Telehealth Part 2: New Rules and Regulations from CMS

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Telehealth Part 2: New Rules and Regulations from CMS

Telehealth: New Rules from CMS and Resources

During these unprecedented times, many adjustments are put into action to accommodate the new normal of social distancing. As previously discussed in our New Rules for Telehealth Technology blog post, the COVID-19 pandemic is causing a large spike in virtual healthcare visits. In these times of rapid change, normal rules and regulations are relaxed to increase accessible care. The Centers for Medicare & Medicaid Services (CMS) recently adjusted its policies so more practitioners can use telehealth during the COVID-19 outbreak. 

How CMS is Responding to COVID-19

Public health emergencies, such as the COVID-19 pandemic, require the U.S. healthcare system work quickly to make sure people are receiving necessary care. As the largest health insurer in the nation, CMS plays a critical role in enforcing new safety and billing guidance during these uncertain times. CMS has implemented temporary changes during our country’s state of emergency. Here is a quick summary of the timeline so far:

Timeline: 

March 13 – The United States declares COVID-19 as a national emergency. CMS publishes an initial emergency declaration fact sheet for healthcare providers.

March 17 – CMS announces an expansion of telehealth services covered for Medicare beneficiaries. CMS also approves the first state request for 1135 Medicaid waiver in Florida.

March 27 – 34 states officially approved for a Medicaid waiver under Section 1135 (see the CMS Newsroom for updated numbers).

March 30 – 80 additional telehealth services added under Medicare coverage.1  

These dates are only a few noteworthy occasions of the many changes made in the past month by our country. CMS reports that Medicaid waiver requests are being approved in historic turnaround times. Fulfilling waiver requests quickly grants states ample flexibility to serve individuals on Medicaid, who are often underserved in communities. CMS reports, “Other types of Medicaid waivers can require months of negotiation, but in light of the urgent and evolving needs of states during COVID-19 CMS developed a streamlined template for facilitate expedited application and approval of Medicaid 1135 waivers.”2  

What does a Section 1135 waiver mean?

The Medicaid-specific waivers approved to many states are under Section 1135 of the Social Security Act. These waivers specifically provide the healthcare system greater flexibility for providing care to individuals. Some of the temporary flexibilities include:

  • Waiving requirements in the authorization for fee-for-service program
  • Out-of-state providers can provide care to another state’s Medicaid population if they have been impacted by the national emergency
  • Waiving requirements that providers be licensed in the specific state they are providing care in (as long as they have equivalent licensure in another state)
  • Suspending requirements relating to pre-admission or annual screenings (specific to nursing homes)

CMS changes are evolving each day. It is important now more than ever to stay up to date with the facts. Regulations differ on a state and local level. As always, follow the guidance of your local health authorities. For further details on the Section 1135 waivers (specific to state Medicaid), please visit Medicaid.gov or trust reliable news sources, such as the CMS Newsroom. Furthermore, CMS is regularly updating this webpage to keep beneficiaries and healthcare professionals up to date.

Further Expansion for Telehealth

Telehealth is continually seeing an expansion during the COVID-19 pandemic. CMS is now allowing 80 additional services to be provided through telehealth, specifically for Medicare patients. Covered healthcare professionals may use any non-public facing product, such as FaceTime, Skype and Facebook Messenger to provide telehealth during this public health emergency. Penalties won’t be imposed on covered providers who have not entered into a HIPAA BAA with these vendors.

Billing has also been adjusted, allowing healthcare professionals to bill telehealth visits at the same rate as in-person visits. New and existing patients can now be at home while receiving various forms of healthcare.

As always, see CMS.gov for more information on the temporary regulatory changes and other changes that might be implemented. 

Patagonia Health is Here for You

There is so much information out there about COVID-19. Patagonia Health is here for you as a resource. We are regularly updating resource pages to specifically help you sift through the noise. 

State-Specific Telehealth Coding and Billing Cheat Sheets and other Educational Resources

COVID-19 Resources for Public & Behavioral Health

As a trusted Public and Behavioral Health EHR, practice management, and billing solution, we understand the importance of combating the ongoing pandemic of COVID-19. Our team is currently collaborating with customers to develop a fully integrated telehealth solution. If we can be a service or resource for you, please contact us today. 

References:

1 https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html

2 https://www.cms.gov/newsroom/press-releases/trump-administration-approves-34th-state-request-medicaid-emergency-waivers

Additional Resources:

The National Council’s COVID-19 Resources

CMS Emergency Information on COVID-19

Medicare Telemedicine Health Care Fact Sheet

Historic Expansion of Telehealth Announcement from HHS

New Rules for Telehealth Technology

It’s no question that COVID-19 is rapidly changing the way we live and work. New social distancing restrictions and shelter-in-place orders cause businesses to become creative in how to stream services online or operate from a distance. Since the beginning of this pandemic, healthcare providers have been on the front lines. As social distancing becomes increasingly important, even healthcare workers must implement measures to serve clients from afar. Telehealth is an even hotter topic right now for just this reason. 

