COVID-19 Telehealth Developments for Healthcare Providers – Medicaid Update

Health Care Regulation / HIPAA

On March 20, the Ohio Department of Medicaid (ODM) joined the Centers for Medicare & Medicaid Services in making it easier for healthcare providers to furnish services remotely to Medicaid patients during the COVID-19 public health emergency.

Under OAC 5160-1-21, during the state of emergency declared by Ohio’s governor, providers may provide medical and behavioral health services to new and established patients through telehealth means without an initial face-to-face encounter.

Where may the provider and the patient be located for the telehealth visit?

The new Medicaid rule does not limit the site of the patient or the provider. The patient site is the location of the patient at the time of the service; the practitioner site is the location of the practice at the time of the service. In other words, both the provider and the patient may be at home.

What type of communication methods or products may be used?

Synchronous, interactive, real-time electronic communication with audio and video, i.e., Apple FaceTime, Facebook Messenger, Google Hangouts, Skype, and any non-public-facing remote communication product.

Asynchronous activities that do not have audio and video such as phone calls and email. (Note that this is different than the current guidance for Medicare patients.)

The rule refers to the recent announcement from the federal Office for Civil Rights at the Department of Health and Human Services that it will not impose penalties for noncompliance with HIPAA against covered healthcare providers in connection with the good faith provision of telehealth during the federal COVID-19 public emergency declaration. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to COVID-19.

What types of providers may practice through telehealth?

A wide array of providers: physicians, psychologists, physician assistants, nurse practitioners, licensed independent social workers, licensed therapists and counselors, supervised practitioners and trainees, occupational and physical therapists and assistants, audiologists and speech-language pathologists and aides, dietitians, supervised practitioners and trainees, Medicaid school program contractors, and other providers as designated by ODM.

Which providers may bill Medicaid for telehealth services?

All of the above providers other than supervised practitioners and trainees, occupational therapist and physical therapist assistants, speech-language pathology and audiology aides, and conditional licensees. Also, the following providers may bill Medicaid for telehealth services: professional medical groups, federally qualified health centers and rural health clinics, ambulatory healthcare clinics, outpatient hospitals, Medicaid school program providers, and other Medicaid providers as designated by ODM.

Which services may be provided to Medicaid beneficiaries via telehealth?

  • Evaluation and management of a new or established patient with medical decision-making not to exceed moderate complexity;
  • Inpatient or office consultation for a new or established patient when providing the same quality and timeliness of care to the patient other than by telehealth is not possible, as documented in the medical record;
  • Mental health or substance use disorder services described as “psychiatric diagnostic evaluation” or “psychotherapy;”
  • Remote evaluation of recorded video or images submitted by an established patient;
  • Virtual check-in by a physician or other qualified healthcare professional who can report evaluation and management services, provided to an established patient;
  • Online digital evaluation and management service for an established patient;
  • Remote patient monitoring;
  • Audiology, speech-language pathology, physical therapy, and occupational therapy services;
  • Medical nutrition services;
  • Lactation counseling provided by dietitians;
  • Psychological and neuropsychological testing;
  • Smoking and tobacco use cessation counseling;
  • Developmental test administration; and
  • Other services as designated by ODM.

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