all provider bulletin 281

Transcript

1 Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth 281 Bulletin All Provider January 2019 Providers All TO: Participating in MassHealth MassHealth for Assistant Secretary , Daniel Tsai FROM: R ealth Services Through Use of Telehealth E: Access to Behavioral H Options Overview MassHealth is taking steps to improve access to behavioral health (mental health and substance use disorder) treatment throughout the Commonwealth through the use of telehealth, including teletherapy and telepsychiatry. This bulletin addresses the use of the telehealth modality for the delivery of MassHealth - covered behavioral health services. Telehealth is the use of electronic communication and information technologies to provide h telehealth involves or support clinical care at a distance. The delivery of services throug - the use of secure interactive audio and video telecommunications systems that permit two time communication between a patient and a provider. way - real , are not Providers Telehealth is a modality of treatment, not a separate covered service. required to deliver services via tele health . Children's Behavioral Health Initiative This bulletin does not apply to services under the program, which may continue to be delivered via all modalities currently authorized ) CBHI ( in applicable program specifications. Terminology terms are used as defined below. urposes of this b For the p ulletin, the following Distant s ite is the site where the practitioner providing the service is located at the time the service is provided via a telehealth system. While all applicable licensure and programmatic requirements apply to the delivery of the service, there are no additional geo graphic or facility restrictions on distant sites for services delivered via telehealth. Originating s is the location of the member at the time the service is being provided. ite There are no geographic or facility restrictions on originating sites. erage of Behavioral Health Services Delivered via Telehealth Cov ommunity M ental H ealth C enters, C ommunity H Effective January 1, 2019, C enters, C ealth may and Outpatient Substance Use Disorder providers ( provider types 20, 26 and 28 ) covered services via telehealth. deliver the following ; and  All services specified in 101 CMR 306.00 et seq.  The outpatient services specified in the followi ng categories of 101 CMR 346.04. Opioid Treatment Services: Counseling; o o Clinical Case Management; and Ambulatory Services: Outpatient Counseling; Services for Pregnant/Postpartum Clients: Outpatient Services o (continued on next page)

2 MassHealth Bulletin All Provider 281 2019 January Page 2 (cont.) Coverage of Behavioral Health Services Delivered via Telehealth Services delivered via telehealth must comport with all applicable licensure regulations and requirements, programmatic regulations, and performance specifications related to the service. Behavioral health services provided via telehealth, as described in this bulletin, may be provided by any qualified MassHealth provider, including, as specified in applicable specifications, psychologists, psychiatrists, psychoanalysts, performance regulations and practitioners, and professional clinical social workers, behavioral health nurses, nurse dditional requirements for counselors. A provider training is set forth below. - Providers must use a HIPAA compliant telehealth technology, as specified below, to deliver covered services via telehealth. Billing and Paymen t Rates for Behavioral Health Services Delivered via Telehealth Providers must include the Place of Service (POS) Code 02 when submitting a claim for services delivered via telehealth. Rates of payment for services delivered via telehealth will be the same as rates of payment - person) methods set forth in the applicable for services delivered via traditional (e.g., in regulations. Providers may not bill MassHealth a facility fee for distant or originating sites. Additional Requirements for Telehealth Prescribing A provider may prescribe medications via telehealth in as otherwise described in this bulletin and with the following requirements. accordance 1. A provider may prescribe Schedule II controlled substances via telehealth only after conducting - an initial in person examination of the patient. 2. In - person ongoing examinations are required every three months for the duration of time that the provider is prescribing the Schedule II controlled substance to the patient. An in - person ongoing exam ination conducted by a primary care provider may meet the require ment for ongoing examinations as long as the results of the examination are shared with the provider telehealth . prescribing medication via Providers must comply with all applicable state and federal statutes and regulations governing medication management and prescribing services when delivering these services via telehealth. Providers who deliver prescribing services via telehealth must m aintain policies for providing patients with timely and accurate prescriptions by use of mail, ph - one, e prescribing and/or fax. Providers must document prescriptions in the patient’s medical record consistent with in - person care. (continued on next pag e)

