Neighborhood Health Plan waives prior authorizations for behavioral health, inpatient medical services

Neighborhood Health Plan of Rhode Island (Neighborhood), a not-for-profit health plan that serves approximately one in five Rhode Islanders, is waiving requirements for health care providers to seek prior authorizations for all behavioral health and all inpatient medical services regardless of whether they are COVID-19 related or not.

As of March 18, Neighborhood began waiving prior authorizations and all members out-of-pocket fees for treatment related to COVID-19, including co-pays, deductibles and co-insurance. Likewise, Neighborhood expanded its telemedicine policies to include phone-only with no prior authorization or cost sharing fees. It is also allowing for early prescription refills.

“As our health care providers on the front lines of the coronavirus pandemic ready for the surge of sick patients, Neighborhood is seeking ways to make it easier for doctors to make decisions quickly about their patients treatment,” said Chief Medical Officer Marylou Buyse. “We understand that it will be critically important for health care providers to triage all levels of care in order to address the needs of the community during this rapidly evolving public health crisis.”

No prior authorizations are required to admit patients for treatment regardless of diagnosis for all levels of behavioral health services, and for medical and surgical inpatient services. Neighborhood will request less burdensome notifications to track and serve members admitted to behavioral health and medical inpatient facilities. These waivers apply to both in-network and out-of-network providers, and Neighborhood will re-evaluate this temporary change in policy on April 30. Neighborhood still requires prior authorizations for medical outpatient services and prescription drugs, but is continuing to assess provider and member ease of access during this state of emergency.

These changes are in place for all Neighborhood health plans which include Medicaid eligible children, adults and families; Medicare-Medicaid dual-eligible adults; and individuals, families and small businesses who purchased their health insurance through HealthSource RI, the states health exchange.

More information on temporary policy changes is available for members and providers on Neighborhoods COVID-19 Update page at nhpri.org.