States have broad flexibility to cover telehealth through Medicaid, including the methods of communication (e.g., telephonic and video technology commonly available on smart phones and other devices) to use. No Federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.
Expanded Medicare telehealth coverage was announced March 17, 2020, effective retroactively to March 6. In accordance with the 1135 waiver, members can remain at home and receive a telehealth visit from their provider. Providers may also provide services from their homes but must use place of service code “02” for distant site when billing for claims reimbursement.
The United States Department of Health & Human Services (HHS) Office for Civil Rights (OCR) is responsible for enforcing certain regulations issued under the Health Insurance Portability and Accountability Act (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health Act (HITECH). During the COVID-19 national emergency, providers may communicate with members through alternative, non-HIPAA-compliant communication technologies. The OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with HIPAA during the COVID-19 nationwide public health emergency.
For a list of acceptable telehealth communication technologies, refer to the HHS Notification of Enforcement Discretion for Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency web page.
Targeted Case Management – extended temporary changes to face-to-face contact - This waiver is set to end on May 11, 2023.
The Minnesota Legislature has continued this waiver, which started March 19,2020, until the end of the federal public health emergency, allowing providers to conduct targeted case management (TCM) services via telephone and video-conferencing in place of in-person, face-to-face contact.
Allows case managers to conduct targeted case management visits by phone or video with adults receiving services and with their legal guardians, and with children receiving services and their parents or legal guardians.
Bill all TCM services following the billing instructions under the South Country Provider Manual Chapter 22 Mental Health and Substance Use Disorders Services while this waiver is in effect. TCM providers do not need to meet the telemedicine standards and do not need to submit a Provider Assurance Statement for Telemedicine#5206.
The affected programs include:
- Child welfare targeted case management (CW-TCM)
- Children’s mental health targeted case management (CMH-TCM)
- Adult mental health targeted case management (AMH-TCM)
- Vulnerable adult or adult with developmental disabilities targeted case management (VA/DD-TCM)
- Relocation service coordination targeted case management (RSC-TCM)
New Interactive Video (ITV) standards go into effect May 12, 2023
Some of the temporary waiver modifications made during the PHE will become permanent according to Minnesota Statutes 256B.0625, subdivision 20(c) & 20b. Specifically, providers can now choose ITV to meet minimum face-to-face contact requirements when applicable within each statute for targeted case management.
Providers choosing to have ITV as a reimbursed medical assistance option must have a Targeted Case Management Provider Interactive Video Assurance Statement on file with the Minnesota Department of Human Services (DHS) for these services:
- Child Welfare Targeted Case Management (CW-TCM)
- Children’s Mental Health Targeted Case Management (CMH-TCM)
- Adult Mental Health Targeted Case Management (AMH-TCM)
- Vulnerable Adult/Developmental Disability Targeted Case Management (VA/DD-TCM)
Providers will be update on when this assurance statement becomes available in the coming weeks.
Attestation requires compliance with the ITV requirements outlined in Minnesota Statutes 256B.0625, subdivision 20b, as well policies and procedures regarding the safety and efficacy of providing TCM services through ITV.
Telehealth Coding & Reimbursement
There are three types of telehealth visits: telemedicine, e-visit, and virtual. The Medicare Telemedicine Health Care Provider Fact Sheet defines the three types of telehealth visits and how these services should be provided.
The member’s home is generally not an eligible site, but under the new 1135 waiver, the member can receive a telehealth service regardless of where he or she is located. All telehealth codes provided when the member is in a facility can be provided when the member is in his/her home under the waiver, and providers are reimbursed as if the service was furnished in person.
South Country follows the CMS and Minnesota Department of Human Services (DHS) telehealth services coverage policies.
Effective April 1, 2020, Medicaid coverage for telehealth services includes telehealth services provided via telephone. Evaluation and management services provided via telephone must be billed with the most appropriate telephone Current Procedural Terminology (CPT) codes. Follow CPT guidelines for use of CPT codes 99441, 99442, and 99443.
Telehealth providers may not bill condition code DR or modifier CR on telehealth claims during the COVID-19 pandemic period. Providers must continue to use the appropriate telehealth modifiers when billing.
Effective March 17, 2020, and throughout the COVID-19 pandemic period, South Country is following CMS billing guidelines for telehealth services:
- Bill using the CPT/Healthcare Common Procedure Coding System (HCPCS) codes and Place of Service (POS) you would normally bill for the service (i.e., office, outpatient, etc.)
- A member can be in his/her home when receiving services
- Use modifier 95 for professional claims
- Use modifier GO in addition to 95 if the telehealth service was performed in relation to acute stroke
- No billing changes for institutional claims
- Critical Access Hospital (CAH) Method II claims should continue to have modifier GT
Source: HSS.gov - Notification of Enforcement Discretion for telemedicine remote communications during the COVID-19 nationwide public health emergency