Medicaid Moves to Extend Telehealth Flexibility
The Ohio Department of Medicaid (ODM) is moving to expand telehealth services, filing permanent rules on the subject after several months of allowing greater use of telehealth on an emergency basis because of the pandemic.
The agency announced the move Tuesday, citing “overwhelming support” from patients and providers based on their experience using telehealth during the pandemic.
ODM said the rules will extend flexibility at least through the pandemic; going beyond that will depend on whether the federal government allows continued flexibility.
About 627,000 Medicaid beneficiaries have received telehealth services generating more than 2.6 million claims since telehealth coverage was expanded in March, according to ODM. Of that, about 200,000 beneficiaries received services totaling 1.28 million claims from providers certified by the Ohio Department of Mental Health and Addiction Services (OhioMHAS.) In comparison, ODM said, providers averaged less than 1,000 physical health claims and 4,000 behavioral health claims monthly for telehealth services before the pandemic.
ODM said the filing of the rules puts them on schedule to take effect as the emergency rules are expiring, pending the input of the Joint Committee on Agency Rule Review (JCARR). The rules can be found on the Register of Ohio at this link: https://tinyurl.com/yxa5ke4r . Interested stakeholders can submit comments on the rule by emailing email@example.com.
“During a time when families are juggling remote learning, work-from-home, and the additional stressors of life during a pandemic, ODM is committed to ensuring members can conveniently access quality health care services -- especially mental health and addiction services,” said ODM Director Maureen Corcoran in a statement. “Expanding telehealth is the silver lining of the COVID-19 pandemic.”
“The relaxation of rules regarding telehealth has undoubtedly led to significantly better care for our patients during these challenging times,” said Central Ohio Primary Care Physicians Senior Medical Director of Ambulatory Services Dr. Robert Stone in a statement. “Making those changes permanent would make those benefits permanent as well – it represents an important step forward in advancing quality patient care.”
According to ODM, the permanent rules make the following revisions to the emergency rules:
- Adds audiology board individuals with a conditional license.
- Adds optometrists.
- Removes fax as a communication medium.
- Allows communication transfers via a “secure patient portal.”
- Removes patient and practitioner location restrictions.
- Telehealth definition now includes remote patient monitoring.
- Requires patients be seen in person at least annually by either the telehealth provider or the provider usually responsible for delivering clinical care, other than an ER provider.
- Adds the requirement that practitioners must adhere to rules promulgated by respective licensing boards.
- Optometry services are added.
- Adds periodic oral evaluation as a covered telehealth dental service.
- Adds interactive complexity, which was not previously included in emergency rule.
- “End stage renal disease” is replaced with “dialysis related services” to be more inclusive.
- Outpatient hospitals are limited to billing for OPHBH and on behalf of licensed psychologists and independent behavior health practitioners.
- Maintains telephone-only service codes 99441 and 99442, but removes 99443 (these codes represent groups of minutes).
- Preserves ability for all telehealth providers to bill consultation E&M codes.
- Removes the provision from the emergency rule allowing a practitioner site to bill an originating fee through telehealth.
- Adds claims submission requirements clarifying that providers must follow ODM billing guidelines when submitting telehealth claims.
** OAMES is having conversations with Ohio Department of Medicaid about telehealth applications to the HME and CRT benefit as well. Watch for updates as work continues. If you have any questions or comments, email OAMES executive director Kam Yuricich at firstname.lastname@example.org.