CMS: For approval of Medicaid home health services, telemedicine counts for face-to-face visits

The Centers for Medicare & Medicaid Services this week published a final rule clarifying requirements for face-to-face encounters for Medicaid beneficiaries to be eligible to receive home health services; the rule outlines that telehealth can be used for such encounters.

To authorize home health services via aides, nurses, equipment and/or appliances, CMS mandates that recipients must have a face-to-face encounter related to the reason for the request either 90 days prior to or 30 days after start of services. CMS says physicians and certain non-physician practitioners must document the encounters, which can be conducted via telehealth, "subject to requirements in section 1834(m)" of the Affordable Care Act.

Some of the comments on the proposed rule were in support of telehealth, CMS notes. One person was "pleased that CMS [was] ready to offer technical assistance to state Medicaid agencies to use telehealth as an alternative so that the requirement" could be implemented in a manner that allows for the continuation of services.

"Telehealth and telemedicine are service delivery modalities that have very specific protocols that ensure quality patient care, and do not include all electronic communications," CMS says.

The agency notes that telephone calls or email will not suffice for face-to-face encounters, but puts the onus on states to determine which forms of telehealth can be used.

"In the absence of specific Medicaid statutory requirements, we are hesitant to proscribe the locations and/or technologies that states may use to meet the face-to-face requirement through telehealth," CMS says. "Under Medicaid policy, states have the flexibility to define coverage of telehealth, including what types of telehealth to cover; where in the state it can be covered; and how it is provided. Our expectation is that care delivered using various technologies will lead to good outcomes and meet the needs of individuals while adhering to privacy requirements, including the requirements under the Health Insurance Portability and Accountability Act of 1996."

CMS also notes the need to update Medicaid telehealth guidance, which it says is forthcoming.

In a letter sent Jan. 19 to Agency for Healthcare Research and Quality Director Richard Kronick, Ph.D., the Healthcare Information and Management Systems Society and the Personal Connected Health Alliance urged the organization to consider conducting additional studies that provide more data on the benefits of telehealth and remote patient monitoring.

Increasingly, providers like Philadelphia-based Jefferson Health and private payers like Anthem are turning to telemedicine to innovate care delivery, as a recent FierceHealthIT special report explores.

In addition, state policies on telemedicine use under Medicare can have a great impact on adoption of the technology, a report published recently in the journal Telemedicine and e-Health found.

To learn more:
- here's the rule (.pdf)
- check out the accompanying CMS fact sheet (.pdf)