Hey guys – you can’t use FaceTime much longer!

As you all probably know by now, the Public Health Emergency (PHE) for COVID is ending on May 11, 2023. During the PHE, the Office of Civil Rights (OCR) used its discretionary powers to waive enforcement of penalties with regard to using telehealth platforms like Facetime and the free versions of Skype and Zoom that are not compatible with the Health Insurance Portability and Accountability Act (HIPAA). That ends with the end of the PHE. FaceTime is a good and convenient technology, but Apple will not sign a Business Associate Agreement (BAA). All covered entities had to have a HIPAA-compliant telehealth platform with a BAA before the PHE, and that rule is back in force. Enforcement of penalties on providers for HIPAA noncompliance will resume on May 11th.  This means as of that date, mental health professionals should all be using a telehealth platform that is HIPAA-compliant and with whom a signed BAA is in place. Here is a partial list of some platforms that claim HIPAA compliance:

TELEHEALTH CONSENT: As of November 2022, 45 states (including KY), DC, and Puerto Rico include some telehealth consent requirements in their statutes, administrative code, or Medicaid policies. If you are not having each telehealth client sign a written telehealth consent, I STRONGLY recommend it and would like you to follow the law and regulations in the state where you and the client are located at the time of service.

PAYMENT: As of March 2023, only 21 states have policies requiring payment parity (KY does), 6 states have payment parity in place with caveats, and 23 states have no payment parity. This means clinicians in many states may find that telehealth is reimbursed at a lower rate than in-person sessions. As of November 2022, 7 states, Alabama, Idaho, North Carolina, Pennsylvania, South Carolina, Wisconsin, and Wyoming, have no law requiring private health plans to cover telehealth. 

Plans may require a physical office address for in-network provider directory listings. This requirement was suspended in many states during the PHE to protect the privacy of providers working from home. Some insurers may not accept a home address as your office address (check with each plan directly).

Health plans may require credentialing/approval for providing telehealth services in addition to the regular network credentialing process. Telehealth credentialing was suspended by many plans during the PHE.

Payment Parity requires that telehealth sessions are reimbursed at the same rate as in-person visits. Kentucky has payment parity. During the pandemic, many states temporarily required payment parity. Now, some states have made it permanent.  But as of March 2023, only 21 states have policies requiring payment parity, six states have payment parity in place with caveats, and 23 states have no payment parity. This means clinicians in many states may now find that telehealth is reimbursed at a lower rate than in-person sessions.

MEDICARE:  The Dec 2022 omnibus spending bill law (HR-2617) extended Medicare telehealth provisions put in place during the COVID-19 PHE for another two years. The hope is that these extra two years will give telehealth advocates (like NASW) time to convince Congress to make telehealth coverage permanent.

Some Key Medicare provisions include:

  • All eligible Medicare providers may continue to provide telehealth until December 31, 2024.
  • The in-person screening requirement for Medicare clients will not be required until December 31, 2024.  Bills have already been introduced in Congress (S-4965 and HR-8497) that seek to remove the in-person screening requirement for mental health services.
  • Other extensions to December 31, 2024, including continuing to allow the home to be an eligible originating site for the client and allowing the phone (audio-only) to provide some services.
  • During the PHE, Medicare telehealth visits were to have been paid at the same rate as in-person but are scheduled to end at the end of 2023 unless Congress intervenes. The fee schedule for 2024 shows reduced rates.

 MEDICAID:   

  • All 50 states and Washington, DC, provide reimbursement for some form of live video in their Medicaid fee for service programs.
  • As of October 2022, 34 state Medicaid programs (including KY) and DC were reimbursed for the audio-only telephone in some capacity.
  • COVERAGE ALERT!!!  During the pandemic, Medicaid expansion in several states increased federal Medicaid funding and legislation that did not allow states to disenroll Medicaid recipients. But that ended on March 31, 2023. The Center for Medicare and Medicaid Service (CMS) estimates that more than 15 million recipients will lose coverage as they are disenrolled from Medicaid. And many clients may not know this. Check KY Medicaid COVID-19 Information – Cabinet for Health and Family Services. In addition, I suggest you verify your client’s Medicaid eligibility every session for the next few months before your service so that you will have time to make financial arrangements with your client. Otherwise, you will be blindsided by denials.
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