Special Medicaid Update Provides Overview of Telehealth Expansion
The New York State Medicaid Program has expanded coverage of telehealth services intended to improve access to needed services and to improve member health. The February 2019 Medicaid Update outlines updated telehealth and reimbursement policy and applies to Article 28 facilities and private practitioners.
Expanded coverage of telehealth services includes:
- Additional originating and distant sites, including adding the patient’s place of residence to the list of acceptable originating sites;
- Additional telehealth applications (store-and-forward technology and remote patient monitoring); and
- Additional practitioner types.
The update also includes guidance related to Confidentiality, Patient Rights and Consents, and Failure of Transmission. Much detail is provided regarding billing rules in relation to modifiers, Place of Service (POS) Codes, Fee-for-Service (FFS) billing for telemedicine by site and location, and application-specific telehealth billing rules for Store-and-Forward and Remote Patient Monitoring. Further, the guidelines address Medicaid Managed Care (MMC) coverage for telehealth and encourage the inclusion of it in Value-Based Payment arrangements.
The policy is effective Jan. 1, 2019 for Medicaid FFS and March 1, 2019 for MMC plans. The update provides several ways to ask questions regarding FFS and MMC coverage and lists several resources for manuals, training, and billing.
Separate guidance is coming soon from the Office for People with Developmental Disabilities (OPWDD), Office of Alcoholism and Substance Abuse Services (OASAS), and Office of Mental Health (OMH) that will align with the payment policies for telehealth services provided under those agencies.
For additional informational resources or answers to policy-related questions, click here.
Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871