Practice Guidance for COVID-19

Updated March 31, 2020

Below is guidance released by the Department of Health and Human Services, FDA and at the state level related to COVID-19 to assist psychiatrists with providing mental health and substance use services.

Click on a topic below to jump to the relevant practice guidance:

[Telehealth]   [Substance Use Disorders]   [Inpatient Psychiatric Settings]   [Commercial Payers]   [State-by-State Guide]

General

  • REMS: On March 23, the Food and Drug Administration released guidance to sponsors and healthcare providers regarding certain Risk Evaluation and Mitigation Strategy (REMS). For drugs subject to REMS with laboratory testing (or imaging) requirements (includes Clozapine), healthcare providers prescribing and/or dispensing these drugs should consider whether there are compelling reasons not to complete lab tests, or delay them, during this public health emergency and use best medical judgement in weighing the benefits and risks of continuing treatment in the absence of laboratory testing. The judgement regarding the risk/benefits should be communicated to patients. The FDA does not intend to take action against sponsors and other health care providers for the duration of the public health emergency for failing to adhere to REMS requirements for certain laboratory testing.
  • Medicare Quality Reporting: CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. In addition, no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS's calculations for the Medicare quality reporting and value-based purchasing programs.

Telehealth

APA has a page dedicated to Telepsychiatry and COVID-19. Key guidance for the duration of the emergency declaration includes:

  • CMS released guidance on March 17, 2020, that allows patients to be seen via live videoconferencing in their homes, without having to travel to a qualifying "originating site" for Medicare telehealth encounters, regardless of geographic location.
  • The Office of Civil Rights (OCR) has indicated they will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through FaceTime or Skype.
  • The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
  • The Ryan Haight Act requires that a provider conduct an initial, in-person examination of a patient—thus establishing a doctor-patient relationship—before electronically prescribing a controlled substance. As of March 17, 2020, the DEA has indicated that this requirement has been suspended.
  • The American Professional Agency, Inc, which provides professional liability malpractice insurance, developed resources to help members, specifically issued an FAQ about Coronavirus and Telehealth and Coronavirus and Telehealth Resources.

Substance Use Disorders

Inpatient Psychiatric Settings

  • March 18, Centers for Medicare & Medicaid Services (CMS) released recommendations on the delay of adult elective surgeries, and non-essential medical, surgical, and dental procedures during the COVID-19 outbreak. CMS indicates that "as more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators." APA considers ECT an essential procedure.
  • You can find a copy of the press release here.
  • You can find a copy of the guidance here.

Commercial Payers (Note that coverage varies by individual policy)

State-by-State Guidance

Additional resources are available on the National Governors Association website, What Steps Have States Taken To Address Coronavirus?

Click on your state below to jump to the state-issued guidance:

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Alabama

Insurance coverage of telehealth: March 13 Department of Insurance bulletin asks asking health carriers to review telehealth services and make sure they're "robust."

Waived Licensure: On March 13, Governor Ivey declared all health care professionals executing "alternative standard of care plans in good faith" to be "Emergency Management Workers." Under AL Code § 31-9-16 (2016), the term "emergency management worker" shall include any full-or part-time paid, volunteer, or auxiliary employee of this state, or other states, territories, possessions, or the District of Columbia, of the federal government, of any neighboring county or of any political subdivision thereof, or of any agency or organization performing emergency management services at any place in this state subject to the order or control of, or pursuant to, a request of, the state government or any political subdivision thereof. Additionally, any requirement for a license to practice any professional, mechanical, or other skill shall not apply to any authorized emergency management worker who shall, in the course of performing his duties as such, practice such professional, mechanical, or other skill during an emergency management emergency.

Prescribing controlled substances via telemedicine during health emergency (DEA/ALBME/ALBOP) (From the Alabama Board of Medical Examiners):

  • Can utilize telemedicine
  • Will authorize prescribers to call the Schedule II prescription in to a pharmacist

BCBS AL general guidance on telemedicine and New Directions Expanded Telemedicine Behavioral Health Coverage for BCBSAL

Viva Health Telemedicine Commercial (as of 3/13):

Telehealth: Members can have telehealth visits from any location with any network provider who offers them though their local office. Members will not have a copayment for telehealth visits with their local provider for the next 30 days. Some employer plans also include telehealth visits through Teladoc or other vendors. Members with this Teladoc coverage through ViVa HealtH can also access this benefit with no copayment for the next 30 days.

Prescription refills: On plans that include prescription drug coverage through ViVa HealtH, members can get early refills of their maintenance medications if needed. Members are encouraged to secure a 90- day supply of non-specialty maintenance medications. Home delivery from our mail-order pharmacy is available on all plans for most medications.

Viva Health Telemedicine Medicaid (as of 3/13)

Telehealth: Members can have telehealth visits from any location with any network provider who offers them though their local office. Members will not have a copayment for telehealth visits with their local provider for the next 30 days.

Prescription refills: On plans that include prescription drug coverage through ViVa HealtH, members can get early refills of their maintenance medications if needed. Members are encouraged to secure a 90-day supply of non-specialty maintenance medications. Home delivery from our mail-order pharmacy is available on all plans for most medications.

CMS has approved an 1135 Waiver for Alabama: Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days

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Alaska

Governor Dunleavy signed HB 29 into law on March 16 requiring health care insurers to provide coverage for telehealth benefits. (Please note that even though the law seems to delete "mental health," the law means that all telehealth must be covered, including mental health).

Alaska Psychiatric Institute: March 13, Governor Dunleavy issued a mandate suspending and limiting general public visitation until otherwise rescinded by DHSS and the Office of the Governor.

Guidance on Telehealth & Licensing During COVID-19: This guidance outlines the currently waived restrictions on practicing telehealth and e-prescribing during the public health crisis. Anyone providing telehealth must hold an Alaska license to perform those services. Courtesy licenses for emergency situations are offered to physicians who come to the state to provide emergency medical care or emergency mental health care for 90 days.

Alaska Respond is recruiting health care professionals who volunteer to work across the state during a disaster or public health emergency. At this time only healthcare professionals, currently licensed in Alaska, can register with Alaska Respond.

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Arizona

Governor's declaration March 11 requires insurers to cover telemedicine visits at a lower cost-sharing point for consumers than the same in-office service to encourage utilization of telemedicine for the duration of the state's public health emergency.

Waived Licensure: Governor Ducey’s March 11 Declaration of Emergency allows ADHS to waive licensing requirements to provide healthcare officials with assistance in delivering services during times of heightened demand.

CMS has approved an 1135 Waiver for Arizona:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment for non-Arizona providers

The Governor issued an executive order requiring health care insurance companies to expand telemedicine coverage for all services that would normally be covered for an in-person visit.

  • Requires all health insurance plans regulated by the Department of Insurance to provide coverage for all telemedicine services. It also includes Medicaid.
  • Must reimburse at the same level of payment as in person visit.
  • Includes physicians, PAs, ARNPs, optometrists, psychologists, dentists, occupational and physical therapists, pharmacists, behavioral health providers, chiropractors, athletic trainers, hearing aid dispensaries, audiologists, and speech pathologists.
  • Does not expand scope.

The Governor signed H.B. 2668 to bring more resources into Arizona’s health care system by increasing Arizona Health Care Cost Containment System (AHCCCS) provider rates for hospitals, doctors and more.

Arizona Medical Association is promoting the use of telemedicine and has partnered with CompuGroup Medical to provide a free telemedicine platform for six months to all physicians in Arizona.

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Arkansas

Emergency Declaration: March 11, 2020 – Governor Hutchinson signed an executive order to declare a public health emergency to facilitate coordination and provide increased support to state agencies that are involved in response to the virus. Waived licensure not included in emergency declaration.

Govenor Hutchison issued an executive order on telehealth:

  • Suspends provisions that require an in-person encounter or a face-to-face examination to allow time audio and visual means to establish a professional relationship;
  • Allows reimbursement to health care providers who take advantage of this provision; and
  • Suspends the Rules and Regulations of the Arkansas Board of Examiners in Counseling to allow licensed counselors to treat their clients by telephone.

The Governor announced the Board of Medicine will grant emergency temporary licenses to Arkansas medical residents who have completed at least one year of postgraduate training and have the written recommendation of their program director.

Arkansas submitted an 1115 Waiver, asking for $116 million in additional Medicaid funding to support a number of initiatives to protect Arkansas health care workers and their patients and to support health care providers.

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California

Guidance for behavioral health programs regarding ensuring access to health and safety during the COVID-19 public emergency. (3/14/2020)

  • Updated guidance for behavioral health programs (3/19/2020): This notice addresses behavioral health services via telephone and telehealth, adapting oversight requirements to prioritize patient needs and accommodate workforce challenges, access to prescription medications, alcohol and other drug (AOD) residential and outpatient treatment facility application, and the process to request fee reductions or waivers.

Waived Licensure: Governor Newsom's March 4 Declaration of Emergency allows out of state personnel, including, but not limited to, medical personnel ENTERING California to provide services related to the emergency without California licensure.

1135 Waiver: (3/16/2020) Request For Medicaid Section 1135 Waiver Flexibilities Related to Covid-19 The waiver requests flexibility for telehealth and virtual communications to make it easier for providers to care for people in their homes. Specifically, flexibility to allow telehealth and virtual/telephonic communications for covered State plan benefits, including but not limited to, behavioral health treatment services, waiver of face-to-face encounter requirements for Federally Qualified Health Centers, Rural Health Clinics, and Tribal 638 Clinics relative to covered services via telehealth, allowance for reimbursement of virtual communication and e-consults for FQHCs, RHCs and Tribal 638 clinics and waiver of limitations around virtual/telephonic communications prior to or after an in office visit.

