About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline

LOG IN
LOG IN


1 1 (October 09, 2020)

handle is hein.crs/govdccm0001 and id is 1 raw text is: October 9,2020 Medicaid Telehealth Policies in Response to COVID-19 Medicaid, authorized in Title XIX of the Social Security Act (SSA), is a federal-state programthat jointly finances primary and acute medical services, as well as long-term services and supports (LTSS), to a diverse low-income population. The 50 states, theDistrict of Columbia (DC), and the five U.S. territories (American Samoa, the Commonwealth of Northern Mariana Islands, Guam, Puerto Rico [PR], and the U.S. Virgin Islands [USVI]) must follow broad federalrules to receive federal Medicaid funding, but they have flexibility to designtheir own versions of Medicaid within the federal statute's basic framework. In addition, several waiver authorities allow states to operate their Medicaid programs outside of federal programrules. (For information on waivers, see CRS Report R43357, Medicaid An Overview, and CRS Leg al Sidebar LSB10430, Section] 135 Waivers and COVID-19: An Overview). This flexibility results in variability across state Medicaid programs in factors such as use oftelehealth as a service delivery method. This In Focus provides backgroundon Medicaid telehealth and an overview of telehealth actions in response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE). It discusses how states leveraged existing flexibilities and PHE-specific federal authorities to increase thenumber of services, provider types, andother telehealth coverage options under Medicaid. mrcd kvd Tedhe 'hadth Nrkw .tca CCOVDC- While federalMedicaid statute does not reco2nize telehealth as a distinct service, the Centers for Medicare & Medicaid Services (CMS) defines Medicaid telehealth as the us e o ftelecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation. sunervision and information across distance. CMS provides states with broad flexibility to define which (if any) telehealth services to provide (e.g., primary care, behavioralhealth, LTSS), allowable modalities (e.2.. live video, audio onlv), where services can be provided, which provider types are authorized to provide the service (subject to federal and statelaw), and the populations served, among other criteria. States that limit telehealth geographically, or to specific providers, must ensure that enrollees in areas without telehealth coverage have face-to-face provider access. In general, states must reimburse providers for a telehealth service at the same rate as an in-person service, unless theyhaveCMS annroval to pay a different rate or with a unique reimbursement methodology. For example, CMS approval is required for payment rates that factor in ancillary costs (e.g., equipment necessary for the delivery oftelehealth services, trans mis sion charges) or cos ts as sociated with time and resources. Medicaid managed care plans are not limited by the payment arrangements outlined in the Medicaid state plan. A September2019 Center for Connected Health Policy's survey of state and DC telehealth laws and Medicaid policies foundthat, as of April2019, all 50 states andDC allowed telehealth as a service delivery mechanismbut allowable provider types, modalities, and s ervice categories varied by state. The COVID-19 pandemic accelerated interest in telehealth as a way to protect health careproviders and to maintain or improve patients' access to care and safety. This section identifies the federal authorities states can leverage to enhance Medicaid telehealth coverage during the PHE and provides an overview of the most commonly added services, provider types, modalities, andcare delivery sites. Summary of Certain Emergency-Related Authorities under Medicaid Disaster Relief State Plan Amendments: Allow states to revise Medicaid eligibility, enrollment, and benefit requirements in their state plan for the duration of a disaster or emergency. Section IllS Waivers: Authorize the Secretary of Health and Human Services (HHS) to waive a number of Medicaid requirements to the extent necessary to allow a state to undertake an experimental, pilot, or demonstration project ' In an emergency, these waivers may be approved without regard to normal process-related requirements and do not need to be budget neutral to the federal government. Section 1915(c) Appendix K Waivers: Appendix K is a stand-alone appendix that states may use during emergency situations to request amendments to existing 191 5(c) Home and Community Based waivers. Section 1135 Waivers: When certain emergency conditions are met, allow the HHS Secretary to temporarily waive Medicaid statutory requirements, such as provider licensure, to ensure sufficient health care items and services are available to meet the needs of enrollees in an emergency area. CMS Gktnx zmdFidra 4ctke CMS released a series ofsub-regulatoryguidance (e.g., frequently asked questions, fact sheets, tool kits) to facilitate increased state reliance on telehealth as a Medicaid service delivery tool. These materials identify existing state flexibilities available to augment telehealth and provide guidance intended to help states identify and address state-levelbarriers to the adoption of new teleheaklh delivery options. For Medicaid changes requiring CMS approval, CMS provided templates and checklists to expedite s taterequests for time-limited Medicaid A A '2 k w- yg