Telehealth policy took some significant strides in 2018, and many of the federal and state polices passed in 2018 take effect January 1, 2019
MEDICARE
Here is a run-down of some of the new policies to be aware of that are taking effect in Medicare today:
- Medicare will now start reimbursing for virtual check-ins, remote pre-recorded information and inter-professional internet consultations. These services are not classified as “telehealth” and therefore not subject to the statutory telehealth restrictions that typically apply in Medicare, such as limitations on services, provider types and originating sites.
- In accordance with the CY 2019 PFS and FQHC and RHC Policy Manual Update, Medicare will reimburse RHCs and FQHCs for communication based technology and remote evaluation services not already captured in the RHC AIR or FQHC PPS payment, waiving the face-to-face requirement. They are not eligible for reimbursement of the inter-professional internet consultation.
- Medicare’s originating site geographic requirement will no longer apply for end stage renal disease (ESRD) services in hospital-based or CAH-based renal dialysis centers. Renal dialysis facilities and the home are also now eligible for reimbursement for ESRD-related services and exempt from the geographic requirement as well.
- Diagnosis, evaluation and treatment for acute stroke via telehealth can take place at any eligible originating site or mobile stroke unit without application of the originating site geographic requirement. The home and renal dialysis facilities are excluded.
- New Telehealth Codes for Prolonged Preventive Services will now be reimbursable (G0513 and G0514) by CMS, although these services are still subject to all of CMS’ statutory telehealth restrictions.
- New remote physiological monitoring codes now reimbursable, including CPT codes 99453, 99454, and 99457 (not subject to statutory telehealth restrictions).
Learn more about these new services and related requirements by referencing the full text of the Calendar Year 2019 Physician Fee Schedule, or see CCHP’s factsheet on the changes.
STATE POLICIES
States have also been actively pursuing telehealth policy changes. Here are a few that take effect today:
- ARIZONA private payer law now applies to the specialties of urology, pain medicine and substance abuse.
- ILLINOIS Medicaid required to begin reimbursing certain mental health professionals and clinicians to provide behavioral health services via telehealth. Illinois insurers will also be required to provide coverage for telehealth services by licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the home.
- KANSAS law now prohibits private payers from excluding coverage solely because a service is provided through telemedicine.
- TENNESSEE officially joins the Interstate Medical Licensure Compact as a new member state.
- UTAH law requiring health benefit plans that offer coverage for mental health services provide coverage for telepsychiatric consultations under certain conditions takes effect today.
For more information on all of the state bills that passed in 2018, see CCHP’s legislative roundup
Published in conjunction with the Center for Connected Health Policy