Insurance Commissioner Lara Directs Health insurance Companies to Increase Telehealth Access: The notice directs health insurance companies to expand telehealth services and encourage patients to use telehealth delivery options to limit the amount of in-person health care they seek while continuing to receive essential care. Cost-sharing requirements for services delivered via telehealth should be consistent with, or no greater than, the cost-sharing requirement for services delivered through in-person settings. The notice also requires health insurers to:

  • Allow all network providers to use all available and appropriate modes of telehealth delivery including, but not limited to, synchronous video, and telephone-based service delivery.
  • Immediately implement reimbursement rates for telehealth services that mirror payment rates for an equivalent office visit.
  • Eliminate barriers to providing medically and clinically appropriate care using appropriate telehealth delivery models.
  • Use telehealth service delivery methods to enable consumers to have access to mental health and substance use disorder services, family therapy, and behavioral health services, including services to treat autism, among others.

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Colorado

Waived Licensure, Generally: DORA releases emergency measures for healthcare professional licensing in response to COVID-19.

Waived Licensure for Telemedicine: "Suspension of requirements that patients must be located in Colorado at time of consultation to expand treatment for traveling Colorado citizens, as currently required under § 12-240-107(1)(g), C.R.S., which defines telemedicine as the practice of medicine requiring a Colorado license to practice telemedicine on patients located in Colorado at time of consultation."

Waived prescription signature requirements due to public health emergency of COVID-19: Permits the utilization of telemedicine through interactive audio, video, or data communication to limit face-to-face visits between clients and health professionals.

Public Health Order 20-20 restricts visitors to all Colorado skilled nursing facilities, assisted living facilities, and intermediate facilities.

The Governor issued a "stay at home" executive order, exempting health care personnel.

Executive Order 2020-011 orders the temporary suspension of certain regulations, including suspending the requirement of a physical examination for a "medical marijuana" card for 30 days.

Executive Order 2020-016 pertains to the criminal justice system, suspending certain regulations related to populations: temporarily suspends the duty of the Department of Corrections to take and receive custody of prisoners.

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Connecticut

Emergency Temporary Telemedicine Coverage (3/13/2020)

  • Waiving the homebound requirements for all otherwise coverable medical telemedicine services;
  • Addition of specified "New Patient" Evaluation and Management (E&M) Services; and
  • Waiving the originating site requirements for psychiatric diagnostic evaluations.

New Coverage of Specified Telemedicine Services Under the Connecticut Medical Assistance Program (3/13/2020) – Includes specifics for behavioral health

Expanded Telemedicine and New Audio-Only (Telephonic) Services for Medicaid– Select E&M codes can be billed for telephone-only services provided to established patients.

Screening for COVID-19 for anyone entering Department of Mental Health and Addiction Services Facilities: screening tool for patients and visitors, including temperature check.

Provider Guidance for Mobile Crisis, Assertive Community Treatment, Inpatient Services, Residential Services.

Licensure Waiver: the Department of Public Health has waived licensure for health care practitioners licensed in other states to provide care within Connecticut, practicing within the scope of practice of Connecticut law. The provider may not balance bill the Connecticut patient.

DMHAS Private Non-Profit Provider Guidance:

  • SA Residential Levels of Care: usually a TB test is required, but due to pressures on labs right now, an assessment tool can be used instead Intensive SA Residential Treatment Programs: DMHAS permitting a reduction in face-to-face therapeutic interventions from 30 hours to 20 hours

CMS Approves 1135 Waiver for Connecticut:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Delaware

Insurance Commissioner Navarro issues bulletin (3/9/2020) prohibiting carriers from excluding a service for coverage solely because the service is provided through telemedicine. Services may be provided through a variety of platforms, including telephones, remote patient monitoring devices, and other electronic means such as web cameras and mobile facetime.

Insurance Commission Navarro issue bulletin (3/20/2020) reiterates coverage of telemedicine and notes that Delaware residents do not need to be in Delaware at the time relevant services are provided. Additionally, out-of-state providers who would be permitted to provide these services in Delaware if they were licensed under Title 24 may provide telemedicine services to a Delaware resident if they hold an active license in another jurisdiction.

Telemedicine may be practiced without a physician-patient relationship [if] furnishing of medical assistance [occurs] by a physician in case of an emergency or disaster if no charge is made for the medical assistance.

Licensure Waiver: The Delaware Department of Health and Social Services and the Delaware Emergency Management Agency announced in their latest emergency declaration guidelines for licensure waivers for the duration of the public health emergency:

  • Nurses, doctors, mental health care providers, pharmacists and other health care professionals who have active licenses or certificates of good standing in any U.S. jurisdiction are authorized to provide in-person health care services in Delaware throughout the emergency, as well as telemedicine services.
  • Delaware health care professionals whose licenses expired in the last five years are authorized to provide health care services in Delaware, assuming their licenses were in good standing for the five-year period.

Delaware 1135 Medicaid Waiver is Approved: The approved waiver enables Delaware to provide flexibilities in Medicaid provider screening and enrollment, forgo certain pre-admission screening and annual resident review assessments, and lift prior authorization requirements.

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District of Columbia

March 12 Guidance on the Use of Telehealth in DC: This guidance provides an overview of the licensure, standards of care, and reimbursement aspects of telehealth in DC, with the caveat that we are awaiting guidance on certain restrictions for Medicare beneficiaries.

March 13 Medicaid Use of Telehealth: On March 12, 2020, DHCF adopted an emergency and proposed rule that established authority for Medicaid reimbursable services to be delivered in a beneficiary's home to ensure the health, safety, and welfare of residents is not threatened by a lapse of in-person access to covered healthcare services due to the threat of infection with COVID-19. The policy change requires Medicaid telemedicine providers to ensure that any technology used meets the standards of care when the beneficiary receives telemedicine services at their home.

  • The rule will be subsequently published in the DC Register and will remain in effect for one hundred and twenty (120) days or until July 10, 2020, unless superseded by publication of a Notice of Final Rulemaking in the DC Register.
  • An update to this guidance provides that the Office of Civil Rights and the US Department of Health and Human Services will be using descretion in enforcing HIPAA, and that non-HIPAA compliant means of communicating with patients will be allowed during the public emergency.

Licensure Waiver: licensure requirements waived for healthcare providers already licensed in their home states and will be considered "temporary agents" in DC. However, those practicing as "temporary agents" can only provide healthcare at a licensed facility in DC (can include telehealth). Can also provide healthcare to patient with whom provider has existing relationship, keeping in line with March 12 guidance on telehealth.

Insurance Commissioner Order:

  • Carriers must enhance their coverage of telehealth services
  • Cost-sharing for telehealth may not be more than in person
  • Carriers must conduct utilization review and appeal processes as quickly as possible
  • Carriers may not cancel or non-renew any health benefit plan without express consent from the Commissioner

DC Medicaid Telemedicine Guide:

  • A primer to start providing telemedicine for Medicaid patients in DC

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Florida

Licensure Waiver: Florida DOH authorizing practice by health providers who are not licensed in the state for a period of 30 days, which includes telehealth.

1135 Waiver: Florida received federal approval for a Section 1135 waiver to provide more flexibility for the health care delivery system. The waiver allows Florida to provide flexibilities in Medicaid provider screening, forgo certain pre-admission screening and annual resident review assessments, lift prior authorization requirements, allow the provision of facility services in alternative settings, and extend fair hearing timelines.

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Georgia

Telemedicine for BH: Effective March 14, 2020 and through April 30, 2020, the following allowances for DBHDD Behavioral Health Services are in effect.

Telemedicine Allowances: Currently, the DBHDD Behavioral Health Provider Manual has this clause associated with several services:

To promote access, providers may use Telemedicine as a tool to provide direct interventions to individuals for whom English is not their first language (one-to-one via Telemedicine versus use of interpreters). Telemedicine may only be utilized when delivering this service to an individual for whom English is not their first language.

For the specific services which have this clause, through April 30, 2020, DBHDD will waive the Service Accessibility requirement to allow for individuals to access services via Telemedicine. All other service requirements must be met (practitioner requirements, documentation, consent, adherence to IRP content, etc.), especially content defined in Part II, Section I, 1.B.16.a-c.

Licensure Waiver: Georgia Composite Medical Board will approve and issue "emergency practice permits"; to physicians, physician assistants, advanced practice registered nurses, and respiratory care professionals who wish to practice medicine during the public health emergency response to novel coronavirus, known as "COVID-19."

Emergency Practice Permit Application: Expedited approval of out-of-state nursing licenses. March 20, 2020. Governor Kemp announced a 24-hour turnaround for any out-of-state nurses with active licenses.

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Hawaii

Licensure Waiver: Governor Ige's proclamation allows out-of-state physicians, osteopathic physicians, and physician assistants to practice in Hawaii without a license, provided that they have never had their license revoked or suspending and are hired by a state or county agency or facility, or by a hospital, included related clinics and rehabilitation hospitals, nursing home, hospice, pharmacy, or clinical laboratory.

CMS Approves 1135 Waiver for Hawaii:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Idaho

Licensure Waiver and Telehealth Waiver

Board of Medicine guidance:

  • Out-of-state MDs, DOs, and PAs licensed and in good standing in other state may practice in Idaho
  • Retired or inactive practitioners of any kind that have retired or gone inactive in last 5 years may apply for temporary license with MDs, DOs, PAs, and RTs receiving priority
  • Physicians may supervise PAs without registering with the Board and may supervise more than the currently allowed 4 PAs for at least 120 days
  • PAs do not need to submit usual documentation regarding supervision or practice
  • PAs may practice temporarily without adequate supervision or reduced supervision
  • Out-of-state physicians and PAs may practice telehealth without Idaho license
  • Out-of-state physicians may supervise PAs in Idaho after completing attestation
  • CME requirements are waived

The state has provided the following reference materials:

CMS Approves 1135 Waiver for Idaho:

  • Temporarily suspends Medicaid FFS prior authorization
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Illinois

Homeless shelters guidance

Executive Order requiring reimbursement for telehealth during emergency :

  • Originating site can be residence
  • Department will reimburse for virtual check in

State is expediting licensing.

