Returning to school is a complex event in the best of times. With the COVID-19 pandemic, changes in the home, school, and social environments require additional measures to be taken to facilitate a successful transition.
AOTA’s new comprehensive, holistic Back-to-School Guide in the Era of COVID-19 provides practical tips to support you, your colleagues, and the families you serve in navigating these new challenges and optimizing all aspects of returning to school. The guide provides an overarching problem-solving model and is intended for teachers and specialized instructional support personnel, school administrators and related personnel, students, parents, and guardians. Tip sheets were developed using the Person-Environment-Occupation (PEO) model of problem-solving to help guide necessary planning and decision making.
OT Decision Guides for COVID-19 and Phased Reopening. AOTA Decision Guides and case examples support occupational therapy practitioners in evaluating, planning, and adapting service delivery in this rapidly changing societal and health care landscape. Resources include:
- NEW—Addressing Acute Stress and Trauma. Occupational therapy practitioners have unique skills to address the intersecting psychological, social, and behavioral factors of their clients.
- NEW—Acknowledging the Impact of Discrimination, Stigma, and Implicit Bias on Provision of Services. This guide provides an overview of the implications of discrimination, stigma, and implicit bias on provision of occupational therapy services. It features resources occupational therapy practitioners can use to address such issues to enhance access to care, improve treatment outcomes, and advocate for equity in service provision.
- Decision Guide for Phased Reopening of Occupational Therapy During a Pandemic and Ambulatory OT case examples for pediatrics and adults.
- Decision Guides for Occupational Therapy Service Delivery, Telehealth, Acute Care, Outpatient Occupational Therapy, and Inpatient Occupational Therapy
- Home Health Decision Guide and a Decision Guide for the CMS COVID-19 Waiver: Occupational Therapy Opening Cases in Home Health Settings
- Pediatric Occupational Therapy Services: Resource Guide for Families During COVID-19
- School-Based and Early Intervention Occupational Therapy Services—Decision Guide for COVID-19
- Considerations for Creating a Partnership Pledge During a Pandemic
- Practitioner Well-Being
Kids and Masks. This thread on CommunOT includes creative ideas to help kids of all ages and abilities to wear a mask.
See the AOTA Coronavirus Resource Center for all available resources.
Chart of State Telehealth Laws. AOTA updated the chart of state telehealth laws, regulations, and licensing entity policy statements on telehealth. The chart highlights legislation signed by some Governors to permanently codify telehealth flexibilities put in place during the pandemic, as well as additional Executive Orders, and emergency and permanent state rules.
CMS Quality Payment Program Reporting Updates. The Centers for Medicare & Medicaid Services (CMS) has released information applicable to eligible clinicians reporting as part of the Quality Payment Program (QPP) under the Merit-based Incentive Payment System (MIPS). Clinicians who have been significantly impacted by the public health emergency (PHE) may apply for a QPP exception to reweight one or all of the MIPS performance categories. CMS also released guidance on which measures will allow for telehealth encounters. See AOTA’s summary and resources.
CMS to Resume Review Choice Demonstration for Home Health Services. Medicare recently announced that it will resume the Review Choice Demonstration for home health services in August, regardless of whether the Department of Health and Human Services (HHS) extends the PHE. Home health agencies in FL, IL, NC, OH, and TX should prepare for review of Medicare Part A home health claims, which had been paused due to the COVID-19 public health emergency.
|During the Pandemic & Beyond: AOTA Advocating for Telehealth Permanence. Throughout the PHE, telehealth expansion and flexibilities by commercial insurers and Medicaid plans have allowed occupational therapy practitioners and clients to maintain continuity of care while mitigating infection. Practitioners and clients have expressed a desire for these flexibilities to continue after the PHE ends. AOTA has initiated an advocacy campaign to make occupational therapy via telehealth a permanent benefit, targeting CMS, major payers, large employers, and state Medicaid plans.
“There’s a person inside the patient.” AOTA member Megan Evangelist, MS, OTR/L, describes for The Doctor’s Channel how OT is at the heart of COVID-19 recovery in the ICU.
