Just one week ago, Medicaid in Connecticut did not cover telehealth services. Then, DSS issued Provider Bulletins 2020-09 and 2020-10 providing for emergency temporary telehealth coverage in response to the Covid-19 pandemic. Today, the Connecticut Department of Social Services (DSS) issued Provider Bulletin 2020-14, which further expands Medicaid reimbursement to include telehealth delivered via telephone. The Governor signed an executive order yesterday that directed this expansion. For services provided to Medicaid beneficiaries, the executive order effectively suspends the explicit prohibition of audio-only telephone as a delivery method under the current telehealth law.
In addition to covering telehealth delivered via telephone, DSS added certain children’s behavioral health services and announced that opioid treatment programs can meet the face-to-face requirement using telehealth. All the expansions announced in Provider Bulletin 2020-14 are effective from March 18, 2020 until the end of the Covid-19 emergency.
Telehealth Via Telephone
In its bulletin, DSS provides limitations on the services and provider types eligible for reimbursement when delivered via telephone. It also details requirements that must be met to obtain reimbursement for those services. Those limitations and requirements are detailed below in outline form:
- Audio-only telehealth services are reimbursable ONLY for established patients.
- Limited evaluation and management (E&M) services are eligible for reimbursement (the specific services and codes are detailed in the bulletin).
- Only the following provider types can bill for audio-only E&M services: physicians, APRNs, PAs, CNMs, free-standing medical clinics (not school-based health centers), behavioral health clinics (including enhanced care clinics), outpatient hospital behavioral health clinics, public and private psychiatric outpatient hospital clinics, federally qualified health centers (FQHCs), and family planning clinics.
- Telehealth is approved for the behavioral health services detailed in last week’s bulletins (2020-09 and 2020-10) as well as the additional services in the 2020-14 bulletin and those services may be delivered via telephone.
- Only the following provider types can bill for audio-only behavioral health services: independent licensed behavioral health clinicians (licensed psychologists, licensed clinical social workers (LCSWs), licensed marital and family therapists (LMFTs), licensed professional counselors (LPCs), and licensed alcohol and drug counselors (LADCs)), behavioral health clinics (including enhanced care clinics), outpatient hospital behavioral health clinics, public and private psychiatric outpatient hospital clinics, free-standing medical clinics (not school-based health centers), rehabilitation clinics, behavioral health FQHCs, physicians, advanced practice registered nurses, and physician assistants.
- Medication assisted treatment (MAT) may NOT be initiated via telephone.
- Providers can only bill for a service that, but for the Covid-19 emergency, would be covered if the service were rendered in person.
- Providers must:
- Comply with all normal billing and coding requirements;
- Obtain verbal consent for the telephone visit before providing services (consent must be from a parent or guardian for a minor) and document consent in the record. In addition, providers must ensure that the patient is aware of his or her option to refuse telephone services at any time;
- Recommendation: Create a script for providers to ensure that all providers are saying the same thing and they can easily document the information provided. Under Connecticut’s telehealth law, the provider must outline the limitations of telehealth prior to obtaining consent. In terms of a script, consider something like: “Before we begin, I want to make sure that you understand that talking on the phone is not as good as seeing you face to face and that I cannot assess you in the same way over the phone that I can in person. But it does allow me to try to help you during times like this when it’s more difficult to meet face to face. Do you have questions about having this visit over the phone? Are you OK with having this visit over the phone? Please know that you can change your mind about having this visit by phone at any time, OK?
- Develop and implement a procedure to verify the identity of both the provider and patient;
- Recommendation: Have the provider give his or her license number to the patient as a means of verifying his or her identity (this is required by the state telehealth statute anyway). As for the patient, have the provider obtain at least two identifiers such as name and date of birth or data points. Document this process.
- Document the visit completely (like an in-person visit) and include the fact that the visit was conducted via telephone;
- Not bill for telephonic communications that were not previously billable, such as routine follow-up, lab results, provider to provider discussions, scheduling etc.; and
- Not bill if the connection is lost and service cannot be completed for any reason.
- Any existing DSS requirements on location of the provider do not apply during this emergency period, however, this does not excuse compliance with licensing and scope of practice requirements.
Additional Telehealth Expansions from DSS
DSS also adds specific children’s behavioral health services that may be provided via telehealth, including some home-based services; emergency mobile psychiatric services; extended day treatment; Autism spectrum disorder treatment services; some case management services; and family therapy without the patient.
Additionally, DSS is allowing Opioid Treatment Programs to fulfill the face-to-face requirement with a physician, APRN or physician’s assistant (PA) via telemedicine as part of the introduction of the service. To do so, an RN must be “in the same location as the individual when the service is initiated” and the RN and the physician, APRN or PA are all employed by the same program.
HIPAA Compliance
Lastly, at the end of the bulletin, DSS acknowledges that the federal Department of Health and Human Services recently announced relaxed HIPAA enforcement by the Office for Civil Rights (OCR) related to telehealth and says “[p]roviders should consult with this communication and future communications from OCR regarding their obligations under HIPAA.” DSS then encourages providers to “whenever possible, . . .fully comply with all details of HIPAA…”. In light of this guidance, for providers offering telehealth services to Medicaid beneficiaries, if the service can be offered via telephone or via telehealth platform that may not meet HIPAA requirements, the provider may want to consider telephone as the more reasonable option.