BlueCHiP for Medicare Advance
- Effective January 1, 2023, BlueCHiP for Medicare Advance (Advance) is no longer available to BCBSRI Medicare members. Any member enrolled in the Advance plan has been transferred to BlueCHiP for Medicare Value.
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 and community-based adult intensive services, and child and family intensive treatment.
Routine foot care
- Starting 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, which includes one foot exam for diabetics per year without a cost share. These visits will consider the expanded set of diagnoses.
Hearing aids
- Effective January 1, 2023, upon a plan’s renewal, plans have eliminated the distinction in hearing aid benefits by age. Patients 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, and $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:
- Effective January 1, 2023, upon a plan’s renewal, BCBSRI will adjust the existing methadone maintenance benefit to a $0 copay or 0% post-deductible, both in-network and out-of-network.
- Until renewal, the benefit will continue be one copay per seven days for all products.
Standers (DME)
- Standers are 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 from the horizontal prone (patient on abdomen) or supine (patient on back) position to an upright standing position.
- Effective January 1, 2023, stander devices are covered with prior authorization, under BCBSRI’s medical policy. These devices are currently listed as exclusions.