Ohio Medicaid Telehealth Rules Made Permanent
On November 5, 2020, rules related to the provision of telehealth services temporarily issued as a response to the COVID-19 (a.k.a. coronavirus) pandemic became permanent. Governor Mike DeWine and the Ohio Department of Medicaid (ODM) initially had expanded telehealth access in March by providing flexibility in patient-provider interactions, broadening the network of providers that can bill Medicaid for telehealth services and expanding eligible telehealth services. ODM announced in September that the agency filed proposed rules to make the telehealth changes permanent. At that time, there had been approximately 2.6 million claims for telehealth services from Ohio Medicaid members since the telehealth coverage expansion in March, about half of which were for behavioral health services. Before the pandemic, ODM provider telehealth claims averaged less than 1,000 claims per month for physical health services and 4,000 claims per month for mental health and addiction services.
The rule was approved by the Joint Committee on Agency Rule Review (JCARR) and makes the following changes to Ohio Administrative Code 5160-1-18:
- Expands the definition of telehealth to include the following asynchronous activities that do not have both audio and video elements: telephone calls, remote patient monitoring and communication through secure electronic mail or a secure patient portal.
- Expands the type of practitioners eligible to render services using telehealth to include supervised practitioners.
- Provides fewer restrictions on patient and practitioner site locations.
- Identifies the provider types eligible to bill for services rendered through telehealth and sets forth provider responsibilities when providing and billing for services delivered through telehealth.
- Exempts supervised practitioners and supervised trainees, occupational therapy assistants, physical therapy assistants, speech-language pathology aides, audiology aides and individuals holding a conditional license from eligibility to bill for services rendered through telehealth.
- Removes active patient requirements and replaces it with modified provisions requiring at least one in-person annual visit for a patient seen for a period of longer than 12 consecutive months.
- Expands the services that may be paid for when delivered using telehealth.
- Provides requirements for claims submitted for health care services utilizing telehealth, including that the claim identify a "GT" modifier, a place of service code that reflects the physical location of the treating practitioner, and a modifier to reflect the physical location of the patient.
- Allows for a facility claim to be submitted by an outpatient hospital for telehealth services delivered by licensed psychologists and independent behavioral health practitioners.
Maureen Corcoran, director at ODM, has said “this permanent expansion of clinically appropriate telehealth services allows us to increase access to quality care while maintaining the fiscal sustainability and integrity of Ohio’s Medicaid program.” The final rule can be found on the Register of Ohio.
Should you have any questions concerning the new telehealth rules, please contact Ms. Rubin.
Anna L. Schroeder, a law clerk with Eastman & Smith who received her law degree from The Ohio State University Moritz College of Law and is awaiting bar exam results, contributed to this article.
At the date of publication the above information was correct. It is quite possible the information above has changed as COVID-19 is a rapidly evolving situation.
The article in this publication has been prepared by Eastman & Smith Ltd. for informational purposes only and should not be considered legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney/client relationship.