Cheating Death and Learning to Live Again: Occupational therapy is highlighted for bringing a 38-year-old “back from the brink” in this Colorado Sentinel story.
Before and During COVID-19: Self magazine features a Q&A with an OT working in home health about the differences between her work before and during the pandemic.
Question: Can outpatient therapy services that are furnished via telehealth and separately paid under Part B be reported on an institutional claim (e.g., UB-04) during the COVID-19 PHE?
Answer: Yes, outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the “-95” modifier applied to the service line.
Update on CMS Authorization for OTs to Open Medicare Home Health Cases
As part of the emergency waivers, the Centers for Medicare & Medicaid Services (CMS) has temporarily authorized occupational therapists to perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. AOTA has obtained clarifications about the waiver from CMS staff and created a new FAQ resource for practitioners. View Part 1 and Part 2 of AOTA's COVID-19 webinar series about what OTs need to know about starting Medicare home health cases. See all AOTA's information on occupational therapy in the era of COVID-19.
When the COVID-19 crisis ends, we anticipate our ability to practice telehealth will be eliminated with cancellation of the executive orders from Governor Mills. MeOTA is looking to garner evidence and support now so that we can advocate for further OT telehealth coverage in the future. We would like to gather key data points about therapists’ and clients’ experiences with telehealth and reimbursement. MeOTA Telehealth Data Tracker.doc
AOTA and MeOTA wanted to give you a heads up on a state-level campaign that has been initiated by the National Association for the Support of Long Term Care.
They are asking their members to “contact your state governor’s office and urge them to temporarily suspend or waive the state supervision requirements for physical therapists, occupational therapists, and speech-language pathologists for the duration of the COVID-19 emergency.”
We are concerned that this request is premature and could have unintended consequences. Please stay tuned for more information before taking any action.
Governor Mill's four-stage plan for opening the economy. Here is the link: https://www.maine.gov/governor/mills/news/governor-mills-presents-safe-gradual-plan-restart-maines-economy-2020-04-28
The Governor’s Plan allows certain health care services to reopen in Stage One. This includes: “Health care from Maine licensed providers, with a recommendation that they prioritize care for patients with time-sensitive conditions; assure the safety of patients, staff, and communities; manage the use of essential resources such as personal protective equipment and testing supplies; and pace reopening services to the level of community COVID-19 activity, maintaining capacity in our hospitals for potential outbreaks.” Reopening is optional and subject to the provider’s adoption of safety recommendations in the Maine DHHS COVID 19- Guidance for Health Care Providers (“DHHS Guidance”) https://www.maine.gov/dhhs/documents/coronavirus/COVID-19-Guidance-for-Health-Care-Providers-043020.pdf.
The DHHS Guidance includes occupational therapy. Occupational therapy services that are offered pursuant to the DHHS Guidance needs to comply to all of the requirements of the DHHS Guidance and the referenced US CDC Infection Control Guidance for Health Care Professionals about COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html.
AOTA Medicare Telehealth Success!
The Centers for Medicare & Medicaid Services (CMS) announced the long awaited news today, April 30th, that occupational therapists, physical therapists, and speech language pathologists can now perform telehealth services for Medicare beneficiaries.
New Wavier Language:
Eligible Practitioners. Pursuant to authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that broadens the waiver authority under section 1135 of the Social Security Act, the Secretary has authorized additional telehealth waivers. CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site. The waiver of these requirements expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services. This allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services. (Emphasis added)
Based on the language in the new blanket waiver, AOTA is immediately seeking clarification regarding whether it extends to occupational therapy assistants, and will be advocating for inclusion. The waiver is retroactive to March 1, 2020 and is effective throughout the public health emergency. Telehealth services can be billed using the list of telehealth approved CPT® codes that CMS issued on March 30, 2020. AOTA will be developing a more in-depth article with billing guidance, listing the available CPT codes.
