In my previous post, I mentioned that the Trump Administration has temporarily loosened telehealth restrictions for Medicare beneficiaries and not surprisingly, states have followed suit. And, to be honest, a number of states have been way ahead of the Feds on telehealth for some time now, but this post is going to focus on those that have recently made changes to deal with growing cases of COVID-19.
To show the wide-reaching impact of this pandemic, I’m purposefully going to focus on a few states with different ideological leanings.
First up is New Jersey.
Governor Phil Murphy (D) has recently signed over 15 bills related to coronavirus into law, many of which were passed unanimously. A3680 allows for providers to use telehealth for the duration of the public health emergency related to coronavirus and waives existing regulations that may impede its use. The bill does include a provision that this expansion of telehealth is only related to “screening for, diagnosing, or treating COVID-19”. It also notes that reimbursement for telehealth should be “consistent with the ordinary fees typically charged for that service” but stops short of requiring full parity. A3862 expedites the process it takes for out-of-state providers to become licensed in New Jersey so that they can provide telehealth. Lastly, A3843 requires Medicaid to pay for the testing of coronavirus and any services rendered through telehealth in accordance with coronavirus treatment. Most importantly, the bill prohibits any cost sharing to ease concerns about cost being a barrier to care. All of these bills went into effect immediately upon the governor’s approval.
Now we’re going to move a little south to our home office location of Washington D.C.
In a recent press release, DC announced emergency rules that allow for Medicaid providers to bill for telemedicine services furnished inside of patient’s home. This policy went into effect on March 12 and will remain in effect until July 10 unless superseded by another rulemaking.
Staying along the East Coast, North Carolina has recently released guidance to offer reimbursement in Medicaid for “virtual patient communication and telephonic evaluation” in instances in which there is already an established patient-provider relationship. Physicians, physician assistants, nurse practitioners, and certified midwives who are currently enrolled as North Carolina Medicaid providers are all eligible to bill the state. In addition, while not related to telehealth, it’s worth mentioning that North Carolina Medicaid has also granted pharmacies the flexibility to refill prescriptions early and reimburse for up to a 90-day supply.
Moving southwest, Texas Governor Greg Abbott (R) has approved the Texas Medical Board’s request to temporarily waive restrictions on their ability to use telemedicine, including the use of “telephone only” to establish a patient-doctor relationship. Telemedicine may be used for as long as the governor’s disaster declaration remains in effect for diagnosis, treatment and prescribing related to COVID-19.
Now making a turn toward the north, Montana’s Medicaid Director released a memo allowing qualified providers to bill for telehealth. It also requires reimbursement parity for virtual visits and in-person, face-to-face visits. Like most other states, this enhanced flexibility will remain in effect for the duration of the state emergency order.
And finally, ending on the west coast, California Governor Gavin Newsom’s (D) emergency declaration has led to the Insurance Commissioner calling on health plans to “maximize the use of telehealth in all appropriate settings, including waiving, or expediting, any network provider credentialing, certification, or pre-authorization requirements”. The Department of Health Care Services has also released new telehealth guidance for all Medicaid managed care plans operating in the state and required parity in telehealth reimbursement.
Additionally, California, New Jersey, North Carolina and several other states have already gotten approval from CMS for 1135 waivers. While most of the provisions in these waivers aren’t related to telehealth, these waivers will grant states new flexibilities in Medicaid to help combat COVID-19. One example of this is expediting the process it takes for out of state providers to become enrolled in a new state so that they can more quickly provide much needed care (e.g., telehealth).
Stay tuned for my next post which will take a look at how states can better improve insurance coverage in the ongoing pandemic.