hphc telehealth policy

The Center for Connected Health Policy is a program of the Public Health Institute. Several nonprofit community health plans that are members of the . For the latest information as this situation evolves, we encourage people to stay informed by visiting the CDC website. (Accessed Aug. 2022). They include preventive services and medically necessary services such as lab services, diagnostic services such as EKGs, x-ray services (including ultrasounds), dental services, medical services, EPSDT services, family planning services, and prenatal services. Remote Patient Monitoring: Yes* (CMS RPM Codes), Originating sites explicitly allowed for Live Video: Yes, Distant sites explicitly allowed for Live Video: Yes, Store and forward explicitly reimbursed: No, Allowed to collect PPS rate for telehealth: Yes, Medicaid Program: Hawaii Medicaid (Med-QUEST), Administrator: Hawaii Dept. 2016, p. 6. The Center for Connected Health Policy is a program of the Public Health Institute. SOURCE: HI Revised Statutes Sec. SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 9-10. Code of HI Rules 17-1737-51.1(c). BMC HealthNet Plan in Massachusetts and Well Sense Health Plan in New Hampshire are now one, unified plan under the name WellSense Health Plan. View CCHPs Fall 2022 edition of the bi-annual summary report! HI Revised Statutes 671-7 (a). Similarly, telehealth can be provided through a wide range of technologies, including video chats, remote . Ensure that documentation of the following issues is made in the member record: Potential difference in obtained scores due to telehealth administration, Any accommodations or modifications that were made to standard administration procedures, Potential limitations of all assessment results or conclusions when test norms used for interpretation are not based on a telehealth administration. SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 8-9. This report provides a snapshot of the progress made in the past six months, reviewing telehealth laws and regulations covering topics such as licensure, reimbursement RPM & audio-only. For the past several years, virtual visits (telemental health) for certain outpatient services have been covered under certain behavioral health plans or Employee Assistance Programs (EAP) offered to members. (Accessed Aug. 2022). All claims for services provided through telehealth technology must be identified by the applicable teledentistry CDT code D9995 or D9996. The updated telehealth policy is effective as of April 1, 2022. HI Medicaid Provider Manual (FQHC) (March 2016), p. 8-9. Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements. Contacts with one or more health care professionals and multiple contacts with the same health care professional that take place on the same day and at a single location shall constitute a single encounter unless: I. Share sensitive information only on official, secure websites. For providers who do not have access to HIPAA-approved technology to conduct a virtual video-enabled session, providers can conduct these sessions immediately using any nonpublic-facing remote communications product that is available to communicate with members as listed below in accordance with OCRs Notice. National Suicide Prevention Lifeline 1-800-273-TALK (8255) Disaster Distress Helpline 1-800-985-5990. (Accessed Aug. 2022). 2016, p. 6. As the public health emergency ends, more resources and guidance will be made available to keep you and your staff up-to-date regarding the latest changes to telehealth policies. The National Telehealth Policy Resource Center project is made possible by Grant #U6743496 from the Office for the Advancement of Telehealth, Health Resources and Services . During the COVID-19 nationwide public health emergency, providers should provide telehealth services in accordance with the OCR Notice. (Accessed Aug. 2022). (Accessed Aug. 2022), HI Med-QUEST Medicaid Provider Manual: Dental, pg. Many of these laws focus on where . will be paid at the facility allowable regardless of location. These are temporary measures under the COVID-19 public health emergency declaration and are subject to change. Telehealth/Virtual Health Policy, Professional IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claims. For dates of service prior to September 1, 2022, . COVID-19 . Providers have more flexibility to use everyday technology for virtual visits during the COVID-19 public health emergency. Secure .gov websites use HTTPS Tufts Health Plan COVID-19 Updates for Providers. Other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient. Please refer to reimbursement guidelines for telehealth billing guidelines as this will allow properly submitted claims to process through auto-adjudication without creating manual work and support timely payment. Additional benefits may be available in some states and under some plans, and applicable state insurance and similar laws and regulations are followed as indicated. Billable