SDSMA Advocates for Key Changes to Telemedicine Regulations During COVID-19 Emergency


The laws and rules concerning telemedicine in South Dakota and the nation have changed considerably to expand access and loosen regulations during the COVID-19 pandemic. The state has taken actions to enhance the use of telemedicine, and SDSMA has suggested specific regulations to suspend pertaining to telemedicine in order keep our health care workers and patients safe amid the COVID-19 pandemic.

The SDSMA has advocated in support of physicians and practices in enhancing and expediting the implementation of telemedicine, so care can continue to be provided to those who need it most. On April 8, SDSMA also requested that the state:

  • Clarify that state agencies (State Employee Health Plan, Medicaid, and any other programs that use medical services) will allow medical visits to be conducted over the phone instead of in-person at the same rate they would receive for in-person visits. 
     
  • Temporarily suspend any rules requiring an existing patient-physician relationship be established prior to the provision of telemedicine services and restrictions regarding types of services, originating sites and geographic limitations, and provide guidance.
     
  • Temporarily allow inactive physicians into the workforce, including physicians who temporarily left for family reasons, retired physicians, and non-clinical physicians provided current or previous license in good standing, in an effort to enhance our health care provider workforce.
     
  • Work with SDSMA to promote mental health and wellness resources for physicians.


The SDSMA is expecting more information from the state in response to these requests soon, and will keep physicians informed.

Other Telemedicine Information

 

On March 19, 2020 the South Dakota Department of Social Services (DSS) requested federal authority from the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) to provide flexibility for South Dakota’s Medicaid program, including its recipients and providers during the COVID-19 pandemic through an 1135 waiver. The 1135 waiver allows the DSS to temporarily waive or modify certain requirements of the Medicaid and Children’s Health Insurance Program (CHIP) to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in these programs.

March 24 – CMS responded to the DSS 1135 waiver request. CMS’s response authorizes the following flexibilities:

1. Suspension of Pre-Admission Screening and Annual Resident Review (PASRR) Level II assessments for 30 days.  Nursing facilities should continue to send positive PASRR screens to the Long-Term Services and Supports (LTSS) Nurse Consultant in their region. If a categorical determination or exemption can be applied, the LTSS Nurse Consultant will do so and send the Level l determination to the requesting facility. If a categorical determination or exemption cannot be applied, the LTSS Nurse Consultant will inform the submitting entity that the individual with mental illness or intellectual/developmental disability may still admit to the nursing facility and a Level II review will take place as soon as resources become available. New PASRR screens, Level l, and Level II assessments are not required for residents who are transferring between nursing facilities.

2. Fair Hearings.  A delay of state fair hearings and appeals was granted to allow recipients up to 120 additional days to request a fair hearing. This means that South Dakota Medicaid has the discretion to give recipients up to 120 extra days to submit an appeal requesting a fair hearing on fee-for-service or eligibility decisions.

3. Flexibility in provider enrollment requirements.  South Dakota Medicaid can enroll and reimburse certain care providers who do not hold a SD license but are licensed to practice in another state. This is effective immediately for professions whose licensing requirements vary little from state to state including medical doctors, osteopathic medicine doctors, physician assistants and nurse practitioners.

South Dakota Medicaid will post enrollment instructions for providers to the provider enrollment website.

4. Flexibility for services provided in alternative settings.  In the event a provider needs to evacuate or relocate as a result of the public health emergency, South Dakota Medicaid can continue to reimburse facilities in these situations as if services were provided at the original location. DSS, the Department of Human Services (DHS) and the Department of Health (DOH) ask that facilities notify the appropriate department immediately if they anticipate a need to evacuate and/or relocate and these agencies will work with them.

DSS will provide additional information regarding the 1135 waiver and any future CMS approvals as the information becomes available.

Find more information from the Department of Social Services response to COVID-19and the public health emergency.

