COVID-19 Update: ODM issues emergency telemedicine rule

On March 20, 2020, the Ohio Department of Medicaid (ODM) issued an emergency rule to expand access to medical and behavioral health services via telehealth.

The emergency rule permits providers to furnish telehealth services:

• using any audio or video non-public facing remote communication products available to communicate with patients; however, public-facing technologies, such as Facebook Live, Twitch and TikTok should not be used.
• without an initial face-to-face visit

Several additional requirements apply to the expanded telehealth services:

• Providers are encouraged (but not required) to notify patients that third party applications used to provide telehealth services may introduce privacy risks and providers should enable all available encryption and privacy modes when using the applications. 
• Providers should exercise professional judgment in using telehealth examinations.
• To the extent possible, practitioner sites should have access to patient records and maintain documentation in accordance with the Office for Civil Rights’ recent notification of HIPAA enforcement discretion during the COVID-19 nationwide public health emergency. HIPPA-related directives of OCR issued during the COVID-19 public health emergency are incorporated by reference. 

The emergency rule authorizes an expanded list of eligible providers to provide services via telehealth, which includes:

• physicians and physician assistants
• psychologists
• clinical nurse specialists, certified nurse-midwives and certified nurse practitioners
• licensed independent social workers, licensed independent marriage and family therapists, licensed professional clinical counselors, and licensed independent chemical dependency counselors
• supervised practitioners and supervised trainees
• audiologists, occupational therapists, physical therapists, speech-language pathologists, occupational therapist assistants, physical therapist assistants, speech-language pathology aides and audiology aides
• individuals holding conditional licenses, Medicaid school program practitioners, dieticians and other participating and non-participating providers delivering services in the managed care or fee-for-service (FFS) programs, as designated by the ODM director.

All of the above provider types are eligible to bill ODM for telehealth services, except the following dependent practitioners: supervised practitioners and supervised trainees, occupational therapist assistants, physical therapist assistants, speech-language pathology aides and audiology aides, any individual holding a conditional license. Professional medical groups, federally qualified health centers (FQHCs), ambulatory health care clinics, outpatient hospitals, Medicaid school programs and other participating and non-participating providers delivering services in the managed care or FFS programs, as designated by ODM, are also eligible to bill ODM for telehealth services.    

ODM payment will be made only for the following specified services: evaluation and management (E&M) services for new and established patients; inpatient or office consults for new and established patients (when the same quality and timeliness of care cannot be furnished otherwise); mental health or substance use disorder services (described as psychiatric diagnostic evaluation or psychotherapy); remote evaluation of recorded video or images for an established patient; virtual check-in by a physician or qualified professional reporting E&M services for an established patient; online digital E&M services for an established patient; remote patient monitoring; audiology, speech-language pathology, physical therapy, and occupational therapy services, medical nutrition services, lactation counseling by dieticians, psychological and neuropsychological testing; smoking and tobacco use cessation counseling; developmental test administration; other services designated by ODM; services under specialized recovery services program.  

The emergency rule also includes specific requirements for claim submission and payment of telehealth claims by practitioner sites for professional services and originating fees, institutions (facilities), FQHCs and RHCs, and others. 

Entities providing services certified by the Ohio Department of Mental Health and Addiction Services (OMHAS) can provide telehealth services using asynchronous activities that do not have both audio and video elements, such as telephone calls, images transmitted via facsimile, and email. The same additional requirements specified above apply, and telehealth services can be provided for both new and established patients and without an initial face-to-face visit. A number of requirements and prohibitions in the prior non-emergency rule are suspended or modified to facilitate the use of telehealth for these OMHAS entities, as well as for outpatient behavioral health (OPHBH) services, such as removal of face-to-face requirements, prohibitions on billing for certain services and similar requirements.