  • IDFPR issued a proclamation to allow out-of-state physicians, nurses, physician assistants, and respiratory care therapists to provide care to Illinois residents affected by COVID-19.
  • The Secretary of IDFPR has prepared a series of Variances allowing Illinois physicians, nurses, physician assistants, and respiratory care therapists whose license status is inactive, non-renewed, or expired that also satisfy an additional set of specific criteria to restore their licenses temporarily during this pandemic.
  • Out-of-state licensed physicians, nurses, physician assistants, and respiratory care therapists may practice in the State of Illinois in a limited set of circumstances as provided for by the IDFPR proclamation.

CMS approved Illinois' Medicaid Section 1135 Waiver. Highlights include:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements. Allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment -- Illinois may reimburse out-of-state providers for multiple instances of care to multiple participants, provided certain criteria are met. If a certified provider is enrolled in Medicare or with a state Medicaid program other than Illinois, Illinois may provisionally, temporarily enroll the out-of-state provider for the duration of the public health emergency in order to accommodate participants who were displaced by the emergency. With respect to providers not already enrolled with another SMA or Medicare, CMS will waive certain screening requirements so the state may provisionally, temporarily enroll the providers for the duration of the public health emergency.
    • CMS is also approving Illinois’ request to temporarily cease revalidation of providers who are located in Illinois or are otherwise directly impacted by the emergency.
    • These provider enrollment emergency relief efforts also apply to the Children's Health Insurance Program (CHIP) to the extent applicable.
  • Provision of Services in Alternative Settings -- Allow facilities, including NFs, intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDDs), psychiatric residential treatment facilities (PRTFs), and hospital NFs, to be fully reimbursed for services rendered to an unlicensed facility (during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services) provided that the State makes a reasonable assessment that the facility meets minimum standards, consistent with reasonable expectations in the context of the current public health emergency, to ensure the health, safety and comfort of beneficiaries and staff. The placing facility would be responsible for determining how to reimburse the unlicensed facility.

Executive Order 2020-13 suspends admissions to the Illinois Department of Corrections from all Illinois county jails, except at the discretion of the Director of the Illinois Department of Corrections for limited essential transfers.

Governor JB Pritzker and Chicago Mayor Lori Lightfoot announced plans to set up a 3,000 bed alternative care setting for COVID-19 patients at the McCormick Place Convention Center in Chicago

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Indiana

State to allow opioid treatment programs the use of lockboxes; provide naloxone to help reduce spread of COVID-19 (updated 3/16/2020)

COVID-19 Interim Recommendations for Outpatient Facilities (updated 3/18/2020)

Guidance for Out-of-Hospital Facilities (updated 3/18/2020)

Guidance for Correctional Facilities (updated 3/18/2020)

Indiana to offer Psychological First Aid training in response to COVID-19 epidemic

No specific guidance on telehealth at this time.

Health and Professional Licensing

  • Mental health professionals are permitted to practice via telemedicine.
  • Advance Practice Registered Nurses are allowed to provide services in multiple locations.
  • The state health commissioner may waive requirements of the nursing home certificate of need statute to respond to COVID-19 issues for long-term care facilities.

Indiana's 1135 Medicaid Waiver Approved:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Expands provider enrollment for out-of-state providers
  • Authorizes care to be provided in alternative settings, including psychiatric residential treatment facilities
  • Lifts some prior authorization requirements

Modification to ASAM 3.5:

  • Provides some flexibility for assessment due to lack of in-person visits
  • Can include use of telemedicine to do assessments and follow up

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Iowa

Licensure Waiver and Telehealth: Effective March 16, 2020, Governor Kim Reynolds declared a state of emergency in Iowa due to the spread of COVID-19. The state of emergency shall expire on April 16, 2020, unless terminated or extended in writing by Governor Reynolds.

Here are the effects on the licensure and medical practice of physicians providing care in Iowa under the state of emergency:

  1. No Iowa Medical License Required: A physician may practice medicine/telemedicine in Iowa without an Iowa medical license on a temporary basis to aid in the emergency, if a physician holds at least one active medical license in another United State jurisdiction, and all medical licenses held by a physician in other United States jurisdictions are in good standing, without restrictions or conditions.
  2. Telemedicine and Telehealth Services: All rules which establish preconditions, limitations, or restrictions on the provision of telehealth or telemedicine services in Iowa are temporarily suspended. All rules which require face-to-face interactions with health care providers, and impose requirements for residential and outpatient substance use disorder treatment and for face-to-face visitations, are temporarily suspended.
  3. Lapsed or Expired Iowa Medical Licenses: A physician whose Iowa medical license lapsed or expired in good standing within five (5) years of the date of the Proclamation may provide medical care and treatment of victims of this public health emergency for the duration of the Proclamation.

***Delivery of emergency services pursuant to these provisions does not require special notification or registration with the Iowa Board of Medicine or any other state agency during this time of emergency.

Governor Reynolds signed legislation that expands the roles of physician assistants in Iowa. The legislation was purportedly aimed at combating COVID-19 makes changes related to the practice of a PA by allowing for full prescriptive rights, legal protections similar to other health care professions, the ability to be reimbursed by Medicaid and a range of other changes.

The Department of Human Services (DHS) issued a bulletin on 3/19 that specified:

  • All Medicaid services, including MH/SUD services, may be provided through telehealth. This may include telephone only, although the bulletin seemed to suggest that this may be limited to phones with video capabilities.
  • Providers should bill originating and distant site bill using HCPCS/CPT codes with POS code 02

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Kansas

Coronavirus Disease 2019 (COVID-19) Guide for Acute Care Hospitals (ACH), Long-term Acute Care Hospitals (LTACH), Inpatient Psychiatric Facilities (IPF), and Inpatient Rehabilitation Facilities (IRF): Healthcare facilities in Kansas cannot and should not be turning away patients or refusing care for fear of COVID-19.

New restrictions on visitors and non-essential individuals entering the Kansas Neurological Institute, Parsons State Hospital and Training Center, Osawatomie State Hospital and Larned State Hospital are in place.

Executive Order 20-08: expands access to telemedicine and empowers the Board of Healing Arts to grant temporary emergency licenses.

  • Removes requirement of in person exam of patient by a physician prior to issuing a prescription.
  • Encourages physicians to utilize telemedicine and allows out-of-state physicians to treat Kansans through telemedicine.
  • Authorizes the Board of Healing Arts to grant a temporary emergency license to practice to any profession regulated by the board to an applicant whose qualifications the board determines to be sufficient to protect public safety and welfare within the scope of professional practice by the temporary emergency license for the purpose of preparing for, responding to, and mitigating COVID-19.

Kansas Section 1135 Waiver approved 3/24:

  • Temporarily suspends some prior authorization processes
  • Extends pre-existing authorizations throughout the public health emergency
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Authorizes provider enrollment for non-Kansas providers

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Kentucky

Psychiatric Facilities: March 17, 2020 – The Governor announced the following steps to continue to respond to the COVID-19 pandemic: All acute care facilities should discourage all visitors except for visits in end-of-life circumstances. The Governor also advised psychiatric facilities to restrict visitation, only allowing it if deemed medically necessary by the attending physician, administrator and the medical director.

Emergency Licensure: Medical and Osteopathic physicians not already licensed to practice in the Commonwealth of Kentucky may register to practice within Kentucky during the state of emergency declared by Governor Beshear.

Telehealth Provisions: The Department will not impose penalties for noncompliance with KRS 304.17A(47)(c) in connection with the good faith provision of telehealth using such non-public facing audio or video communication products. Insurers cannot require that the patient have a prior relationship with the provider in order to have services delivered through telehealth, if the provider determines that telehealth would be medically appropriate.

KBML Guidance on Prescribing (Including MAT):

  • Telehealth can be used to prescribe controlled substances
  • Can screen patient for buprenorphine via telehealth

CMS has approved an 1135 Waiver:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Expands provider enrollment for out-of-state providers
  • Authorizes care to be provided in alternative settings, including psychiatric residential treatment facilities
  • Lifts some prior authorization requirements

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Louisiana

Telehealth: Novel Coronavirus Disease (COVID-19) Medicaid Provider Update: (3/17/2020) Louisiana Medicaid encourages the use of telemedicine/telehealth with an interactive audio/video telecommunications system, when appropriate, to decrease the potential for patient-to-patient transmission in shared spaces (e.g., waiting rooms) and patient-to-provider transmission. Generally, when an interactive audio/video system is not available, an interactive audio-only system (e.g., telephone), without the requirement of video, may be employed unless service- specific policy indicates that only an audio/video system is permissible. For use of an audio-only system, the same standard of care must be met and the need and rationale for employing an audio- only system must be documented in the clinical record.

Licensing Waiver: In Governor Edwards' Declaration of Emergency, he references the Louisiana Health Emergency Powers Act, which says, in part "(9) for the temporary appointment, licensing or credentialing of health care providers who are willing to assist in responding the public health emergency."

The Governor issued a proclamation outlining the use of telehealth and licensure.

  • Use of telehealth in the delivery of healthcare services within the scope of practice regulated by the licensing entity is hereby suspended during the term of this emergency declaration.
  • The practice of the healthcare provider administered via telehealth must be within the scope of the provider's license, skill, training, and experience.
  • The services provided to the patient must meet the standard of care that would be provided if the patient were treated on an in-person basis.
  • Prescribing of any controlled substances via telehealth must be medically appropriate, well-documented and continue to conform to rules applicable to the prescription of such medications.

BCBS LA has issued guidance for members.

Louisiana Psychiatric Medical Association resource page with guidance from Department of Health, private payers, and other government agencies.

