Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.21-004 - DHS Telemedicine COVID-19 Response Manual

Current through Register Vol. 49, No. 6, June, 2024
200.000
OVERVIEW
201.000
Authority
The following rules are duly adopted and promulgated by the
				Arkansas Department of Human Services (DHS) under the authority of Arkansas
				Code Annotated §§
										20-10-203,
				20-10-701,
				2038-103,
				20-38-112,
				20-48-103,
				20-76-201,
				20-76-401,
				20-77-107,
				,
				25-10-126,
				and
				25-10-129.
202.000
Purpose
In response to the COVID-19 pandemic, DHS identified programs
				and services that required additional flexibility or changes to adapt to
				ensuring the health and safety of our clients. This manual details them so that
				DHS may render uninterrupted assistance and services to our clients.
203.000
Appeals
Appeal requests for COVID-19 response policies must adhere to
				the policy set forth in the Medicaid Provider Manual Section 160.000
				Administrative Reconsideration and Appeals which can be accessed at
https://medicaid.mmis.arkansas.gov/Provider/Docs/all.aspx
.
204.000
Severability
Each section of this manual is severable from all others. If
				any section of this manual is held to be invalid, illegal, or unenforceable,
				such determination shall not affect the validity of other sections in this
				manual and all such other sections shall remain in full force and effect. In
				such an event, all other sections shall be construed and enforced as if this
				section had not been included therein.
241.000
First Connections Developmental
			 Therapy Telemedicine
During a public health emergency, the Office of Special
				Education Programs (OSEP) requires that eligible children with disabilities
				have continuity of Individual Family Service Plan (IFSP) services provided
				through alternative means such as teletherapy or other video conferencing.
				Currently, Medicaid's telehealth policies exclude Developmental Therapists from
				providing teletherapy services. First Connections needs a way to continue to
				provide developmental and consultative services to parents/guardians to support
				program-eligible children in developing and learning functional skills.
This method will be available until December 31, 2021.
* Modification to use teletherapy to provide developmental
				therapy/consultative services (DT) to parents/guardians of eligible children
				0-3 with a current IFSP to help parents help their child develop and learn as
				required by IDEA, Part C.
* DT is provided to parents/guardians of eligible children
				through accessible real-time technology which includes a video component with
				originating site requirements removed so that families can receive services
				from their home (maximum 60 minutes per week).
* DT through teletherapy must be billed to the First
				Connections grant. T1027 Developmental Therapy is prior authorized at $18.00
				per unit and T1027 modifier UB Developmental Therapy Assistant is prior
				authorized at $15.00 per unit.
244.000
Telemedicine for Occupational,
			 Physical, and Speech Therapists and Assistants
In response to COVID-19 allowable telemedicine services include
				services provided by licensed occupational, physical, or speech therapists or
				assistants. These services are available to established patients only.
Parental Consultation is a COVID-19 response service that
				allows a therapist assistant or therapist to instruct a parent or caregiver on
				how to use therapeutic equipment or techniques with their child to continue
				working on therapy goals and objectives. To bill for this service, the therapy
				assistant or therapist must document that the parent or caregiver was present
				with a beneficiary. The service must be provided using the appropriate
				real-time technology that includes both a video and audio component. The
				originating service requirement is relaxed so that the parent may receive this
				service from their home.
The service may be provided in 15-minute sessions with a
				maximum of 8 sessions per month. All services must be prior authorized by
				eQHealth Solutions. This service and individual therapy services through
				telemedicine will be available until December 31, 2021.
Individual Therapy Services provided by a licensed Physical
				Therapist, Occupational Therapist, or Speech Therapist or Assistant allows for
				continued therapy services for established patients during this time of social
				distancing.
The technology used must be real-time and include a video and
				audio component. The sessions are limited to thirty minutes a piece, with a
				maximum of three (3) sessions per week.
The following services cannot be completed via
				telemedicine:
A. Evaluations and
			 re-evaluations. However, if an annual evaluation is due during this time, the
			 deadline may be extended until the patient is able to come into the
			 office.
