The Centers for Medicare and Medicaid Services (CMS) and the Drug Enforcement Administration (DEA) have clarified existing authorities and provided more flexibility for states to respond to the coronavirus. The following allowances will remain effective for the duration of the COVID-19 public health emergency.
CMS guidance says that states can cover telehealth using various methods of communication including audio-only, telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services. Note: States themselves, not CMS, are responsible for making these options, including audio-only telephonic services, available to providers.
- CMS: Medicaid Telehealth Guidance to States
- Alliance for Connected Care State-by-State Telehealth and Licensure Expansion (frequently updated)
MEDICAID TELEHEALTH STATE EXAMPLES
- National Governors Association: Gubernatorial Strategies for Telehealth
- Arizona: The Association Commissioner of the Children’s Bureau stated in a letter to Child Welfare Leaders that videoconferencing for fostercare visits is now permitted
- “The monthly caseworker visit requirement remains in place, but we are modifying our policy to permit such visits to be conducted by videoconferencing in these current extraordinary circumstances.”
- Connecticut: Issued a bulletin to expand telemedicine and allow Audio-Only services.
- Florida: Florida became the first state to obtain CMS approval of a Section 1135 waiver in response to the COVID-19 National Emergency:
- Waive prior authorization requirements to remove barriers to needed services for beneficiaries with COVID-19,
- Streamline provider enrollment processes to ensure access to care for beneficiaries with COVID-19,
- Allow care for beneficiaries with COVID-19 to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility,
- Suspend certain nursing home screening requirements to provide necessary administrative relief, and
- Extend deadlines for appeals and state fair hearing requests.
- Florida Medicaid Health Care Alert
- CMS Approval
- Illinois: Broad allowance for behavioral healthcare services to be delivered via telehealth, including via audio-only technologies.
- Maine: Allowing broad reimbursement for telebehavioral health services
- Massachusetts: Medicaid and most commercial carriers (by Executive Order) are permitting telehealth via telephone.
- Missouri: MHD is allowing telehealth services to be provided to a MHD participant, while at home, using their telephone.
- Nevada: The Department issued guidance allowing telehealth delivery of services including telephonic delivery. Updated to allow telehealth for group therapy.
- New Jersey
- New York:
- Ohio: Expanded use and definition of telehealth broadly to include audio-only technology, and a wide range of covered providers delivering services via telehealth.
- Pennsylvania: https://www.ddap.pa.gov/Documents/Information%20Bulletins/IB%2001-20.pdf
- SUD Counselors who meet the qualifications provided in 28 Pa. Code § 704.7(b) are able to provide telehealth using real-time, two-way interactive audio-video transmission services in licensed Drug and Alcohol Outpatient clinics. While the two-way interactive transmission is the preferred method, services provided by telephone and in the home are also acceptable.”
- Telehealth will allow the use of telephonic video technology commonly available on smart phones and other electronic devices. In addition, telephone only services may be utilized in situations where video technology is not available):
- OMHSAS COVID-19 Telehealth Expansion – Final 3.15.20
- OMHSAS Telehealth Bulletin 2.20.20
- Attachment B – Telehealth Attestation UPDATED 031920
- Virginia: Governor eliminates copays for all Medicaid services, extends Medicaid prescription supply from 30 – 90 days.
- Washington, DC: Department of Health Care Finance issued Public Health Emergency Guidance on Medicaid-Reimbursable Telemedicine Services Allowance for Audio-Only Visits and HIPAA.
- Washington: Washington State Health Care Authority issued Apple Health (Medicaid) clinical policy and billing for COVID-19
TELEHEALTH AND PRESCRIPTIONS OF CONTROLLED SUBSTANCES
DEA has announced that registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, providing the following conditions are met:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
- The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
- The practitioner is acting in accordance with applicable Federal and State law.
- DEA Coronavirus Information Page
Retroactive to March 6, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries across the country. A range of providers, including clinical psychologists and licensed clinical social workers, will be able to offer Medicare-covered telehealth services to enrollees based in any health care facility, including physicians’ offices, nursing homes, as well as from enrollees’ homes.
- Additionally, the Families First Act corrects language included in Congress’s first COVID-19 response package to clarify that, for the purposes of establishing a relationship with a provider to waive current prohibitions surrounding telehealth services in Medicare, any services allowable under Medicare will qualify as an existing relationship, even if Medicare was not the program paying for the service.
- CMS: Medicare Telehealth Fact Sheet
- CMS: Medicare Telehealth FAQs
- Alliance for Connected Care: Federal Telehealth Guidance (Frequently updated)
A number of private payers have issued detailed guidance for behavioral health providers on telehealth service expansion and billing throughout the COVID-19 crisis.
