September 19-25, 2021 is Telehealth Awareness Week. NHeLP joins many stakeholders, health care providers, and advocates to acknowledge this week and raise awareness of the importance of telehealth.
Telehealth is the use of digital technologies to deliver health care, health information, and other health services by connecting two or more users in separate locations. The three main telehealth modalities are two-way live audio and video, store-and-forward (the electronic transmission of medical information like images and documents), and remote patient monitoring (which entails collecting health and medical information from a patient in one location and transmitting it to a provider in another location). Telehealth is not a distinct service but a service delivery model that allows us to “visit” a provider without going to the provider’s office.
Medicaid Developments on Telehealth
The Centers for Medicare and Medicaid Services (CMS) views telehealth or telemedicine as a cost-effective alternative to the more traditional face-to-face way of providing medical care that states can choose to cover under Medicaid. In 2020, CMS issued some guidance on telehealth, including a Medicaid & CHIP (Children Health Insurance Program) Telehealth Toolkit to help states accelerate adoption of broader telehealth coverage policies for Medicaid and CHIP.
To ensure that further expansion of telehealth services meets the technological and access needs of low income individuals across the country, NHeLP developed a baseline set of Medicaid telehealth principles. The guiding principle is that telehealth should be accessible and equitable to ALL Medicaid recipients.
During the COVID-19 Public Health Emergency (PHE), NHeLP also published numerous fact sheets, blogs, and top-ten lists explaining how states expanded telehealth services in various areas to respond to the health care needs of their residents during the pandemic, which we will highlight on Twitter over the next few days. Additionally, our staff have shared expertise on telehealth to diverse audiences through presentations and webinars on various telehealth related topics.
During the PHE, all 50 states implemented temporary telehealth policies, while some adopted permanent telehealth policies for Medicaid recipients. Below are some state examples (including states that are current COVID hotspots):
✔️ States that have implemented permanent or long-term telehealth policies:
- California: AB 133 requires permanent Medicaid coverage of remote patient monitoring and extends many telehealth flexibilities available during the PHE (including payment parity for audio only modalities) until December 31, 2022.
- Massachusetts: Massachusetts made major changes to its telehealth policy in 2021, expanding its definition of telehealth and the use of telehealth. For instance, it required payment parity for telehealth and in-person services permanently and primary care and chronic disease management for 2 years.
- New York: New York ended its telehealth emergency waivers and issued new Medicaid guidance, formally relaxing rules on the types of clinicians, facilities, and services eligible for billing under the New York State telehealth rules and allowing for the use of audio-only modality if needed. These changes are also reflected in the Rules and Regulations of the State of New York.
- Ohio: On October 19, 2020, Ohio made permanent the temporary expansion of telemedicine services in its Medicaid program. The rule changes under Ohio Administrative Code §5160-1-18 include: expanding the definition of telehealth to include audio-only telephone calls, remote patient monitoring, and other electronic communication that may not have audio or video components. Additionally it expanded the types of practitioners including supervised practitioners like aides and trainees, placed fewer restrictions on patient and practitioner site locations, and expanded the types of telehealth services that may be paid for by Medicaid.
❌ States with only temporary telehealth policies*:
- Alabama: In March 2020, Alabama Medicaid temporarily allowed clinicians (including some behavioral health service providers) to provide medically necessary services via telecommunication services including telephone consultations. These telehealth flexibilities, among other COVID-19 related flexibilities, are currently set to expire on October 31, 2021. After ending the COVID-19 state of emergency (SOE) on July 6, 2021, amid the rise of COVID-19 related hospitalizations within the state, Alabama Governor Kay Ivey re-declared the SOE on August 13, 2021.
- Tennessee: In March 2020, Tennessee Medicaid and its Managed Care Organizations temporarily allowed for the use of telehealth for behavioral health care, EPSDT and well-child services in the pediatric population, and skilled therapy services. These temporary telehealth policies (which also included coverage of telephone-only services for behavioral health care) expired on June 30, 2021, followed by the ending of Tennessee’s SOE on August 31, 2021.
- Texas: During the PHE, Texas temporarily allowed for many Medicaid and CHIP flexibilities, such as the use of audio-only modality to conduct certain mental health assessments and reassessments for Medicaid recipients and the use of telemedicine in lieu of face-to-face reassessments for recertification of hospice services and specialized therapies. Most flexibilities are currently set to expire on September 30, 2021. Additionally, although Texas Governor Greg Abbott recently renewed the COVID-19 disaster proclamation that is set to end on September 20, 2021, Texas has not extended or made permanent the Telemedicine Emergency Rule that expired on September 12, 2021.
* In states where expanded telehealth services are not yet permanent, there are numerous pieces of pending legislation aimed at doing so. The Center for Connected Health Policy (CCHP) is tracking these changes.
Ways to stay informed and help promote telehealth awareness
- Check out each state’s Health Department and Medicaid Agency telehealth webpages for state specific telehealth policies and changes
- Check out CCHP and sign up for its free telehealth webinars
- Check out NHeLP’s Resource Library and follow us on Twitter (@NHeLP_org). We will be sending out a series of tweets between 9/20 to 9/24 to feature some of our recent telehealth publications. Stay tuned!