B. Group Therapy
			 Services.
245.000
Telemedicine for Applied Behavioral Analysis (ABA) for BCBA
In response to COVID-19 allowable telemedicine services
				includes Applied Behavioral Analysis (ABA) services to established patients
				only. To allow for continued therapy services for established patients during
				this time of social distancing, DMS/DDS is lifting the requirement that the
				beneficiary be located at a healthcare facility (originating site) to receive
				telemedicine services for the following services only:
* Adaptive behavior treatment provided by a Board-Certified
				Behavior Analyst (BCBA) or Board-Certified Behavior Analyst-Doctoral
				(BCBA-D)
* Family adaptive behavior treatment guidance, by a BCBA or
				BCBA-D
This service through telemedicine will be available until
				December 31, 2021.
Billing Instructions
All units are prior authorized. To bill for this service, the
				BCBA must document that the parent or caregiver was present with a beneficiary.
				The service may be provided at the same rate as the regular "face-to-face"
				rate. All services must be prior authorized by eQHealth Solutions. When billing
				for these services you must include all modifiers on the claim. All Therapy
				claims submitted for Telemedicine must include the GT modifier and (02) as the
				place of service
.
BCBA is a licensed clinician that may perform telemedicine
				under the scope of their license. The sessions are limited to 30 minutes, with
				a maximum of three (3) sessions per week.
97155EP
Adaptive behavior treatment provided by a BCBA or BCBA-D.
				Individual adaptive behavior treatment by BCBA, face-to-face with the patient
				and may also include caregivers. This includes implementation and modification
				of treatment the plan. This may also include simultaneous direction of
				technician.
97156 EP
Family adaptive behavior treatment, provided by a BCBA,
				face-to-face with parents and/or caregivers. Family sessions should address
				education of the parents or caregivers on the patient's plan of care, specific
				objectives, treatment approaches, etc. as they relate to the individual
				client's ASD symptoms and how to address them in the patient's natural
				environment.
The following services cannot be completed via
				telemedicine:
A. Evaluations and
			 re-evaluations. However, if an annual evaluation is due during this time, the
			 deadline may be extended until the patient is able to come into the
			 office.
B. Group ABA
			 Services.
246.000
Telemedicine Autism Waiver
In response to COVID-19 the allowable telemedicine service
				available under the Autism Waiver is 2024 U3 Individual Assessment/Treatment
				Plan/Development/Monitoring.
These services through telemedicine will be available until
				December 31, 2021.
260.102
Telemedicine Originating Site Requirements for Advanced Practice
			 Registered Nurses
Section 105. 190, regarding the originating site
				requirements for services provided to established patients by advanced practice
				registered nurses is suspended through date of service December 31,
				2021.
DMS issues the following guidance and policy related to Nurse
				Practitioners (NP) use of telemedicine.
Professional Relationship
				Requirements
A provider must have an established relationship with a patient
				before utilizing telemedicine to treat a patient.
Nurse Practitioners may provide telemedicine services using the
				following guidelines to establish professional relationship with new patients
				until the State Public Health Emergency is rescinded:
* The NP providing telehealth services must have access to a
				patient's personal health record maintained by a physician.
* The telemedicine service may be provided by any technology
				deemed appropriate, including telephone, but it must be provided in real time
				(cannot be delayed communication).
* NP may use telemedicine to diagnose, treat, and, when
				clinically appropriate, prescribe a non-controlled drug to the patient as
				allowed under their scope of practice.
To bill for these services, use the appropriate billing
				procedure code with the "GT" modifier and Place of Service (POS) "02".
Once the State Public Health Emergency has ended, Section
				105.190 of the Medicaid Provider Manual is reinstated according to statutory
				authority.