For the duration of the COVID-19 public health emergency, the Office of Civil Rights (OCR) at the Department of Health and Human Services (HHS) as well as the Substance Abuse and Mental Health Services Administration (SAMHSA) have waived certain privacy requirements for providers to expedite the availability and uptake of telehealth services.
TELEHEALTH AND HIPAA
HHS’s OCR will exercise its enforcement discretion and waive potential penalties for HIPAA violations against health care providers who serve patients through everyday communications technologies. This applies to widely available communication apps such as FaceTime or Skype when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.
TELEHEALTH and 42 CFR Part 2
SAMHSA issued guidance related to the sharing of substance use disorder health records throughout the public health emergency. SAMHSA makes clear in the guidance, information disclosed to the medical personnel who are treating such a medical emergency may be re-disclosed by such personnel for treatment purposes as needed. SAMHSA notes that Part 2 requires programs to document certain information in their records after a disclosure is made pursuant to the medical emergency exception. SAMHSA emphasizes that, under the medical emergency exception, providers make their own determinations whether a bona fide medical emergency exists for purposes of providing needed treatment to patients.
The Health Services and Resources Administration (HRSA) has released guidance and answers to FAQs regarding how health centers can access the National Stockpile to get personal protective equipment (PPE) and additional supplies in response to the coronavirus.
If a health center’s regular distributors are unable to fulfill orders for critical medical supplies such as personal protective equipment, the first step is to contact your local and/or state public health department for immediate assistance. If the state is unable to provide supplies, state health officials — through the governor or his/her representative — may request federal assistance from the U.S. Department of Health and Human Services (HHS).
If assistance is approved, the HHS Assistant Secretary for Preparedness and Response will direct deployment of supplies from the SNS to state public health officials. The state is then responsible for distributing the supplies to areas in need. We understand the difficulty of this situation, but the state department of health is your best option for assistance with needed supplies.
- HRSA: COVID-19 FAQ
- The National Council is working to clarify whether CMHCs and addiction treatment organization are eligible to participate in a similar fashion.
STATE-SPECIFIC HUMAN RESOURCES FAQs
With information evolving rapidly about COVID-19, almost every state (and Washington, D.C.) across America has developed resource pages to address the specific needs of its residents. These resource pages include FAQs, as well as details on unemployment insurance benefits, paid leave laws, closures, and more. The information on these resource pages varies from state to state, and in instances where a state does not have a dedicated resource page for COVID-19, information is available at website links provided in the table linked below.
NEW GUIDANCE ON PAID SICK LEAVE & FMLA
The US Department of Labor issued guidance around the new COVID-19 sick leave and FMLA provisions included in the Families First Coronavirus Response Act.
- FMLA and COVID-19 – FAQs (from Mutual of Omaha)
- Families First Coronavirus Response Act: Questions and Answers
- Families First Coronavirus Response Act: Employee Paid Leave Rights
- Families First Coronavirus Response Act: Employer Paid Leave Requirements
- COVID-19 and the Fair Labor Standards Act: Questions and Answers
- COVID-19 and the Family and Medical Leave Act: Questions and Answers
- Paid Sick Leave and Expanded Family & Medical Leave
- From US DOL: In response to the ongoing coronavirus pandemic, the US Department of Labor’s Wage and Hour Division (WHD) has temporarily moved to telephone contact only. To contact WHD confidentially, you may call their toll-free help line: 1-866-4-USWAGE (1-866-487-9243). Alternatively, you may use the Contact Us form on their website.
IMPACT ON SMALL BUSINESSES
Summary from the US Chamber about the small business provisions across all three coronavirus bills to date.
The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act infused trillions of dollars into the American economy and health care system. Provisions in both laws modified existing financing levels and made available new programs and funding resources for health care providers, including behavioral health providers.
- The Families First Coronavirus Response Act increased the federal Medicaid match rate knowing at the Federal medical Assistance Percentages (FMAP).
We need to hear from you.
There are a couple of priority concerns that have been raised among members so far, and we request additional information from you:
- We understand the need to quickly and broadly increase access to services via telehealth, and that being able to bill for telephonic (audio-only) contact is important.
- What are your reimbursement challenges and what additional specific services do you need to provide via telephone that are currently restricted or prohibited?
- We understand there are urgent supply issues concerns facing residential facilities.
- What treatment or service supplies specifically can you not access or receive/can foresee being difficult to access in the near future?
- What state regulatory hurdles are you facing that will need to be addressed to continue your operations during the COVID-19 response?
Additionally, what is the number one concern not covered here that you face or anticipate facing during this crisis? Please be as specific as possible.
Email responses to: Policy@TheNationalCouncil.org