New Mexico Human Services Department Issues Letter of Direction #30 – COVID-19 Guidance for Centennial Care 2.0 Managed Care Organizations

March 27, 2020

The information below is current as of the date of publication; however, Blue Cross and Blue Shield of New Mexico (BCBSNM) anticipates that guidance and directives will change as this health emergency evolves. BCBSNM encourages providers to check for changes to the Letter of Direction Learn more about third-party links on the New Mexico Human Services Department website daily.

On March 18, 2020, the New Mexico Human Services Department issued Letter of Direction (LOD) #30 – COVID-19 Guidance for Centennial Care 2.0 MCOs Learn more about third-party links. This LOD provides guidance and directives for Managed Care Organizations (MCO) for the modification of services and program standards related to the national public health emergency associated with 2019 Novel Coronavirus (COVID-19) outbreak.

The following services and protocols are impacted by LOD #30:

  1. Member and Provider Communication Protocols
         a.   MCO Call Centers
         b.   Nurse Advice Lines
         c.   MCO Websites and Member Materials
  2. COVID-19 Testing and Treatment Services
         a.   New Billing Codes for Testing (U0001, U0002, 87635)
         b.   Drive-Through Testing/Screening
         c.   Prior Authorizations for Testing and Treatment
         d.   Prohibition Against Cost-Sharing for Testing or Treatment
         e.   Prior Authorizations for All Other Services
         f.    Coverage of Durable Medical Equipment
  3. New Codes for Telephonic Visits and E-Visits
         a.   Physical Health
         b.   Telehealth Billing for FQHCs, RHCs, HBRHCs, and IHS
         c.   Behavioral Health
  4. Care Coordination
  5. Other In-Home Services and Community Benefits
         a.   Centennial Home Visiting (CHV)
         b.   In-Home Community-Based Services and Personal Care Services (PCS)
         c.   Nursing Facility Level of Care (NFLOC) Redeterminations
  6. Pharmacy Requirements
         a.   Maintenance Drugs
         b.   Controlled Substances
         c.   Non-Maintenance Drugs
         d.   Monitoring and Reporting of Drug Shortages
  7. Provider Network Requirements
         a.   Network Adequacy
         b.   Network Changes
         c.   Provider Site Visits and Revalidations
  8. Fair Hearings
  9. Reporting Requirements
         a.   Reporting on Provider Rate Increases
         b.   Other Reporting Requirements
  10. Effective Date and Additional Emergency Actions Pending Federal Approval