Click on a topic to see how its applied in your state. Billable FQHC encounters are face-to-face contacts between a patient and a FQHC covered professional. Be consistent with directives from the CDC and SAMSHA, health services that are not urgent should be postponed where possible. D9996 (teledentistry-asynchronous; information stored and forwarded to dentist for subsequent review) can be used to identify eligible telehealth delivered services. PDF Telehealth Policy and Procedure Starter - NRTRC Many of these laws focus on where . CIS services may be rendered via telehealth as appropriate, as long as the required face-to-face interaction requirements are met (See Section 16, Service Settings for more information). With the implementation of the new policy, we will introduce a number of claim edits, which are intended to support industry standard correct coding principles and . Clinical policies help identify whether services . Dentistry & Federally Qualified Health Centers. Dental providers who are eligible to bill Hawaii Medicaid are also eligible to bill for telehealth for specific services (see Dental Manual Attachment A for details). Suspension of enforcement penalties related to provider prescribing practices and out-of-state providers (See p.22-23, 27-28). Point32Health is the parent organization of Tufts Health Plan and Harvard Pilgrim Health Care. (Accessed Aug. 2022). SOURCE: HI Revised Statutes 453-2(b) (7). (Accessed Aug. 2022). See our Privacy Policy. SOURCE: HI Revised Statutes 431:10A-116.3; 432D-23.5; & 432:1-601.5. COVID-19 Information and Resources - Harvard Pilgrim Health Care Memo QI- 2139/FFS 21-15 replaces Memo QI-1702A. SOURCE: HI Revised Statutes 346-59.1 & 431:10A-116.3. 2016, p. 6. (Accessed Aug. 2022). For more information, please visit HRSA.gov. GT, GQ or 95 modifiers must be used. Several remote monitoring codes in Attachment A are listed as prime candidates for telehealth services. Patients can receive a wide range of telehealth services, including check-ins with their primary care providers, mental health care, and specialty services. The most recent extension from April 16, 2022, will be in effect until July 15, 2022. Telehealth | UHCprovider.com CCHP encourages you to check with the appropriate state agency for further information and direction. Issuing a prescription based solely on an online questionnaire is nottreatmentforthepurposesofthis section and does notconstitute an acceptablestandardof care. Telehealth means the use of telecommunications, as that term is defined in section 269-1, 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 non-interactive 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 radiologist is at a distant site. Telemedicine claims may also be submitted with the POS code that would have been reported had the service been furnished in person and modifier 95. CPT 99453. SOURCE: HI Dept. If no mandate was issued, the expanded policy was applicable through June 17, 2020. 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. 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. Harvard Pilgrim Health Care Expands Telehealth Options in - Benzinga (Accessed Aug. 2022). This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. Anesthesia. CMS has stated that this new telehealth place of . SOURCE: HI Revised Statutes Ch. 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 Administration, DHHS. Medicaid Membership: State Medicaid guidance/mandates apply. Distant site providers should use the 02 Place of Service Code. We track and compile telehealth-related laws and regulations across all 50 states and the District of Columbia, as well as at the federal level. The Center for Connected Health Policy is a program of the Public Health Institute. MedQUEST Memo QI-2007/FFS 20-03 (March 16, 2020). The FQHC section of CCHPs Policy Finder Tool is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,656,250 with zero percentage financed with non-governmental sources. (Accessed Aug. 2022). SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 70 Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation. Policies & Procedures - National Consortium of Telehealth Resource Centers SOURCE: HI Revised Statutes 671-7 (a). SOURCE: HI Revised Statutes 431:10A-116.3(g); 432D-23.5(g); & 432:1-601.5(g). UnitedHealthcare will reimburse appropriate claims for telehealth services in accordance with the member's benefit plan. Med-QUEST Division. Under this notice, covered health care providers may use popular applications to deliver telehealth as long as they are non-public facing. Examples of non-public facing applications include: Examples of public facing applications not allowed for this use are Facebook Live and Twitch. For each organization type listed below, you will find documents outlining policies and procedures for . Behavioral Health-Division of Financial Responsibilities. Harvard Pilgrim Telehealth Billing Guidelines Blue Cross, Harvard Pilgrim, Tufts waive patients' out-of-pocket As a necessary precaution, clinics and hospitals limited the number of visitors to stem spread of the dreaded disease. Office of the Governor COVID-19 Emergency Proclamation from June 7: Suspension of enforcement penalties related to provider prescribing practices and out-of-state providers (See p.22-23, 27-28). SOURCE: HI Revised Statutes 329-126. Preparing patients for tele-physical therapy, Physical therapy and remote patient monitoring, deliver telehealth services to Medicare and Medicaid patients, Medicare Coverage and Payment of Virtual Services, Current State Laws & Reimbursement Policies. HI State Plan Amendment 16-0004. PDF Telehealth/Virtual Health Policy, Professional - UHCprovider.com Med-QUEST Division. Policy changes during COVID-19 | Telehealth.HHS.gov Hawaii Medicaid is required under statute to reimburse telehealth equivalent to reimbursement for the same services provided via face-to-face contact. MedQuest provides some areas of consideration when approving ABA services through telehealth (see memo). Department of Commerce and Consumer Affairs: State Provides Guidance for Dental Profession During COVID-19. PDF Disclaimer - Highmark Health Options The pandemic presented a unique dilemma for doctors and their patients. In January 2021, the Massachusetts legislature passed Chapter 260 of the Acts of 2020, establishing a comprehensive framework for the coverage and reimbursement of health care services delivered via telemedicine for all state-regulated commercial plans and public plans.The COVID-19 State of Emergency was lifted on June 15th, 2021, triggering the sunset of . 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. Two (2) encounters are payable when the first encounter is for treatment of an acute and/or chronic condition such as cough/ fever and/or hypertension and patient returns to the FQHC with an acute injury such laceration of the forearm, sprained ankle, etc. HI Revised Statutes Sec. Documentation requirements for telehealth/telemedicine services are the same as those required for any face-to-face encounter, with the addition of the following: A statement that the service was provided using telehealth/telemedicine consult; The location of the patient; The location of the provider; and Medicaid: Memo on Telephonic Services and Qualified non-physician Health Care Professionals, STATUS: State PHE ended, unclear if still active, Medicaid: Memo on Telehealth Guidance With Procedure Codes, Medicaid: COVID-19 Pandemic Action Plan for QI Health Plans. (Accessed Aug. 2022). For more information, read FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency or visit HIPAA and COVID-19. 21: Federally Qualified Health Centers. 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. 2022, this interim policy will be retired, and Harvard Pilgrim's new Commercial Telehealth/Telemedicine Payment Policy . 453-2(3-4). InternationalPuerto RicoOther US TerritoryAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming. HI Revised Statutes 671-7 (a). SOURCE: HI Revised Statutes 431:26-101. QUEST Integration Health Plans & Community Case Management Agencies. Provider Telehealth Guidelines | UPMC Health Plan 2 (March 2016). 2016, p. 6. The OCR Notice contains information regarding applications that may be used to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. 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