The Centers for Medicare and Medicaid Services came out with a final rule yesterday that would require face-to-face visits prior to home health services for Medicaid patients, a rule that already exists for Medicare patients. But, as Politico spotted, the rule also includes a parenthetical allowing those "face-to-face" visits to be conducted via telehealth.
Exactly what constitutes telehealth isn't really spelled out in the language of the bill. In responses to public comments, the agency said it would defer to state definitions of telehealth but did not mean for phone calls or emails to suffice. Thorough guidelines on telehealth from CMS, it added, are forthcoming.
"It is not our intention to allow telephone calls or emails to replace the face-to-face encounter," the comment response says. "In other words, telehealth and telemedicine are service delivery models and do not replace the requirement that a physician or NPP must have a face-to-face encounter with a beneficiary. Rather, the face-to-face encounter can be met though a telehealth delivery model that is recognized by the state as a physician or NPP encounter under its approved state plan."
The provision won't make telehealth itself reimbursable by Medicaid per se, but might have that practical effect in some states, as there are already provisions for reimbursement for transportation to facilitate the required face-to-face visit, and states could decide to extend those to telehealth based on the new rule.
"Medicaid does not reimburse for telecommunications equipment or facility costs separately," the document says. "However, states could build reimbursement for the costs into the rate and states can include in the rate a separate amount for such costs. Reimbursement for services provided through telehealth is voluntary on the part of state Medicaid agencies as they are viewed as alternative methods of providing services, not as a separate type of service. Therefore, reimbursement is only available if the state has chosen to cover services provided via telehealth or telemedicine and only in the circumstances selected by the state."
The promise to provide additional guidance in the future came in the response to a comment about security and privacy concerns surrounding telehealth.
"Our expectation is that care delivered using various technologies will lead to good outcomes and meet the needs of the individual while adhering to privacy requirements, including the requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)," CMS wrote. "We recognize the need for updated Medicaid telehealth guidance, which will be forthcoming. In the meantime, we are available to provide technical assistance."
