medicaid reimbursement Archives - OF DIGITAL INTEREST

medicaid reimbursement

Trending in Telehealth: July 2 – 8, 2024

by Amanda Enyeart and Jae Hyun Lee | Jul 12, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Insurance and Medicaid reimbursement
Behavioral and mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In Pennsylvania, the governor signed SB 739, which amends Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to require health insurers and Medicaid and CHIP managed care programs to provide coverage for healthcare services delivered through telemedicine using a HIPAA compliant technology. This bill establishes definitions related to telemedicine, as well as requirements for health insurance and Medicaid coverage of telemedicine services.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

Delaware issued a proposed rule to amend the Delaware Administrative code concerning professional counselors of mental health and chemical dependency professionals to clarify that face-to-face supervision or counseling includes live video conferencing.
Arizona issued a notice of rulemaking to notify of its intent to amend the Arizona Board of Behavioral Health Examiners rules to make them consistent with statutory changes including: (1) amending the definition of direct client contact to include therapeutic or clinical care via telehealth; (2) registration of out-of-state providers of telehealth services; (3) removing the requirements for evidence of indirect client hours obtained during training for social workers, counselors, marriage and family therapists, and addiction counselors; and (4) implementing the interstate compact for licensed professional counselors.

Why it matters:

States are increasing access to and coverage for telemedicine services. Pennsylvania expanded access to and coverage of telehealth services across insurance providers and across the state. Additionally, Delaware and Arizona are considering rules to include live video conferencing under the definition of direct patient care.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.

Trending in Telehealth: June 25 – July 1, 2024

by Lisa Mazur and Jae Hyun Lee | Jul 2, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Medicaid reimbursement
Teledentistry
Professional standards
Behavioral and mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking:

Rhode Island entered into the following compacts:
- Social Work Licensure Compact (SB 2184)
- Counseling Compact (SB 2183)
- Speech-Language Pathology Interstate Compact (SB 2173)
- Occupational Therapy Licensure Compact (SB 2623)

Louisiana enacted HB 888 which enters the state into the Social Work Licensure Compact.
In New Hampshire, the governor signed SB 411 which requires coverage of behavioral health or mental health crisis assessments, including both in-person and telehealth services for children and youth 21 years of age and younger.
In Illinois, the governor signed SB 1 which creates the Department of Early Childhood and transfers to it certain rights, powers, duties and functions currently exercised by various state agencies. The bill makes for provision of certain programs that have the ability to utilize telehealth as an option.
Ohio adopted a final rule that provides guidance from the Chemical Dependency Professional Board regarding the ethics and professional conduct of practice for certificate holders and licensees when using telehealth.

Legislation & Rulemaking Activity in Proposal Phase: 17

Highlights:

The Ohio Senate passed SB 211 that would enroll the state in the Dietitian Licensure Compact.
The Pennsylvania Senate passed SB 739 which would amend Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to provide for telemedicine. This bill updates definitions related to telemedicine and requirements for health insurance and Medicaid coverage of telemedicine services.
The lower chamber in Pennsylvania passed HB 2268 which defines telehealth for speech language pathology and requires coverage by payors.
The upper chamber in Pennsylvania passed SB 913 which would require parental consent for virtual mental health services provided by a school entity.
The Delaware House passed SB 301 which would require public universities to provide access to medication to terminate pregnancy and emergency contraception, including requirements for accommodating a student’s request for a telehealth appointment if the student health center is not equipped or staffed to provide the medication.
In Puerto Rico, the Senate passed PS 1136 which would establish the Dental Examining Board of Dentists, Hygienists, Dental Assistants, Dental Technicians or Technologists and, among other things, develop a framework for teledentistry. The bill includes items on consent, patient information protection, definitions and other items related to teledentistry.
Mississippi published a proposed rule that amends the Department of Mental Health’s rules concerning assessments for persons receiving mental health services and/or substance use services to allow initial and subsequent visits to be provided [...]

