Broadening Telehealth Coverage for Medicaid and CHIP

Trump Administration on 23rd April 2020, released a new toolkit for states to help accelerate the 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.

Toolkit for broadening telehealth coverage for Medicaid and CHIP

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 the state within federal parameters, and this toolkit will help states identify policies that 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 smartphones and other devices) a state may use.

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 of 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.

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 2019 Novel Coronavirus (COVID-19) outbreak. Visit our blog section for more billing resources on medical billing during COVID-19 and Telehealth Billing. These resources will help you to prepare your practice and address patient concerns during the COVID-19 pandemic. To get reimbursed for medical services rendered during the COVID-19 pandemic, contact Medical Billers and Coders (MBC) at 888-357-3226/