Notable Industry Changes for 2023

Here at Hansei Solutions, we strive to keep our clients informed and up-to-date on the latest industry changes. As we enter 2023, it is important to stay ahead of the curve and be prepared for the potential impacts these changes may bring. We are committed to providing our clients with the most relevant and reliable information, allowing them to continuously remain competitive and successful in their respective industries. The following changes being made in 2023 are discussed below.

Anthem BCBS – Change in Pricing Methodology

Anthem BCBS plans with the alpha prefix ‘CPR’ have historically been managed by the California Public Employee Retirement System [CALPERS]. These plans allowed payments at 100% of billed charges, with 60% paid by insurance and 40% by the member. However, as of 2023, Anthem CALPERS plans will no longer base reimbursement on billed charges. The new method chosen by Anthem BCBS has yet to be released, but it is likely that it will follow general Anthem procedures, which are in line with local allowable rates.

CIGNA – Change in Geographic Coverage

Cigna has taken steps to limit the coverage of its Individual & Family Plans (IFP) purchased on the exchange, only offering treatment in select states using providers that are part of Cigna’s Connect Network. This means that customers will have access to fewer treatment options than they may have previously expected, so it is important to verify that their desired providers are included in the Connect Network before purchasing an IFP plan. Coverage is an important factor when selecting a health insurance plan, and customers should be aware of the limits imposed by Cigna’s new policy.

Our team is dedicated to providing the highest level of care for our clients and will work tirelessly with Cigna to ensure that those with IFP plans currently in our care are able to continue receiving the care they need. During this process, we recommend that all clients contact our Utilization Review department and/or their Account Manager with any additional questions or concerns.

Regence – Change in ASAM Approval Criteria in California

Regence has had to take a firm stance on the regulations of the American Society of Addiction
Medicine (ASAM) Approval Criteria in California, and as of now, is no longer approving ASAM 3.7 for
any facility that does not have CARF and/or a license from the Department of Public Health. Further,
a license issued from the Department of Managed Health Care (DMHC) will not be accepted due to
them no longer providing licensure for Sub-Acute Detox services.

Managed Health Network – Clinical Reporting for Seizure History Potentially Changes Detox Admissions

As we enter the new year, we’re adjusting our clinical reporting process to align with newly set expectations from MHN.

While we await the official payor update, we’ve been informed by three different representatives that newly admitted patients with a history of seizures will be flagged for review prior to authorization approval. Simply put, MHN may now be able to get coverage detox for these patients.

In summary, this means:

• The client’s seizure history must be reviewed with the medical provider.
• Provider shall document the clinical review accordingly, with an agreement to accept the client at the recommended level of care.
• The case shall be reviewed with MHN, noting the provider’s attestation to accept responsibility, which will officially be recorded by the payor.

What You Need to Know (MHN)

When admitting an MHN client with a history of seizures, the following must be documented and provided to MHN:

• When did the seizure occur?
• How long did it last?
• Was there the typical tonic/clonic motor activity associated with a grand mal seizure?
• Was there confusion after the seizure?
• Did anyone witness the seizure?
• Was medical attention required?
• Were medications initiated?
• Were there multiple seizures? If so, provide similar details.

For those admitting with a history of seizures, MHN will allow detox services at your facility only if the treatment team of providers are willing to attest to offering a safe detox environment and the attending provider is willing to assume responsibility for the client’s care.

Hansei Solutions is Here to Help

At Hansei Solutions, we understand the importance of staying informed with the current industry updates in order to ensure the best possible service to our clients. As a reminder, Hansei Solutions is actively monitoring these updates and developments and will keep you informed of any changes.

We are here for you and want to ensure that you have all of the information you need to seamlessly adapt to these changes. Therefore, do not hesitate to contact us with any additional questions or concerns that you may have.