CareFirst Discontinues Home-Based Services Program

Posted on 2020-10-01
Updated on 2020-10-01 10:27:11

Effective January 1, 2020, CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) will no longer be offering our Home-Based Services (HBS) program. This decision was based on several factors including the availability of traditional home healthcare services. We will also not accept any new service requests for HBS starting October 1, 2020.

Your CareFirst patients with this benefit will be able to continue taking advantage of the Home-Based Services program through December 31, 2020 providing they are in the program on or before September 30, 2020. After December 31, 2020, their current services through the program will end.

Depending on your patient’s health situation, after December 31, 2020, you can refer them to home healthcare services. Services may include skilled nursing, home health aide, therapy (physical/speech/occupational) and medical social work, depending on your patients’ benefits.

In order to participate in traditional home healthcare services, patients with commercial CareFirst insurance coverage must be homebound and have a referral from their provider.

Note: Patients who are 64 or older or have Medicare secondary insurance must have a face to face form confirming that the patient is clinically homebound. The patient must have seen their PCP within 90 days of the services being provided.

Federal Employee Program Updates

If your patient is part of the Federal Employee Program (FEP), the HBS pilot is concluding as of December 31, 2020 and patients will be responsible for paying any costs (copay, coinsurance or deductible) related to using home-based service benefits after that date. Members will also be subject to visit limits, which are reflected in the FEP brochure. Patients who are in the HBS pilot will receive a letter by mail, notifying them of this change effective January 1, 2021.

For FEP members to participate in traditional home healthcare services, a physician must order the care, and the care must be provided in accordance with the requirements of the FEP brochure.

Questions

For questions about this change, please reach out to your Provider Relations Representative.