AOTA has been proactively and tirelessly advocating for this change with the U.S. Department of Health and Human Services (HHS) and CMS through many means, including meetings, the submission of comment letters, and development of a fillable template comment letter for the profession to engage in advocacy directly. On April 6, AOTA, along with APTA and ASHA, met with CMS to discuss the CARES Act waiver authority to expand the list of telehealth eligible professionals and implore CMS to allow OTs, PTs, and SLPs to perform telehealth immediately amid the COVID-19 PHE.
AOTA is analyzing additional Medicare flexibilities in the 1135 waiver. Additional changes include increased payments to telephone services retroactive to March 1. CMS is also allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. AOTA continues to analyze the new waiver and will provide an update on any additional flexibilities. Read the full press release.
Maine OT Licensing info
These waivers from the Centers for Medicare and Medicaid Services were updated on April 9th.
CMS Allows OTs to Open Medicare Home Health Cases
Late on April 9, the Centers for Medicare & Medicaid Services (CMS) temporarily suspended certain regulatory requirements through 1135 waivers so that health care facilities can maximize their frontline medical staff during the COVID-19 national health emergency, including a key rule for occupational therapy. After years of AOTA advocacy to allow occupational therapists to open Medicare home health cases, CMS has temporarily suspended the rule that would prevent OTs from opening Medicare home health cases, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. Occupational therapists may now perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. According to the CMS Fact Sheet, the waiver:
Allow[s] occupational therapists (OTs) to perform initial and comprehensive assessment for all patients. 42 C.F.R. 484.55(a)(2) and 484.55(b)(3). CMS is waiving the requirement that OTs may only perform the initial and comprehensive assessment if occupational therapy is the service that establishes eligibility for the patient to be receiving home health care. This temporary blanket modification allows OTs to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether occupational therapy is the service that establishes eligibility.
Q: Will Occupational Therapy Assistants be reimbursed for telehealth services?
A: Yes, for MaineCare, OTAs are listed as Qualified Professional Staff under Section 68.09-1 of the MaineCare Benefits Manual. They can provide and
bill for services under their scope of practice for MaineCare eligible services. Similarly for Maine commercial payers, as long as the provider,
including OTAs is providing an eligible service under their scope of practice, they can do so via telehealth.
AOTA Update: CMS Expands Therapy E-Visit Services During COVID-19 Outbreak: http://www.aota.org/Practice/Manage/telehealth/Nonphysician-Evisits.aspx
How to Bill the Medicare E-visit: http://www.aota.org/Practice/Manage/telehealth/Billing-Medicare-Evisit
OT LicensureOT licensure is due for renewal by the 31st of March. Anyone who misses the deadline should receive an email from the licensure board informing them that as long as they renew before June 30th, they will not be charge a late fee. For those renewing online, the website should not be showing a late fee until after the end of June. If anyone encounters a problem and lets me know and/or contact the licensure office directly.
EO Suspending Licensing Regs.pdf
FOR ANTHEM BC/BS COVERAGE:
What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies?
For 90 days effective March 17, 2020, Anthem will waive member cost shares for telehealth visits for the following physical, occupational and speech therapies for visits coded with Place of Service (POS) “02” and modifier 95 or GT:
- Occupational (OT) therapy evaluation codes 97165, 97166, 97167 and 97168
- PT/OT treatment codes 97110, 97112, 97530 and 97535
- Speech therapy (ST) evaluation codes 92521, 92522, 92523 and 92524
PT/OT codes that require equipment and/or direct physical hands-on interaction and therefore are not appropriate via telehealth include: 97010-97028, 97032-97039, 97113-97124, 97139-97150, 97533 and 97537-97546.
Information about the CARES Act help for businesses
MaineBiz - 4/1/20: SBA to have $349B payroll stimulus program up and running this week
Verrill Law Firm - 4/2/20: PPP Forgivable Loan Program: How to Do the Math
Thank you to each occupational therapy practitioner, educator, and student as we together respond to this coronavirus pandemic. AOTA is continuing to gather information and create resources to help support you through this challenging time. We are listening to and exploring your concerns, seeking answers to your questions, and advocating on your behalf. Here are the latest COVID-19 news updates, webinars, and resources to inform and guide you through this evolving situation.