The Board of Medical Examiners has waived fingerprinting for out-of-state and retired physicians joining the state work force. The revised application is now on-line.

CMS has approved an 1135 Waiver for Louisiana:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment for non-Louisiana providers
  • Provision of Services in Alternative Settings including inpatient residential psychiatric facilities

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Maine

Telehealth: Bureau of Insurance (3/12/2020) Health carriers are reminded that 24-A M.R.S. § 4316 requires parity between coverage of telehealth and in-person services, and are directed to review their telehealth programs with participating providers to ensure that the programs are robust and will be able to meet any increased demand.

  • Superintendent of Insurance Requires Insurers to Expand Telehealth: The Superintendent signed an order that requires insurance companies to provide coverage for clinically-appropriate services delivered by telephone, as well as via more commonly used apps, such as FaceTime, WhatsApp and Skype, as long as they are private. This provides flexibility to patients who may not have access to web-based applications traditionally used for telehealth.

DHHS issued release outlining the following provisions for Medicaid:

  • Allows prescribing through telehealth
  • No copays for prescriptions, office visits, emergency department visits, radiology and lab services
  • Allow early refills of prescriptions
  • No prior authorization requirements for asthma and for immune-related drugs
  • Lengthen the period that prior authorization applies for prescription medications
  • Lengthen the period that prior authorization applies for certain durable medical equipment, such as home oxygen therapy, glucose test strips, and Continuous Positive Airway Pressure (CPAP) supplies for individuals diagnosed with COVID-19, those with pending test results who are in self-isolation, and those in a high-risk category for infection
  • Extend the amount of time that home health providers have to submit plans of care from within five business days to within 30 business days from the start of services
  • Allow providers to extend 34-day supply maximums on brand prescriptions (MaineCare already allows 90-day supplies of generic prescriptions)

MaineCare Guidance Relating to Telehealth and Telephone Services During COVID-19 Emergency Period: This document provides a comprehensive overview for Medicaid providers to consider utilizing telehealth services for the delivery of MaineCare-covered services when appropriate and necessary. It outlines guidance for:

  • Utilizing Telehealth to Satisfy Face-to-Face Requirements in MaineCare Policies
  • Member and Service Criteria for Telehealth Eligibility (Updated March 20, 2020)
  • Delivery of Telehealth via Telephone (Updated March 20, 2020)
  • Prior Authorization (PA) Requirements
  • Telehealth and Pharmacy (Updated March 20, 2020)
  • Telehealth Sites
  • Telehealth Provider Eligibility
  • Billing for Telehealth Services
  • Reimbursement for Originating Sites
  • Waiver of Advance Written Notice (Added March 20, 2020)
  • Telephone-Only Evaluation and Management (Added March 20, 2020)
  • Buprenorphine and Buprenorphine Combination Products (Added March 20, 2020)
  • Selective Waiver of Comparable Quality Requirements (Added March 20, 2020)
  • Telehealth and Behavioral Health Services (Added March 20,2020)
  • Telehealth Resources for Providers

Licensure Waiver: Governor Mills announced an executive order that allows:

  • the expedited licensure (at no cost) of qualified retired physicians and physician assistants to provide assistance for the duration of the emergency. (COVID-19 Emergency Application)
  • the expedited licensure (at no cost) of qualified physicians and physician assistants licensed in other jurisdictions to provide assistance for the duration of the emergency. (COVID-19 Emergency Application)
  • licenses from expiring or needing to be renewed for 30 days after the end of declaration of the emergency (including CME requirements).

Any retired physician or physician assistant who is interested in obtaining an emergency COVID-19 license from the Board should contact:

  • Applicants with last names A-L call (207) 287-3602 tracy.a.morrison@maine.gov
  • Applicants with last names M-Z call (207) 287-3782 Elena.I.Crowley@maine.gov

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Maryland

Medicaid telehealth guidance: I hereby temporarily expand the definition of a telehealth originating site under COMAR 10.09.49.06 to include a participant's home or any other secure location as approved by the participant and the provider for the purpose of delivery of Medicaid-covered services. Services provided through telehealth are subject to the same program restrictions, preauthorizations, limitations and coverage that exist for the service when provided in-person.

  • Somatic services: Providers must contact the participant's Healthchoice MCO with questions regarding prior authorization requirements for services rendered via telehealth.
  • Behavioral health services: Providers must contact the behavioral health ASO with questions regarding prior authorization requirements for services rendered via telehealth.

Licensure Waiver: INTERSTATE RECIPROCITY FOR HEALTH CARE LICENSES: Under the order, any person who holds a valid, unexpired license as a health care practitioner that is issued by another state may, at a health care facility in Maryland, engage in the activities authorized under that license. INACTIVE PRACTITIONERS: Any inactive practitioner may, at a health care facility in Maryland, engage in activities that would have been authorized under his/her inactive license without first reinstating his/her inactive license.

Governor Hogan signed Executive Order 20-03-20-01, expanding the use of telehealth to include previously unacceptable platforms. Audio-only telehealth calls for behavioral health services are now authorized for reimbursement by Medicaid providers or providers in a program of the Behavioral Health Administration.

CMS Approves Maryland's Request for an 1135 Medicaid Waiver: The approved waiver enables Maryland to temporarily enroll providers who are enrolled with another State Medicaid Agreement or Medicare, lift prior authorization requirements, and allow for reimbursement facility services in alternative settings.

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Massachusetts

Governor Baker issued an executive order requiring the following regarding telehealth:

  • Commercial insurers must cover telehealth for all in-network providers that is medically necessary
  • Insurers may not impose any specific restrictions on telehealth technology, including any limitations on audio-only or live video technologies
  • Payment must be the same as in-person
  • All COVID-19 services delivered through telehealth must have no cost sharing
  • No prior authorization for COVID-19-related telehealth services

Licensure and Telehealth (3/17/2020): Supporting Expedited Licensing Of Health Care Professionals: The Administration today announced four new emergency orders to expedite the onboarding of more licensed health care professionals during the COVID-19 emergency. Changes as a result of these orders include:

  • Licenses of physicians who have retired within the last year, without complaints at the time of retirement and in good standing, may be reactivated, and licenses that would otherwise be up for renewal may be extended for 90 days after the end of the public health emergency.
  • Providers in good standing licensed in other states may obtain emergency licenses to practice in person or through telemedicine.
  • The ability of residents to provide services, subject to appropriate supervision, will also be expanded.
  • Assures continuity of care for college and university students, licenses for nurses, pharmacists and physician assistants that would otherwise be up for renewal for 90 days after the end of the public health emergency may be extended, and no nurse, social worker, psychologist or medical doctor may be prohibited from providing telehealth services across state lines to college or university students who have returned home.
  • Recognizing the crucial need for sufficient EMS capacity during this public health emergency, these orders adjust minimum standards for ambulance staffing to ensure sufficient availability and capacity of EMS services.
  • Expands telehealth by facilitating telehealth services across state lines.

MassHealth issued a bulletin to providers specifying the following for fee-for-service Medicaid:

  • Services may be provided through telehealth, including telephone
  • Reimbursement will be same as in-person
  • Providers must use POS code 02 for telehealth billing
  • Medically necessary evaluation services provided through telephone should bill CPT codes for physicians: 99441, 99442, 99443
  • Children's Behavioral Health Initiative (CBHI) providers should use the regular CBHI codes when billing for CBHI services delivered telephonically
  • Will now allow for the following codes for home visits for physicians and outpatient hospital facilities: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99511, and 99512
  • Will now allow for the following codes for home visits for community health centers: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99511, 99512, and 99600
  • Psychiatric inpatient hospitals may bill MassHealth for members no longer requiring an inpatient level of care but who must be quarantined in the hospital or otherwise cannot be safely discharged due to COVID-19 by keeping the member as an inpatient, switching the member to administrative day status, and billing MassHealth accordingly. Psychiatric hospitals rendering COVID-19-related services to MassHealth members will be paid in accordance with the Amended and Restated Psychiatric Hospital Request for Applications Rate Year 2020 and Amended and Restated Psychiatric Hospital Contract.
  • Pharmacists are not allowed to give 90-day prescription for MH/SUD medications and those subject to the PDMP

CMS Approves 1135 Waiver for Massachusetts:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Michigan

Medicaid Telehealth: Governor ordered Medicaid to reimburse for telehealth provided in recipients' homes.

Telemedicine Policy Expansion Bulletin for Medicaid: Codes for Behavioral Health and Developmental Disabilities Administration able to provide telephone-only services.

Licensure: Executive Order 2020-13 grants LARA and DHHS authority to waive or defer certain requirements in order to expedite the process of bringing additional care facilities online during the COVID-19 emergency. The order also empowers LARA to ensure an adequate supply of care providers during the emergency by granting the department additional flexibility in its decisions about licensing, registration, and workflow requirements. (Awaiting more specifics from LARA & DHHS).

