The COVID-19 pandemic has significantly disrupted access to health care as providers scramble to up their game in regard to telehealth. To assist states and stakeholders in advancing the use of telehealth, CMS has released a Medicaid and CHIP Telehealth Toolkit with a special emphasis on pediatrics. The toolkit is intended to help identify state-level policy topics that need to be addressed to facilitate widespread adoption of telehealth services, particularly when policies like the Family Educational Rights and Privacy Act (FERPA) are beyond the authority of Medicaid and CHIP.
The toolkit points out that states have a great deal of flexibility in whether they cover Medicaid and CHIP services via telehealth and how. This includes what types of services are covered, where services can be utilized, the types of providers or other practitioners that may deliver telehealth, and how much to reimburse for telehealth services. The toolkit suggests that states may wish to re-evaluate scope of practice laws to maximize telehealth flexibilities.
State plan amendments (SPA) are not needed to pay for telehealth services if payments are made in the same manner as in-person services. A state may need to file a SPA to describe telehealth services and will need CMS approval to adopt payment rates or methodologies that differ from face-to-face services. In addition to paying for the actual service, states may pay ancillary costs such as technical support, connection charges, and equipment. An approved SPA payment methodology that spells out these costs and circumstances is required.
In regard to pediatric telehealth, it is important to take note of privacy laws and HIPAA requirements that may have a unique impact on children and adolescents. State consent laws that establish the age of consent may vary by type of service. Additionally, school-based telehealth services may be impacted by FERPA or the Individuals with Disabilities Education Act (IDEA).
The toolkit includes a state checklist to help identify questions and policies regarding populations served, services, providers, payment rates, technology, managed care, and other considerations. It also includes appendices of frequently asked questions and resources.
On a related note, The Federal Communications Commission has released guidance on how providers can begin to apply for funding through the COVID-19 Telehealth Program. The program was established with $200 million in funding from the CARES act and will help cover the cost of equipment and other technology needed to bolster telehealth services.
Telehealth is an important element in ensuring that children receive ongoing preventive and routine care that is essential to their health and success in school and beyond. But telehealth does not address a growing concern among child health advocates and pediatricians – the precipitous drop in vaccination rates for children, as this New York Times article reports. The article describes various strategies that pediatricians are using to deliver immunizations in ways that alleviate parents’ fear of bringing their children into the doctor’s office. As Dr. Sean O’Leary, a member of the American Academy of Pediatrics committee on infectious diseases, aptly states in the article, “The last thing we want as the collateral damage of COVID-19 are outbreaks of vaccine-preventable diseases, which we will almost certainly see if there continues to be a drop in vaccine uptake.” In addition to expanding pediatric telehealth, identifying successful ways to ensure the kids get their shots needs to be a priority for our state Medicaid and CHIP programs.