3 MassHealth 281 All Provider Bulletin January 2019 Page 3 Requirements for Telehealth Encounters ivering Providers must adhere to and document the following best practices when del services via telehealth. Providers must properly identify the patient using, at a minimum, the patient’s name, date of 1. birth, and MassHealth ID. Providers must disclose and validate the provider’s identity and credentials, such as the 2. title, and, if applicable, specialty and board certifications. provider’s license, For an initial appointment with a new patient, the provider must review the patient’s relevant 3. medical history and any available medical records with the patient before initiating the delivery of the service. For existing provider - patient relationships, the provider must review the patient’s medical 4. history and any available medical records with the patient during the service. Prior provider is able to deliver to each patient appointment, the provider must ensure that the 5. the service to the same standard of care and in compliance with licensure regulations and requirements, programmatic regulations, and performance specifications related to the service , accessibility and communication access) using telehealth as is applicable to the delivery of (e.g. or other requirements , the services in person. If the provider cannot meet this standard of care - provider must make this person care. The the provider must direct the patient to seek in determination prior to the delivery of each service. Providers must ensure the same rights to confidentiality and security as provided in face - to - 6. face services. 7. consi stent with those followed Providers must follow consent and patient information protocol during in person visits. Providers must inform patients of the location of the provider rendering services via telehealth 8. and obtain the location of the patient ( i.e. , originating site) . (i.e., distant site) 9. he provider must inform the patient of how the patient can see a clinician in - person in the T event of an emergency or as otherwise needed. Training in Use of Telehealth Only behavioral health professionals who have been trained in the provision of services via telehealth, including training in the use of the telehealth equipment, may pr ovide services via telehealth. Providers delivering services via telehealth must have a training program in place to ensure the competency of all staff members involved in the delivery of se rvices via telehealth. Training must include: Familiarity with telehealth equipment, its operation, and limitations; ● Familiarity with procedures to follow for equipment problems and/or failures; ● ● Safeguarding the confidentiality and security of telehealth records and compliance with all applicable state and federal laws, including, but not limited to, HIPAA regulations, at both the originating and distant sites; and ● Bes t practices for clinical work using telehealth technologies, including proto cols for clinical risk management. ( continued on next page)

4 MassHealth All Provider Bulletin 281 January 2019 Page 4 Telehealth Technologies Eligible ll telehealth transmissions are conducted using a HIPAA Providers must ensure that a . The technology utilized to provide a service via telehealth compliant telehealth technology must conform to industry - wide compressed audio - video communication standards for real - time, two - way, interacti ve audio - video transmission. Providers must have a written procedure for all telehealth sites detailing the contingency plan in the event of a transmission failure or other technical difficulty that renders the transmission undeliverable. Telehealth - only telephone conversation, electronic does not include the use, in isolation, of audio mail, instant messaging, phone text, or facsimile transmission. Documentation and Record Keeping Providers delivering services via telehealth must meet all health re cords standards required by the applicable licensing body as well as any applicable regulatory and program specifications required by MassHealth . This includes storage, access, and disposal of records. MassHealth regulations pertaining to documentation In addition to complying with all applicable of services, providers must include a notation in the medical record that indicates that the service The ant and the originating sites. was provided via telehealth and the physical location of the dist prov ider must also include the CPT code for the service rendered via telehealth in the patient’s medical record. MassHealth may audit provider records for compliance with all regulatory requirements, including record keeping and documentation requirements, and may apply appropriate sanctions to providers who fail to comply. MassHealth Website This bulletin is available on the MassHealth website at www.mass.gov/masshealth - provider - bulletins . To sign up to receive email alerts when MassHealth issues new bulletins and transmittal letters, join send a blank email to - masshealth - provider - [email protected] . No text in the body or subject line is needed. Questions If you have any questions about the information in this bulletin, please contact the your inquiry to Center at (800) 841 - 2900, email MassHealth Customer Service - 8974. [email protected] , or fax your inquiry to ( 617 ) 988 @MassHealth Follow us on Twitter

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