Coronavirus (COVID-19) Updates
Community Health Choice is monitoring the Coronavirus disease (COVID-19) and providing the most updated information from the Centers for Disease Control and Prevention (CDC), Texas Department of State Health Services, and the Harris County Public Health Department. We will update this page as more information becomes available.
Last updated: July 2, 2020.
Health Conditions at Increased Risk
People of ANY AGE with the following conditions are NOW DEFINED TO BE AT INCREASED RISK of severe illness from COVID-19. Please read the full list and more specific advice from the CDC.
At INCREASED RISK for severe illness from COVID-19:
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Immunocompromised state (weakened immune system) from solid organ transplant
- Obesity (body mass index [BMI] of 30 or higher)
- Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Sickle cell disease
- Type 2 diabetes mellitus
- Children who are medically complex are at higher risk for severe illness from COVID-19 than other children.
- Those who have neurologic, genetic, and metabolic conditions
- Those who have congenital heart disease
MAY be at an INCREASED RISK for severe illness from COVID-19:
- Asthma (moderate-to-severe)
- Cerebrovascular disease (affects blood vessels and blood supply to the brain)
- Cystic fibrosis
- Hypertension or high blood pressure
- Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines Neurologic conditions, such as dementia
- Liver disease
- Pulmonary fibrosis (having damaged or scarred lung tissues)
- Thalassemia (a type of blood disorder)
- Type 1 diabetes mellitus
Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 Infection
The Centers for Disease Control and Prevention (CDC) issued a Health Advisory on May 14, 2020 informing healthcare providers of a Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 infection. The Health Advisory and additional information provided by the CDC provide a case definition for this syndrome and a recommendation for healthcare providers to report patients meeting the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.
Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C):
- An individual aged <21 years presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
- No alternative plausible diagnoses; AND
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms
Additional information is available on the Health Advisory and the CDC pages as well as the CDC’s 24 hour Emergency Operations Center:
CDC’s 24-hour Emergency Operations Center at 770-488-7100. After-hour phone numbers for health departments are available at the Council of State and Territorial Epidemiologists website https://resources.cste.org/epiafterhours.
COVID-19 Diagnosis, Testing, and Treatment
- Community is waiving all deductibles, co-insurance, and co-payment for testing, diagnosis, and medically-necessary acute treatment of COVID-19 and COVID-19 related illnesses consistent with CDC guidance to the extent allowed under federal and state law for CHIP and Marketplace Members through September 30, 2020.
- Community is waiving early medication refill limits on prescriptions.
Wellness Services during COVID-19
The American Academy of Pediatrics issued a statement on the importance of prioritization of well care services including childhood Immunizations and provided guidance on telehealth for pediatric well care. Recommendations include:
- prioritize well child visits
- provide care that is consistent with Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents (4th Edition) and Bright Futures/AAP Recommendations for Preventive Pediatric Health Care
- in-person visits for newborn to 24 months are strongly suggested
- telemedicine services for pediatric patients over 24 months and then complete missed elements (comprehensive physical exam, laboratory testing, immunizations, etc.) when an in-person visit is possible
Visit the following websites for additional information and resources:
- CHIP – Copayments for all services are waived March 13 – September 30, 2020.
- Marketplace/D-SNP – Copayment and Member cost-share waiver is limited to testing (U0001 and U0002) and CDC recommended treatment for COVID-19, telemedicine services, and inpatient admissions with a primary diagnosis of COVID-19 through September 30, 2020.
- Coinsurance and deductibles will apply per plan benefits for all other services, including inpatient admissions without a primary diagnosis of COVID-19.
Community is encouraging our Members to use telemedicine whenever possible. Please continue to encourage use of telemedicine services.
Community is waiving copay and Member cost-share for telemedicine services of any modality for any reason.
- Marketplace and DSNP Members: Continue zero cost telemedicine services through Teladoc.
- Marketplace, DSNP, and CHIP Members: Waive Member copay / cost-share for telemedicine services provided by network providers through September 30, 2020.
- STAR Members: Access to and coverage of telemedicine services provided by network providers.
Prior Authorization Requirements
- Community is waiving authorization requirements for inpatient admissions with a primary diagnosis of COVID-19 through July 31, 2020.
- Please continue to provide notice of admission and clinical information due to conditions unrelated to COVID-19 on our admitted Members.
- Receiving timely physician documentation, preferably a history and physical and physician progress notes will allow for easier approvals.
- If a peer-to-peer call with our Medical Director is necessary to support approval, we are extending peer-to-peer calls to within 3 days of admission and as needed for extended stays.
- As is always the case, authorizations are not required for emergency care (e.g., COVID-19, heart attack, labor, etc.).
Whether Members are admitted for COVID-19 related treatment or an unrelated condition, Community is committed to assisting with our Members’ discharge needs. Providing timely clinical information will help us to support your staff and prevent gaps of service, i.e., home health.
Safe discharge to home is a priority to us for member health and well-being and to prevent hospital readmission. Community receiving timely physician documentation, preferably a history and physical and physician progress notes, is essential for us to partner with your staff in this regard. Our goal is to assist Members after they leave your facility with care coordination following discharge.
To read what Community is sharing with Members about COVID-19, please click here.
Community Press Release
Please click here to read our press release: Update on COVID-19 and the Novel Coronavirus.
Small Business Administration
- UPDATED GUIDANCE: CHIP Office Visit Co-Payments
- Additional Testing Codes for COVID-19 (Updated 6/10/20)
- Alert: Letter from the Office Inspector General
- Applying for Federal Funds
- Authorizations – Elective Procedures (Updated 7/8/2020)
- CARES Act Resources
- CDC Provider Page
- Center for Clinical Standards and Quality/Quality, Safety and Oversight Group
- Claims for Telephone (Audio Only) Behavioral Health Services (updated 7/8/2020)
- Claims for Telephone (Audio Only) Medical (updated 7/8/2020)
- Clinical Preventive Services & Immunizations
- CMS Partner Toolkit
- COVID-19 Coding Guidance
- DSHS COVID-19 Specimen Collection and Submission Instructions
- DSHS Novel Coronavirus Testing Algorithm
- Extension for Prior Authorizations (STAR/CHIP) (updated 7/8/2020)
- Harris County Public Health COVID-19 Provider Page
- HHS COVID-19 Provider page
- Multiple Medicaid COVID-19 Flexibilities Extended Through July 31, 2020 (updated 7/8/2020)
- Teladoc Health
- Telehealth: Behavioral Health Services (updated 7/8/2020)
- Telehealth: Home Health, Speech Occupational, and Physical Therapy Services (updated 7/8/2020)
- Telehealth: PT, ST, and OT Services
- Texas DSHS Provider Page
- THSteps Medical Checkups via Remote Delivery during Implementation of COVID-19 Restrictions (updated 7/8/2020)
- THSteps Medical and Dental Check-ups during COVID-19