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Trending in Telehealth: January 22 – 29, 2024

by Patrick Zanayed and Adetoro Olugbemi | Feb 2, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Scope of practice
Medicaid reimbursement

A CLOSER LOOK

Finalized Legislation & Rulemaking

Arkansas passed final rule, which provides Medicaid coverage for ambulance telemedicine triage services. Specifically, an ambulance service may triage and transport a beneficiary to an alternative destination or treat in place if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Florida proposed a rule to clarify the Board of Psychology’s supervised experience requirements in light of recent statutory changes involving telehealth.
Iowa proposed rules to clarify the scope of practice including recordkeeping, ethical practice standards, and use of telehealth visits for occupational therapists and occupational therapy assistants and physical therapists and physical therapist assistants.
Nevada proposed a rule to define a social workers’ scope of practice and licensure requirements and clarify when services may be provided through telehealth to a client outside the State of Nevada, among other things.
South Carolina progressed H 4159 in the second chamber to enact the South Carolina Telehealth and Telemedicine Modernization Act. The bill defines necessary terms and provides requirements for certain regulated healthcare professionals who provide healthcare by means of telehealth; amends definitions in the medical practice act to define “telehealth”; and amends law relating to the practice of telemedicine to revise requirements for the practice of telemedicine and to include provisions concerning telehealth.
South Dakota progressed HB 1015 in the second chamber to adopt the social work licensure compact.
Utah progressed SB 24 in the first chamber. The bill clarifies the scope of practice of physician assistants to include telepsychiatry services.

Why it matters:

States continue to progress laws clarifying the use of telehealth within a practitioners’ scope of practice. This week, Florida, Iowa, Nevada and Utah proposed rules or progressed legislation clarifying that several healthcare practitioners’ scope of practice include the use of telehealth.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott digital health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance. Are you working to make healthcare more accessible through telehealth? Let us help you transform telehealth.

Trending in Telehealth: November 8 – 14, 2023

by Patrick Zanayed and Angela Irene Theodoropoulos | Nov 17, 2023 | Telehealth

Trending in the past week:

Coverage and Payment Parity
Regulatory Licensing
Interstate Compacts
Medicaid Reimbursement

A CLOSER LOOK
Finalized Legislation and Rulemaking

In Florida, the Florida Board of Psychology issued Rule 64B19-17.002 to revise the disciplinary guidelines for licensed psychologists who commit professional conduct violations. The guidelines provide for first and subsequent offenses committed by licensees, including separate disciplinary consequences for out-of-state telehealth registrants.
In Texas, the state’s Health and Human Services Commission (HHSC) renewed its e-Health Advisory Committee (eHAC) by final rule. eHAC currently advises the HHSC executive commissioner and health and human services agencies in the state on strategic planning, policy, rules, and services related to the use of health information technology, health information exchange systems, telemedicine, telehealth, and home telemonitoring services. eHAC was set to expire on December 31, 2023, but has now been extended for a two-year period until December 31, 2025.
Legislation and Rulemaking Activity in Proposal Phase

Highlights:

Michigan proposed several bills concerning coverage and payment parity for telehealth services.
- HB 4580 focuses on coverage parity for telemedicine services in the Medicaid context for the state’s medical assistance program or Healthy Michigan program through amending the state’s Social Welfare Act.
- HB 4131 aims to amend the state’s insurance code to prohibit health insurance policies from denying or restricting coverage for telemedicine services and to require that telemedicine services be treated the same as in-person medical care.
- HB 4579 focuses on amending the state’s insurance code to provide coverage parity for services provided via telemedicine.

Why it matters:

A push for parity. Michigan’s proposed bills are pushing for coverage parity across insurers and payment parity (i.e., telehealth and in-person services must be reimbursed at equal rates). While coverage parity for private payors is already widespread across most states, there is an ongoing debate as to the benefits and drawbacks of payment parity for telehealth. Some argue that equal reimbursement rates for telehealth results in overuse, or that telehealth services are lower value and/or cause less to administer, thereby warranting the lower reimbursement rate. However, without payment parity, a lower reimbursement rate makes telehealth financially impractical for many providers, particularly those with small practices or who are working in underserved communities. The reduction in telehealth services, in turn, has a negative outcome; without as many options, patients face diminished access to care overall and to provider choice, expertise and quality.
Advisory committees can provide state-level oversight to health initiatives. While some states quickly sunset their telehealth advisory councils, others continue to have telehealth and e-health advisory committees and initiatives to guide state programs. Texas’ choice to renew eHAC for another two years signals a [...]

