Association Executive Directors Community

  • 1.  State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-06-2022 12:09

    Dear Colleagues - Once the PHE is ended, Maryland Medicaid is proposing to eliminate audio-only telehealth in any capacity, and potentially restrict the use of audio-visual telehealth in a variety of behavioral health programs, including psychiatric rehabilitation, supported employment, ACT, and other team-based or paraprofessional interventions. I know that Missouri and Pennsylvania have adopted regulations or statutes to extend telehealth in Medicaid-funded behavioral health settings. I am looking for examples of other state Medicaid programs that have:

    • Allowed any type of telehealth in psych rehab, ACT, supported employment, etc.
    • Allowed audio-only telehealth in some circumstances in any behavioral health programs.

     

    Please send a link or citation to any adopted regulations or statutes on this topic – and thank you in advance.

     

    Shannon Hall

    CBH



    ------------------------------
    Shannon Hall
    Executive Director
    Community Behavioral Health Association of Maryland
    Catonsville MD
    410-788-1865 ext 2
    ------------------------------


  • 2.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-06-2022 17:38

    Hi Shannon,

     

    Here is the legislation Tennessee passed. Initially, it did not include audio-only. We got that added for behavioral health in 2021. It was due to sunset in 2022, but is now permanent. I'm told MCOs try to regulate what can be delivered via audio-only, but I haven't seen anything consistent just yet.

     

    https://www.tncourts.gov/Tennessee%20Code

     

    TCA: 63-1-155

     

    Provider-based telemedicine.

    (a) As used in this section:

    (1) "Health insurance entity" has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5;

    (2) "Healthcare services" has the same meaning as defined in § 56-61-102;

    (3) "Healthcare services provider" means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33;

    (4) "Healthcare system" means two (2) or more healthcare organizations as defined in § 63-1-150, that are affiliated through shared ownership or pursuant to a contractual relationship that controls payment terms and service delivery;

    (5) "Practice group" means two (2) or more healthcare services providers that share a common employer for the purposes of the healthcare services providers' clinical practice;

    (6) "Provider-based telemedicine":

    (A) Means the use of Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

    (i) The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;

    (ii) The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and

    (iii)

    (a)  The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare service provider, the healthcare services provider's practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit; and

    (b)  The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit is tolled for the duration of a state of emergency declared by the governor pursuant to § 58-2-107; provided, that the healthcare services provider or the patient, or both, are located in the geographical area covered by the applicable state of emergency;

    (B) Does not include:

    (i) An audio-only conversation;

    (ii) An electronic mail message or phone text message;

    (iii) A facsimile transmission;

    (iv) Remote patient monitoring; or

    (v) Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity's business; and

    (C) Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of:

    (i) Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and

    (ii) Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;

    (7) "Qualified site" means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity; and

    (8) "Store-and-forward telemedicine services":

    (A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and

    (B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation.

    (b) Healthcare services provided through a provider-based telemedicine encounter must comply with state licensure requirements promulgated by the appropriate licensure boards. Provider-based telemedicine providers are held to the same standard of care as healthcare services providers providing the same healthcare services through in-person encounters.

    (c) A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity's network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity's network.

    (d) A health insurance entity:

    (1) Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;

    (2) Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient's health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;

    (3) Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and

    (4) Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

    (e) A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

    (f) This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

    (g)

    (1) This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

    (2) As used in subdivision (g)(1):

    (A) For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, "medically necessary" means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and

    (B) For all other healthcare services, "medically necessary" means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

    (i) In accordance with generally accepted standards of medical practice;

    (ii) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; and

    (iii) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease.

    (3) This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

    (4) This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

    (h) Any provisions not required by this section are governed by the terms and conditions of the health insurance policy or contract.

    (i) Provider-based telemedicine is subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

    (j)

    (1) This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.), medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies.

    (2) This section does apply to the basic health plans authorized under title 8, chapter 27, parts 1, 2, 3, and 7.

    (k) A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall:

    (1) Confirm and maintain documentation that the patient:

    (A) Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter;

    (B) Is at a location where an audio-video encounter cannot take place due to lack of service; or

    (C) Has a physical disability that inhibits the use of video technology; and

    (2) Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.

     

    ALYSIA SMITH KNIGHT

    Executive Director

    TENNESSEE ASSOCIATION OF MENTAL HEALTH ORGANIZATIONS (TAMHO)

    201 Seaboard Lane, Suite 100| Franklin, TN 37067

    PHONE: 615-519-3985 mobile

    EMAIL: asmithknight@tamho.org

    URL:  www.tamho.org

     

    tamho final

     

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  • 3.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-06-2022 17:38
    Shannon, 

    Michigan's proposed post-PHE Medicaid telehealth policy can be found at: https://cmham.org/wp-content/uploads/2022/08/2223-Telemedicine-ProposedPolicy.pdf 

    This policy has some strengths, but eliminates audio-only telehealth practices. 

    Our association has voiced opposition to this elimination and has urged our members and allies to do the same. Our association's comments on this segment of the draft policy can be found at: https://cmham.org/wp-content/uploads/2022/09/CMHA.MemoLauraKilfoyle.pdf

    ------------------------------
    Robert Sheehan
    Chief Executive Officer
    Community Mental Health Association of Michigan
    Lansing MI
    (517)374-6848
    ------------------------------



  • 4.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-06-2022 17:38
    Hi Shannon.

