This tool summarizes and provides links to telehealth information on the global coronavirus (COVID-19) situation. It is current as of March 23 and will be updated as further information is made available.
Telehealth Policies, Definitions, and Payment
Medicare: Effective March 6, Medicare will pay for visits furnished via telehealth across the nation, including in the patient’s place of residence. Previous restrictions on originating and geographic sites are waived. Medicare is allowing a wide range of providers—including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers—bill for telehealth services. For more information, including billing codes, please see the Centers for Medicare & Medicaid Services (CMS) telehealth toolkit. CMS has also published a fact sheet and FAQs.
Medicaid: Currently, under New York State Insurance Law and Public Health Law, services that are covered under a comprehensive insurance policy or contract—including Medicaid—must be covered when the service is delivered via telehealth. The New York State Department of Health (DOH) published a Medicaid Update in February 2019 that outlines DOH’s telehealth policy and includes billing guidelines and codes. A March 7 Executive Order (EO) further introduced flexibility for offering telehealth services by suspending New York State Public Health Law §2999-cc, which defines telehealth services and establishes rules on how such services can be provided and who provides them. A recent Medicaid Update further detailed these flexibilities. Specifically, the guidance relaxes rules on the types of clinicians, facilities, and services eligible for billing under the New York State telehealth rules. It also addresses technological barriers to telehealth by allowing health care providers to bill for telephonic services if they cannot provide the audiovisual technology traditionally referred to as telemedicine.
Department of Financial Services-regulated insurers: To offer additional encouragement to manage patients via telehealth, insurers are required to waive cost-sharing related to all telehealth services for any service that would be otherwise covered, including mental health care and substance use disorder treatment services. These services do not have to be related to COVID-19.
Provision of Services for Special Populations
New York State Office of Mental Health: Certain regulatory requirements applicable to telemental health services—including requirements for the written approval process, policies, and procedures—have been waived. In addition, the definition of telemental health for Medicaid-reimbursable services is expanded to include telephonic and video. Any limitations and restrictions pertaining to the location of the telemental health practitioner while providing services have also been waived.
New York State Office for People with Developmental Disabilities (OPWDD): All residential and non-residential facilities and programs certified or operated by OPWDD are permitted and encouraged to be delivered via telehealth whenever possible. Health care services delivered by means of telehealth are reimbursable by Medicaid.
Office of Addiction Support and Services (OASAS): Certain sections of the regulations regarding telepractice, including requirements for prior written authorization from OASAS, have been waived. Providers who want to deliver telepractice and do not already have approval should complete the self-attestation. OASAS also clarified that telephonic is a form of telepractice and provided billing guidelines.
New York State: A March 19 EO includes waivers that will allow out-of-state physicians, nurses, licensed practical nurses, and physician assistants to practice in New York State without limitation on what type of care they may provide. The EO also includes flexibilities related to privileging and credentialing. Specific citations can be found here. Surrounding states have issued similar waivers to allow providers from other states, including New York, to provide telehealth services to their patients (not residing in New York State). Please see our tool for information for New York State providers offering telehealth services to their patients residing in surrounding states.
Privacy and Security
Office for Civil Rights (OCR): OCR issued a notice of enforcement discretion for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding telehealth remote communications. OCR will not impose penalties for noncompliance against health care providers in connection with the good faith provision of telehealth. A covered entity can use any non-public facing remote communication product, such as Skype or Facetime, that is available to communicate with patients. OCR’s discretion applies to any telehealth service, regardless of the connection of the service to COVID-19. OCR encourages providers to notify patients that the devices or apps used to communicate could potentially introduce privacy risks. OCR will not impose penalties against covered entities for the lack of a business associate agreement with video communication vendors. OCR also issued a FAQs document about its guidance.
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA issued guidance clarifying the medical emergency exception under 42 CFR Part 2 (Part 2). Under this exception, patient identifying information may be disclosed by a Part 2 program or other medical personnel, without patient consent, to the extent necessary to meet a bona fide medical emergency, where the patient’s prior informed consent cannot be obtained. Information disclosed to the medical personnel who are treating in the medical emergency may be re-disclosed for treatment purposes as needed. Programs must document certain information in their records after a disclosure is made pursuant to the medical emergency exception. SAMHSA emphasized that providers make their own determinations whether a bone fide medical emergency exists for purposes of providing treatment to patients.
US Office of the Inspector General (OIG): Pursuant to an OIG policy statement, health care providers will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations (i.e., co-insurance and deductibles) that Federal health care beneficiaries may owe for telehealth services provided that: 1) a provider reduces or waives cost-sharing obligations that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules; and 2) services are furnished during the time period subject to the COVID-19 declaration. OIG also stated that the provision of free telehealth services and subsequent services occurring as a result of these services will not be viewed as standalone evidence of inducement or as likely to influence future referrals.
New FCC Telehealth Program: The Federal Communications Commission released an order establishing a telehealth program to support health care providers responding to the pandemic, and adopted final rules for the longer-term Connected Care Pilot Program. The COVID-19 Telehealth Program will quickly distribute $200 million that Congress appropriated in the Coronavirus Aid, Relief, and Economic Security (CARES) Act for connected care services and devices to treat COVID-19 and other health conditions during the pandemic. A presentation about the funding opportunity is available. For the application and additional materials please visit the FCC telehealth site.
Federal Telehealth Toolkit: The Centers for Medicare & Medicaid Services released a toolkit for states to accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs during the COVID-19 pandemic.
ASPR TRACIE Telehealth Resources
The ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE) has published three webinars on implementing telehealth services to address the access and functional needs of at-risk individuals during the COVID-19 pandemic. Also available is the Lifehacks for Telemedicine handbook, which helps organizations conduct and bill video-based telemedicine visits.