We’ve seen a spike in organizations using technology to continue providing care. Offering telehealth keeps both patients and healthcare professionals safe during the COVID-19 outbreak. For that reason, the government recently lifted restrictions on telehealth. Telehealth is expanding to every type of healthcare provider, not just those working to treat COVID-19. The expansion of telehealth helps slow the spread of COVID-19 and provides more healthcare access to individuals during this unique time. 

So, what are these lifted restrictions and how can you get started with telehealth?

What is Telehealth?

Flow chart describing the differences between telehealth and telemedicine

Before we can understand new rules and regulations for telehealth, it’s important to define what telehealth is. Telehealth is the distribution of health-related services electronically or through telecommunications. It allows for individuals to receive health education, clinical visits, health administration from a distance by utilizing technology.1 Telemedicine is a category of telehealth. Telemedicine refers directly to clinical services being offered electronically. Telehealth covers a large umbrella of health services, as shown on the flow chart.

Relaxed HIPAA Regulations for Telehealth

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) released last week that normal penalties on HIPAA noncompliance will not be imposed on organizations providing telehealth. This means that normal HIPAA requirements are now being relaxed to allow more healthcare workers to use telehealth. These rules may vary across states, so it is important to check local health authority updates. However, relaxed HIPAA regulations do not mean relaxed privacy standards. Security of a patient’s private health information is always held at first priority. These relaxed penalties allow professionals to begin offering care electronically as soon as possible. Here’s what you need to know about the new HIPAA guidance from OCR:

Healthcare Workers Can Now Use “Non-Public” Products to Offer Telehealth

Non-public products include technologies such as:

  • Apple FaceTime
  • Skype
  • Google Video Hangouts

Non-public applications still allow for the privacy of a patient’s information; whereas, public applications may not provide the same security. Public-facing applications are prohibited in electronic healthcare visits, even with the relaxed HIPAA regulations.  OCR specifically prohibits such “public-facing” solutions, which include apps like Facebook Live or Tik Tok.

Safety Not Automatically Ensured

While the commitment to privacy and security remains the same, it’s important to note safety is not automatically ensured in these non-public solutions. OCR recognizes the use of these applications will present potential risks in privacy. 

Clients and healthcare professionals should work diligently to confirm encryption and privacy modes are enabled in non-public applications. It is always better to double-check privacy settings rather than assume everything is in place. 

Roger Severino, the director at OCR, recently stated, “We are empowering medical providers to serve patients wherever they are during this national public health emergency.”2 Telehealth will allow more people to access the care they need during this trying time in public health history.

Getting Started with Telehealth

With telehealth quickly expanding, it’s important to know how to get started. The American Medical Association recently released a helpful quick guide to facilitate using implementation for providers. When getting started, it’s recommended organizations think through these 3 steps:

  1. Designate team members to make decisions quickly about solution options for a facilitated implementation
  2. Make sure your malpractice insurance carrier policy covers telehealth options
  3. Develop a base knowledge of the payment and policies that come with telehealth services

HHS additionally provides a list of technology vendors claiming to be HIPAA compliant.3 While this is not an exhaustive list, it includes vendors that would qualify as HIPAA-compliant products under the normal HIPAA circumstances. These vendors additionally claim to be willing to enter into a HIPAA Business Associate Agreement (BAA) with healthcare providers. In short, BAAs are legal documents that ensure video service products protect patient privacy. Products on the HHS list include:

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings / Webex Teams
  • Amazon Chime
  • GoToMeeting

Again, these products are not an exhaustive list. Although, they may be important to consider as a longer-term telehealth solution. These products have more established privacy policies as they are commonly used under normal HIPAA circumstances.

Stay Up To Date on Telehealth News

It is likely that we will continue to see an increase in electronic care options and policies as the COVID-19 pandemic continues. To stay up to date with the growing expansion and changes in telehealth, be sure to check trusted sources. The following links are resources to trust during the ongoing pandemic:

Patagonia Health is Here to Help

As a trusted Public and Behavioral Health EHR, practice management, and billing solution, we understand the importance of combating the ongoing pandemic of COVID-19. As always, if there’s anything we can do to support you, please reach out to us. 

