Utilization Review of Behavioral Health Services
- BCBSRI is moving from requiring prior authorization to a notice of admission and discharge process for certain out of network* behavioral health services. The impacted services are non-urgent inpatient services, partial hospitalization, intensive outpatient services, transcranial magnetic stimulation, home & community-based adult intensive services, and child and family intensive treatment.
Routine Foot Care
- As of January 1, 2023, routine foot care will expand from being covered for members with diabetes to include those who have other systemic conditions such as metabolic, neurologic, or peripheral vascular disease. This applies to all plans.
- For VantageBlue and New England Health (NEHP) plans specifically:
- These plans have the Value Based Benefit to include one foot care exam for diabetics per year without a cost share. These visits will consider the expanded set of diagnoses.
Hearing Aids
- Starting January 1, 2023, upon a plan’s renewal, plans will eliminate the distinction in hearing aid benefits by age. Clients with a New England Health Plan (NEHP) product will be covered at $2,000 per hearing aid. All other plans will cover $1,500 per hearing aid.
- Example:
- Current: The benefit limit is $1,500 per hearing aid for a member under 19; the benefit limit is $700 per hearing aid for a member over 19.
- New: The benefit limit is $1,500 per hearing aid per occurrence.
Methadone Maintenance
- This update will change the Methadone Maintenance benefit to the following:
- Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust existing methadone maintenance benefit to $0 copay or 0% post deductible both in-network and out-of-network
- Until a client’s renewal, the benefit will continue be one (1) copay per seven (7) days for all segments.
Standers (DME)
- Medical equipment that transitions a member who cannot stand on their own from a sitting to an upright standing position, with the ability to stop at any point in between and be supported during incremental weight bearing or transitions a member from the horizontal prone (patient on abdomen) or supine (patient on back) position to an upright standing position.
- As of January 1, 2023, stander devices will be covered with prior authorization, under BCBSRI’s medical policy. These devices are currently listed as exclusions.