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Trending in Telehealth: November 1 – 7, 2023

by Stacey Callaghan and Angela Irene Theodoropoulos | Nov 10, 2023 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Telehealth Practice Standards
Medicaid Reimbursement
Interstate Licensure Compacts
Regulatory Licensing

A CLOSER LOOK

Finalized Legislation and Rulemaking

In Michigan, the Department of Licensing and Regulatory Affairs promogulated, through final rule, practice standards and requirements for dentistry (including tele-dentistry under Part 6B of the final rule) found at Mich. Admin. Code R. 338.11611 to 338.11615.
- Under the final rule, “telehealth” covers the use of electronic information and telecommunication technologies to support or promote long-distance clinical healthcare, patient and professional health-related education, public health or health administration. Telehealth also may include, but is not limited to, “telemedicine,” which is the use of electronic media to link patients with healthcare professionals in different locations. The final rule also allows for e-prescribing, subject to enumerated requirements.
- The Department waived the existing requirement for in-person contact with the dentist or dental therapist once every 24 months for telehealth services, unless the dentist or dental therapist delegates or assigns duties other than radiographic imaging to allied dental personnel.
- The Department set forth specific requirements for the informed consent process to treat remotely via telehealth. Among other requirements, the licensee must explain the alternatives, capabilities and limitations of telemedicine, and the patient may decline to receive telehealth services.
- The Department articulated privacy standards for telehealth, including that the telehealth encounter must be secure and compliant with federal and state security and privacy regulations.
In Washington, the state’s Health Care Authority issued a permanent rule amending the standards for Medicaid reimbursement of childbirth education classes. The permanent rule added criteria to allow reimbursement for online classes through telemedicine, subject to a one-on-one check-in with the client and qualified childbirth education provider during or after the online classes.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

In West Virginia, the Governor’s Committee on Crime, Delinquency, and Correction modified its proposed rule on Sexual Assault Forensic Examinations to specifically include sexual assault telehealth services. The modification adds a definition for “TeleSANE” to allow certified sexual assault nurse examiners (SANE) with documented expertise to provide forensic exam guidance through telehealth technology.
In Wisconsin, SB 1, discussed in-depth last week, continued to advance after passing through the first chamber and being recommended for concurrence during an executive session. The proposed legislation would ratify and enter Wisconsin into several interstate compacts, including the Audiology and Speech-Language Pathology Interstate Compact, the PA Licensure Compact, the Social Work Licensure Compact and the Counseling Compact.

Why it matters:

Telehealth increasingly represents a mechanism to satisfy niche and specialty care needs. This week saw significant rulemaking activity aimed at leveraging telehealth in unique contexts, from dentistry services to childbirth education, and even sexual assault forensic [...]

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Trending in Telehealth: August 29 – September 5, 2023

by Dale C. Van Demark and Jayda Greco | Sep 8, 2023 | Telehealth

Trending in the past week:

Medicaid Reimbursement of Behavioral Health Services
Practice Standards for Counselors and Therapists
Technology and EHR access

A CLOSER LOOK

Finalized Legislation and Rulemaking

West Virginia enacted emergency rulemaking, effective October 12, 2023, that establishes the scope of practice for the provision of counseling services via telehealth technologies and the process for licensed professional counselors or licensed marriage and family therapists to obtain an interstate telehealth registration with the West Virginia Board of Examiners in Counseling. This rule ensures continuity of care while existing patients are either transitioning to become a resident of another jurisdiction or temporarily located in another jurisdiction.
Washington, DC, adopted an emergency rule, effective September 1, 2023, that reimburses the use of audiovisual telehealth visits in the Assertive Community Treatment (ACT) program within DC Medicaid.
Mississippi finalized rulemaking, effective October 1, 2023, regarding Medicaid coverage for continuous glucose monitoring services via telemedicine.
Oklahoma finalized rulemaking, effective September 11, 2023, that allows for onsite and mobile crisis intervention services to be provided in person or via telehealth.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

California’s state legislature presented AB 1241 to the governor on August 30, 2023. If signed, the bill will loosen certain requirements related to the virtual delivery of care within the Medi-Cal program. Existing law requires providers that furnish services through video synchronous interaction or audio-only synchronous interaction to also either offer those services in person or arrange for a referral to, and a facilitation of, in-person care. That requirement will go into effect by a date set by the State Department of Health Care Services, but no sooner than January 1, 2024. Under AB 1241, providers will instead be required, in the above-described circumstance, to maintain protocols for patient referral to appropriate in-person care when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction.
California’s state legislature progressed AB 965.The bill is an amendment to the Permit Streamlining Act that would require local agencies that process applications for the construction of broadband projects to simultaneously process multiple broadband permit applications for substantially similar projects under a single permit (so-called “batch broadband permit processing”), with the goal of a more efficient broadband approval process.
California also progressed AB 1369 to the Second Committee. This legislation provides that a person licensed as a physician and surgeon in another state would be authorized to deliver healthcare via telehealth to a patient who, among other requirements, has a disease or condition in which there is a reasonable likelihood of death within a matter of months.
Alaska proposed rulemaking to [...]