COVID-19 & OT News
- CARES Act and Implications for OT—AOTA has been actively working with Congress, the Administration, and our allies to advocate for OT practitioners, educators, students, and clients during the COVID-19 pandemic. Today, Congress passed the $2.2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act, designed to help ensure access to health care during the pandemic, support health care providers, and support the economy. Learn about the major provisions and how they can help support you, in your practice and in your day-to-day life, in the areas of telehealth, personal protective equipment, financial hardship, and education. Additional analysis will be shared in the coming days and weeks.
- Telehealth Advocacy With CMS—AOTA, in collaboration with the American Physical Therapy Association and the American Speech-Language-Hearing Association, today asked the Centers for Medicare & Medicaid Services to immediately expand Medicare coverage of telehealth services.
- New HHS Guidance Creates Opportunities for States—The U.S. Department of Health and Human Services has urged governors to waive or suspend certain state licensure, supervision, and scope-of-practice laws and regulations to extend the capacity of the health care system during the pandemic. AOTA is working with state associations to explore opportunities for OT, especially related to telehealth.
COVID-19 & OT Resources
- AOTA Coronavirus Resource Center equips practitioners, educators, and students to continue to navigate through complex situations resulting from the COVID-19 pandemic. We have lifted the member-only access to coronavirus and telehealth content to support all OT practitioners, educators, and students during this time.
- To explore issues and share resources with follow OT practitioners, join the new COVID-19 community on CommunOT .
- To advocate for occupational therapy protections that matter to you, visit the AOTA Legislative Action Center.
AOTA will inform you regularly of new COVID-19 developments and guidance pertaining to OT professional issues, and we invite you to direct your coronavirus-related questions and insights to email@example.com.
New resources are available on the AOTA Coronavirus Resource Center to equip occupational therapy practitioners, educators, and students to continue to navigate through complex situations resulting from the COVID-19 pandemic. AOTA is advocating on your behalf daily. Together, using our clinical judgment, problem solving skills, and leadership, we can effectively move occupational therapy practice forward in these uncertain times.
Resources for Practitioners
Practitioners are faced with the need to modify and adapt service delivery during the COVID-19 pandemic. New resources on the AOTA Coronavirus Resource Center can assist practitioners in creative problem solving, including:
- A framework to consider the role of occupational therapy as an essential service during a pandemic, including ethical guidance
- Guidance for working with children, caregivers, and clients with dementia, and guidance for approaching prevention of social isolation
- Telehealth provisions in state practices and regulations, and considerations for billing new therapy "e-visits," including clinical scenarios
- State-by-state chart detailing state updates affecting occupational therapy related to licensing board updates, telehealth policies, and Medicaid and private insurance
- State-by-state continuing competency requirements highlighting states with limitations on online courses and activities
- Changes to unemployment benefits and paid leave.
Resources for Educators and Students
AOTA and ACOTE are working on behalf of educators and students to navigate through the disruptions caused by the COVID-19 pandemic. New resources on the AOTA Coronavirus Resource Center include:
- ACOTE® guidance regarding distance learning modalities during the COVID-19 pandemic
- Changes to federal student loan payments and interest.
Please complete a quick 8-question survey to share your experiences related to COVID-19. AOTA will use your feedback to inform state and federal agencies as they work to address health care issues related to COVID-19, and to inform new AOTA resources and education.
To explore issues and share resources with fellow OT practitioners, join the new COVID-19 community on CommunOT. To advocate for occupational therapy protections that matter to you, visit the AOTA Legislative Action Center. For inspiration, watch a personal video message from AOTA President Wendy C. Hildenbrand, PhD, MPH, OTR/L, FAOTA.
As a reminder, we are currently offering 20% off AOTA Press and CE products to help earn the CE credit that you may need for certification and licensure. The sale is valid through Thursday, 3/26 (Discount Code: SPRING20).