Temporary restrictions on visitor entry to health care facilities

  • Includes all health care facilities

Governor Whitmer issued Executive Order 2020-29: The Michigan Department of Corrections must continue to implement risk reduction protocols to address COVID-19. Highlights include:

  • Screening all persons arriving at or departing from a facility, including staff, incarcerated persons, vendors, and any other person entering the facility, in a manner consistent with guidelines issued by the CDC.
  • Restricting all visits, except for attorney-related visits, and conducting those visits without physical contact to the extent feasible.
  • Limiting off-site appointments for incarcerated persons to only appointments for urgent or emergency medical treatment.
  • Developing and implementing protocols for incarcerated persons who display symptoms of COVID-19.
  • Providing, to the fullest extent possible, appropriate personal protective equipment to all staff as recommended by the CDC.
  • To mitigate the risk of COVID-19 spreading in county jails, strict compliance with the capacity and procedural requirements regarding county jail overcrowding states of emergency in the County Jail Overcrowding Act is temporarily suspended.
  • Anyone authorized to act under section 2 of this order is strongly encouraged to consider early release for all of the following, so long as they do not pose a public safety risk:
    • Older people, people who have chronic conditions or are otherwise medically frail, people who are pregnant, and people nearing their release date.
    • Anyone who is incarcerated for a traffic violation.
    • Anyone who is incarcerated for failure to appear or failure to pay.
    • Anyone with behavioral health problems who can safely be diverted for treatment.
  • Effective immediately, all transfers into the Department’s custody are temporarily suspended. Beginning seven (7) days from the effective date of this order, and no more than once every seven (7) days, a county jail or local lockup may request that the director of the Department determine that the jail or lockup has satisfactorily implemented risk reduction protocols as described in section 1 of this order. Upon inspection, if the director of the Department determines that a county jail or local lockup has satisfactorily implemented risk reduction protocols, transfers from that jail or lockup will resume in accordance with the Department’s risk reduction protocols. The director of the Department may reject transfers that do not pass the screening protocol for entry into a facility operated by the Department.

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Minnesota

Telehealth: SF 4334 signed into law 3/17, effective 3/18 (section expires Feb 1, 2021): Section 1. COVERAGE OF TELEMEDICINE SERVICES PROVIDED DIRECTLY TO A PATIENT AT THE PATIENT'S RESIDENCE; RESPONSE TO COVID-19.

  1. The definition of "originating site" under Minnesota Statutes, section 62A.671, subdivision 7, includes a patient's residence if the patient is receiving health care services or consultations by means of telemedicine.
  2. The definition of "telemedicine" under Minnesota Statutes, section 62A.671, subdivision 9, includes health care services or consultations delivered to a patient at the patient's residence.
  3. Under Minnesota Statutes, section 62A.672, subdivision 2, a health carrier shall not exclude or reduce coverage for a health care service or consultation solely because the service or consultation is provided via telemedicine directly to a patient at the patient's residence.
  4. "Telemedicine" as defined in Minnesota Statutes, section 256B.0625, subdivision 3b, paragraph (d), includes the delivery of health care services or consultations with a patient at the patient's residence and the licensed health care provider at a distant site.
  5. This section expires February 1, 2021.

Governor signed EO 20-12 on 3/20: Allows flexibility regarding telehealth and other electronic strategies for communicating with providers or patients. Provides the Department of Human Services with short-term flexibility to alter background study requirements, licensing and certification standards, requirements for in-person assessments, eligibility renewal standards for public programs, work or community engagement requirements, service delivery standards including treatment setting and staffing ratios, payment procedures, and more.

Governor signed EO 20-11 on 3/20: allows the Department of Human Services to seek federal authority to waive or change federal requirements for all programs and services, including the Minnesota Family Investment Program (MFIP), Medical Assistance, MinnesotaCare, and other programs to maximize federal funding, maintain enrollee coverage and provider participation, and to ensure public health and safety.

Governor signed EO 20-10, which, in part, prohibits price gouging for essential goods and services including medical supplies and health care goods.

Minnesota's 1135 Waiver Approved:

  • Authorizes provision of care in alternative settings
  • Extends provider enrollment to non-Minnesota providers
  • Temporarily suspends some prior authorization requirements
  • Other waivers continue

Minnesota Department of Human Services' Commissioner, under the Governor's peacetime emergency order, has waived or modified certain requirements in order to:

  • Allow telemedicine alternative for School-Linked Mental Health services and Intermediate School District Mental Health services for children and their families
  • Allow phone or internet use for targeted case management visits
  • Allow 90-day refill limits for prescription maintenance medications
  • Postpone provider screening and re-enrollment

On 3/28, the Governor signed legislation (HF 4531) into law, in response to COVID-19, which in part:

  • Establishes a Coronavirus Minnesota fund.
  • Appropriates funding for emergency child care grants for essential workers, veterans impacted, food shelter programs, housing, small business loans; etc.
  • Eliminates refill timelines for opiate or narcotic pain relievers.
  • Empowers the medical director of the Department of Corrections to make a health care decision for an inmate incarcerated in a state correctional facility or placed in an outside facility on conditional medical release if the inmate's attending physician determines that the inmate lacks decision-making capacity and other conditions are met.

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Mississippi

Telemedicine Licensure: Out of state physicians may provide telemedicine without being licensed in Mississippi.

CMS has approved an 1135 waiver for Mississippi:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment for non-Mississippi providers
  • Provision of Services in Alternative Settings, including inpatient residential psychiatric facilities

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Missouri

Medicaid Telehealth: Medicaid will waive requirement of pre-existing relationship prior to providing services via telehealth and allow services to be provided to enrollee while at home via telephone.

The state legislature passed a supplemental budget, which also includes COVID-19 funding.

The Governor signed Executive Order 20-04, allowing state agencies to suspend laws and rules that would hinder response to COVID-19. In addition, he temporarily suspended the law that requires a physician-patient relationship prior to prescribing, along with the prohibition on dispensing based on an internet or telephone questionnaire.

Anthem provided a telemedicine announcement in response to COVID 19: it is expanding telehealth benefits for individual, family, and employer plans. It includes connecting with a doctor through the Sydney Care mobile app's Virtual Care text session or LiveHealth Online video and covers telehealth visits by phone with the primary care doctors in network until June 14, 2020.

CMS approved Missouri Medicaid Section 1135 Waiver on 3/25:

  • Temporarily waives some prior authorization requirements
  • Authorizes care to be provided in alternative settings
  • Extends enrollment to non-Missouri providers
  • Current waivers continue

On 3/26, Governor Parson held a press conference emphasizing the importance of mental health during the COVID 19 crisis and highlighting resources.

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Montana

DPHHS guidance on COVID 19 - awaiting telehealth guidance.

Telehealth: State enacted private insurance telehealth parity law in 2013. Medicaid also reimburses with few restrictions.

Medicaid will reimburse for telemedicine via telephone or live video.

CMS approved Montana's Medicaid Section 1135 Waiver

  • Temporarily waives some prior authorization requirements
  • Authorizes care to be provided in alternative settings
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Extends enrollment to non-Montana providers
  • Current waivers continue

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Nebraska

DHHS COVID 19 guidance for health care professionals - awaiting telehealth guidance.

3/16: Aetna offering zero co-pay telemedicine visits for any reason and offering its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members.

The Governor issued an Executive Order expediting licensing for physicians, surgeons, and non-physician providers. The order also suspends requirements, allowing physicians to supervise any number of physician assistants and allows physicians to use their personal judgment in determining if these physician assistants need to have a written agreement.

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Nevada

Telehealth: A health insurer shall issue guidance to inform its insureds and network providers about available benefits, options for medical advice and treatment through telehealth, and preventive measures related to COVID-19.

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New Hampshire

Telemedicine: Pursuant to RSA 415-J, health carriers may not deny coverage simply because it was provided through telemedicine.

Expanded Telemedicine: Telehealth will be paid at same rate as in-person. No restriction on originating site.

Licensure: Any out-of-state personnel, including medical personnel, entering New Hampshire to assist in preparing for, responding to, mitigating the effects of, and recovering from COVID-19 shall be permitted to provide services in the same manner as prescribed in RSA 21-P:41 and any other applicable statutory authority with respect to licensing for a period of time not to exceed the duration of this emergency.

CMS Approves New Hampshire's Section 1135 Medicaid Waiver Request: The approved waiver enables New Hampshire to provide flexibilities in Medicaid provider screening and enrollment, forgo certain pre-admission screening and annual resident review assessments, lift prior authorization requirements, allow for reimbursement facility services in alternative settings, and extend fair hearing and appeals timelines.

NH Responds: Governor Sununu announced NH Responds, an effort to register medical and non-medical volunteers who can quickly mobilize if needed during the public health crisis. NH Responds is part of a nationwide volunteer management system that was established after 9/11 to get medical professionals quickly, and properly deploy them during a public health emergency or disaster.

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New Jersey

Emergency legislation (A 3860) enacted 3/19 specifies the following about telehealth:

  • Practitioner licensed in any state may practice telehealth in NJ, within scope of practice of practitioner's home state
  • Services must be limited to COVID-19 unless practitioner already has existing relationship with patient

Department of Human Services directed managed care plans that:

  • Should provide reimbursement for telehealth, including mental telehealth, at same rate as in-person
  • Should waive site-of-service requirements for licensed practitioners in NJ
  • Should allow use of alternative telehealth technologies such as phone or smartphone app

Department of Banking and Insurance directed commercial payers that they should:

  • Review telehealth networks to determine adequacy and allow out-of-network exceptions when in-network providers are not available
  • Waive cost sharing for any telehealth services, COVID-19 or otherwise
  • Encourage providers to use telehealth
  • Reimbursement for telehealth should be no lower than in-person
  • Allow for telephonic telehealth service delivery
  • No prior authorization for telehealth services

Department of Treasury has advised Horizon Blue Cross that it should:

  • Cover in-network telehealth with no cost sharing

Department of Children and Families specified that for all MH/SUD and IDD non-residential services:

  • Cover telehealth at same rate as in-person
  • Waive site of service requirements
  • Allow alternative telehealth technologies such as phone and smartphone apps

Division of Consumer Affairs within Department of Law and Public Safety specifies:

  • Allow practitioners to establish new patient relationships through telehealth, allow alternative technologies for telehealth, and patients do not need to establish address of location

CMS approved New Jersey's Section 1135 Medicaid waiver request: The approved waiver enables New Jersey to provide flexibilities in Medicaid provider screening and enrollment, forgo certain pre-admission screening and annual resident review assessments, lift prior authorization requirements, allow for reimbursement facility services in alternative settings, and extend fair hearing and appeals timelines.

