Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
“Today (April 23, 2020), the Trump Administration released a new (25-page) toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) pandemic. This release builds on the agency’s swift actions to provide states with a wide range of tools and guidance to support their ability to care for their Medicaid and CHIP beneficiaries during this public health emergency.
Ensuring that patients can safely receive the care they need at home minimizes travel to healthcare facilities and supports efforts to limit community spread of the virus. Under President Trump’s leadership, CMS has taken numerous steps to ensure that Americans can access the health care services they need through electronic and virtual means. Swift actions in Medicare have ensured that the nation’s health coverage program for seniors is able to pay for telehealth services delivered nationwide and in any setting, with recent steps expanding Medicare payment for 80 additional telehealth services.
Building on those actions, CMS is providing this toolkit for states to take similar steps. Medicaid and CHIP programs are jointly administered by the state and federal governments, and together provide health coverage for over 71 million Americans, including 35 million children. Coverage and payment policies vary by state within federal parameters, and this toolkit will help states identify policies which may impede the rapid deployment of telehealth when providing care. States enjoy broad federal flexibility to cover telehealth through Medicaid, including which methods of communication (such as telephonic, video technology commonly available on smart phones and other devices) a state may use.
“While not all patient interactions can be delivered through telehealth, our clinicians on the frontlines need every tool in their arsenal to fight this invisible enemy,” said CMS Administrator Seema Verma. “I’m urging states to use this toolkit to make sure our Medicaid patients, particularly our children, can continue to receive needed care from the safety of their homes.”
This toolkit provides states with issues to consider as they evaluate the need to expand their telehealth capabilities and coverage policies, including:
- Patient populations eligible for telehealth: Federal rules allow Medicaid services to be delivered via telehealth across all populations. The toolkit will help states identify restrictions on telehealth eligibility, like only allowing coverage for beneficiaries who live in rural areas.
- Coverage and reimbursement policies: While telehealth may not be appropriate for all services, states should review services even if they have not traditionally been delivered in such a manner. For example, some states may have only allowed behavioral health services to be delivered through telehealth. Medicaid reimbursement rates also need to be adequate to facilitate care delivered through telehealth. Not all states have provided reimbursement parity with face to face encounters.
- Providers and practitioners eligible to provide telehealth: The toolkit will help states to evaluate whether state practice acts or regulations limit the ability for certain providers to deliver services through telehealth.
- Technology requirements: The dominant form of telehealth is generally thought of as two-way audio/visual communication, or a video chat. However, telehealth is much broader than this since other forms have always existed alongside what some people consider standard telehealth, such as remote patient monitoring, etc.
- Pediatric considerations: Given the importance of Medicaid and CHIP to the pediatric population, the toolkit includes a special focus on this group. For example, states should consider state consent and privacy laws in the development of telehealth coverage policies for children.
The toolkit also includes a compilation of frequently asked questions (FAQs) and other resources available to states. This toolkit is the latest in a series of tools and checklists that CMS has released to help provide states emergency flexibilities and resources that they need during the during the 2019 Novel Coronavirus (COVID-19) outbreak.
This release and earlier CMS actions in response to the COVID-19 virus, are all part of ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, click here www.coronavirus.gov. For a complete and updated list of CMS actions, guidance, and other information in response to the COVID-19 virus, please visit the, please visit the Current Emergencies Website.”