As AOTA staff continue to work virtually through the COVID-19 pandemic, we encourage you to use our online options to manage your membership, and to explore educational products and other resources. AOTA will inform you regularly of new COVID-19 developments and guidance pertaining to OT professional issues, and we invite you to direct your coronavirus-related questions and insights to firstname.lastname@example.org.
New MaineCare COVID-19 Resources and Updates
MaineCare Telehealth Guidance
Our telehealth guidance has been updated is now available on MaineCare’s COVID-19 webpage.
Upcoming Telehealth Webinar
Join Maine DHHS leadership and Northeast Telehealth Resource Center (NETRC) staff on March 26, 2020 at 11:30 am. The webinar will include an overview of the recent significant expansions to telehealth policy at the state and federal level that will allow Maine providers and patients to better leverage technology and promote continuity of care for their patients during the COVID-19 pandemic. NETRC staff will also share key telehealth resources and information that are being made available to help clinicians implement telehealth services, including a new, weekly “Telehealth Virtual Office Hours” that will begin the week of March 30th to provide ongoing and timely technical assistance to clinicians and their staff. Go to the webinar registration to register for the event.
Two new pharmacy-related documents have been added to our website.
For MaineCare Members:Pharmacy Services and COVID-19 (Coronavirus): Questions and Answers.
For Pharmacies and Prescribers:MaineCare’s COVID-19 Guidance for Pharmacies and Prescribers.
Notice of Agency Emergency Rule-making Adoption
AGENCY: Department of Health and Human Services, Office of MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Ch. 1, Section 5, COVID-19 Public Health Emergency Services
ADOPTED RULE NUMBER:
This emergency rulemaking institutes measures, effective immediately, to expedite and improve access to medical care for MaineCare members due to the 2019 Novel Coronavirus (COVID-19). Pursuant to 5 M.R.S. Sections 8054 and 8073, the Department has determined that immediate adoption of this rule is necessary to avoid a potentially severe and immediate threat to public health, safety or general welfare. The Department’s findings of emergency are included in detail in the Emergency Basis Statement. Maine is facing a substantial public health threat posed by the global spread of COVID-19. On March 11, 2020 the World Health Organization declared COVID-19 a worldwide pandemic. On March 15, 2020, Governor Janet T. Mills declared a state of civil emergency in Maine.
This is a single new section of the MaineCare Benefits Manual that implements emergency changes for multiple types of MaineCare services. The following sections of MaineCare policy are affected by this rulemaking: Ch. 1, Section 1 (General Administrative Policies and Procedures); Ch. I, Section 4 (Telehealth Services); Chs. II and III, Section 31 (Federally Qualified Health Center Services); Chs. II and III Section 40 (Home Health Services); Chs. II and III, Section 45 (Hospital Services); Ch. II, Section 55 (Laboratory Services); Ch. II, Section 60 (Medical Supplies and Durable Medical Equipment); Chs. II and III, Section 65 (Behavioral Health Services); Ch. II, Section 80 (Pharmacy Services); Ch. II, Section 90 (Physician Services); Chs. II and III, Section 96 (Private Duty Nursing and Personal Care Services; Ch. II, Section 101 (Medical Imaging); and Chs. II and III, Section 103 (Rural Health Clinic Services).
The Department is waiving certain co-payment requirements for all MaineCare members, including pharmacy, clinical visits, medical imaging, laboratory services, behavioral health services, medical supplies and durable medical equipment, private duty nursing, and home health services. Should COVID-19 specific treatments or vaccines become available during the duration of this rule, co-payments will be waived for those services as well.
The Department is altering some of the MBM, Section 80, Pharmacy Services, requirements in order to expedite and improve access to prescriptions. Restrictions are lifted for asthma and immune-related prescriptions. Prior Authorizations for COVID-19 treatments and vaccines, should they come available, are waived. Early refills of prescriptions are allowed, and the physical assessment requirements for Buprenorphine and Buprenorphine Combination products for SUD are waived.
Prior Authorization requirements for certain durable medical equipment are being extended and early refills/orders allowed for individuals with COVID-19, in self quarantine who may have COVID-19, or in a high-risk category for developing complications from COVID-19.
