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California Archives - National Consortium of Telehealth Research Centers

POLICY ADVANCEMENTS FOR TELEHEALTH AT CMS AND CA MEDICAID

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

CMS Proposes Changes to Medicaid Network Adequacy Standards

In a proposal released on Nov. 8, 2018, CMS proposed changes to regulations on network adequacy standards. The changes would allow states to elect alternative quantitative standards to measure network adequacy, including but not limited to, minimum provider-to-enrollee ratios; maximum travel time or distance to providers, maximum wait times for an appointment, and other quantitative standards. Currently, regulations require states to establish network adequacy standards by developing and enforcing time and distance requirements for specified specialty providers. States have commented that these measurements are sometimes inaccurate, especially in locations where telehealth services are heavily used, where a provider-to-enrollee ratio provides a more accurate representation of access.
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Issue in Focus: California Department Health Care Services Solicits Feedback on Major Telehealth Policy Changes

By | Center for Connected Health Policy

The California Department of Health Care Services (DHCS) released two draft proposals impacting telehealth policy in the state’s Medicaid program known as Medi-Cal.  The Department is soliciting feedback from interested stakeholders on both proposals.

California State Plan Amendment

The first proposal is a State Plan Amendment (SPA) intended for submission to the Centers for Medicare and Medicaid Services (CMS), that provides clarification as to when services provided outside of the “Four Walls” of a federally qualified health center (FQHC) or  rural health center (RHC) is eligible for the prospective payment system (PPS).  It is proposed that all such services be paid the PPS when rendered to homebound, migratory, seasonal workers and homeless patients, patients in the hospital, dental services rendered to established patients by a contracted dental provider, and telehealth services provided to its established patients when certain requirements are met.

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