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Trending in Telehealth: March 6 – March 12, 2023

by Marshall E. Jackson, Jr. and Ashley Ogedegbe | Mar 16, 2023 | Telehealth

Trending in Telehealth is a new series from the McDermott Digital Health team in which we highlight state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Interstate Compacts
Medicaid and Private Payor Reimbursement
Prescribing
Health Practitioner Licensing
Behavioral Health

A CLOSER LOOK
Finalized Legislation & Rulemaking:

In Oregon, the Workers’ Compensation Division of the Department of Consumer and Business Services adopted a final rule that updates and incorporates by reference the new medical billing codes and fee schedule for telehealth and telemedicine services published by the American Medical Association. The rule, which becomes effective on April 1, 2023, among other things, specifies that providers should use certain place of service codes to indicate where the provider provides medical services to a patient through telehealth (i.e., place of service code “02” to be used for “Telehealth provided other than in a patient’s home,” and place of service code “10” to be used for “Telehealth provided in a patient’s home.”). The rule also clarifies that modifier 95 should be used when a provider renders synchronous medical services via a real-time interactive audio and video telecommunication system (i.e., technology that permits the provider and patient to hear each other and see each other in real-time).
In Colorado, the Department of Health Care Policy and Financing adopted an emergency rule that aims to expand access to healthcare in rural communities by launching two new projects, the Health Care Access Project and the Health Care Affordability Project. The Health Care Access Project will, among other things, increase access to telemedicine, including remote monitoring support, while the Health Care Affordability project aims to modernize the information technology infrastructure of qualified rural providers through shared analytics and care coordination platforms, enabling technologies, including telehealth and e-consult systems, and funding for qualified rural providers to share clinical information and consult electronically to manage patient care. The projects are currently set to commence no earlier than July 1, 2023 and to conclude no later than December 31, 2026.
Texas passed two rules: the first rule clarifies that during telehealth sessions, chiropractors must conspicuously display a mandatory notice from the Texas Board of Chiropractic Examiners (Board) that provides patients with the Board’s contact information in the event that the patient wants to issue a complaint against the chiropractor, and the second rule clarifies that licensed marriage and family therapists that provide telehealth services must complete two hours of continuing education in technology-assisted services.

Legislation & Rulemaking Activity in Proposal Phase:
Highlights:

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Trending in Telehealth: February 27 – March 5, 2023

by Ashley Ogedegbe and Dale C. Van Demark | Mar 13, 2023 | Telehealth

Trending in the past week:

Interstate Compacts
Medicaid Reimbursement
Prescribing
Health Practitioner Licensing
Behavioral Health

A CLOSER LOOK
Finalized Legislation & Rulemaking: 10

Virginia continues to have significant activity:
- The state’s legislature “enrolled” or agreed to the final version of the Counseling Compact (HB 1433). If signed by the governor, the bill will be effective on January 1, 2024.
- Virginia legislators also finalized a separate bill (SB 1119) which modifies licensing exceptions for out of state practitioners utilizing telemedicine for patients within the state who are in the same specialty and who belong to the same group practice. The bill was sent to the governor for approval on March 2, 2023.
- A third bill (HB 1602) approved by legislators among other things, amends the state Medicaid plan by specifying that a health care provider duly licensed in the Commonwealth who provides health care services exclusively through telehealth services will not be required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment.
Colorado legislators passed bill (HB 1071) requiring licensed psychologists to obtain a prescription certificate from the Colorado Medical Board to administer or prescribe psychotropic medication via telepsychology. The bill was sent to the governor for approval on March 1, 2023.
In Tennessee, the governor signed a bill (SB 1) prohibiting the use of telehealth services for the benefit of a minor with respect to a medical procedure related to discordance between a minor’s sex and identity.
Utah legislators agreed to pass a bill (SB 237) that eases the supervision requirements for dental hygienists by authorizing the practice of dental hygiene in a public health setting without general supervision by a dentist, usually via teledentistry and electronic methods, and without a collaborative practice agreement with a dentist under certain conditions. The bill will be sent to the governor for approval.
New York has finalized a rule (NY A 2200) providing for patient prescription pricing transparency through “real-time benefit tools” (RTBTs) which are electronic prescription decision support tools that can integrate with a health care provider’s electronic prescribing system. The rule parallels the Medicare Advantage and Part D Drug Pricing Final Rule published by the Centers for Medicare and Medicaid Services which require Part D plans to offer RTBTs to enrollees starting January 1, 2023 so that plan enrollees can access formulary, cost-sharing, and benefit information in real-time and potentially find lower-cost alternatives under their prescription drug plan.