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October 9, 2020

Dear Adult Day Health Providers,
As you know, the 2019 Novel Coronavirus Disease (COVID-19) outbreak has presented a public health emergency across the world. Commonwealth Care Alliance (CCA) remains committed to working with our provider partners to provide the highest quality, individualized care to the members we so proudly serve.

CCA is changing its processes in accordance with the recent release of Bulletin 19 EOHHS’ Additional Guidance and Requirements for Reopening Adult Day Health Programs during phase III (https://www.mass.gov/doc/adult-day-health-bulletin-19-additional-guidance-andrequirements-for-reopening-adult-day-0/download).

Based on the EOHHS guidance, we would like to convey some of our expectations regarding the reopening of your programs and the health and safety of our members.

Required Documentation
CCA is aligning our processes with EOHHS and requesting all documentation submitted to EOHHS be forwarded to CCA as well. If you have not already submitted your Provider Attestation and CCA roster, please do so ASAP. Please send all documents to Tim
Guthrie ([email protected]) and Mindy Celona ([email protected]) via email. As referenced in our August 19th communication, this includes, but is not limited, to:

As we also outlined in our August communication, ADH providers are required to conduct a case conference with the returning members and their care partner prior to return and resumption of services. This will allow a discussion and revision of the current care plan to ensure the member’s health and safety needs are maintained.

Please note: If a member has already returned, please ensure a case conference call has been completed with their CCA care partner. Please call the Provider Services line at (866) 420-9332 and select option 4 to reach your patient’s care partner.

Notification of Exposure
As noted in the EOHHS’ Additional Guidance (https://www.mass.gov/doc/adult-day-healthbulletin-19-additional-guidance-and-requirements-for-reopening-adult-day-0/download), if any participant (regardless of payer source) attending the ADH provider’s congregate site or a staff participant working at the ADH provider’s congregate site tests positive for COVID19, the ADH provider must notify both MassHealth and CCA.

As outlined in the Massachusetts Day Program Reopen Approach
(https://www.mass.gov/doc/phase-3-eohhs-day-programming-guidance) (issued July 2, 2020, page 16, E), notifying required parties, funding, and licensing agencies if a participant or staff has tested positive or has been exposed to COVID-19 is required. In addition to notifying MassHealth, please contact both Tim Guthrie ([email protected]) and Mindy Celona ([email protected]), who represent CCA’s Network Contracting Team, via email.

Telehealth/Remote
In relation to the re-opening of Adult Day Health Centers and continuation of remote services, MassHealth released Managed Care Entity Bulletin #43 to detail the temporary reimbursement changes and clinical guidelines associated with re-opening and extended remote services (https://www.mass.gov/doc/managed-care-entity-bulletin-43-one-careplans-and-senior-care-organizations-participating-in-0/download).

Providers must submit the attached Remote Service Log for each Plan (One Care and Senior Care Options), documenting outreach and connection with CCA member(s) an submit it by the 15th of each month to CCA via email to:
[email protected]. For the months of August and September, please submit the Remote Service Log as soon as possible.

CCA has begun implementing these changes to our claims processing system in accordance with the effective dates and modifier details referenced in the bulletin listed above. Any claims received and paid at the original rate with dates of services outlined in the bulletins will be automatically adjusted to pay at the updated rate. Providers will not be
required to resubmit claims and no further action will be needed to receive COVID rate adjustments.

CCA may cover telehealth services if they are medically necessary and clinically appropriate as outlined below. CCA expects that the ADH Provider utilizes appropriate technologies in their communication with our members while maintaining confidentiality and
security as provided by face to face services.

As a reminder, ADH services are provided to members only if the provider’s congregate site opened and began operation no later than September 25, 2020.

Please note: New admissions to ADH can occur only if the individual attends the program in the congregate setting. New admissions cannot occur for remote services only.

Additionally, ADH Providers are expected to notify the CCA care partner immediately of any noted changes in the member’s functional, social, medical, and behavioral status

Excluded Telehealth/Remote Services
The following services are not covered ADH remote services and will not be reimbursed:

Documentation of all remote/telehealth/in-person service delivery must be clearly documented in the member’s record, indicating that the service was provided remotely, and noting how the service provided promoted the prevention of decompensation of member’s baseline.

If a member changes from Remote Only to In-Person services, the ADH member’s care partner needs to be informed of this change. You can reach the care partner by calling (866) 420-9332 and selecting option 4.

Prior Authorization
Once the opening requirements have been met, the ADH provider can move forward with submitting for Prior Authorization for all CCA members. The Prior Authorization requirements can be found in section 4 of the Provider Manual. https://www.commonwealthcarealliance.org/provider-manual/covered-services-priorauthorization-requirement/table#manual-top

All Adult Day Health Services require a Prior Authorization. Please include your documentation to support in-person or remote services.

We realize these are challenging times and look forward to working with you to ensure the appropriate care and safety for our members.

Please feel free to contact Tim Guthrie ([email protected]) or Mindy Celona ([email protected]) via email with any questions.

Sincerely,


Robert Tirimacco
Vice President, Network Management