A number of updates have made by the Oregon Well being Authority (“OHA”) and the Well being Proof Evaluate Fee (“HERC”) since this alert was first posted. The next is up to date as of March 31, 2020.
On March 16, 2020, the Oregon Well being Authority (“OHA”) issued a new temporary emergency rule revising OAR 410-130-0610 – OHA’s Medicaid telehealth reimbursement rule. The brand new rule is meant to broaden using telehealth providers for Medicaid recipients and to extend reimbursement for sure telehealth providers. OHA additionally adopted a modified Prioritized Checklist of Well being Providers issued by the Well being Proof Evaluate Fee (“HERC”) on March 13, 2020 (“Prioritized Checklist”). The Prioritized Checklist comprises an up to date Guideline Note A-5 and a brand new Statement of Intent 6. The Guideline Be aware, Assertion of Intent, and momentary guidelines outline the scope of telehealth providers which might be thought of lined for Medicaid recipients.
The revised Guideline Be aware A-5 is meant to facilitate entry to key providers, together with digital, video, and phone visits to allow suppliers to service sufferers with out the sufferers risking illness transmission. It features a pretty sturdy listing of process codes that will probably be thought of lined when suppliers are engaged in synchronous visits with each audio and video functionality. As well as, HERC issued an modification to the Guideline Be aware A-5 on March 23, 2020 stating that “[t]hese providers might be offered by phone when applicable through the COVID-19 disaster. See CMS FAQ #2 and Oregon Well being Plan COVID-19 page for up-to-date particulars and billing steering for fee-for-service.” Permitted providers embrace, for instance, psychotherapy, Finish-State Renal Illness-related providers, new and established affected person visits, subsequent hospital care, subsequent nursing facility care, and sure behavioral well being and care administration codes. The notice supplies:
Telehealth (Synchronous audio/video visits)
Telehealth visits are outlined as synchronous visits with each audio and video functionality. The affected person could also be at dwelling or in a well being care setting. The originating web site code Q3014 could solely be utilized by applicable well being care websites. Codes eligible for telehealth providers embrace 90785, 90791, 90792, 90832-90834, 90836, 90837-90840, 90846, 90847, 90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961, 90963, 90964-90970, 96116, 96156-96171, 96160, 96161, 97802-4, 99201-99205, 99211-99215, 99231-99233, 99307-99310, 99354-99357, 99406-99407, 99495-99498, G0108-G0109, G0270, G0296, G0396, G0397, G0406-G0408, G0420, G0421, G0425-G0427, G0436-G0439, G0442-G0447, G0459, G0506, G0508, G0509, G0513, G0514, G2086-G2088.
Telehealth visits are lined for inpatient and outpatient providers for brand spanking new or established sufferers.
Telehealth consultations are lined for emergency and inpatient providers.
Billing for telehealth visits requires the identical stage of documentation, medical necessity and protection determinations as in-person visits.
This can be a important replace due to the expanded quantity and sort of procedural codes that qualify for telehealth visits and since it applies to each new and current sufferers. The notice continues to authorize sure codes (CPT 98966-98968, 99441-99443, 99421-99423, 98970-98972, G2012, G2061-G2063) that have been beforehand obtainable when a clinician had sure telephonic or digital service go to with an established affected person but in addition acknowledged that the requirement that the codes be used just for established sufferers can be waived through the Covid-19 disaster. The notice additionally continues to acknowledge protection for sure clinician-to-clinician consultations by phone. In keeping with HERC, the revisions to Guideline Be aware A-5 will allow entry to telemedicine providers going ahead.
HERC’s new Assertion of Intent 6 applies particularly throughout an outbreak or epidemic and supplies:
Throughout an outbreak or epidemic of an infectious illness, lowering administrative limitations (e.g. rising reimbursement charges) for telephonic analysis and administration providers (CPT 99441-99443) and evaluation and administration providers (CPT 98966-98968) is suitable to make sure entry to care whereas avoiding and stopping pointless potential infectious publicity.
The referenced codes will allow reimbursement for sure Non-Face-to-Face Doctor and Nonphysician Phone Providers. OHA’s momentary rule additionally specifies that in an outbreak or epidemic, OHA will present protection and reimbursement of patient-to-clinician telephonic and digital providers for established sufferers utilizing the OHA’s most allowable rate-setting methodology. OAR 410-130-0610(4). On March 20, OHA issued a public notice stating that OHA intends to submit an expedited State Plan Modification to the Facilities for Medicare & Medicaid Providers (“CMS”) asking CMS to approve an modification retroactive to Oregon’s State Medicaid Plan permitting Oregon to extend reimbursement for telehealth providers to charges which might be corresponding to in-person providers.
The brand new momentary rule specifies necessities that should be met to acquire reimbursement for bodily well being telemedicine providers together with:
- Compliance with HIPAA and OHA’s Confidentiality and Privateness Guidelines and safety protections for the affected person in reference to the telemedicine communication and associated information;
- Utilizing expertise within the telemedicine communication that’s compliant with privateness and safety requirements in HIPAA and the Authority’s Privateness and Confidentiality Guidelines set forth in OAR 943 division 14;
- Guaranteeing insurance policies and procedures are in place to stop a breach in privateness or publicity of affected person well being data or information (whether or not oral or recorded in any kind or medium) to unauthorized people;
- Complying with the related HERC guideline notice for telehealth, teleconsultation, and digital/telephonic providers;
- Sustaining scientific and monetary documentation associated to telemedicine providers as required in OAR 410-120-1360;
- Guaranteeing that the performing suppliers maintain a present and legitimate license with out restriction from a state licensing board the place the supplier is situated and have authority to supply bodily well being telemedicine providers for eligible Oregon Medicaid beneficiaries; and
- Compliance with appropriate coding requirements utilizing essentially the most applicable Present Procedural Terminology (CPT) or Healthcare Frequent Process Coding System (HCPCS) codes.
Be aware that two days after OHA issued its momentary rule, the Workplace of Civil Rights of the U.S. Division of Well being and Human Providers announced that it could train its enforcement discretion and waive any potential penalties for HIPAA violations towards well being care suppliers that serve sufferers by on a regular basis communications applied sciences through the COVID-19 nationwide public well being emergency. See our blog post discussing different adjustments on the federal stage designed to bolster the accessibility of telehealth providers. HERC promptly amended its Guideline Be aware A5 to state “[c]ertain necessities for encryption will not be enforced by federal authorities throughout this disaster. This implies providers like Facetime, Skype and Google Hangouts can be utilized for affected person contact. Compliant platforms are in fact most popular when obtainable.” We might anticipate to see OHA amend its rule to align with this place within the close to future. As that is an evolving space we’ll plan to replace our put up as new data turns into obtainable.
 HERC issued an errata on March 23, 2020 eradicating “96150-96154” and changing it with “96156-96171.”