On March 27, 2023, Connecticut’s Department of Social Services (CT DSS) published post-pandemic guidance regarding the delivery of telehealth services. Important subjects in the guidance include written consent, provider location, documentation requirements and the re-introduction of the established patient requirement for some services.
This guidance is effective on May 12, 2023, the day after the end of the declared public health emergency (PHE). It supersedes all early pandemic-era guidance from CT DSS on the subject. Healthcare providers serving Medicaid patients must study this guidance and any subsequent guidance from CT DSS on the subject, which will be available at www.ctdssmap.com.
Here is a brief overview of notable requirements outlined in the guidance:
- Capable of Delivering In-Person Services. All Medicaid billing entities must be capable of delivering in-person services “to the full extent that is clinically appropriate for their patients and to the full extent necessary if the HUSKY Health member does not consent” to telehealth.
- Provider and Patient Identity Verification Procedures. Providers must have procedures for verifying provider and patient identity before providing telehealth services. Consider displaying the provider’s full name, contact information and license number on the video. The CT telehealth statute requires these elements. Verifying patient identity could follow a provider’s existing policy on the issue (e.g., provide three identifiers like name, DOB, and address).
- Informed Consent. Providers must obtain written informed consent for telehealth in advance of the visit and annually thereafter. Electronic consent is acceptable. CT DSS requires that Medicaid patients be aware that they can opt-out of telehealth at any time. (It is best to include this in the written consent.)
- Services Rendered to Minors. CT DSS will require that a parent or legal guardian be present for a telehealth visit to the same extent required for in-person visits, unless the minor is seeking services without parental consent as permitted by law. CT DSS then states that the parent or legal guardian must provide informed consent for a telehealth service as detailed above. This creates some confusion around confidential visits of minors and whether those can occur via telehealth without parental consent.
- Location of Provider.
- For independent and group practitioners as well as FQHCs, with some exceptions (including enrolled border state providers), the provider must be in the state of Connecticut (or the approved border state) when rendering services but does not need to be present in the enrolled site.
- For freestanding clinics generally required to provide services at the clinic under federal law, either the practitioner or the patient must be present at the clinic for the telehealth service. The clinic presence must be documented.
- Audio-only Services: There are more restrictions on audio-only services than before. They are covered only if the services:
- Are (1) clinically appropriate, as determined by the Commissioner, (2) it is not possible to provide comparable covered audiovisual telehealth services, and (3) provided to individuals who are unable to use or access comparable, covered audiovisual telehealth services (based on P.A. 21-133, now at Conn. Gen. Stat. §17b-245g); AND
- Meet any other restrictions/requirements outlined in the CMAP Telehealth Table attached to the guidance. For example, medical visits via audio-only are limited to established patients who have had an in-person visit within the prior 12 months. The visit must be scheduled, and there must be documentation that an in-person or video visit was offered and declined. Other categories of audio-only visits are also limited to established patients. Refer to the Table at the end of the guidance for details.
- HIPAA Compliance. DSS highlights the importance of HIPAA Security Rule compliance when providing telehealth services. With the end of the PHE comes the end of enforcement discretion related to certain telehealth technologies. See our Three Little Pigs Trilogy for details.
Most providers are juggling numerous changes with the impending end of the PHE. Preparing for these upcoming changes will take time and coordination. It may make sense for providers to assign a task force to monitor changes and plan for implementing them before the end of the PHE. May 12th will be here soon, which means enforcement tied these changes is likely to follow!