New York Department of Health Releases Updated Guidance on Telehealth

March 2019 ~

The New York Department of Health, last month, posted a Medicaid Update newsletter on its recent expansion of telehealth. The update applies to fee-for-service recipients as of January 1, 2019, and Medicaid managed care enrollees as of March 1, 2019.

The state’s budget, last year, expanded Medicaid covered telehealth services to home settings to allow for greater access to remote patient monitoring and alternative health care delivery models.

The updated document outlines NYS Medicaid’s updated telehealth coverage and reimbursement policy as it applies to Article 28 facilities and private practitioners. According to the guidance, pursuant to New York State (NYS) Public Health Law (PHL) Article 29-G, as recently amended, and Social Services Law (SSL) Section 367-u, NYS Medicaid has expanded coverage of telehealth services to include:

1. Additional originating and distant sites;
2. Additional telehealth applications (store-and-forward technology, and remote patient monitoring); and
3. Additional practitioner types.

The updates included in the guidance became effective as of January 1, 2019 for Medicaid Fee-for-Service (FFS) and March 1, 2019 for Medicaid Managed Care (MMC) plans. (NOTE: Nothing precludes implementation by the MMC Plans prior to January 1, 2019.)

These updates, as seen in the Medicaid Update, can be seen below.

Originating Site

The originating site must be located within the fifty United States or United States territories. Originating sites previously included facilities licensed under Article 28 (general hospitals, nursing homes, and diagnostic and treatment clinics) and private physician’s or dentist’s offices located within the state of New York.

Since the last article on telehealth was published in the March 2015 Medicaid Update, several originating sites have been added. The list now reads as follows:

1. Facilities licensed under Article 28 of the PHL (general hospitals, nursing homes, and diagnostic and treatment clinics);
2. Facilities licensed under Article 40 of the PHL (hospice programs);
3. Facilities as defined in Subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL) (includes clinics certified under Articles 16, 31 and 32);
4. Certified and non-certified day and residential programs funded or operated by OPWDD;
5. Private physician’s or dentist’s offices located within the state of New York;
6. Any type of adult care facility licensed under Title 2 of Article 7 of the SSL;
7. Public, private and charter elementary and secondary schools located within the state of New York;
8. School-age child care programs located within the state of New York;
9. Child daycare centers located within the state of New York; and
10. The member’s place of residence located within the state of New York or other temporary location within or outside the state of New York.

Distant Site

The distant site is any secure location within the fifty United States or United States’ territories where the telehealth provider is located while delivering health care services by means of telehealth. Services provided by means of telehealth must be in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all other relevant laws and regulations governing confidentiality, privacy, and consent (including, but not limited to 45 CFR Parts 160 and 164 [HIPAA Security Rules]; 42 CFR, Part 2; PHL Article 27-F; and MHL Section 33.13).

Telehealth Application

NYS Medicaid has covered telemedicine both remote patient monitoring provided by Certified Home Health Agencies (CHHAs) for their patients and telemedicine for a number of years. At this time, NYS Medicaid is expanding coverage of telehealth to include store-and-forward technology, additional originating sites, and additional practitioners.

Telemedicine

The totality of the communication of information exchanged between the physician or other qualified health care practitioner and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.

Store-and-Forward Technology

Store-and-forward technology involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site.

1. Store-and-forward technology aids in diagnoses when live video or face-to-face contact is not readily available or not necessary.
2. Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

Remote Patient Monitoring (RPM)

Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, blood pressure, heart rate, weight, blood sugar, blood oxygen levels, and electrocardiogram readings. RPM may include follow-up on previously transmitted data conducted through communication technologies or by telephone. Follow-up is included in the monthly time component (see Application-Specific Telehealth Billing Rules).

The following considerations apply to RPM:

1. Medical conditions that may be treated/monitored by means of RPM include, but are not limited to, congestive heart failure, diabetes, chronic obstructive pulmonary disease, wound care, polypharmacy, mental or behavioral problems, and technology-dependent care such as continuous oxygen, ventilator care, total parenteral nutrition or enteral feeding.
2. RPM must be ordered and billed by a physician, nurse practitioner or midwife, with whom the member has or has entered into a substantial and ongoing relationship. RPM can also be provided and billed by an Article 28 clinic when ordered by one of the previously mentioned qualified practitioners.
3. Members must be seen in-person by their practitioner, as needed, for follow-up care.
4. RPM must be medically necessary and shall be discontinued when the member’s condition is determined to be stable/controlled.
5. Payment for RPM, while a member is receiving home health services through a Certified Home Health Agency (CHHA), is pursuant to PHL Section 3614 (3-c)(a)-(d) and will only be made to that same CHHA.

Telehealth Providers

The Medicaid Update article addresses the telehealth payment policy for the following provider types:

1. Physicians;
2. Physician assistants;
3. Dentists;
4. Nurse practitioners;
5. Registered professional nurses (when such nurse is receiving patient-specific health information or medical data at a distant site by means of RPM);
6. Podiatrists;
7. Optometrists;
8. Psychologists;
9. Social workers;
10. Speech/language pathologists;
11. Audiologists;
12. Midwives;
13. Physical therapists;
14. Occupational therapists;
15. Certified diabetes educators;
16. Certified asthma educators;
17. Genetic counselors;
18. Credentialed alcoholism and substance abuse counselors (CASAC) credentialed by OASAS or by a credentialing entity approved by such office pursuant to Section 19.07 of the MHL;
19. Providers authorized to provide services and service coordination under the Early Intervention (EI) Program pursuant to Article 25 of PHL (Note: The EI Program will issue program-specific guidance regarding the use of and reimbursement for EI services delivered via telehealth.)
20. Hospitals licensed under Article 28 of PHL, including residential health care facilities serving special needs populations;
21. Home care services agencies licensed under Article 36 of PHL; and
22. Hospices licensed under Article 40 of PHL;

The following applies to practitioners providing services via telehealth:

1. Practitioners providing services via telehealth must be licensed or certified, and currently registered in accordance with NYS Education Law or other applicable law, and enrolled in NYS Medicaid.
2. Telehealth services must be delivered by providers acting within their scope of practice.
3. Reimbursement will be made in accordance with existing Medicaid policy related to supervision and billing rules and requirements.
4. When services are provided by an Article 28 facility, the telehealth practitioner must be credentialed and privileged at both the originating and distant sites in accordance with Section 2805-u of PHL. The law can be viewed here.

NOTE: The Office of Mental Health (OMH), the Office for People with Developmental Disabilities (OPWDD), and the Office of Alcoholism and Substance Abuse Services (OASAS) will be publishing separate guidance on telehealth and regulations that will align with state law and Medicaid payment policy for Medicaid enrollees being served under their authority. Additional guidance on specialty consultations for OMH, OPWDD, and OASAS members will be forthcoming. These regulations will address:

1. Clinics licensed or certified under Article 16 of the MHL;
2. Certified and non-certified day and residential programs funded or operated by the OPWDD; and
3. Any other provider as determined by the Commissioner of Health pursuant to regulation or in consultation with the Commissioner, by the Commissioner of OMH, the Commissioner of OASAS, or the Commissioner of OPWDD pursuant to regulation.

Source(s): New York State Department of Health; New York State Medicaid Update – Special Edition – February 2019 Volume 35 – Number 2; HMA Weekly Roundup February 27, 2019; mHealthIntelligence; Northeast Telehealth Resource Center;