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Telehealth Reimbursement for Mental Health During COVID-19

 

Telehealth Reimbursement for Mental Health during COVID-19

Updated May 18, 2020
By Allison Ostrowsky, LCSW, VP, Care Options, Quartet Health

Public and commercial payers are adapting their telehealth policies to make it easier for mental health providers to treat patients virtually during the COVID-19 public health emergency. Below is a summary of these changes, as of April 18, 2020. This site will continue to be updated as information changes. Policies are quickly evolving.

It is recommended that you verify current policies of insurers and regulatory agencies, including through the HHS Office for Civil Rights (OCR) and SAMHSA’s COVID-19 guidance materials. Recent telehealth changes vary by state and payer, but may include:

  • Platforms: New changes allow providers to connect with patients via everyday communications technologies like FaceTime and Skype, or by telephone, waiving the requirement to use a HIPAA-compliant video platform during COVID-19. Telehealth services may be provided, for example, through audio, text messaging, or video communication technology, including video conferencing software. For purposes of reimbursement, certain payors may impose restrictions* on the types of technologies that can be used. 
  • Reimbursement: New changes to pay at parity for telehealth. This would end previous challenges providers faced who practice in a state without payment parity enforcement, and thus would receive a lower reimbursement for offering a service via telehealth than they would have if the service was provided in person.
  • Billing codes: New changes that create unique billing codes for providers to identify services provided via telehealth during COVID-19.
  • State licensure: Quartet recommends that mental health providers contact their State Board of Medicine or Department of Health to understand any applicable leniencies during COVID-19. The Federation of State Medical Boards (FSMB) has a helpful resource page tracking licensure changes during COVID-19.
  • Originating and distant sites: New changes that allow patients and providers to use telehealth from their homes as long as only the intended parties are participating in the communication.
  • Prior authorization: New changes that waive requirements for prior authorizations and referrals to allow providers to offer telehealth to new and existing patients.
  • Controlled substance prescriptions: New changes that allow DEA-registered practitioners to prescribe controlled substances via telehealth without an initial in-person evaluation during COVID-19, as outlined on the DEA COVID-19 Information Page

*The suggested platforms are and should be non-public facing remote communication products which employ end-to-end encryption, and are acceptable forms of communication. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. In contrast, public-facing products such as TikTok, Facebook Live, Twitch, or a chat room like Slack are not acceptable forms of remote communication fortelehealth because they are designed to be open to the public or allow wide or indiscriminate access to the communication. For more details on Medicare and Medicaid restrictions on the type of technology eligible for reimbursement, see HHS’ Telehealth and HIPAA FAQ.


Below are plan changes as they pertain to:

  1. Commercial & Medicare Advantage
  2. Medicaid
  3. Medicare


Commercial & Medicare Advantage

Last Updated April 1, 2020


Pennsylvania

State Payer Line of Business What is reimbursable during COVID-19? Notes Provider Resources

New Jersey



Medicare, Medicaid, National health plan policies cited below
Horizon BlueCross BlueShield of New Jersey Commercial, Medicare Advantage, and Medicaid
Virtual visits conducted via video or phone with in-network providers.


Virtual visits will be reimbursed at the same rate as in-person visits.

These changes will remain in effect until June 30, 2020.
Horizon BCBS COVID-19 Information for Providers

North Carolina



Medicare, Medicaid, National health plan policies cited below
BlueCross BlueShield of North Carolina
Commercial and Medicare Advantage Virtual visits conducted via video or phone.


Virtual visits will be reimbursed at the same rate as in-person visits.

These measures will remain in effect during the COVID-19 pandemic. They will be effective through July 31st. BCNC will revisit the extension closer to the July 31st date.

BCNC COVID-19 Information for Providers

Telehealth Corporate Reimbursement Policy- BCNC


Medicare, Medicaid, National health plan policies cited below
Highmark BlueCross BlueShield Commercial and Medicare Advantage
Virtual visits conducted via video or phone.


Highmark will reimburse each code at the contracted rate or established Fee Schedule for services, based on Highmark’s Telehealth Reimbursement Policy.

These changes will remain in effect until September 30, 2020.
Highmark BCBS COVID-19 Telehealth Information for Providers


Washington


Medicare, Medicaid, National health plan policies cited below

Regence BlueShield Commercial and
Medicare Advantage

Virtual visits conducted via video or audio.


Visits will be reimbursed at the same rate as in-person visits.


Providers can verify a patient’s eligibility for telehealth services through the Availity Provider Portal.


Claims may be submitted on or after March 24, 2020 for dates of service beginning on March 19, 2020. These updates will remain in effect for the duration of the state’s declaration of emergency.

Regence FAQ for temporary telehealth updates
Asuris Northwest Health Commercial and
Medicare Advantage

Virtual visits conducted via video or audio.


Visits will be reimbursed at the same rate as in-person visits.


Providers can verify a patient’s eligibility for telehealth services through the Availity Provider Portal.


Claims may be submitted on or after March 24, 2020 for dates of service beginning on March 19, 2020. These updates will remain in effect for the duration of the state’s declaration of emergency.

Asuris Northwest FAQ for temporary telehealth updates
BridgeSpan Health Commercial
Virtual visits conducted via video or audio.


Visits will be reimbursed at the same rate as in-person visits.


Providers can verify a patient’s eligibility for telehealth services through the Availity Provider Portal.


Claims may be submitted on or after March 24, 2020 for dates of service beginning on March 19, 2020. These updates will remain in effect for the duration of the state’s declaration of emergency.

