers can confirm with Community Hospitals to determine if they are offering testing for COVID-19.

Testing can be ordered only by physicians or other authorized health care providers.

• Members seeking testing for COVID-19 should consult with their physician or health care provider who may order the test if they determine the patient meets testing criteria.

The Lab Patient Service Centers will not be collecting specimens for COVID-19 testing. DO NOT refer patients to Lab Patient Service Centers. Please contact specific labs for instructions for specimen collection and transport, and to obtain specimen collection supplies.

What are the screening and testing guidelines for COVID-19?

Refer to the Centers for Disease Control and Prevention (CDC) for updated guidelines for testing patients suspected of having the COVID-19 infection.

• CDC Updated Guidelines (PDF)

The state of California launched a coronavirus awareness website. This site provides the following testing recommendations:

Tier 1:

• Hospitalized patients
• Healthcare workers, first responders, and other social service employees
• Any symptomatic person
• People exposed to infected individuals in places where COVID-19 risk is high
• Asymptomatic residents or employees of group living facilities including:
  • After positive cases have been identified in a facility
  • Before resident admission or re-admission to a facility
• People in essential jobs

Tier 2:

• Lower risk asymptomatic people

Is Health Net waiving cost-share requirements for COVID-19 related treatments?

During the course of this declaration of emergency, Health Net will waive member cost sharing for COVID-19 related treatments for commercial fully insured members.

Health Net will waive member cost sharing for COVID-19 related treatments for Medicare members through December 31st, 2020.

Exceptions:

• Members in the Blue & Gold benefit plan for the University of California flex funded employer group will not have COVID-19 treatment cost share waived (plan code "FMD"). Members should contact the employer group plan sponsor with questions related to this plan design matter. Standard cost sharing will apply.
• Cost sharing payable by the secondary Medi-Cal payor for Health Net dual eligible Medicare plans will continue to be that payor's responsibility through normal coordination of benefits.

Waived cost share for capitated physician groups' or IPAs' paid COVID-19 related treatments will be reimbursed by the health plan. Details regarding the process for capitated services to receive reimbursement for waived member cost shares will be released at a later date.

Is Health Net waiving prior authorizations for COVID-19 related treatments?

Health Net and its delegated entities will waive prior authorizations for COVID-19 related treatments for all Medicare, Medi-Cal and commercial fully insured members. Inpatient admission notification is still required as soon as possible to Health Net and the member's assigned delegated participating physician group (PPG) or IPA, if available.

What COVID-19 ICD-10 diagnoses codes are approved for use?

• B97.29: Confirmed cases - other coronavirus as the cause of diseases classified elsewhere (prior to 4/1/20)
• U07.1: 2019-nCoV - Confirmed by lab testing (effective 4/1/20)

Since March, Health Net Medicare Advantage (MA) has waived prior authorizations, co-pays, and other costs related to COVID-19 testing, screening and medically necessary treatment.

We have also waived prescription refill limits and allowed members to refill prescriptions prior to their refill date during this course of declaration of emergency.

As seniors face increased social and economic barriers to care amid this pandemic, we are now offering a number of expanded benefits to help our eligible MA members address issues such as out-of-pocket medical costs, food insecurity, and medication assistance.

Effective July 1, 2020, expanded benefits will include:

• $0 Member Liability Extension: We are waiving in-network member costs for all primary care visits for the rest of 2020. We are also waiving member costs for outpatient, non-facility-based behavioral health visits and are extending telehealth cost share waivers for all telehealth visits—primary care, specialty, and behavioral health—for in-network providers for the remainder of 2020. This does not include inpatient hospital, behavioral health facility, or urgent care visits. Medicare members with state benefits will continue to receive support through coordination with their states.

Beginning July 1, 2020, providers should waive the member liability for the eligible primary and behavioral health care claims at the point of service, and forego the collection of the member cost share. This is a benefit change for our members and our claims system will be configured to administer these adjusted benefits. We recognize that providers have different reimbursement/accounting arrangements with us, and the costs associated with this benefit change will follow the accounting processes as outlined in the provider's contract with MA from Health Net. For services rendered to Medicare members with state benefits, providers should continue to collect that member cost share from their State Medicaid Agency as per usual.

What resources are available for providers to request and/or order Personal Protective Equipment (PPE)?

We understand that access to necessary PPE and other important supplies during the COVID-19 crisis has been challenging. If you need access to appropriate PPE and/or other supplies to provide care to your patients, we encourage you to reach out to the following resources for assistance.

Designated Local Public Health Department by County

Resource requests for health care providers and facilities are handled through the designated Public Health Department for your county.