Blog Resources

1 https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth

2 https://www.hhs.gov/about/news/2020/03/20/ocr-issues-guidance-on-telehealth-remote-communications-following-its-notification-of-enforcement-discretion.html

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

https://blog.sigmundsoftware.com/hipaa-telehealth-coronavirus-provision?utm_campaign=Sigmund%20Blog&utm_source=hs_email&utm_medium=email&utm_content=85054459&_hsenc=p2ANqtz-8whNmUMZQfoIIp6zYVPoTQsnUVjhzK1ueThi9-6oo_XmdcqLlTmQaK2Z8exzrEIi6qGHnLyuM-1vIzI9icv1dz1UhT8A&_hsmi=85086582

https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice?utm_source=twitter&utm_medium=social_ama&utm_term=3207044834&utm_campaign=Public+Health

Inside Behavioral Health: What is a CCBHC?

This month, SAMHSA announced $200 million is now available nationwide for the Certified Community Behavioral Health Clinic (CCBHC) Expansion Grants. Not only is this a $50 million increase from 2019 funding, but it also advances the program to be available in all states. While clinics from all 50 states may apply for grants, SAMHSA indicates they will prioritize the 24 states that received CCBHC planning grants in 2016. To see if your state is included in the 24 receiving priority, please reference who is eligible for expansion grants from The National Council. The CCBHC model intends to provide more access to mental health and addiction services to vulnerable populations. With this increase in funding, more behavioral health care will become available to individuals nationwide. So, let’s back up: what is a CCBHC?

The CCBHC Model Defined

Certified Community Behavioral Health Clinics provide a range of behavioral health services. They have a designated provider type in Medicaid, allowing them to receive enhanced reimbursements. The model began under the Protecting Access to Medicare Act of 2014, which established a 2-year, eight-state initiative based on the Excellence in Mental Health and Addiction Act1. The Excellence Act is centered on providing access to mental health and addiction services through CCBHCs while improving Medicaid reimbursement. Improved reimbursement rates allow more people in need to access necessary care. As an underserved population, Medicaid recipients struggling with complex mental health and substance use disorders often can’t access quality care. CCBHCs work not only to fill this gap but also to provide a comprehensive and integrated model for care. The hope behind the model is to provide stability, access, and necessary treatment for these vulnerable behavioral health patients.

As described by The National Council2, CCBHCs must provide the following nine comprehensive care requirements:

  1. 24/7/365 crisis mental health services
  2. Screening and risk assessment
  3. Patient-centered treatment planning
  4. Outpatient mental health and substance use services
  5. Primary care screening and monitoring of key health indicators/health risk
  6. Targeted case management
  7. Psychiatric rehabilitation services
  8. Peer and family support
  9. Tailored care for active-duty military and veterans

SAMHSA3 states they expect “this program will provide comprehensive 24/7 access to community-based mental and substance use disorder services; treatment of co-occurring disorders; and physical healthcare in one single location.”

Who Receives Care at a CCBHC?

Any individual in need of behavioral health services can receive care at a CCBHC. This includes, but is not limited to, individuals with mild to serious mental illness, long-term chronic addiction, and substance use disorders. The enhanced Medicaid payment method allows organizations to receive reimbursements more effectively. Prior to this model, it was difficult for Medicaid-recipients to receive quality behavioral health coverage. Therefore, Medicaid-recipients largely benefit from care at CCBHCs. Additionally, CCBHCs provide care to individuals, regardless of their ability to pay. CCBHCs provide service to those who are insured, uninsured, and on Medicaid.

How to Become a CCBHC:

SAMHSA describes 6 program requirements for CCBHCs. The 2020 Funding Opportunity Announcement defines the following requirements:

SAMHSA has 6 program requirements to become a CCBHC
  • Staffing
  • Availability and accessibility of services
  • Care coordination
  • Scope of services
  • Quality and other reporting
  • Organization authority, governance, and accreditation

If your organization meets these requirements, visit the SAMHSA website to apply for the Certified Community Behavioral Health Clinic Expansion Grant.

Resources to Help CCBHCs

If your organization follows an integrated, comprehensive care model such as a Certified Community Behavioral Health Clinic, your resources need to support the care you provide. For example, CCBHCs have specific procedure codes for billing. SAMHSA also requires particular reporting for CCBHCs, including certain data selection and performance measurements. Electronic Health Records play a critical role in these billing and reporting requirements. Patagonia Health not only supports but easily automates the unique reporting and billing that’s required when an organization becomes a CCBHC. To find out more about how our solution can support your organizational needs, contact us today.

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Resources:

1 https://www.thenationalcouncil.org/topics/excellence-in-mental-health-act/

2 https://www.thenationalcouncil.org/wp-content/uploads/2017/11/What-is-a-CCBHC-11.7.17.pdf

3 https://www.samhsa.gov/grants/grant-announcements/sm-20-012

https://www.samhsa.gov/sites/default/files/programs_campaigns/ccbhc-criteria.pdf