BridgeSpan FAQ for temporary telehealth updates
Premera BlueCross Commercial and
Medicare Advantage
Virtual visits conducted via video or phone.


Premera will reimburse telehealth visits for Medicare Advantage members at the same rate as in-person visits.


Telehealth services for commercial plan members are coded differently than in person visits. There are additional codes that can be used for online video encounters and telephone visits in conjunction with the office visit codes.


Providers are advised to visit the telehealth payment policy page for virtual care codes and searching for “Remote Technologies” under the Enhanced Benefits tab at the top.


Providers are required to use the correct coding and notify the patient if they are using non-HIPAA compliant communication tools.


These updates will remain in effect for the duration of the state’s declaration of emergency.

Premera COVID-19 Information for Providers

State Payer Line of Business What is reimbursable during COVID-19? Notes Provider Resources
Nationwide
BCBS Federal Employee Plan (FEP) Virtual visits conducted by in-network providers for fully-insured members via video or audio.

FEP is encouraging the adoption and use of video, chat or e-visits among providers and health systems.

BCBS recommends checking with local Blue Plans on FEP benefits as the range of covered services may vary.

These measures will remain in effect for a 90-day period, starting March 19, 2020

March 19th press release
United Healthcare Commercial, Medicare Advantage, and Medicaid Virtual visits conducted via video or phone are reimbursable. In order for a virtual visit provider to be listed in the virtual visit provider directory, an attestation form must be submitted.

These changes will remain in effect until July 24, 2020, but may be extended as necessary.

United Behavioral Health COVID-19 Information for Providers
Aetna Commercial and Medicare Advantage Virtual visits conducted via a platform with an audio-visual connection are reimbursable. These changes will remain in effect until June 30, 2020.

Providers can access Aetna’s telemedicine policy through NaviNet or the Availity Provider Portal

Aetna COVID-19
Information for Providers
Cigna Virtual visits conducted via video or phone are reimbursable. Telehealth attestations and/or additional credentialing is not required during this interim period.

Cigna recommends verifying a patient’s behavioral health benefits and eligibility for all plan types prior to rendering telehealth services.

These changes will remain in effect until May 31, 2020.

Cigna COVID-19 Information for Providers


Medicaid

Last Updated April 1, 2020

State What is reimbursable? Notes Provider Resources
California Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating or distant site restrictions, meaning patients and providers may use tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary California COVID-19 Telehealth Policies

California Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

California Department of Health Care Services COVID-19 Provider Notices

Illinois Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating site restrictions, meaning patients may access tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary Illinois COVID-19 Telehealth Policies

Illinois Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

Illinois Department of Healthcare and Family Services COVID-19 Provider Notices

Louisiana Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating site restrictions, meaning patients may access tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary Louisiana COVID-19 Telehealth Policies

Louisiana Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

Louisiana Department of Health COVID-19 Provider Notices

New Jersey Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating or distant site restrictions, meaning patients and providers may use tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary New Jersey COVID-19 Telehealth Policies

New Jersey Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

New Jersey Department of Health COVID-19 Provider Notices

North Carolina Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating or distant site restrictions, meaning patients and providers may use tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary North Carolina COVID-19 Telehealth Policies

North Carolina Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

North Carolina Department of Health and Human Services COVID-19 Provider Notices

Pennsylvania Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating site restrictions, meaning patients may access tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary Pennsylvania COVID-19 Telehealth Policies

Pennsylvania Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

Pennsylvania Department of Human Services COVID-19 Provider Notices

Washington Virtual visits conducted via video, and phone when video is not available.

Virtual visits will be reimbursed at the same rate as in-person visits.

No originating or distant site restrictions, meaning patients and providers may use tele from the home.

Providers can see new and existing patients without prior authorizations or referrals.

Temporarily in effect until further notice.


Temporary Washington COVID-19 Telehealth Policies

Washington Section 1135 Waiver for Temporary Enrollment of Out-of-State Providers

Washington State Department of Health COVID-19 Provider Notices

 


Medicare

Last Updated April 1, 2020

Payer Line of Business What is reimbursable during COVID-19? Notes Provider Resources
Original Medicare Medicare Under this waiver originating site restrictions have been lifted and members can access tele from their home.

All Medicare members can now access teleservices. Eligibility is no longer limited to members in rural areas.

Telehealth visits will be reimbursed at the same rate as in-person visits.

CMS has waived the requirement of using video technology for certain telehealth services furnished using interactive telecommunications systems. The waiver allows the use of audio-only equipment to furnish services described by the codes, including behavioral health counseling services.

Effective for services starting on March 6, 2020 and will remain in effect for the duration of the state of emergency.
CMS Fact Sheet

CMS Provider FAQ

CMS Medicare COVID-19 Provider Notices

CMS Learning Network Telehealth Services Booklet

COVID-19 Emergency Declaration Blanket Waivers for Healthcare Providers

 

If you have any questions about the information above, please reach out to support@quartethealth.com.

Disclaimer: This site will continue to be updated as information changes, but may not be the most up to date or comprehensive as policies are quickly evolving. It is recommended that you verify current policies of insurers and regulatory agencies, such as the HHS OCR, CMS, and SAMHSA’s COVID-19 guidance materials. We suggest providers who need specific information on out-of-state licensure and/or service options to look at their respective state licensure page, and reach out to their state licensing board and/or their personal malpractice for additional resources. Quartet is not responsible for provider reimbursement.

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