NYSDOH Office of Health Insurance Programs

  • Memo is also available in Portable Document Format (PDF)

To: CEOs, Government Liaisons, and Medical Directors Re: Preparedness for Coronavirus (COVID–19)
Date: March 5, 2020

Please share this information with all staff as appropriate.

As you are most likely aware, in late 2019, a new Coronavirus was identified as the cause of an outbreak of acute respiratory illness (COVID–19) in Wuhan, China. Since then, an increasing number of COVID–19 cases have been reported in other countries, including the United States, and now New York. The purpose of this guidance is to instruct the Medicaid Managed Care (MMC) plans to develop and institute strategies for COVID– 19 preparedness that ensures timely member access to all relevant information and needed health care services.

This guidance is effective immediately and shall remain in effect for the remainder of the disaster emergency declared by Executive Order No. 202, or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of such state disaster emergency declaration.

Additional guidance to MMC plans will be forthcoming as testing capabilities are expanded and other information becomes available. An emergency declaration may require changes to this guidance. At this time, the MMC plan´s COVID–19 preparedness strategy should include, at a minimum, the following components:

  1. Emergency preparedness plan
    • MMC plans should review and update their internal emergency preparedness plan as needed to ensure infrastructure stability and business continuity so that care is delivered to members in the event of the further spread of COVID–19 in New York.
  2. Prompt access to all needed services
    • The COVID–19 oral/nasal swab test is currently only performed and funded through public health laboratories, including the CDC and Wadsworth Laboratories. As approval is granted for additional laboratories, the test will likely become billable to, and payable by, health plans.
    • MMC plans must ensure prompt member access to all services relevant to COVID–19 care, including outpatient services, telehealth services, inpatient services, emergency services, screening and diagnostic tests, medications, treatments, and emergency transportation services.
    • Such procedure includes evaluation and removal of preauthorization requirements that may delay access to medically necessary treatment for COVID–19. MMC plans should be prepared to expedite utilization review and appeal processes for services related to COVID–19 when medically appropriate.
  3. Proper member guidance and education
    • MMC plans must implement processes to provide information and resources to members on how to protect themselves and minimize transmission of the virus and assist members with understanding how and when to access services for COVID–19 care. Available resource links are below in #6.
  4. Proper provider guidance and education
    • MMC plans must implement processes to promptly answer all provider questions and concerns about the relevant covered services and ensure that providers deliver all necessary care to members.
    • Diagnostic coding guidance is available here.
    • Procedure coding guidance is available here.
  5. Prompt access to appropriately trained providers
    • MMC plans must ensure their provider networks are adequate and appropriately trained in the COVID–19 care and are ready to handle a potential increase in the need for health care services in the event of a rise in COVID–19 cases. If an MMC plan lacks a provider network with sufficient providers with the appropriate experience to meet the health care needs of members affected by COVID–19, the MMC plan must provide access to out–of–network providers to meet the needs of its COVID–19 affected members.
    • Provider guidance is available here.
  6. Utilize public health resources and implement directives
    • Governor Cuomo has issued a directive regarding access and cost sharing for COVID–19 testing and treatment available here.
    • The Department of Financial Services has issued a circular letter on COVID–19 for health insurers here.
    • The Department of Health provides public health information and guidance here and has implemented a Novel Coronavirus Hotline at 1–888–364–3065.
    • The Centers for Disease Control´s website offers up to date information here.

If you have any questions, please contact omcmail@health.ny.gov. Thank you for your attention and action on this important matter.