Originating Site Requirements
DMS is waiving the originating site requirement for evaluation
				and management (E&M) services provided to established patients by NPs. This
				will allow the NP to utilize telemedicine technology, including telephone, when
				appropriate, to diagnose, provide treatment and prescribe to patients as
				allowed by their scope of practice, while the patient remains in their home. To
				use telemedicine technology to provide services without an originating site,
				the following requirements must be met:
* The technology must be real-time (cannot be delayed
				communications).
* The NP must have access to the patient's medical
				records.
To bill for these services, please use the appropriate billing
				codes with the "GT" and Place of Service "02" modifier.
Virtual Patient Check-Ins
To prevent unnecessary travel and office visits, Medicaid is
				opening the virtual check-in CPT (code G2012) described below through date of
				service December 31, 2021.
To use the Code G2012 to provide virtual check-in services,
				meet the following requirements:
* Can be any real-time audio (telephone), or "2-way audio
				interactions that are enhanced with video or other kinds of data
				transmission."
* For established patients only.
* To be used for:
* Any chronic patient who needs to be assessed as to whether an
				office visit is needed.
* Patients being treated for opioid and other substance-use
				disorders.
* Nurse or other staff member cannot provide this service. It
				must be a clinician who can bill evaluation and management (E&M)
				services.
* If an E&M service is provided within the defined time
				frames, then the telehealth visit is bundled with that E&M service. It
				would be considered pre- or post-visit time and not separately billable.
* No geographic location restrictions for the patient.
* Communication must be HIPAA compliant.
Code
Short Description
Fee
G2012
Brief communication technology-based service, e.g.
						  virtual check-in, by a physician or other qualified health care professional
						  who can report E&M services, provided to an established patient, not
						  originating from a related E&M service provided within the previous 7 days
						  nor leading to an E&M service or procedure within the next 24 hours or
						  soonest available appointment. Typically, 510 minutes of medical
						  discussion.
$13.33
260.103
Telemedicine Originating Site Requirements to Allow Services to a
			 Beneficiary in his or her Home Through Date of Service December 31, 2021
Section 105.190 is suspended for the originating site
				requirement to allow all providers who can provide telemedicine services to
				provide those services to a beneficiary in his or her home through date of
				service December 31, 2021.
An out-of-state physician, nurse practitioner, or
				physician assistant who is an enrolled provider in Arkansas Medicaid may
				provide telemedicine services to an Arkansas Medicaid client, including
				prescribing drugs when clinically appropriate. The provider must follow any
				applicable requirements, including without limitation requirements of the
				United States Drug Enforcement Agency (DEA), the Arkansas State Medical Board,
				and the Arkansas Board of Nursing. It is the understanding of DHS that the DEA
				has temporarily waived the requirement that out-of-state physicians have an
				Arkansas DEA registration to prescribe drugs through
				telemedicine:
https://www.deadiversion.usdoj.gov/GDP/(DEA-DC018)(DEA067)%20DEA%20state%20reciprocity%20(final)(Signed).pdf
Professional Relationship
				Requirements
Generally, a provider must have an established relationship
				with a patient before utilizing telemedicine to treat a patient. (See Medicaid
				Provider Manual § 105.190.) However, DMS has the authority to relax this
				requirement in case of an emergency. DMS is lifting the requirement to have an
				established professional relationship before utilizing telemedicine for
				physicians through date of service December 31, 2021 under the following
				conditions:
* The physician providing telehealth services must have access
				to a patient's personal health record maintained by a physician.
* The telemedicine service may be provided by any technology
				deemed appropriate, including telephone, but it must be provided in real time
				(cannot be delayed communication).
* Physicians may use telemedicine to diagnose, treat, and, when
				clinically appropriate, prescribe a non-controlled drug to the patient.
To bill for these services, please use the appropriate billing
				procedure code with the "GT" modifier and Place of Service (POS) "02"
Originating Site Requirements
DMS is waiving the originating site requirement for evaluation
				and management (E&M) services provided to established patients by primary
				care providers. This will allow the physician to utilize telemedicine
				technology, including telephone, when appropriate, to diagnose, treat and
				prescribe non-controlled substances to patients while the patient remains in
				their home. The following requirements must be met to use telemedicine
				technology to provide services without an originating site:
* The technology must be real-time - cannot be delayed
				communications
* The physician must have access to the patient's medical
				records.
