THE VALUED VOICE

Vol. 64, Issue 35
Click here to view past issues
Thursday, August 27, 2020

   

WHA Telemedicine Work Group Hears about DHS Medicaid Telehealth Expansion Plans

At its August 24 meeting, WHA’s Telemedicine Work Group welcomed Brooke Anderson, DNP, RN, of the Wisconsin Department of Health Services’ (DHS) Division of Medicaid Services. Anderson provided a status update on DHS’ Telehealth Expansion Project.
 
While 2019 Act 56, developed by a bipartisan group of legislators with WHA input, requires the department to provide reimbursement under the Medical Assistance (MA) program for any Medicaid covered benefit that is delivered by a MA-certified provider through interactive telehealth, DHS’ approach has been somewhat different. DHS is engaged in identifying which services among the 18,000 CPT service codes covered by Wisconsin Medicaid can be provided via telehealth in a “functionally equivalent” manner to in-person health care visits. Work group members said that providers should determine the functional equivalence of telehealth with face-to-face services.
 
DHS has identified the following service areas where codes will be identified for coverage in the first phase:
 
  • School-based services
  • Medication therapy management
  • Targeted case management
  • Therapies (Occupational, Physical and Speech)
  • Behavioral health
  • Medicare parity
  • Remote patient monitoring
  • Provider-to-provider consults
2019 Act 56 authorizes DHS to promulgate rules that limit specific telehealth services, as follows: 
 
  • Medicare-adopted telehealth services which should be covered under Medicaid
  • Provider-to-provider consultations
  • Remote patient monitoring
  • Asynchronous telehealth services
  • Audio-only telephone, facsimile machine, or e-mail services
If DHS does not promulgate these rules by Dec. 1, 2020, the above-listed services will be covered by Medicaid. The Work Group provided feedback to Anderson on the scope of coverage for these services, focusing its comments on audio-only services, remote supervision of providers, coverage of ancillary therapies such as genetic counseling, and diabetes management. Work group members discussed lessons learned during the COVID pandemic on how audio-only services have improved health care access for several type of patients, including those with transportation barriers, lack of broadband access and inadequate data plans to support video visits. Behavioral health patients have greatly benefited from being able to receive Medicaid-reimbursable services in an audio-only mode.
 
WHA will continue to work closely with DHS as the state agency formulates policies on Medicaid coverage of telehealth services. For more information, contact WHA’s Laura Rose , Jon Hoelter or Matthew Stanford.
 

This story originally appeared in the August 27, 2020 edition of WHA Newsletter

WHA Logo
Thursday, August 27, 2020

WHA Telemedicine Work Group Hears about DHS Medicaid Telehealth Expansion Plans

At its August 24 meeting, WHA’s Telemedicine Work Group welcomed Brooke Anderson, DNP, RN, of the Wisconsin Department of Health Services’ (DHS) Division of Medicaid Services. Anderson provided a status update on DHS’ Telehealth Expansion Project.
 
While 2019 Act 56, developed by a bipartisan group of legislators with WHA input, requires the department to provide reimbursement under the Medical Assistance (MA) program for any Medicaid covered benefit that is delivered by a MA-certified provider through interactive telehealth, DHS’ approach has been somewhat different. DHS is engaged in identifying which services among the 18,000 CPT service codes covered by Wisconsin Medicaid can be provided via telehealth in a “functionally equivalent” manner to in-person health care visits. Work group members said that providers should determine the functional equivalence of telehealth with face-to-face services.
 
DHS has identified the following service areas where codes will be identified for coverage in the first phase:
 
  • School-based services
  • Medication therapy management
  • Targeted case management
  • Therapies (Occupational, Physical and Speech)
  • Behavioral health
  • Medicare parity
  • Remote patient monitoring
  • Provider-to-provider consults
2019 Act 56 authorizes DHS to promulgate rules that limit specific telehealth services, as follows: 
 
  • Medicare-adopted telehealth services which should be covered under Medicaid
  • Provider-to-provider consultations
  • Remote patient monitoring
  • Asynchronous telehealth services
  • Audio-only telephone, facsimile machine, or e-mail services
If DHS does not promulgate these rules by Dec. 1, 2020, the above-listed services will be covered by Medicaid. The Work Group provided feedback to Anderson on the scope of coverage for these services, focusing its comments on audio-only services, remote supervision of providers, coverage of ancillary therapies such as genetic counseling, and diabetes management. Work group members discussed lessons learned during the COVID pandemic on how audio-only services have improved health care access for several type of patients, including those with transportation barriers, lack of broadband access and inadequate data plans to support video visits. Behavioral health patients have greatly benefited from being able to receive Medicaid-reimbursable services in an audio-only mode.
 
WHA will continue to work closely with DHS as the state agency formulates policies on Medicaid coverage of telehealth services. For more information, contact WHA’s Laura Rose , Jon Hoelter or Matthew Stanford.
 

This story originally appeared in the August 27, 2020 edition of WHA Newsletter