Ohio Medicaid Asks to Make Expanded Telehealth Coverage Permanent

Ohio’s Medicaid program is petitioning the state to make permanent telehealth coverage that had been expanded to address the coronavirus pandemic.

The state’s Department of Medicaid has filed documents seeking to add a wide range of healthcare providers to the list of those eligible to bill for telehealth services, as well as expanding the number of services and modalities – including asynchronous telehealth, remote patient monitoring, virtual check-ins and phone calls, e-mail and fax transmissions.

“This permanent expansion of clinically appropriate telehealth services allows us to increase access to quality care while maintaining the fiscal sustainability and integrity of Ohio’s Medicaid program,” Ohio Medicaid Director Maureen Corcoran said in a press release.

The expanded coverage was included in an emergency order signed in March by Ohio Governor Mike DeWine, with the goal of enabling care providers to use more connected health platforms to treat patients outside the hospital, clinic or office.

According to Ohio Medicaid, prior to the pandemic the program saw less than 1,000 telehealth claims per month and roughly 4,000 telehealth claims per month for mental health and substance abuse treatment. Since March, almost 630,000 members have used telehealth, totaling about 2.6 million claims, and more than 200,000 have sought help via virtual care channels from the Ohio Department of Mental Health and Addiction Services (MHAS), totaling about 1.28 million claims. Another 1.3 million claims were filed by more than 480,000 Medicaid members using telehealth to access care from providers outside the MHAS network.

The pandemic has caused a surge in telehealth use in most, if not all states, prompting a barrage of emergency state and federal directives to expand coverage. Now both state and federal agencies are exploring how to continue coverage once the public health emergency ends.

“During a time when families are juggling remote learning, work-from-home, and the additional stressors of life during a pandemic, ODM is committed to ensuring members can conveniently access quality healthcare services – especially mental health and addiction services” Corcoran said. “Expanding telehealth is the silver lining of the COVID-19 pandemic.”

Under a new rule proposed for adoption, the definition of telehealth would be expanded to include RPM, phone calls and communication through secure e-mail and fax.

To the list of providers eligible to bill for telehealth services, it would add supervised practitioners such as trainees and aides, Medicaid School Program (MSP) providers, audiologists, speech-language pathologists, occupational therapists, physical therapists, home health and hospice aides, private duty nurses working in a home health or hospice setting, dentists, dietitians, behavioral health practitioners and optometrists.

To the types of services that may be covered when telehealth is used, the new rules would add remote evaluation of recorded video or images submitted by an established patient, virtual check-in by a physician or other qualified health care professional who can report evaluation and management services provided to an established patient, online digital evaluation and management services for an established patient, RPM, physical therapy, occupational therapy, audiology, speech-language therapy, additional behavioral health services, medical nutrition services, lactation counseling provided by dietitians, psychological and neuropsychological testing, smoking and tobacco cessation counseling, developmental test administration, oral evaluations provided by dentists, hospice care, state plan home health care, dialysis-related services, services under the Specialized Recovery Services (SRS) program and optometry services.

Finally, the proposed rule relaxes the requirements for balancing virtual care with in-person care, and expands the list of sites where telehealth can be delivered.

“The relaxation of rules regarding telehealth has undoubtedly led to significantly better care for our patients during these challenging times,” Robert Stone, MD, Senior Medical Director of Ambulatory Services for Central Ohio Primary Care Physicians, said in a press release. “Making those changes permanent would make those benefits permanent as well – it represents an important step forward in advancing quality patient care.”

The new rule will be reviewed by the Joint Committee on Agency Rule Review and, if approved, would become effective when the public health emergency expires.