Issued: March 24, 2020
Letter to Partners Members
Partners is sending a letter to all members regarding COVID-19. View the letter here.
Telehealth Service Decisions
NC Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policies (Special COVID-19 Medicaid Bulletin #7: Telehealth Providers – Clinical Policy Modification) to better enable the delivery of remote care to Medicaid beneficiaries. In addition to telephone conversations and secure electronic messaging, the modifications will include the use of two-way real-time interactive audio and video to provide and support physical and behavioral health care when participants are in different physical locations.
Telehealth refers broadly to electronic and telecommunications technologies and services used to provide care and services at a distance. Telehealth encompasses a range of practices, including telemedicine and telepsychiatry, which use two-way, real-time interactive audio and video between provider and patient to deliver health care and behavioral health services, respectively. Virtual patient communication is another part of telehealth used to provide evaluation and consultation between provider and patient or between different providers.
Partners is committed to ensuring the Provider Network can continue to support members in our communities.
Effective with March 10, 2020 dates of services, Partners is allowing the following expansions to telehealth:
- All E&M codes can be provided virtually via telephone or video at the same rates
- All basic outpatient codes can be provided virtually; ONLY if both audio and visual are utilized at the same rates
- Comprehensive Clinical Assessments (90791) can be completed virtually; ONLY if both audio and visual are utilized at the same rates
- Waive training requirements for new and existing provider staff for 30 days for all providers
- Waive FTE requirement for enhanced services (the intent is to allow staff to cross between service lines) for 30 days for all providers
This communication is in keeping with the announcement from NC Medicaid involving several policy changes around the use of telemedicine in response to COVID-19. These changes will enable Medicaid beneficiaries to continue to access the care they need.
Additional illustration of the Medicaid policy changes includes:
- Payment parity for approved services, meaning providers will be paid the same fee for a service regardless of whether it is provided in-office or via an approved technology platform;
- Expanding eligible telehealth technologies to any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers;
- Expanding the types of provider that can provide telehealth to include clinical pharmacists, licensed clinical mental health counselors (LCMHCs), licensed marriage and family therapists (LMFTs), licensed clinical addiction specialists (LCASs), and licensed psychological associates (LPAs);
- Expanding the list of eligible originating sites, which is where the patient may be located (e.g., health care facilities, community sites, the home) and distant sites, which is wherever the provider is located (Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs) are considered eligible distant sites); and
- Eliminating the need for some prior authorizations and referrals.
These changes will be retroactive to March 10, 2020 and will remain in effect until the North Carolina State of Emergency is declared over or when this policy is rescinded, whichever comes first. Medicaid will continue to release telehealth policy provisions and will continue to evaluate this policy throughout the state of emergency period.
For more information, visit Special COVID-19 Medicaid Bulletin #7: Telehealth Providers – Clinical Policy Modification on the Medicaid website at https://medicaid.ncdhhs.gov/providers/medicaid-bulletin.
Additional telehealth details and guidance will be available online at www.medicaid.ncdhhs.gov/coronavirus.
Immediate Changes under EPSDT for Children under the Age of 21: The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.
Partners is working with the North Carolina Department of Health and Human Services (NC DHHS) on service specific guidance in response to the COVID-19 virus. The North Carolina Division of Health Benefits (DHB) coordinated with the Center for Medicare and Medicaid Services (CMS) and requested waivers that support flexibility in service delivery that both protects the public while ensuring our most vulnerable citizens are able to continue receive support for their Behavioral Health (BH) and/or Intellectual and Developmental Disability (I/DD) needs.
This guidance is in place for the duration of the declared state of emergency or until further notice or amendment. Partners may require at some future point replacement claims to add modifiers to service codes used for billing during this event. All service notes during this time must include the following statement: This service was delivered under EPSDT during the COVID-19 State of Emergency requiring social distancing.
Partners is implementing the following changes under EPSDT IMMEDIATELY for children under the age of 21 who have active authorizations or receive unmanaged visits:
- Partners has approved Intensive In-Home to be billed for services provided under the social distancing mandate via video or telephonic presence. Each week Intensive In-Home provider MUST have contact with each child authorized for Intensive In-Home services. Partners wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than 2 hours per week per child. These hours do not have to be consecutive. We also continue to expect the Intensive In-Home provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid Emergency Department (ED) use during this time. Partners expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all staff employed in the traditional Intensive In-Home team.
- Partners has approved Multi-Systemic Therapy (MST) to be billed for services provided under the social distancing mandate via video or telephonic presence. Each week MST provider MUST have contact with each child enrolled/authorized for MST. Partners wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than two hours per week per child. These hours do not have to be consecutive. We also expect the MST provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Partners expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home.
- Partners has approved Research Based Behavioral Health Treatment (RBBHT) to be billed for services provided under the social distancing mandate either in the home of the member or via video or telephonic presence. Each week RBBHT provider MUST have contact with each child enrolled/authorized for RBBHT. Partners wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than two hours per week per child. These hours do not have to be consecutive. We also expect the RBBHT provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Partners expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours, to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all levels of staff employed as a provider for RBBHT.
- Partners has approved Family Centered Treatment (FCT) to be billed for services provided under the social distancing mandate either in the home of the member or via video or telephonic presence. Each week FCT provider MUST have contact with each child enrolled/authorized for FCT. Partners wants to honor social distancing requirements set forth by the State of NC and provide continuity of care for children. Therefore, we strongly recommend providers deliver this service through a telehealth platform up to the number of hours that are currently authorized for each child but not less than two hours per week per child. These hours do not have to be consecutive. We also expect the FCT provider to be the first responder during any crisis for these children and to assist the child and family with strategies to avoid ED use during this time. Partners expects providers who deliver this service under EPSDT to respond to any child that does end up in an ED with a rapid response within 24 hours to help the child and family get back home and out of that setting including weekends. Providers of this service must also provide the family education about COVID-19 and the need for social distancing along with assisting the family to secure any needed resources to remain at home. This approval under EPSDT includes all staff employed in the traditional FCT team.
A Message from NCTracks on Behalf of NC Medicaid
Today, March 24 – COVID-19 Question and Answer Webinar for Providers
DHHS will host a question and answer webinar to discuss new guidance for all health providers related to COVID-19.
Tuesday, March 24, 2020, from 5:30-6:30 p.m.
- Questions can only be taken during the webinar through the Q&A function for those accessing the webinar through their computers.
- Those with audio access only (calling in) will not be able to ask questions during the webinar.
- Questions can be submitted in advance through questionsCOVID19forum@gmail.com.
Pre-registration is not required; the webinar can be accessed:
- Through computer or smart phone at https://zoom.us/j/478662233
- Audio-only access on a mobile phone by dialing: +1 (646) 558-8656 and entering Webinar ID: 478 662 233#
- Audio-only access on a land line phone by dialing: (646) 558-8656 and entering Webinar ID: 478 662 233#
Additional information on COVID-19 is available at https://www.ncdhhs.gov/coronavirus.