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medicaid Archives - National Consortium of Telehealth Research Centers

2019 KICKS OFF WITH EXPANDED REIMBURSEMENT ANTICIPATED IN MEDICARE ACOs & CA MEDICAID (Medi-Cal)

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

ACO Telehealth Expansion in Medicare Shared Savings Program

As required by the Bipartisan Budget Act, CMS has finalized their rule to broaden telehealth reimbursement for Medicare Accountable Care Organizations (ACOs) in the Shared Savings Program under the BASIC track (under a two sided model) and ENHANCED track when the ACO elects prospective assignment.  The finalized regulation allows eligible physicians and practitioners in the applicable ACOs to be reimbursed regardless of the geographic location of the patient and allows the home to be the originating site.  If the home was the originating site, there would be no facility fee allowed.  Other locations, besides the patient’s place of residence, would not qualify for reimbursement under the new rule, such as a school.  Other Medicare telehealth requirements would still apply, such as provider type and service code limitations.  Additionally, CMS also clarifies in the rule that in the case where the beneficiary’s home is the originating site, Medicare will not pay for telehealth services that are inappropriate to be furnished in the home even if the services are on the approved list of telehealth services, such as inpatient hospital visits.  The change would not be applicable until plan year 2020.

To learn more, read the full text of the rule.

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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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Updated & Redesigned Fall 2018 Edition of the 50 State Telehealth Laws and Reimbursement Policies Report

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

An updated Fall 2018 edition of CCHP’s “State Telehealth Laws and Reimbursement Policies” Report is available today!  The Fall 2018 edition offers policymakers, health advocates and other interested health care professionals a freshly redesigned compendium of state telehealth laws, regulations and Medicaid policies.  The new report features the same detailed telehealth policy information (with references) found in previous reports, but in a fresh new format with policies grouped into three primary categories (Medicaid Reimbursement, Private Payer Laws, and Professional Regulation). This report was made possible through generous support from the Health Services & Resources Administration and the California Health Care Foundation.

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Public Sector Telehealth Reimbursement – Beg Forgiveness or Ask permission

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Reimbursement is an essential element to measuring long term telehealth success. Our presentation will explore resources used for determining public sector policy and reimbursement with a particular focus on Medicaid. We will explore the pitfalls faced by programs who make incorrect assumptions or overly relied on single source information. The presentation will more deeply explore how Medicare, Medicaid and VA rules governing reimbursement for telehealth are rapidly changing and site examples where government payers reported services as being allowed without having established codes for reimbursement. We will show how rules governing reimbursement, specifically for Medicaid recipients are not only changing rapidly, but differ from state to state. Finally, we will provide insight into how Insurance companies with large statewide Medicaid contracts keep current with rapidly changing claim edits and offer suggestions that will help improve reimbursement and help build long term program success.

Download the Webinar Powerpoint