Guidance for Opioid Treatment Programs: As the NJ Department of Human Services, Division of Mental Health and Addiction Services (DMHAS) learns more about COVID-19 (the coronavirus), it will provide updated guidance to assist Opioid Treatment Programs (OTPs) in their response to mitigate exposure and spread of this disease.

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New Mexico

Licensure Waiver: The Department of Health and the Department of Homeland Security and Emergency Management shall credential out-of-state professionals who can render aid and necessary services during the pendency of this order. NSMA 1978 12-10-10.1 through 12-10-13.

The Governor announced New Mexico's Medicaid Program is requiring managed care organizations to reimburse doctors, behavioral health providers and other health care professionals for telephone and video patient visits. Additionally, managed care organizations are now required to:

  • Waive all prior authorizations for members to obtain COVID-19 testing and treatment services;
  • Expand nurse advice lines to operate 24/7;
  • Coordinate with home care providers to ensure coordinated care for those patients requiring telemedicine services;
  • Allow for replacement of durable medical equipment through telemedicine; and,
  • Reimburse for prescriptions dispensed in amounts up to a 90-day supply.

CMS has approved an 1135 Waiver for New Mexico:

  • Temporarily suspends Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days

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New York

March 17 Supplemental Guidance Regarding Use of Telehealth for People Served by Medicaid: Providers who submit a Self-Attestation containing all of the elements below will be authorized to deliver services via telemental health for a time-limited period, not to exceed the disaster emergency. Telemental health for Medicaid-reimbursable services is temporarily expanded to include telephonic and video, including technology commonly available on smart phones and other devices. They will certify to the following:

  • That the practitioner(s) will possess a current, valid license, permit, or limited permit to practice in NYS.
  • That the transmission linkages will be dedicated, secure, and meet minimum federal and NYS requirements.
  • That confidentiality will be maintained as required by NYS Mental Hygiene Law Section 33.13 and 45 CFR Parts 160 and 164 (HIPAA Privacy Rules).
  • That claim modifiers "95" or "GT" will be used on each claim that represents a service via telemental health.

Comprehensive Guidance for Medicaid Provider Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency: The following information applies to all Medicaid providers and providers contracted to serve Medicaid members under Medicaid managed care plans. However, the Office of Mental Health (OMH), the Office for People with Developmental Disabilities (OPWDD), and the Office of Addiction Services and Supports (OASAS) have issued separate guidance on telehealth and regulations that will align with state law and Medicaid payment policy for Medicaid members being served under their authority.

Licensure guidance: Permits unlicensed individuals, upon completion of training deemed adequate by the Commissioner of Health, to collect throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing; and to the extent necessary to permit non-nursing staff, upon completion of training deemed adequate by the Commissioner of Health, to perform tasks, under the supervision of a nurse, otherwise limited to the scope of practice of a licensed or registered nurse.

Governor Cuomo calls on health, mental health, and related professionals to set up a reserve workforce interested in supporting the state's response to COVID-19.

OMH COVID-19 Guidance RE: Clozapine and Blood Test Monitoring: Prescribers and pharmacies have discretion to order and dispense clozapine without an absolute neutrophil count reported within the specified timeframes.

CMS Approves 1135 Waiver for New York:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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North Carolina

NCDHHS COVID 19 Guidance as of 3/16: Consider using telemedicine, nurse triage lines and other options to prevent people with mild illnesses from coming to clinics and emergency rooms.

Insurance Commissioner Bulletin (3/12/2020): Insurance Commissioner requests insurers to remove barriers of treatment, including making sure their telehealth programs are "robust" and able to meet the demand.

BCBS NC 3/13/2020: (in effect for 30 days) telehealth will be paid at parity with office visits, provided they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020.

  • These temporary measures include virtual care encounters for patients that can replace in-person interactions across appropriate care settings, including outpatient clinics, hospitals, and the emergency departments.
  • Please do not file telehealth claims with Blue Cross NC until March 21, 2020 and use Telehealth as Place of Service (02).
  • For providers or members who don’t have access to secure video systems, telephone (audio-only) visits can be used for the virtual visit. Please use both Telehealth as Place of Service and CR (catastrophe/disaster-related) modifier for audio-only visits.
  • If you believe an eligible telehealth claim has been improperly denied, please resubmit it after March 21, 2020.
  • Some commercial members can access MDLIVE or TeleDoc as a virtual care benefit, as noted on their member ID card. Federal Employee Program (FEP) members can only access virtual care through the Teledoc service.
  • Teledoc offers both video or audio virtual services. You can view COVID-19 benefits for the Federal Employee Program here.

Licensure Waiver: licensure requirements are waived for health care professionals licensed in other states

CMS has approved an 1135 Waiver for North Carolina:

  • Provider Enrollment for providers not licensed in North Carolina
  • Provision of Services in Alternative Settings, including psychiatric residential treatment facilities
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Temporarily suspend Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.

NC Department of Health and Human Services has asked for volunteers to bolster the clinician workforce. Please access the registration form here.

Guidance for Behavioral Health Group Homes: this link will download a document.

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North Dakota

ND Dept of Health COVID 19 guidance: as of 3/16:

  • Healthcare facilities can increase the use of telephone management and other remote methods of triaging, assessing and caring for all patients to decrease the volume of persons seeking care in facilities.
  • If a formal “telehealth” system is not available, healthcare providers can still communicate with patients by telephone (instead of visits), reducing the number of those who seek face-to-face care.
  • Health plans, healthcare systems and insurers/payors should message beneficiaries to promote the availability of covered telehealth, telemedicine, or nurse advice line services.

Licensure Waiver: Governor issued emergency declaration on 3/13. State's Emergency Services statute provides "if a person holds a license, certificate, or other permit issued by any state or political subdivision evidencing the meeting of qualifications for professional, mechanical, or other skills, the person may render aid involving that skill in this state to meet an emergency or disaster, and this state shall give due recognition to the license, certificate, or other permit."

North Dakota's Section 1135 Waiver approved 3/24. Highlights:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements.
  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
  • Provider Enrollment:
    • Allow the state to enroll providers who are not currently enrolled with another State Medicaid Agency or Medicare so long as the state meets the following minimum requirements.
    • Temporarily cease revalidation of providers who are located in North Dakota or are otherwise directly impacted by the emergency.
  • State Plan Amendment Flexibilities: Tribal Consultation: Flexibility to modify the timeframes associated with tribal consultation, including shortening the number of days before submission or conducting consultation after submission of the SPA. This approval applies only with respect to SPAs that provide or increase beneficiary access to items and services related to COVID-19 (such as cost sharing waivers, payment rate increases, or amendments to ABPs to add services or providers) and that would not restrict or limit payment or services or otherwise burden beneficiaries and providers, and that are temporary, with a specified sunset date that is not later than the last day of the declared COVID-19 emergency (or any extension thereof).

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Ohio

Ohio Department of Insurance issued a bulletin that specified the following regarding telehealth:

  • Issuers that provide coverage for services delivered via telemedicine are expected to provide such coverage for COVID-19 testing and treatment
  • Requests that issuers comply early with telehealth law scheduled to take effect 1/2021 that prohibits denials of a service just because it was delivered through telehealth and requires telehealth to be covered "on the same basis and to the same extent."

Ohio Department of Health (ODH) issued a director's order regarding health screening for admission to state psychiatric facilities and youth service facilities. Potential psychiatric admittees and youth services admittees:

  • Must be screened for COVID-19 prior to admission
  • Answer questions about exposure
  • Will be refused admittance if meeting criteria and do not have negative COVID-19 test results
  • Must have medical clearance attestation from physician stating negative results within prior 48 hours
  • Presumably, positive test allows disallows admission

Ohio Department of Mental Health and Addiction services issued emergency order to reduce restrictions on telemedicine (can’t find anything more specific than this website from Gov. Dewine):

  • In partnership with the Ohio Department of Medicaid, Director Criss announced emergency orders that reduce restrictions on telehealth, ensuring that every Ohioan has access to behavioral health Care via telehealth services by landline or cell phone.

Guidance from the Board of Medicine on Telemedicine: Effective March 9, 2020 until Executive Order 2020-01D expires, providers can use telemedicine in place of in- person visits, without enforcement from SMBO. This includes, but is not limited to:

  • Prescribing controlled substances
  • Prescribing for subacute and chronic pain
  • Prescribing to patients not seen by the provider
  • Pain management
  • Medical marijuana recommendations and renewals
  • Office-based treatment for opioid addiction

Providers must document their use of telemedicine and meet minimal standards of care. The Medical Board will provide advance notice before resuming enforcement of the above regulation when the state emergency orders are lifted.

Emergency Licensure: The Medical Board will partner with the Ohio Emergency Management Agency (EMA) or other necessary government entity if the need arises to temporarily license out-of-state physicians and physician assistants.

The Department of Health (ODH) issued an order specifying the following:

  • All adult day support or vocational habilitation services for those with IDD cannot be provided in a congregate setting with more than 10 people
  • This does not apply to residential settings

ODH issued an order specifying the following regarding nursing homes and similar facilities:

  • No visitors shall be admitted except for end-of-life situations
  • Personnel may only be admitted after being screened for COVID-19 each time they attempt to enter
  • Points of access to each facility should be limited to as few as possible
  • Access will be granted only to those with official state or federal identification

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Oklahoma

Licensure Waiver: Allows health professionals licensed in states that are members of the Emergency Management Compact to practice, so long as they meet certain other conditions; and allows state occupational licenses for health care professionals that are set to expire to be temporarily extended during the crisis.

Medicaid announces 3/20 that behavioral health providers may provide telehealth services through the telephone when enrollee does not have typical telehealth technology available.

  • Same link as above indicates that on 3/16 providers can use telehealth for all services that can be safely provided through telehealth. Indicates that the following codes can be submitted for telephone service delivery: "For providers who bill E&M codes, the codes for telephonic services are 99441, 99442 and 99443. Other healthcare professionals can bill using 98966, 98967 and 98968."