To bill for these services, please use the appropriate billing
				codes with the "GT" and Place of Service "02" modifier.
Virtual Patient Check-Ins
To use the Code G2012 to provide virtual check-in services, the
				following requirements must be met:
* Can be any real-time audio (telephone), or "2-way audio
				interactions that are enhanced with video or other kinds of data
				transmission."
* For established patients only.
* To be used for:
* Any chronic patient who needs to be assessed as to whether an
				office visit is needed.
* Patients being treated for opioid and other substance-use
				disorders.
* Nurse or other staff member cannot provide this service. It
				must be a clinician who can bill primary care services.
* If an E&M service is provided within the defined time
				frames, then the telehealth visit is bundled with that E&M service. It
				would be considered pre- or post-visit time and not separately billable.
* No geographic location restrictions for the patient.
* Communication must be HIPAA compliant.
Code
Short Description
Fee
G2012
Brief communication technology-based service, e.g.
						  virtual check-in, by a physician or other qualified health care professional
						  who can report E&M services, provided to an established patient, not
						  originating from a related E&M service provided within the previous 7 days
						  nor leading to an E&M service or procedure within the next 24 hours or
						  soonest available appointment. Typically, 510 minutes of medical
						  discussion.
$13.33
265.100
Behavioral Health Telemedicine
Sections 252.113 and 252.114 concerning face-to-face
				treatment requirements are suspended through date of service December 31, 2021.
				Section 252.117 concerning telemedicine service limitations for beneficiaries
				age twenty-one (21) and over is suspended through date of service December 31,
				2021 along with Section 252.119 concerning telemedicine service limitations
				related to substance abuse assessments and Section 255.001 concerning
				face-to-face service requirements for crisis intervention.
DMS is suspending the rules prohibiting telemedicine for
				Marital/Family Behavioral Health Counseling with or without the Beneficiary
				being present. By suspending this rule, licensed behavioral health
				professionals will be able to provide Marital and Family Therapy Services via
				telemedicine. Any technology deemed appropriate may be used, including
				telephones, but technology must utilize direct communication that takes place
				in real-time.
The allowable codes for these rule suspensions:
* Marital/Family Behavioral Health Counseling with Beneficiary
				Present
* 90847, U4, GT
* 90847, U4, U5, GT - Substance Abuse
* 90847, UC, UK, U4, GT - Dyadic Treatment
* Place of Service to include 02 Telemedicine
* Marital/Family Behavioral Health Counseling without
				Beneficiary Present
* 90846, U4, GT
* 90846, U4, U5, GT - Substance Abuse
* Place of Service to include 02 Telemedicine
DMS is suspending the rule limiting Mental Health Diagnosis be
				conducted via telemedicine to only the adult population over age 21. By
				suspending this rule, licensed behavioral health professionals will be able to
				use telemedicine as an allowable mode of service delivery to beneficiaries
				under the age of 21.
The allowable code for this rule suspension:
* Mental Health Diagnosis
* 90791, U4, GT
* 90791, UC, UK, U4, GT - Dyadic Treatment Diagnosis
* Allowable Mode of Delivery- Adults, Youth and Children
DMS is suspending the requirement that substance abuse
				assessments be conducted face-to-face. By suspending this rule, licensed
				behavioral health professionals will be able to use telemedicine as an
				allowable mode of service delivery to provide substance abuse
				assessments.
The allowable code for this rule suspension:
* Substance Abuse Assessment
* H0001, U4
DMS is suspending the rule prohibiting telemedicine for Crisis
				Intervention Services. By suspending this rule, licensed behavioral health
				professionals will be able to provide Crisis Intervention Services via
				telemedicine. Technology must utilize direct communication that takes place in
				real-time.
The allowable billing codes for this rule suspension:
* Crisis Intervention
* H2011, HA, U4, GT
* Place of service code 02