Home Health Services document submission requirements are being extended for Plans of Care submissions.
The Department is waiving the advance written notice/consent for telehealth services, waiving the comparability requirement for specific services subject to approval by the Department, and allowing telephone-only evaluation and management services.
In the event of conflict between the COVID-19 Public Health Emergency Services rule and any other MaineCare rule, the terms of this rule supersede other rules and shall apply.
The Department shall seek and anticipates receiving approval of those changes from the Centers for Medicare and Medicaid Services (CMS) retroactive to March 18, 2020.
These emergency rule changes shall be effective for ninety (90) days, per 5 M.R.S. § 8054. MBM.
http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
EFFECTIVE DATE: March 20, 2020
AGENCY CONTACT PERSON: Anne E. Labonte, Comprehensive Health Planner II
AGENCY NAME: Division of Policy
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207)-624-4082 FAX: (207) 287-1606
TTY users call Maine relay 711
The continued spread of Coronavirus Disease (COVID-19) across the globe has sparked concern in the occupational therapy profession regarding practice, options for delivering quality therapy services while doing our part to slow the spread and “flatten the curve,” and academic requirements for educators and students. AOTA is continuing to closely monitor this fluid situation, and has compiled resources to answer practitioners’ frequently asked questions.
AOTA’s top priority as we navigate this pandemic together is the health and safety of occupational therapy practitioners, students, and the clients they serve. We will update this page as information becomes available and will continue to empower students, educators, and clinicians to navigate these unprecedented circumstances.
Resources for Occupational Therapy Practitioners
· OT and Telehealth in the Age of COVID-19: Additional flexibilities for telehealth have been incorporated into both federal programs and private insurance. However, these flexibilities don’t always expand the definition of who can provide telehealth services.
· Looking for information on whether you can use telehealth in your state and considerations for practice while many areas are under precautions for COVID-19? AOTA’s Telehealth Resources page contains resources to help OT practitioners to navigate this emerging area.
· AOTA has created a comprehensive list of State-by-State Resources pertaining to COVID-19 (PDF)
· CMS Guidance to Providers About COVID-19: The Centers for Medicare & Medicaid Services (CMS) has taken action to protect the health and safety of our nation’s patients and providers in the wake of the COVID-19 outbreak. This includes clear, actionable information on the screening, treatment, and transfer procedures to follow when interacting with patients. AOTA recommends you review CMS actions if you treat Medicare or Medicaid beneficiaries, many of whom are at high risk for COVID-19.
· Provision of Special Education, Early Intervention, and 504 Services During the COVID-19 Outbreak: On March 12, the U.S. Department of Education released guidance on how to continue providing services to children with disabilities during the COVID-19 outbreak. Based on that guidance, AOTA has provided some answers to the most frequently asked questions.
· To connect with your colleagues and learn more information as this situation develops, visit AOTA’s online community, CommunOT.
AOTA is continuing to develop more resources pertaining to COVID-19. Please check back for more information, which will be posted here as it becomes available.
Stateside Associates is publishing a state by state chart of state legislative actions, executive agency actions, and gubernatorial actions related to the outbreak of the coronavirus.
MaineCare Guidance Relating to Telehealth and COVID-19
As we respond to COVID-19, we encourage MaineCare providers to consider utilizing telehealth services for the delivery of MaineCare-covered services when appropriate and necessary. MaineCare has long had a robust telehealth policy and has recently created additional flexibility for its usage. Please read this message in its entirety to understand your options and additional resources.
Utilizing Telehealth to Satisfy Face-to-Face Requirements in MaineCare Policies
Telehealth allows providers to deliver services to individuals remotely so that providers can monitor and address health conditions. This can be done through Interactive Telehealth Services, which are real time, interactive visual and audio telecommunications; or telephonically when Interactive Telehealth Services are unavailable.
With few exceptions such as personal care services and ambulance, telehealth can be used to satisfy the MaineCare face-to-face requirements when telehealth delivery of the service is of comparable quality to in-person service delivery. Providers are also required to ensure they are complying with all federal, state, and local regulations that apply, including HIPAA requirements, when network services are used.