Oklahoma Insurance Department issued a bulletin specifying the following for insurers:

  • Should waive cost sharing for COVID-19 testing
  • Should ensure that telehealth capabilities are "robust" and waive copayments for telehealth and reimburse the provider for the cost of the copayment
  • Provide out-of-network access at in-network cost sharing when in-network providers are not available to meet demand for COVID-19 services
  • Should not impose prior authorization of COVID-19 services
  • Make expedited formulary decisions for those who may be affected by COVID-19
  • Should not cancel coverage of someone who may be infected and extend grace period for nonpayment of premiums to 60 days from 30 days

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Oregon

March 16 Medicaid Telehealth Guidance: Coverage for physical health telemedicine services include Telehealth (synchronous audio/video visits), Patient to Clinician services (electronic/telephonic) and Clinician to Clinician Consultations (electronic/telephonic).

  1. Telehealth patient visits using a synchronous (live two-way interactive) video and audio transmission resulting in real time communication between a licensed health care provider located in a distant site and the recipient being evaluated located in an alternate site, are covered when billed services comply with the guideline notes set forth by the Health Evidence Review Commission (HERC) and correct coding standards;
  2. Patient to clinician services using electronic and telephone communications are covered when billed services comply with HERC guideline notes and correct coding standards;
  3. Clinician to clinician consultations using electronic and telephone communications are covered when billed services comply with HERC guideline notes;
  4. For purposes of physical health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person subject to the requirements outlined in the Prioritized List and associated guideline notes.

During an outbreak or epidemic, the Authority shall provide coverage and reimbursement of patient to clinician telephonic and electronic services for established patients using the Division’s maximum allowable rate setting methodology:

(6) Providers billing for covered physical health telemedicine services shall:

  1. Comply with HIPAA and the Authority’s Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records;
  2. Obtain and maintain technology used in the telemedicine communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules set forth in OAR 943 division 14;
  3. Ensure policies and procedures are in place to prevent a breach in privacy or exposure of patient health information or records (whether oral or recorded in any form or medium) to unauthorized individuals;
  4. Comply with the relevant HERC guideline note for telehealth, teleconsultation and electronic/telephonic services. Refer to the current prioritized list and guidelines.
  5. Maintain clinical and financial documentation related to telemedicine services as required in OAR 410-120-1360.

(7) Performing / Rendering Providers of covered physical health telemedicine services shall:

  1. Hold a current and valid license without restriction from a state licensing board where the provider is located;
  2. Have authority to provide physical health telemedicine services for eligible Oregon Medicaid beneficiaries;
  3. Comply with correct coding standards using the most appropriate Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes

Updated Medicaid Guidance for coverage of telehealth services: The guidance outlines additional E/M codes for payment of telephone services for behavioral health providers, as well as ways to decrease administrative burden.

OHA is submitting a State Plan Amendment to increase Medicaid reimbursement for telehealth and telephone services

Limiting or restricting entry into inpatient psychiatric programs for patients and also testing visitors.

Limiting or restricting entry into MH treatment programs

Licensure Guidance: The Oregon Medical Board (OMB) will allow physicians and physician assistants licensed in another state to provide medical care in Oregon under special provisions through the public health emergency. Out-of-state health care professionals who wish to provide care in Oregon during this time must complete this authorization application.

Physicians and PAs with an active status license to practice medicine in Oregon may provide care via telemedicine to their Oregon patients. Out-of-state physicians with a telemedicine license may provide remote care to their Oregon patients. For more information regarding telemedicine rules and licensure qualifications in Oregon, see here.

Department of Consumer and Business Services and the Oregon Health Authority's Telehealth Guidance for Commercial plans and Medicaid health plans: The state expects health plans of all types to provide increased access to health care services through telehealth delivery platforms and to encourage patients to use telehealth delivery options to limit the amount of in-person health care services they seek. Health plans shall use telehealth service delivery methods to ensure patients maintain access to behavioral health services, including the following:

  • Psychotherapy
  • Team psychotherapy
  • Team conferences
  • Crisis psychotherapy
  • Group therapy
  • Mental health assessments
  • Service plan development
  • Substance use disorder services
  • Peer-delivered services (for the Oregon Health Plan)

Guidance on Telehealth Billing codes for the Oregon Health Plan

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Pennsylvania

Telehealth Guidelines Related to COVID-19 (3/15/2020)

Office of Mental Health and Substance Abuse Services specifies:

  • Preference for use of telehealth services
  • Medicaid FFS and MCOs will allow telehealth through smartphone apps and telephone only service delivery
  • Staff trained in the use of telehealth not necessary during emergency
  • LCSWs, LPCs, and LMFTs can provide telehealth now in addition to already-allowed providers
  • Other provider types may bill for telehealth reimbursement
  • Procedure codes are expanded to ones beyond what had been covered (unspecified but presumably means any reasonable code)
  • Delivery of at home services no longer limited to: Assertive Community Treatment, Dual Diagnosis Treatment Team, or Mobile Mental Health Treatment
  • Requirements for the number or percentage of face-to-face contacts for various behavioral health services may be met with the use of telehealth
  • Program limits on the amount of service that can be provided through telehealth are temporarily suspended

Delivery of BHRS Services During School Closures Due to COVID-19 (Updated March 16, 2020)

Use of telehealth for Outpatient Drug and Alcohol Services funded by the Single County Authority (3/18/2020)

  • Outpatient SUD facilities can provide counseling and other clinical services through telehealth
  • Services provided through telephone are permitted
  • Specifies this is consistent with OMHSAS guidance summarized above

Insurance Department issued a bulletin specifying that insurers are encouraged to:

  • Waive prior authorization and cost sharing for COVID-19 testing
  • Work with insureds to secure access to in-network or publicly-funded services and avoid balance billing
  • Increase use of telehealth and provide "coverage of costs"
  • Check directories to ensure network adequacy and allow out-of-network utilization at in-network costs
  • Expedite utilization review decisions
  • Expedite formulary decisions and grant early prescription refills
  • Coordinate with self-funded ERISA plans they may act as TPAs for

CMS Approves 1135 Waiver for Pennsylvania:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Rhode Island

HIC on March 13, 2020: Update telemedicine policies to include telephone-only services within the definition of telemedicine for primary care and behavioral health providers. Telephone-only primary care and behavioral health services coded using CPT codes 99211 or 99212 (or equivalent) with a code modifier shall not be subject to cost sharing. This instruction supports guidance from the Centers for Disease Control (CDC) and the Rhode Island Department of Health (RIDOH) to have patients call their health care providers before seeking in-person care.

Telehealth: Today the Governor signed an executive order directing health insurers to follow previously announced instructions to cover visits conducted over the phone and online during this crisis. This order for an expansion of Telemedicine coverage will apply to primary and specialty care, as well as mental and behavioral health care.

Licensure Waiver: If someone holds a valid license in good standing in another state, that person will be able to get a 90-day temporary license to practice in Rhode Island. This is applicable for physicians, APRNs, mental health counselors, pharmacists, and many other health professions. This temporary license can be renewed one time. There will be no cost to obtain the license or for the one-time renewal. RIDOH is also extending the expiration dates for any of these professionals whose license is set to expire in the next 90 days.

CMS Approves Rhode Island's 1135 Waiver Request:

  • Expands provider enrollment to cover non-Rhode Island licensed providers
  • Lifts some prior authorization requirements

Recording of Department of Health Provider Update Call: RIDOH will hold these calls regularly on Wednesdays at 12:30 pm. Please visit this link for call-in details.

No visitors to Eleanor Slater Hospital: only exception end of life

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South Carolina

Licensure Waiver: The state medical board can expedite temporary licensure for out-of-state physicians, physician assistants and respiratory care practitioners within 24 hours. These licenses are free.

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South Dakota

South Dakota Department of Health COVID-19 Hub (mostly provides links to CDC for health care providers).

Section 1135 Waiver. Highlights include:

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Provider Enrollment
  • Provision of Services in Alternative Settings: Allow facilities, including NFs, intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDDs), psychiatric residential treatment facilities (PRTFs), and hospital NFs, to be fully reimbursed for services rendered to an unlicensed facility (during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services) provided that the State makes a reasonable assessment that the facility meets minimum standards, consistent with reasonable expectations in the context of the current public health emergency, to ensure the health, safety and comfort of beneficiaries and staff. The placing facility would be responsible for determining how to reimburse the unlicensed facility.

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Tennessee

Telehealth: Department of Commerce and Insurance issued bulletin to insurers that, among other things, specified:

  • Reminded insurers to review existing statute regarding coverage of telehealth
  • Recommended that insurers refrain from imposing prior authorization on COVID-19 services
  • Requests that insurers waive cost sharing
  • Request that insurers review provider directories and also allow enrollees to go out-of-network if no provider qualified to screen or treat COVID-19 is available in-network

Licensure Waiver: If out of state health care professional is assisting in the medical response to COVID-19, can practice without Tennessee licensure.

Executive Order Suspending Certain Laws and Regulations

  • Licensing for out-of-state healthcare professionals
  • Pharmacists to dispense maintenance medications for 90 days without prior authorization
  • Allow NPs and PAs to prescribe independently
  • Pharmacists may process computer-based Rx's from alternate locations
  • Suspends CON

The Governor signed an Executive Order to better mobilize health care workers, by:

  • Loosening restrictions around retired medical professionals returning to the workforce;
  • Temporarily suspending continuing education requirements so professionals can continue to work through the pandemic;
  • Calling for the availability of phone assessments for individuals with mental illness or emotional disturbances; and
  • Expanding telemedicine efforts.

