Type: Law Bulletins
Date: 03/24/2020

Ohio Medicaid Expands Telehealth Service Capability and Reimbursement

On March 20, 2020, the Ohio Department of Medicaid (ODM) issued an emergency rule to expand telehealth services within Ohio during the COVID-19 pandemic.  This rule allows all Medicaid covered individuals to receive telehealth services, regardless of the last time they had a face to face visit with their provider, and regardless of their status as a new or existing patient. In addition, the rule also incorporates by reference Ohio Department of Mental Health and Addiction Services (OhioMHAS) emergency rule changes to interactive videoconferencing.

The ODM emergency rule defines telehealth as activities that are synchronous involving real-time interactive audio and visual communications, as well as activities that are asynchronous and do not have both audio and video elements. As such, telehealth services can include video conferences, phone calls, images transmitted via fax and e-mail.  Furthermore, ODM specifically incorporated the Office of Civil Rights Department of Health and Human Services COVID-19 HIPAA related directives into the emergency rule. Therefore, providers can utilize any audio or video non-public facing remote communication products (e.g. FaceTime and Skype) to communicate with patients for telehealth visits, however public facing applications are prohibited (e.g. Facebook Live and TikTok). During the telehealth visit, to the greatest extent possible, the practitioner should have access to the records of the patient at the time of services and shall maintain existing documentation requirements.  While the normal Medicaid telehealth rules require a patient to be located at a specific site to receive Medicaid reimbursable telehealth services, the emergency rule removes these restrictions and allows a patient to be seen for a telehealth visit in any location, with the exception of penal facilities or public institutions. 

Additionally, the rule greatly expands on the types of providers eligible to provide telehealth services to Ohio Medicaid patients. These providers include, among others:

  • Physicians and physician assistants.
  • Psychologists.
  • Clinical nurse specialists, certified nurse midwives, and certified nurse practitioners.
  • Licensed independent social workers, marriage and family therapists, and professional clinical counselors.
  • Licensed independent chemical dependency counselors.
  • Supervised practitioners and trainees.
  • Audiologists and speech language pathologists and their aides.
  • Physical and occupational therapists and their assistants.
  • Individuals holding conditional licenses.
  • Dietitians.

The providers set forth above are eligible to bill Medicaid for services rendered through telehealth except for supervised practitioners and trainees, occupational and physical therapist assistants, speech language pathology and audiology aides, and individuals holding a conditional license. In addition, professional medical groups, FQHCs, RHCs, ambulatory health care clinics, outpatient hospitals, hospitals delivering outpatient hospital behavioral health services, including psychiatric hospitals, and other participating and non-participating providers delivering services in the managed care or fee for service programs, as defined by the ODM director, may also bill Medicaid for the provision of telehealth services.

All of the changes in the emergency rule apply to Medicaid fee-for-service, Medicaid managed care plans and MyCare Ohio services. The following types of telehealth services may be billed:

  • Evaluation and management of new and existing patients (not to exceed E&M levels 1-4).
  • Inpatient or office consultations for new or established patients.
  • Mental health and substance abuse disorder evaluations and psychotherapy.
  • Remote evaluation of recorded videos or images.
  • Occupational therapy, physical therapy, speech language pathology and audiology services.
  • Medical nutrition services.
  • Lactation counseling provided by dietitians.
  • Psychological and neuropsychological testing.
  • Smoking and tobacco cessation counseling.
  • Developmental test administration.
  • Follow up consultations with a patient.
  • Services under the specialized recover services program.
  • Nearly all behavioral health services provided under OhioMHAS’ emergency rule.

This rule will remain in effect so long as Ohio is still under a state of emergency as declared by the governor.  For further guidance, ODM has published frequently asked questions with respect to the emergency rule.

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