COVID-19 Autism/Applied Behavior Analysis Telehealth Policy Updates 

Providers are encouraged to confirm member benefits and coverage provided by their health plan at the time of service due to the rapidly changing situation.

• Optum will review claims that may be impacted by cost-sharing waivers and reprocess them automatically. The provider will not need to request a claim adjustment or appeal.
• Due to the rapidly changing environment around patient cost-sharing waivers, providers may want to allow their claim to be fully processed before collecting any patient cost-sharing responsibility.

Optum is taking action to ensure health plan members affected by COVID-19 (coronavirus) have the support and resources they need. In order to make it easier for our members to receive appropriate treatment during this challenging time, we are encouraging providers and members to observe social distancing, isolation, and quarantine rules as outlined by the CDC. To support this, consistent with an applicable Notice of Enforcement Discretion from the Office for Civil Rights (OCR) at the Department of Health and Human Services (Notice), on a temporary basis, health care providers, qualified and licensed in accordance with applicable regulations to provide ABA services, may use audio or video communications technology immediately to deliver telephonic and telehealth care to Optum Behavioral Health plan members in addition to any HIPAA-approved telehealth technology as long as this method will effectively support the behavioral health needs of the individual member. Please continue to be aware of other potentially applicable federal and state privacy laws.

Immediate care options open to all Behavioral Health providers during the national COVID-19 health crisis:

Telephonic care:

For providers who do not have access to HIPAA-approved technology typically required to conduct a video-enabled virtual session, or video chat platforms as listed below, telephonic services can begin immediately. Providers do not need to attest through our virtual visits process to provide telephonic care. Please refer to reimbursement guidelines below for telehealth billing guidelines as this will allow properly submitted claims to process through auto-adjudication without creating manual work and support timely payment.

Virtual visits:

HIPAA-approved technology can continue to be used by providers to deliver telehealth care to members. For providers who do not have access to HIPAA- approved technology to conduct a virtual video-enabled session, providers can conduct these sessions immediately using any nonpublic-facing remote communications product that is available to communicate with members as listed below in accordance with OCR’s Notice. Although providers are encouraged to use HIPAA-compliant technologies, consistent with OCR’s Notice, as outlined below and follow Optum standard telehealth processes, during the nationwide public health emergency, providers do not need to attest through the Optum virtual visits process to provide telehealth or virtual visit care. (Please note: Providers will not be listed in the virtual visit provider directory until attestation is completed, including the use of HIPAA-compliant technologies.) Please refer to reimbursement guidelines below for telehealth billing guidelines as this will allow properly submitted claims to process through auto-adjudication without creating manual work and support timely payment.

ABA Services

• Providers must use their clinical judgement about the appropriateness and effectiveness of using telehealth to deliver ABA services based on knowledge of each member’s specific clinical needs. This applies to all ABA CPT and HCPC codes, with the exceptions of 0362T and 0373T, which require on-site services with multiple staff present.
•  Direct ABA treatment rendered via telehealth must be synchronous in nature.
• Current authorizations can be used for telehealth services. If additional units outside of your current authorizations are needed, please contact the ABA team by calling the Behavioral Health number on the back of the members card.
• For more information regarding the Optum ABA network, please visit our ABA Information page.
• Please refer to “Reimbursement Policies” for telehealth billing guidelines, as this will instruct you on properly submitting claims and support timely payment.

During the COVID-19 nationwide public health emergency, providers should provide telehealth services in accordance with the OCR Notice. The OCR Notice contains information regarding applications that may be used to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. 

Optum has temporarily expanded our policies around telehealth services to make it easier for UnitedHealthcare members to connect with their behavioral health provider during the COVID-19 public health emergency.

Commercial Membership:  The above flexibilities are effective for in-network providers through July 31, 2022 and are set to end effective August 1, 2022.  For out-of-network providers, these flexibilities may be applicable in accordance with the member’s benefit plan and as mandated by the state.

Medicaid Membership:  State Medicaid guidance/mandates apply. If no mandate was issued, the expanded policy was applicable through June 17, 2020.

Standard member cost-sharing and benefit plan terms apply unless otherwise mandated by state or contractual requirements. For information regarding our post-COVID Telehealth policy that will be in place after the  Flexibilities end, please review our Frequently Ask Questions here.

Links to other Health Plan COVID-19 sites can be found here.

In addition, providers should continue to:

• Use HIPAA-approved telehealth technologies as well as temporarily allowed popular applications that allow for video chats to provide telehealth in accordance with the OCR Notice
• Notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications

In order for a virtual visit provider to be listed in our virtual visit provider directory for members, a provider must complete a virtual visit attestation form. Optum is processing new virtual visit attestations in the order they are received as quickly as possible and once completed, your information will be displayed in our virtual visit provider directory for members, but, during the nationwide public health emergency, virtual care can be provided to a member..

Optum is continually monitoring this situation and if any further modifications to our normal processes are necessary to accommodate individuals impacted by COVID-19 we will communicate immediate updates on Provider Express. For the latest information as this situation evolves, we encourage people to stay informed by visiting the CDC website.