Member & Service Criteria for Telehealth Eligibility
The significant majority of medically necessary MaineCare-covered service may be delivered via Interactive Telehealth Services if the following requirements are met:
- The member is otherwise eligible for the covered service, as described in the appropriate section of the MaineCare Benefits Manual; and,
- The covered service delivered by Interactive Telehealth Services is of comparable quality to what it would be if it were delivered in person.
If a member is eligible to receive the underlying covered service, and if delivery of the covered service via telehealth is medically appropriate as determined by the health care provider, the member is eligible to receive telehealth services. For services that traditionally have not been considered medically appropriate or of comparable quality via telehealth (e.g. Intensive Outpatient Treatment (IOP) or Home & Community Based Treatment (HCT)), providers are encouraged to consider alternative treatment options that could be more appropriately delivered via telehealth (e.g. 1:1 counseling visits).
Delivery of Telehealth via Telephone
In addition to Interactive Telehealth Services, telephones are an acceptable mode to deliver telehealth if Interactive Telehealth Services are unavailable, and if Telephonic Service is medically appropriate for the underlying covered service.
Prior Authorization (PA) Requirements
Prior Authorization (PA) is only required for Interactive Telehealth Services if a PA is required for the underlying covered service. In these cases, the PA relates to the underlying covered service, not to the telehealth mode of delivery.
Telehealth and Pharmacy – NEW!
Through emergency rules, going forward the Department will allow for prescribing through telehealth.
Two distinct sites are necessary for delivering interactive telehealth. The first site – called the Originating Site – is where the MaineCare member is located when receiving the service. The second site – the Receiving Site – is where the provider who is administering the covered service or consultation is located.
The Originating Site can be a member’s home, nursing facility, long-term care facility, or other health care facility, with telehealth capabilities.
Telehealth Provider Eligibility
To receive reimbursement for telehealth services, a health care provider must be:
· Acting within the scope of his or her license,
· Enrolled as a MaineCare provider, and;
· Otherwise eligible to deliver the underlying covered service according to the requirements of the applicable section of the MaineCare Benefits Manual.
Billing for Telehealth
In general, services must be billed in accordance with applicable sections of the MaineCare Benefits Manual. Providers must submit claims in accordance with Department billing instructions. The same procedure codes and rates apply to the underlying covered service as if those services were delivered face-to-face. When billing for Interactive Telehealth Services, health care providers at the Receiving (provider) Site should bill for the underlying covered service using the same process they would if it were delivered face-to-face; with the addition of a GT modifier to the claim.
Reimbursement for Originating Sites
In general, when a member is receiving telehealth services, any health care provider who is present with the member at the Originating Site (where the member is, e.g. a nursing facility or the member’s home), may not bill for assisting the health care provider delivering the covered telehealth service from the remote Receiving Site. However, if a health care provider at an Originating site is not providing clinical services but is making a room and telecommunications equipment available, that health care provider may bill MaineCare for an originating facility fee using code Q3014 for the service of coordinating the telehealth service.
Telehealth Resources for Providers
Providers who need assistance with implementing and/or have general billing questions regarding telehealth services are encouraged to contact the Northeast Telehealth Resource Center (NETRC) by email: email@example.com or 1-800-379-2021. Specific questions can also be submitted to NETRC at https://www.netrc.org/contact.php. Many other helpful telehealth resources are available on NETRC’s website including NETRC’s Telehealth Toolkit for COVID-19.
MaineCare providers with telehealth questions related to MaineCare-specific billing and/or policies should contact their provider relations specialist or call Provider Services at 1-866-690-5585.
MaineCare encourages providers who would like to learn more about telehealth to participate in the National Consortium of Telehealth Resource Center’s webinar on March 17th related to telehealth and COVID-19.
Update your subscriptions, modify your password or email address, or stop subscriptions at any time on your Subscriber Preferences Page. You will need to use your email address to log in. If you have questions or problems with the subscription service, please visit subscriberhelp.govdelivery.com.