New requests are:

1. Submitted by your designated local health department to the Medical Health Operational Area Coordinator (MHOAC) through the Regional Disaster Medical Health Coordinator (RDMHC)
2. Upon receipt by the RDMHC, the request is then sent to the California Department of Public Health (CDPH) Medical and Health Coordination Center (MHCC) for proper tracking and fulfillment by both the State Operations Center (SOC) and the Emergency Medical Services Agency (EMSA).

Facilities currently facing a shortage of respirators, N95 masks or other supplies, should contact their MHOAC.

Direct Relief^®

Direct Relief provides clinics and health care centers throughout the United States and globally with access to no-cost pharmaceuticals, medical supplies and other resources to care for the world's most vulnerable people.

Learn more about Direct Relief and how to become a network partner.

Western Drug Medical Supply

Western Drug Medical Supply is a leading provider of home medical equipment and supplies in Southern California. They have a large volume of masks procured and have volunteered to donate to providers located in Southern California who need them. Providers should reach out to Western Drug directly or at 1-800-891-3661.

How do Community-Based Adult Services (CBAS) centers continue adult services during the COVID-19 outbreak?

The Department of Health Care Services (DHCS) has released guidance via All Plan Letter (APL) 20-007 that outlines ways CBAS centers may continue to provide services to CBAS participants now remaining at home.

Providers should refer to the Provider Update titled How to Continue Community-Based Adult Services During the COVID-19 Outbreak distributed on April 17, 2020, for additional information.

• For information for Health Net Medi-Cal (20-359)
• For information for CalViva Medi-Cal (20-360)
• For information for Cal MediConnect (20-361)

What steps are certified CBAS providers required to take for approval to participate in CBAS Temporary Alternative Services (TAS)?

The California Department of Aging (CDA) CBAS Branch has issued All Center Letter (ACL) 20-07 that outlines the requirements for CBAS TAS and the steps that certified CBAS providers must take for approval to participate in CBAS TAS.

Providers should refer to the Provider Update titled How to Continue Community-Based Adult Services During the COVID-19 Outbreak distributed on April 17, 2020, for additional information.

• For information for Health Net Medi-Cal (20-359)
• For information for CalViva Medi-Cal (20-360)
• For information for Cal MediConnect (20-361)

How do members obtain an emergency supply of a prescription?

To obtain an emergency supply of a prescription medication, affected members can return to the pharmacy where the original prescription was filled. In addition, we are waiving prescription refill limits for medically necessary drugs and relaxing restrictions on home or mail delivery of prescription drugs. If the pharmacy is not open due to the state of emergency, affected members can contact the Emergency Response line at 1-800-400-8987, 8 a.m. to 6 p.m. Pacific Time (PT) for questions or assistance.

Commercial Members:
Providers should refer members on an individual, family or employer plan seeking additional information and guidance on pharmacy and prescriptions to the Health Net member alerts page under the accordion titled Pharmacy and Prescriptions – Refills and Emergency Supply.

Is coping assistance offered to members impacted by COVID-19?

Members impacted by COVID-19 may contact MHN, our behavioral health subsidiary, for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss, or other trauma resulting from COVID-19. For the duration of the COVID-19 public health emergency period and its immediate aftermath, affected members may contact MHN 24 hours a day, seven days a week at 1-800-227-1060, or the telephone number listed on the member's identification (ID) card.

Health Net encourages participating provider groups (PPGs) to educate contracted providers on disaster-responsive, trauma-informed care. This education or training should include the crucial roles of:

• Ensuring physical and emotional safety of patients
• Building trust between providers and patients
• Recognizing and responding to the signs and symptoms of stress on physical and mental health
• Promoting patient-centered, evidence-based care
• Ensuring provider and patient collaboration in treatment planning
• Sensitivity to the racial, ethnic, cultural, and gender identity of patients
• Supporting provider resilience

PPGs should ensure their providers and care management teams learn the signs of and assess for stress-related morbidity, and create responsive treatment plans, including supplementing usual care with measures that help regulate the stress response system, such as:

• Supportive relationships
• Age-appropriate, healthy nutrition
• Sufficient, high-quality sleep
• Mindfulness and meditation
• Adequate physical activity
• Mental health care

Additional resources on how to mitigate the stress-related health outcomes anticipated with the COVID-19 emergency can be found at ACEs Aware.

Adverse Childhood Experiences (ACEs) resources and information for Medi-Cal can be found at California Department of Health Care Services | ​​​​​​​​Trauma Screenings and Trauma-Informed Care Provider Trainings.

What if my office or facility is impacted by COVID-19?