    Ohio has passed legislation that support telehealth generally for behavioral health conditions.  The link to HB 122 is included below.  Additionally, the Ohio Department of Medicaid and Ohio Department of Mental Health and Addiction Services also have administrative rules that support wide use of telehealth.  The administrative rules were put in place early in the pandemic and allowed community BH providers to use a wide range of telehealth services and we saw little decline in overall access to services.  Even today, about 30% of community BH services are being delivered via telehealth.

    HB 122:  https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA134-HB-122

    Ohio Medicaid Telehealth rule:  https://codes.ohio.gov/ohio-administrative-code/rule-5160-1-18

    OhioMHAS Telehealth Rule:  https://codes.ohio.gov/ohio-administrative-code/rule-5122-29-31

    Hope these are useful to you.  Let me know if you'd like to talk more about this.  Our biggest barrier was our Medical Board - they have a very old school approach to telehealth.  But the legislation has helped move them into a better place.

    Teresa

    ------------------------------
    Teresa Lampl
    CEO
    Ohio Council of Behavioral Health & Family Services Providers
    Columbus OH
    614-228-2747
    ------------------------------



  • 5.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-06-2022 17:39
    Hi Shannon,

    We have a statute that requires coverage of telehealth for BH in the Medicaid delivery system "if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth..."  "Behavioral health services" are defined as " care and services for the evaluation, diagnosis, treatment or management of patients with mental health, developmental or substance use disorders, and "telehealth" is broadly defined as "use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient's physical health, oral health, mental health or substance use disorder condition."  Link here

    Relative to your two questions:
    1.) psych rehab and supported employment are not part of the delivery system subject to the statute.   The Department that oversees the largest psych rehab service now enforces a contractual obligation for weekly face-to-face contact.   ACT straddles both third-party reimbursable Medicaid and state contracted services.   Our state mental health authority is not supportive of ACT delivered via telehealth. 
    2.) Audio-only is broadly allowable.  Anecdotally, our members are reducing use of audio-only service delivery.  That said, our Medicaid agency began requiring use of an audio-only payment modifier, and we expect pushback on this in the future.  

    Medicaid has made clear in implementing materials that there may be future limitations:  Medicaid "will continue to analyze telehealth's impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023."  


    ------------------------------
    Lydia Conley
    President/CEO
    Association for Behavioral Healthcare
    Natick MA
    508-647-8385
    ------------------------------



  • 6.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-07-2022 09:14
    Hi Shannon- 

    The Center for Connected Health Policy is an excellent resource for state telehealth policy details and citations across every state. The page specific to audio-only provisions can be found here. I have a few state provisions in mind that may be helpful (WA, TX, UT)- I'll email those directly. 

    Best, 

    Keisha 


    ------------------------------
    Keisha Pitts
    National Council for Mental Wellbeing
    Washington DC
    202-684-7457
    ------------------------------



  • 7.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-07-2022 17:05
    Hi, Shannon - In New Jersey a law was passed (https://pub.njleg.state.nj.us/Bills/2020/PL21/310.PDF ) that leaves most provisions in place permanents; only the parity rate provision expire in December 2023 (to be reviewed following a report due by then). Specifically, the law provided parity reimbursement, i.e., requires the same rates for telehealth and in-person services except for audio-only physical health services. (NJAMHAA took the lead and with other stakeholders was successful in having audio-only services for behavioral health services remain subject to parity reimbursement requirements). The parity provision is set to expire after two years (December 2023) and requires a study in the interim before extending the provisions.  The bill allows clients to receive telehealth services in their homes or other places of their choosing and for providers to be at any location when delivering services.  Meeting HIPAA and other standards are required in the law, as are levels of licensure or certification to be able to bill for telehealth services.

    ------------------------------
    Debra Wentz
    President & Chief Executive Officer
    New Jersey Association of Mental Health and Addiction Agencies, Inc
    Mercerville NJ
    (609)838-5488
    ------------------------------



  • 8.  RE: State Medicaid Rules Allowing Telehealth for Behavioral Health After the PHE Ends - Examples Requested - 12/6/22

    Posted 12-08-2022 14:35
    Hi, Shannon -

    Connecticut passed a law in 2021 that requires Medicaid to reimburse for audio-only as long as it's allowed by CMS through 2024. We expect legislative efforts to pass a "permanent" law (which may change some of those requirements) in 2023 or 2024. Our Medicaid authority has just presented a very preliminary draft of which services will continue (both with any type of telehealth and audio-only) after the PHE, significantly limiting what's available under the PHE but not eliminating them altogether. However, nothing is final here yet.

     

    Here is Public Act 21-9: https://www.cga.ct.gov/2021/act/pa/pdf/2021PA-00009-R00HB-05596-PA.pdf



    ------------------------------
    Gian-Carl Casa
    President and CEO
    Connecticut Community Nonprofit Alliance, Inc.
    Hartford CT
    (860)525-5080 1022
    ------------------------------