 

March 24 – the South Dakota Division of Insurance requests health carriers providing coverage through health benefits plans take the following measures through June 30, 2020:

1. Testing for COVID-19. In conjunction with H.R. 6201, the Families First Coronavirus Response Act, all health carriers must cover COVID-19 testing and the associated office visit, urgent care, or emergency room charge at no cost to insureds.

 

2. Medical Management. Preauthorization requirement for COVID-19 testing or treatment should be waived or expedited. Further, health carriers should be prepared to expedite utilization review and appeal processes for services related to COVID-19.

 

3. Telehealth. Health carriers are strongly encouraged to take necessary steps to expand the availability of telemedicine services in all areas of care for their insureds by eliminating barriers to its use. Carriers are also encouraged to waive cost sharing (copayment, coinsurance, deductibles) for telehealth services

 

Third Party Payers Relaxing Rules Regarding the Utilization of Telehealth


Avera:

 

Avera Health Plans and DAKOTACARE are following suit with the HHS guidance on relaxation of telehealth HIPAA requirements.

·       Relaxation of requirements were effective March 17, 2020 and will continue through June 14th, 2020;

o   Normal telehealth requirements would be reinstated again effective June 15.

 

·       Telehealth services will remain subject to all normal benefits provisions during this period inclusive of normal member cost share amounts unless a self-funded employer group directs us to waive normal cost share provisions.

o   Providers will be expected to follow all normal CPT coding and billing guidelines inclusive of complete medical record documentation.

o   The record should document the means by which the telehealth service was provided and billed with place of service (POS) code 02.

o   Providers who have the capability to deliver telehealth using HIPAA compliant, real time interactive audio-video technology may append those services with modifier 95 although it will not be required.

 

·       During this Avera/DAKOTACARE we will temporarily map POS code 02, to pull from the higher, “non-facility” level of the professional fee schedule.

o   This measure is meant as an additional means of supporting the provider community during this unprecedented disruption.

o   On June 15th, the site of service differential mapping for POS code 02 will return to the “facility” rates consistent with CMS mapping.

 

Sanford:

Specific to COVID-19, for telemedical visits – via e-visit, Sanford Health Plan is waiving co-pays.

 

Additional changes specific to COVID-19 include:

·       The waiving of the co-pays for video visits;

·       Testing and initial diagnosis – covered at 100 percent;

  • Office visits and ED visits for COVID 19 testing- cost share waived and covered at 100 percent;
  • Rule out testing for other respiratory illness (RSV, influenza, etc.) covered at member cost share – specific to member plan;
  • IP stays are covered at member cost share – specific to member plan; and
  • All prior authorizations for COVID waived.

 

SDSEHP:

To help slow the spread of the COVID-19 pandemic, the South Dakota State Employee Health Plan will

·       Cover 100 percent of the cost for telehealth services between March 16 through June 30.

o   Telehealth services are a convenient and affordable alternative that can help minimize exposure for others during the COVID-19 pandemic.  

 

·       The South Dakota State Employee Health Plan offers video visits with medical providers. A video visit is a service that allows medical professionals to remotely diagnose and treat patients through any video-capable device.

 

·       All members may utilize video visits, which are available from Avera, Monument Health (formerly Rapid City Regional Health) and Sanford Health.

 

Wellmark:

For dates of service beginning March 16, 2020, Wellmark will provide coverage and waive member co-pays or other cost-shares for virtual visits, both medical and behavioral health, for all our commercial members for the next 90 days. This decision will be reassessed prior to the end of the 90 days.

 

Additional changes include:

·       The allowance of telehealth visits via telephone when audio-visual capabilities aren’t accessible.

 

In order for claims to process accurately, providers must follow these billing guidelines:

·       Providers should bill the appropriate CPT codes for the services provided;

·       Use place of service 02 (telehealth) on the claim for interactive audio-video or telephonic visits;

·       Providers conducting telephonic only visits with Wellmark’s members during this period must document in their medical records that the visit was conducted via telephone;

Additional guidance on billing for telehealth services may be found in Wellmark’s Provider Guide.