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Telehealth Reimbursement for Mental Health During COVID-19

Telehealth Reimbursement for Mental Health during COVID-19
Updated as of March 24, 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 March 24, 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: New changes that may waive the requirement for providers to be licensed to practice in the state where a member is located. For more information, see Federal Disaster Resources.
  • 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 for telehealth 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.

 

Commercial & Medicare Advantage

Last Updated 3-24-20
  • Nationwide
    • Original Medicare
    • BCBS Federal Employee Plan (FEP)
    • United Healthcare
    • Aetna
    • Cigna 
  • New Jersey
    • Horizon BlueCross BlueShield of New Jersey 
  • North Carolina
    • BlueCross BlueShield of North Carolina 
  • Pennsylvania
    • Highmark BlueCross BlueShield 
  • Washington
    • Regence BlueShield
    • Asuris Northwest Health
    • BridgeSpan Health
    • Premera BlueCross

 

State National What is reimbursable during COVID-19? Notes Provider Resources
Payer Original 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.  

These visits must be conducted via an interactive platform with audio and video capabilities.

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

CMS Learning Network Telehealth Services Booklet

Line of Business Medicare

       

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