FQHC encounters are face-to-face contacts between a patient and a FQHC covered professional. info@cchpca.org The health plan must document the reason for conducting an interaction using a technology option. Click on a topic to see how its applied in your state. Telehealth for families of children with special health care needs, Cultivating trust and building relationships during a telehealth visit, Announcing the availability of telehealth, Getting patients set up with telehealth technology, Helping patients prepare for their telehealth appointment, HIPAA flexibility for telehealth technology, Telehealth licensing requirements and interstate compacts, Consolidated Appropriations and American Rescue Plan Acts of 2021 telehealth updates, Medicaid and Medicare billing for asynchronous telehealth, Billing and coding Medicare Fee-for-Service claims, Billing Medicare as a safety-net provider, Private insurance coverage for telehealth, Telehealth for American Indian and Alaska Native communities, Developing a telebehavioral health strategy, Preparing patients for telebehavioral health, Creating an emergency plan for telebehavioral health, Tele-treatment for substance use disorders. We track telehealth-related laws and regulations across three categories and 19 unique topics. Telehealth is done primarily online with internet access on your computer, tablet, or smartphone. HI Revised Statutes 431:26-103. We track telehealth-related laws and regulations across all 50 states and the District of Columbia, as well as at the federal level. Eligible services will be consistent with Memo QI-1702A and FFS 19-01. There may be other technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA business associate agreement with a covered entity. (Accessed Aug. 2022). SOURCE: HI Department of Human Servies, Med-QUEST Division, Quest Integration (QI) Health Plans Memo QI-2139/FF2 21-15. Ensure the integrity of the psychometric properties of the tests or assessment procedures used, Modifying the test environment as necessary to prevent access to cell phones, the Internet, or coaching from other persons during administration, Minimizing any potential distractions which could affect performance, Ensure that additional consideration is given to issues that arise with testing diverse populations that could further lower reliability and validity of scores due to changes in administration procedures and the test environment, Ensure the quality of the technologies being used and the hardware requirements needed are considered prior to starting testing, Consideration should be given to the availability of back-up technologies should technical problems be encountered during administration, Use HIPAA approved telehealth technologies as well as temporarily allowed popular applications that allow for video chats to provide telehealth in accordance with the OCR Notice Notify patients that telehealth applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. (Accessed Aug. 2022). SOURCE: HI Revised Statutes 346-59.1. Services may also be rendered via an approved telehealth modality, if determined by the health plan to be appropriate and effective and agreed to by the member. HI Revised Statutes 329-126. With respect to the latter, we encourage providers covered by 42 CFR Part 2 to confirm the application of the medical emergency exception, or some other permission, and proceed with the guidance below. CPT 99454. SOURCE: HI Revised Statutes 453-2(b) (7). 1. See Attachment A for full list of CPT codes that are prime candidates for telehealth services. 5C (Other Activities/Locations) sites are not eligible to receive PPS reimbursement in Hawaii and therefore are not eligible to receive PPS for tele-health services. Telehealth means health care services provided through telecommunications technology by a health care professional who is at a location other than where the covered person is located.. Under this notice, covered health care providers that seek additional privacy protections should use technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements in connection with the provision of their video communication products. QI-2139 Tele-Health Law (Act 226, SLH 2016) Implementation/FFS-21-15 (Replaces QI-1702A/FFS-1701A). An official website of the United States government. Get updates on telehealth Use of any other platform for clinical service delivery is strictly prohibited. Telehealth means the use of telecommunications services, as defined in section 2691, to encompass four modalities: store-and-forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and noninteractive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. Virtual health encompasses all synchronous, asynchronous You may need to consider extra . If you have any questions about Optums standard virtual visits program, please contact our Provider Service Line at 1-877-614-0484, or contact your Provider Relations Advocate. 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