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Medical Policies - UNDER REVIEW

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Medical Policies - UNDER REVIEW
 
Medical Policies - CURRENTMedical Policies - ARCHIVED (inactive)


HMSA's medical directors welcome comments and suggestions from participating physicians regarding new medical policies that are under development as well as medical policies that are undergoing annual review. The information below lists policies for which HMSA is currently soliciting input from physicians.

 

Physicians may comment via e-mail to medical_policy@HMSA.com or by fax at 944-5611 on Oahu.

 

Physician input will be taken into consideration during the policy development and review processes. However, HMSA does not guarantee any specific change will be included in the reviewed policy.

 

HMSA medical policies rely on the use of evidence-based medicine, which typically comes from peer-reviewed literature. Physicians submitting comments should include citation source material to support their positions. Inclusion of this material will help HMSA's medical directors evaluate the comment or proposed change.

 

Current Versions of HMSA’s medical policies can be found on the PRC Medical Policies - CURRENT page.
 

The following policies are currently under review. The current review period is Quarter 4 (Q4 2023).

  • Aduhelm (Aducanumab) for Treatment of Alzheimer’s Disease
  • Intensity Modulated Radiation Therapy (IMRT)
  • Bone (Mineral) Density Studies
  • Charged-Particle (Proton or Helium Ion) Radiation Therapy for Neoplastic Conditions
  • Clinical Practice Guidelines 
  • Colonoscopy
  • Colorectal Cancer Screening
  • Digital Breast Tomosynthesis (3D)
  • Home Health Care - Commercial
  • Home Health Care – QUEST Integration
  • Image-Guided Radiation Therapy (IGRT)
  • Knee Orthoses for Osteoarthritis
  • Laser Therapy for Plaque Psoriasis
  • Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
  • Esketamine Nasal Spray for Treatment-Resistant Depression
  • Gender Identity Services
  • Transcranial Magnetic Stimulation as a Treatment of Depression and other Psychiatric/Neurologic Disorders
  • Precertification Requirements - HMSA Medicare Advantage Plans

HMSA Akamai Advantage® is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.
Rev#:Date:Nature of Change:
3.0 (v20)02/08/2024The following disclosure statement has been added: 
HMSA Akamai Advantage® is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.
2.9 (v19)10/03/2023Posted the list for Medical Policies under review for Q4 2023.
2.8 (v18)06/28/2023Posted the list for Medical Policies under review for Q3 2023.
2.7 (v17)05/19/2023Posted the list for Medical Policies under review for Q2 2023.
2.6 (v16)01/18/2022Posted the list for Medical Policies under review for Q1 2023.
2.5 (v15)09/27/2022Posted the list for Medical Policies under review for Q4 2022.
2.4 (v14)06/29/2022Posted the list for Medical Policies under review for Q3 2022.
2.3 (v13)04/01/2022Posted the list for Medical Policies under review for Q2 2022.
2.2 (v12)01/04/2022Posted the list for Medical Policies under review for Q1 2022.
2.1 (v11)09/29/2021Posted the list for Medical Policies under review for Q4 2021.
2.0 (v10)07/01/2021Posted the list for Medical Policies under review for Q3 2021.
 
