Telehealth Guidance for Health Centers
Dear Health Centers Leaders,
Last night NYS Medicaid issued emergency regulations permitting reimbursement for services delivered via a telephone by a physician, nurse practitioner, physicians assistant, or licensed midwife enrolled in Medicaid. All other telehealth regulations remain in effect.
This email outlines current NYS Medicaid and Medicare policies for health centers as of Monday, March 16th.
CHCANYS has urged the State to permit additional flexibility for health centers to use telehealth services as broadly as possible, in order to continue to provide needed care to patients while limiting risk of exposure to the virus and reducing unnecessary visits to overwhelmed emergency rooms.
Additionally, although the legislation signed last week by the President provided some additional flexibility during a public health emergency for Medicare coverage for telehealth, it was not as expansive as we had hoped and maintains the Medicare prohibition on health centers serving as distant sites.
A summary of current regulations is below:
Medicaid- Article 28
NYS Medicaid will reimburse FQHCs for Article 28 services as both distant sites and originating sites, as long as the visit would otherwise be considered a threshold visit if it happened in person. Providers can be reimbursed for services provided via telephone that occurred on or after March 13th, 2020. An eligible provider must be located on site to provide services via telehealth.
There is ongoing disagreement within DOH about whether an FQHC can receive wraparound payments for telehealth visits billed at a health centers offsite rate (4012 rate). CHCANYS is working with DOH to ensure that health centers are reimbursed at their full PPS rate and receive wraparound payments for all telehealth visits. We will provide update guidance when we receive it. In the meantime, please refer to the following resources for more detailed guidance:
Pursuant to federal law, FQHCs are unable to bill Medicare as distant site providers. FQHCs can bill Medicare as originating site providers in limited situations. Although President Trump signed legislation relaxing certain telehealth provisions during a public health emergency, such as the Covid-19 outbreak, the prohibition on FQHCs as distant site providers remains in place. This means that FQHCs cannot bill Medicare when providing services via telehealth to a patient at home or at any other offsite location. For further information on the recent changes to Medicare coverage of telehealth please review the Center for Connected Health Policy Special Edition Memo on Coronavirus and Telehealth.
At this time, NYS Medicaid follows Medicare rules for services delivered to dual eligible patients via telehealth. Therefore, FQHCs cannot bill for any services provided via telehealth to dual eligible patients located in their home or any other location. CHCANYS is aware of the impact this guidance has on many health centers and has urged DOH to permit FQHCs to bill Medicaid for these visits. We will provide updated guidance as we receive it.
If the FQHC would be eligible to be reimbursed by Medicare as an originating site, NYS Medicaid will reimburse using the same methodology as for face to face visits. For more information, please refer to the 2019 Medicaid Update.
Center for Connected Health Policy