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State Medicaid Guidance Authorizes Telehealth, Telephonic Services and Billing for COVID-19 Emergency

A special edition of the state’s Medicaid Update issued last night (see here) includes a guidance broadly expanding the use of telehealth, telephonic services and other communications methods by Medicaid providers during the COVID-19 state of emergency.

Effective for dates of service after March 1, and for the duration of the state of emergency, “New York State Medicaid will reimburse telephonic assessment, monitoring, and evaluation and management services provided to members in cases where face-to-face visits may not be recommended and it is appropriate for the member to be evaluated and managed by telephone.” HCA has confirmed with DOH officials that the guidance applies to Article 36 home care providers.

It adds: “All telephonic encounters documented as appropriate by the provider would be considered medically necessary for payment purposes in Medicaid fee for service or Medicaid Managed Care.”

The guidance goes on to explain how payment for telephonic encounters will be supported in “six different payment pathways utilizing the usual provider billing structure,” along with additional billing guidance.

Since the onset of COVID-19, HCA and members have advocated daily for the state to authorize broad and expansive use of telehealth and telephonic means of service to patients at home. This is especially vital to help ensure service access, safety, protection and to cope with worker shortages.

HCA welcomes the new guidance. On immediate review last evening, we identified a number of key areas where we feel further direction and clarity are needed to ensure coverage, reimbursement and use. In response, state Department of Health (DOH) officials said last night that DOH favors a Q&A to address these needs, and HCA anticipates working with the Department today on this.

At the federal level, HCA and our federal affairs representative, Brett Heimov, continued to communicate with key Congressional offices yesterday about similar telehealth needs in home care under federal Medicare and Medicaid rules. Late into the night and early this morning, HCA received word that Senate negotiators were working to insert telehealth-related language into the federal COVID-19 aid package that is on track for finalization now.

HCA will keep members posted of significant developments as they arise.

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