Rev#:Date:Nature of Change:
 09/15/2010First Published
1.009/16/2010Added links to policies that will be undergoing annual review. And minor changes to document title - made it all caps.
1.101/24/2011Revised page with the new links to policies undergoing annual review. 
1.202/09/2011Revised page with the new links to policies undergoing annual review. 
1.302/10/2011Added link to "Home Hydration Therapy for Adults" to list.
1.402/10/2011No changes. Just checked hyperlink color properties for verification. 
1.503/01/2011Updated the page with the medical policies that will be undergoing annual review for March 2011. 
1.603/02/2011Added to the list: Endoscopic Radiofrequency Ablation for Barrett's Esophagus
1.704/08/2011Updated the list with the current medical policies undergoing annual review for April 2011.
1.804/18/2011Updated the list with the current medical policies landing page links undergoing annual review for April 2011. 
1.904/21/2011Updated the list with the current medical policies landing page links undergoing annual review for April 2011. 
1.1005/01/2011Updated the list with the current medical policies landing page links undergoing annual review for May 2011. 
1.1106/01/2011Updated the list with the current medical policies landing page links undergoing annual review for June 2011. 
1.1203/30/2012Updated page for April 2012, as there are no policies currently undergoing annual review or any new policies.
1.1307/10/2012Updated the fax number.
1.1407/18/2012Updated the list since there are currently no policies undergoing annual review.
1.1508/13/2012Added the new policies undergoing annual review with a deadline for comments on September 30, 2012.
1.1612/14/2012Removed the links to the policies, as there are no longer any new policies or policies undergoing annual review.
1.1702/13/2013Added a link to the New, draft policy with the March 13, 2013 deadline for comments.
1.1803/14/2013Added a link to the "Transcatheter Pulmonary Valve Implantation", draft policy with the April 14, 2013 deadline for comments.
1.1903/14/2013Added a link to the "Habilitative Services" Draft policy to the table.
1.2007/28/2013Added a link to the "Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry" Draft policy to the table.
1.2108/19/2013Added a link to the "Spinal Interventional Pain Management and Lumbar Spine Surgery" Draft policy to the table.
1.2202/19/2014Added a link to the "Repetitive Transcranial Magnetic Stimulation for Treatment Refractory Depression" policy with a 30-day comment period to the table.
1.2308/11/2014Added a link to two new draft policies.
1.2401/14/2015Added a new policy to the New Policy section: MM.06.025 Subcutaneous Implantable Cardioverter Defibrillator (ICD) System DRAFT POLICY  Comments due 2/13/2015
1.2501/26/2015Removed Chiropractic Services from Annual Review section.
1.2602/10/2015Removed Subcutaneous Implantable Cardioverter Defibrillator (ICD) Systems from the New Medical Policies section.
1.2702/19/2015Added a link to the draft policy: Percutaneous Mitral Valve Repair DRAFT POLICY pdf.  Due date for comments:  March 21, 2015
1.2802/26/2015Added links to policies currently under annual review Due date for comments:  April 30, 2015
1.2903/18/2015Added link to a new policy for 30-day review: Home INR Monitors. Due date for comments:  April 18, 2015
1.3003/30/2015Removed the link for the Percutaneous Mitral Valve Repair policy.
1.3104/14/2015Added a link to the new Gradient Compression Garments for the Extremities policy with a 30-day comment due date.
1.3204/21/2015Removed the link for the Home INR Monitor medical policy.
1.3304/28/2015Added new section for the CVS medical policies.
1.3405/29/2015Removed CVS policies that are available for comments through 5/31/15. To be posted 6/1/15. Removed all medical policies that are under annual review and available for comments through 5/31/15. To be posted 6/1/15. Added 15 medical policies that are under annual review and available for comments through 6/30/15.  Added 13 medical policies available for comment through 7/31/15.
1.3506/19/2015Removed: Gradient Compression Garments for the Extremities (review due date 5/14/15).  
1.3607/15/2015Added link to 30-day review for Laser Therapy for Plaque Psoriasis (due 08/17/2015).  
1.3709/04/2015Removed all outdated information.  
1.3809/16/2015Updated list with 28 policies that are currently under review. Deadline for comments: October 31, 2015. 
1.3905/16/2016Removed all outdated entries.
1.4006/01/2016Updated format of the tables and added entries for Humira and PCSK9 Inhibitors.
1.4107/08/2016Removed the PCSK9 Inhibitors entry as the 30-day comment period has passed.
1.4207/08/2016Added five links to policies undergoing a 90-day review, effective 10/1/2016.
1.4311/23/2016Updated list for policies under review, effective 3/1/17.
1.4408/28/2017Updated table with policies under review, with comments due 10/1/17. Removed the outdated list of policies with comments due 3/1/17.
1.4511/06/2017Updated table with policies under review, with comments due 12/1/17. 
1.4612/11/2017​*Change "Pre-certification Requirements - Akamai Advantage Plans" link name to "Precertification Requirements - Medicare Advantage Plans" *Replace "Akamai" with "Medicare"
1.4712/19/2017Updated page with policies solicited for annual policy review due before 1/15/18.
1.4812/27/2018Updated the page with current content. Removed table formatting.
1.4903/26/2019Updated the page with current content.
1.5006/26/2019Updated the page with 2019 Q3 policies under review.
1.5110/03/2019Updated the list of policies under review - removed Q3 policies and replaced with Q4 policies.
1.5201/07/2020Updated the list of policies under review - removed Q4 policies and replaced with Q1 policies.
1.5301/31/2020Updated the list for Medical Policies under review for Q1 2020.
1.5403/30/2020Updated the list for Medical Policies under review for Q2 2020.
1.5506/30/2020Updated the list for Medical Policies under review for Q3 2020.
1.5608/05/2020Added the following links to the top of the page for user accessibility:
Medical Policies - CURRENT
Medical Policies - ARCHIVED (inactive)
1.5710/01/2020Updated the list for Medical Policies under review for Q4 2020.
1.5812/29/2020Updated the list for Medical Policies under review for Q1 2021.
1.5903/30/2021Updated the list for Medical Policies under review for Q2 2021.
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Medical-Policies-UNDER-REVIEW
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