DOH Telehealth Work Group Meets

The New York State Department of Health's (DOH) Telehealth Work Group met for the second time on Sept. 27, 2017. The meeting focused on recent changes in mainstream Medicaid managed care policies to allow for greater flexibility in coverage of telehealth services, regulatory barriers to the delivery of telehealth services to patients in their homes and other community sites, and the lack of clarity surrounding the permissibility and reimbursability of telehealth services. The meeting agenda is available here, and the webcast is available here.

The first part of the meeting covered a recently released policy intended to advance the use of telehealth services for mainstream Medicaid managed care enrollees. The new policy allows managed care plans to provide telehealth services "in lieu of" conventional covered health care services, to the extent that the use of telehealth improves access, quality, outcomes, and cost-effectiveness. As a result of this policy, the costs associated with the use of telehealth technology will be included in the development of mainstream managed care premium rates. In order to benefit from this policy, plans must receive approval from the Department of a Telehealth Innovation Plan (TIP). If a plan's TIP is approved, it will also receive bonus points for purposes of calculating the plan's Quality Incentive award. Although the new policy is limited to mainstream plans, the Department has indicated that it is planning to expand this approach to MLTC. The policy memorandum is available here.

Much of the meeting was dedicated to a discussion of the restrictions on the originating site (the site where the patient is located) under New York law. The Public Health Law defines an "originating site" as a health care facility, private physician or dentist's office, adult care facility, school, or day care center. In addition, if the patient is receiving remote patient monitoring, the originating site may be the patient's place of residence. This provision has been interpreted to restrict the use of telehealth modalities to deliver other services in the home. The consensus among Work Group participants was that the state should permit the delivery of telemedicine services in the home and other community sites.

The Work Group also discussed the challenges experienced by providers in obtaining reimbursement for telehealth services from managed care plans, both commercial and Medicaid. Although this meeting was intended to be the Work Group's last, the Work Group Chair suggested that there might be an additional meeting. As next steps in the process, the Work Group asked the Department to provide clarification concerning the types of telehealth services that are permissible and reimbursable and to explore with other agencies ways of expanding broadband access in both urban and rural areas. The Department is welcoming comments on telehealth policy through its Regulatory Modernization email address.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124