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Texas

Telehealth: The Governor granted waivers to allow hospitals to increase the total number of unused beds without having to apply or pay additional fees in addition to directing the Texas Department of Insurance to issue an emergency rule regarding telemedicine care for patients. Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits. Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.

Texas Medical Association offering members help ramping up telemedicine practice in light of COVID-19.

Telemedicine: Texas Medical Board received authorization from Governor Abbott to allow telephone-only consults and ease some licensing regulations (mainly around continuing education).

Governor Abbott is requiring daily reporting of hospital beds, but has exempted psychiatric beds.

CMS has approved an 1135 Waiver.

  • Extends pre-existing prior authorizations.
  • Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a Resident Review as soon as resources become available.
  • Can temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare.
  • CMS waives screening requirements including application fees, criminal background checks to include fingerprinting, and site visits.

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Utah

Telehealth: COVID-19 Task Force task force discussed several other mitigation steps in their Friday morning meeting, including developing outreach plans to address vulnerable populations, identifying ways to increase capacity to test for COVID-19 and ensuring access to telehealth care for residents statewide. More information is forthcoming.

On 3/25 the Governor issued an order that specifies the following about telehealth:

  • Providers do not have to meet security and privacy requirements of HIPAA and HITECH to the extent that it interferes with the ability to offer telehealth
  • Provider must notify patients if telehealth capabilities in place do not meet HIPAA or HITECH standards and provide patient opportunity to decline telehealth services

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Vermont

Telemedicine Services: Department of Financial Regulation (insurance department) urges but does not require insurers to:

  • Expand coverage of telehealth, including telephone only
  • Cost sharing for telehealth should not exceed in-person cost sharing
  • Reimburse providers for brief screening through HCPCS codes G2012 and G2010

Vermont Department of Health Advisory for Congregate Care Settings (Including State Psychiatric Hospital):

  • Visitors limited to medically-necessary personnel and visitors to those receiving end of life care.
  • Details equipment that should be available at the facilities
  • Makes recommendation about tiering care in case patients within the facility contract COVID-19.

Vermont Crisis Standards of Care: includes information about the Health Action

CMS has approved an 1135 Waiver for Vermont:

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Virginia

Licensure Waiver: During the declared coronavirus emergency in Virginia, the board of medicine is making accommodations to its licensing process for the following professions: medicine and surgery, osteopathic medicine and surgery, physician assistant, podiatry, and respiratory therapy. If a report is directly submitted by the National Practitioner Data Bank to the board, the following will not be required in the application process: Transcripts of professional education; Form b employment verifications; State verifications of licensure

CMS has approved an 1135 Waiver for Virginia:

  • FFS prior authorization is waived
  • Previously approved prior authorizations are extended
  • MCO beneficiaries may proceed to fair hearing within one day
  • MCOs must adjudicate appeals within one day
  • Enrollees have an additional 120 days to request fair hearing after initial 120 days elapse

Updated 3/30/20: VDH issued guidance to long term care facilities that, among other things, specified the following:

  • Restrict visitors except for end-of-life situations
  • Restrict all non-essential volunteers and health care providers
  • Consider telework for staff when possible
  • Screen all staff for symptoms before shifts
  • Residents who must leave facility for other health care delivery must wear masks
  • Screen residents at least once daily and isolate anyone with symptoms
  • Immediately notify VDH if there is an outbreak
  • Consider suspension of new admissions if there is an outbreak
  • Consider short-term closures, cleaning, and contact tracing if there is an outbreak
  • Consider longer-term closures and quarantine until outbreak resolves
  • Implement universal mask and PPE wearing by staff if outbreak occurs when interacting with patients
  • Infected staff follow isolation and return-to-work guidelines before returning to work
  • Asymptomatic infected staff may work only while wearing mask and must not have any interactions with immunocompromised patients

Governor Northam encouraged medical professionals to join the volunteer organization Virginia Medical Reserve Corps. Applicants should visit https://vvhs.vamrc.org/.

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Washington

Licensure Waiver: If volunteers are registered in the volunteer health practitioner system and verified to be in good standing in all states where they are licensed, they may practice in Washington without obtaining a Washington license once activated and assigned by DOH.

In-state practitioners can become volunteers in two ways:

  • Via RCW chapter 70.15 by registering and completing the Emergency Volunteer Health Practitioners Application which can be found here.
  • Via registering with their local Medical Reserve Corps; more information can be found at: https://mrc.hhs.gov

Out-of-state practitioners may:

  • Become volunteers via RCW chapter 70.15 by registering and completing the Emergency Volunteer Health Practitioners Application which can be found here.
  • Out of state MDs and DOs that would like an expedited Washington license and to volunteer, may use the Interstate Medical License Compact and become registered under RCW 70.15. At this time, we are limiting our request for health care practitioners to U.S. jurisdictions due to technical issues. We may expand the call to international jurisdictions in the future as needs arise, and if that remains available to us based on federal restrictions.

DSHS limits visits at its 24/7 facilities including behavioral health.

Approved 1135 Medicaid Waiver: Along with several other provisions, the waiver requests flexibility for provision and payment of telehealth services. Apple Health has already opened new billing codes for both telehealth and telephonic services, including for behavioral health services to cover telehealth services in the same manner and at the same rate as in-person care.

Washington Health Care Authority offers limited number of no-cost telehealth technology licenses for Medicaid providers: The Health Care Authority has purchased a limited number of licenses for Zoom, a video conferencing technology that helps health care providers continue seeing patients without a physical encounter. HCA will prioritize Zoom licenses for those providers who need them most. To submit your application, go to the Zoom application page.

Guidance for Opioid Treatment Programs (OTP) Medical Directors: This guidance contains recommendations and resources from state and federal partners. Among the many issues addressed, the guidance expands on what OTPs need to know about the use of telemedicine or telephonic services to provide medically necessary services for the continuity of care for OTP clients.

Guidance for Buprenorphine Prescribers: This interim guidance contains recommendations and resources, including telehealth recommendations for this patient population. The Health Care Authority will continue to update resources for BUP prescribers on this site.

Parity for Telemedicine: The Governor's proclamation increases parity between health care providers who deliver in-person and telemedicine care. The measure encourages the use of telemedicine and specifically prohibits insurance carriers from:

  • Reimbursing in-network providers for telemedicine claims for medically necessary covered services at a rate lower than the contracted rate that would be paid if the services had been delivered through traditional (in-person) methods.
  • Denying a telemedicine claim from an in-network provider for a medically necessary covered service due to an existing provider contract term with that provider that denies reimbursement for services provided through telemedicine.
  • Establishing requirements for the payment of telemedicine services that are inconsistent with the emergency orders, rules or technical advisories to carriers issued by the Office of the Insurance Commissioner.

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West Virginia

Medicaid Telehealth: Allowing non-emergent E&M services via telehealth in Medicaid.

West Virginia Bureau of Medical Services within Department of Health and Human Resources issued a guidance specifying:

  • Nonemergent E&M visits can be rendered through the Telehealth for Medicaid recipients
  • Codes 99211 and 99212, may be billed with place of service 02 will be allowed.
  • All existing telehealth statutes still apply

A separate guidance from same entity specifies:

  • Psychological testing for Medicaid enrollees may be delivered through telehealth through May 30
  • This affects the following codes:
    • 96130
    • 96131
    • 96132
    • 96136
    • 96137
    • 96113

Same entity issued guidance announcing that the requirement for MAT-related counseling in order to receive MAT is suspended (Medicaid recipients can get MAT without such services)

Insurance Commissioner issued a bulletin specifying that issuers should:

  • Suspend cost sharing for COVID-19 testing
  • Urged that their telehealth programs are "robust and will be able to meet any increased demand"
  • If in-network providers with training to provide COVID-19 services are not available, allow out-of-network utilization at in-network cost sharing
  • Should not impose prior authorization for COVID-19 services and should expedite other utilization review
  • Should make expedited formulary decisions

CMS has approved an 1135 Waiver for the state.

  • Temporarily suspends Medicaid FFS prior authorization.
  • Extends pre-existing authorizations.
  • Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
  • 42 CFR new preadmission level I and II screens are not required for residents who are being transferred between nursing facilities.
  • May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
  • Allows for billing in alternative settings for patients in psychiatric residential treatment facilities

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Wisconsin

Wisconsin Department of Health Services COVID 19 guidance

Telehealth: Health Plan Issuers are reminded to review provisions in current policies regarding the of the Commissioner of Insurance (OCI) is issuing this Bulletin to assist individuals delivery of health care services via telehealth and ensure their telehealth programs with participating providers are robust and will be able to meet any increased demand.

Guidance for Correctional Facilities: screening of individuals in custody and determine measures for isolation ahead of time if an individual becomes ill.

Guidance for Long Term Facilities: limit visitors and screen those who do visit

Emergency Order Related to Certain Health Care Providers and the Department of Safety and Professional Services Cleaning:

  • Allows physicians licensed out-of-state to treat Wisconsin residents via telemedicine.
  • Encourages insurers to reimburse for telemedicine.
  • Provides avenue for licensed out-of-state practitioners to practice in Wisconsin without first requiring an in-state credential.
  • Eliminates time limits for temporary licenses.
  • Enables nursing students close to graduation to be a part of the state’s COVID-19 response by adjusting some clinical education requirements.
  • Suspends practice restrictions for advanced practice nurses.
  • Allows physician assistants to practice beyond the scope of the supervising physician and allows physician assistants to supervise other health care professionals. Removes the limit on how many physician assistants a physician may supervise at once.

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Wyoming

No guidance on licensure or telehealth at this time.

Awaiting action/ announcements from the Governor's COVID-19 task force.

CMS approved Wyoming's Medicaid Section 1135 Waiver:

  • Temporarily waives some prior authorization requirements
  • Authorizes care to be provided in alternative settings
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • Extends enrollment to non-Wyoming providers
  • Current waivers continue

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