If your office or facility is impacted by COVID-19 and this affects your ability or capacity to provide services and access to members, please contact your provider network regional representative immediately. If you are affiliated with a participating physician group (PPG) or independent physician association (IPA), please contact your PPG of IPA immediately. Health Net contracted PPGs must notify their Health Net designated network representative of any changes in access to their provider panel.

As a reminder, providers are responsible to provide coverage to their patients, and to communicate this to patients via appropriate signage, messaging, and communications. We encourage the use of telehealth services to promote physical distancing while supporting the needs of your patients, whenever possible. The use of urgent care or emergency room/department services to provide routine coverage for your office is not appropriate, unless the use of emergency room/department services are medically necessary.

If you close your office, or if you switch to only providing virtual appointments, take the following action:

1. Contact your Health Net provider network regional representative immediately.
2. Notify your patients who have upcoming appointments about your office changes and provide documentation of how your patients were notified to your Health Net designated network representative.
3. Inform your patients about available coverage options for your office, including voicemail instructions and/or message for patients, posters and member outreach.

Where can I obtain general information and guidance on COVID-19?

Coronavirus disease 2019 (COVID-19) is an emerging illness. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness. New information, obtained daily, will further inform the risk assessment, treatment options and next steps. We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.

Guidance:

• Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.
• Be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
• Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
• Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
• Refer to the Centers for Disease Control and Prevention (CDC) criteria for a patient under investigation for COVID-19. Notify local and/or state health departments in the event of a patient under investigation for COVID-19. Maintain a log of all health care personnel who provide care to a patient under investigation.
• Monitor and manage ill and exposed healthcare personnel.
• Safely triage and manage patients with respiratory illness, including COVID-19.
• Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.

Take Action:

1. Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
2. Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
3. Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
4. Refer to the CDC and the World Health Organization (WHO) for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
5. Be familiar with the intended scope of available testing and recommendations from the U.S. Food & Drug Administration (FDA).
6. Visit the California Department of Public Health (CDPH) for information about COVID-19 and the latest guidance from public health officials.

Provider Alerts:

You can also visit the provider alerts page at Welcome Health Net Providers and access Health Net Alerts: COVID-19 in the yellow bar.

Does the Department of Healthcare Services (DHCS) have any resources available for providing care during COVID-19?

Providers are encouraged to reference the following resources distributed by the DHCS to managed care plans (MCPs) to assist with providing care during the COVID-19 crisis:

• Asthma Management (PDF)
• CalHope (PDF)
• Managing Diabetes (PDF)
• Managing Hypertension (PDF)
• Prenatal and Postpartum Care (PDF)
• Well Visits and Immunizations (PDF)

What resources are available from DHCS to assist with the COVID-19 epidemic's immediate and long-term impacts on the mental health?

Providers can refer to the DHCS notice on suicide and prevention screening and resources to assist with providing immediate and long-term care for patients resulting from the COVID-19 crisis.

• DHCS notice on suicide and prevention screening and resources (PDF)

• All participating providers must continue to provide health care services and perform delegated functions. However, the CDC, CMS and other health authorities may recommend delaying elective inpatient and outpatient surgical and procedural cases. The referring or treating provider must have determined and noted in the relevant record that when considering COVID-19 implications during this public health emergency period, a longer waiting time will not have a detrimental impact on the health of the member.
• Telehealth services during this emergency period may be used to determine medical necessity for someone to come into the office, emergency room or urgent care center. Refer to Telehealth Guidance above for more information.
• For Commercial and Medi-Cal, where mailing hard-copy notices to members and providers as required by law is delayed due to personnel shortages and/or safety precautions enacted, please contact the member or provider electronically or by telephone. If the provider or PPG, as the case may be, does not have personnel available to mail hard-copy information, it is sufficient to communicate with members and providers electronically and/or by telephone, so long as a log or record of such communications is maintained. (Note: CMS has not yet communicated a similar relaxation of its regulatory requirements for Medicare Advantage.)
• Health care workers, including those supporting healthcare operations, are considered essential workers and are exempt from the "stay at home," "shelter in place," and "shelter at home" recommendations and orders recently announced.
• Los Angeles County providers can refer to the Los Angeles County Department of Public Health's alert regarding Preserving Critical Supplies and Resources.
  • Los Angeles County Department of Public Health's alert regarding Preserving Critical Supplies and Resources (PDF)
• San Joaquin County providers can refer to the San Joaquin County Public Health Office (PHO) Isolation and Quarantine Orders for community members diagnosed with or suspected of having COVID-19.
  • San Joaquin County Public Health Office (PHO) Isolation and Quarantine Orders