Audience: Behavioral Health Providers and Outpatient Facilites
On November 27, 2020, the New York State Department of Financial Services issued an extension of its emergency regulation and circular letter, which was set to expire on November 27. The regulation waives member cost-share for outpatient mental health services provided to essential workers during the COVID-19 state of emergency.
Under the extension, health plans are prohibited from imposing copayments, coinsurance, or deductibles for outpatient mental health visits rendered by in-network outpatient mental health service providers through January 26, 2021. However, collecting deductibles is permissible from members with coverage under a high-deductible health plan until the member has met the deductible amount.
Excellus BlueCross BlueShield will continue to waive member cost-share through January 26, 2021 for in-network outpatient behavioral health services provided to our members with coverage under:
- Commercial insured
- Medicare Advantage
- Essential Plan
- Healthy NY
- Qualified health plans
- Student plans
- Article 47 plans
- Self-funded plans that opt in to provide coverage
- High-deductible health plans where deductible has been met
This cost-share waiver does not apply to self-funded employer groups that have elected not to offer the waiver. It also does not pertain to Medicaid Managed Care or Child Health Plus members, as they already have no cost-share responsibility. As stated above, collecting deductibles is permissible from members with a high-deductible health plan until they have met their deductible, at which point there will no cost-share responsibility. Please note that preauthorization is still required, as applicable.
Please refer to our May 27, 2020 communication for additional information, including claims billing information for our members who are considered “essential workers” as well as a list of professions considered “essential” by New York state standards.
Please contact your Behavioral Health Provider Relations representative if you have any questions regarding this information.
Thank you for the quality care you provide to our members.