Advances in State Telehealth Policies Persist as Companies Work to Improve Cybersecurity & New Billing Codes are Released

Original Source: Center for Connected Health Policy


CCHP Provides Resources to Navigate CA Medicaid’s New Telehealth Policy

Last month the California Department of Health Care Services (DHCS) released its finalized telehealth policy update for Medi-Cal (CA Medicaid) fee-for-service, as well as a few other programs (including Indian Health Services, Memorandum of Agreement (IHS-MOA), Federally Qualified Health Centers/Rural Health Clinics (FQHCs/RHCs), Family Planning, Access, Care, and Treatment (PACT), Local Education Agency (LEA) and Vision Care).  An All Plan Letter was also distributed to Managed Care plans on the changes.  The most significant changes to the fee-for-service policy included allowing providers to decide what modality, live video or store-and-forward, will be used to deliver eligible services to a Medi-Cal enrollee as long as the service is covered by Medi-Cal and meets all other Medi-Cal guidelines and policies, can be properly provided via telehealth and meets the procedural and definition components of the appropriate CPT or HCPCS code.  Additionally, the home now qualifies as an originating site with no requirement that a provider be present with the patient at the time services are rendered.  DHCS has also opened up one code for e-consult, considered a subset of store-and-forward.  Finally, DHCS has specified that in order for a provider to qualify for reimbursement, they must be licensed in CA, enrolled as a Medi-Cal rendering provider or non-physician medical practitioner and affiliated with an enrolled Medi-Cal provider group.  The enrolled Medi-Cal provider group must be located in California or a border community.

The program specific manuals (for example, IHS-MOAs, and FQHCs/RHCs) do have additional requirements and restrictions.  CCHP has created a factsheet and comparison chart between the programs that outlines the various changes to the revised Medi-Cal policies.

To learn more, visit CCHP’s California webpage for all the latest developments in CA telehealth policy.

American Medical Association Releases 2020 CPT Codes with Telehealth Additions
Last week the American Medical Association (AMA) released their 2020 Current Procedural Terminology (CPT) code set that describe medical, surgical and diagnostic services for billing purposes. Many of the major changes for 2020 to the code set revolve around telehealth, with six new codes being created that describe online digital evaluation services (e-visits).  New codes were also created to better support home blood pressure monitoring as well as codes for long term electroencephalographic (EEG) monitoring services.

To learn more about the changes, see AMA’s press release and request the CPT 2020 Data File.

NIST Seeks To Collaborate with Tech Companies on Telehealth Security Issues
The National Institute of Standards and Technology (NIST) is seeking to collaborate with technology companies to address cybersecurity challenges in the healthcare sector.  Through September 30th, NIST is accepting letters of interest from product and technical experts who can provide guidance on securing a telehealth remote patient monitoring (RPM) ecosystem in healthcare delivery organizations as well as in the patient’s home environment.  The goal of the project is to provide a practical solution for securing the telehealth RPM ecosystem using existing commercial and open-source available cybersecurity products.
To learn more about the requirements for participation, see the Federal Register Announcement

American Well Releases 2019 Consumer Survey on Telehealth

American Well recently released the results of their 2019 consumer survey for telehealth. The survey measures the usage of and opinion on telehealth among the adult population and is weighted to be representative of American adults across demographics.

The survey results show that demands for telehealth vary by age among adult consumers. For example, older populations, aged 65 and over, generally desire to use telehealth for follow-up care. The middle-aged population is most interested in using telehealth for urgent care. However, millennials are more likely to use telehealth for mental healthcare, such as video visits with a behavioral health care professional. Rates of telehealth use also varied across levels of income, education, and employment status. Consumers who are employed and have a higher level of income are more willing to utilize telehealth to facilitate a live-video visit with a provider.

The survey also identifies five barriers to telehealth adoption among consumers, including:

  1. A preference for in-person care
  2. Concerns about privacy
  3. Uncertainty about reimbursement
  4. Concerns about technology
  5. Uncertainty about the use of telehealth


For more information, read the full report accessible through the American Well website.

OIG Announces Review of States’ use of Telehealth for Behavioral Healthcare
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced in August that it will be conducting a review on the use of telehealth to provide behavioral health services in Medicaid Managed Care. The OIG states the review, which is expected to conclude in 2020, will focus on selected states and is intended to “analyze how state and managed care organizations (MCOs) use telehealth to provide behavioral healthcare.” This will include a review of states’ monitoring and oversight of MCOs’ provision of these services. The OIG also intends to identify state and MCO practices that may improve overall quality of care when providing behavioral healthcare through telehealth.

The official posting for the review is accessible through the OIG website.

Telehealth Webinar Series Focused on FQHCs Now Available

The National Consortium of Telehealth Resource Centers (NCTRC) has concluded a 3-part webinar series focused on telehealth policy issues specific to Federally Qualified Health Clinics (FQHCs). These webinars were designed to train and educate FQHCs on how to set up and/or expand a successful telehealth program, and featured three key topic areas that are particularly relevant to FQHC’s current needs: chronic care management, opioid use disorder, and mental/behavioral health. Collaborating FQHC partners shared how their telehealth programs have achieved success. During each webinar, presenters held a Q & A session in which excellent questions were received from the audience.

If you missed it, you can find the full FQHC webinar series on NCTRC’s Youtube page


SB 258 – Requires Medicaid coverage of telemedicine and telehealth services provided within the scope of practice of a physician or other health care provider as a method of delivery of medical care.  Telemedicine services for primary care, remote patient monitoring, and substance use disorder services shall only be covered in the event that the patient has already established care at an originating site via face-to-face in-person service. (Status: Enacted)

AB 1264 – Specifies that an appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, including but not limited to a self-screening tool or a questionnaire, provided that the licensee complies with the appropriate standard of care.   (Status: Passed Senate)

SB 380 – Requires the Department of Health Services to provide Medicaid reimbursement for any benefit that is covered under the program, delivered by a certified Medical Assistance program, and provided through interactive telehealth. The distant site provider must be paid an amount equal to the amount the provider would have received under the Medicaid program if the service were provided through a method other than telehealth. (Status: In Senate)

HB 555 – Requires the Department of Health and Human Services to reimburse for telemedicine and telepsychiatry services delivered to a patient’s home or delivered from a licensed practitioner’s home. Requires reimbursement for telemedicine and telepsychiatry services delivered via phone or video cell phone. Requires that telemedicine and telepsychiatry services shall not be subject to the exact same restrictions as face-to-face contacts. (Status: Vetoed)

Board of Medicine – Standards for Telemedicine Practice:
A proposal to repeal the current telemedicine practice standards rule, which outlines when treatment recommendations (including prescribing) can be done when utilizing telemedicine. (Status:  Proposed)

Health and Human Services Amendments:
Provides definitions and requirements for the delivery of telehealth services under Medicaid. Allows for the delivery of behavioral health services for children via telehealth. Provides for telehealth reimbursement. (Status: Proposed)

Department of Health Compassionate Care Renewal:
Provides definition for “telemedicine” and “compassionate care renewal” in the prescribing of medical marijuana. (Status: Proposed)