State Medicaid Best Practice School-based Telehealth

Transcription

1 S a emedi cai dbes Pr ac i ce School BasedTel eheal h Jul y201 3 Thi sdocumenwasmadepos s i bl ebygr an#g22rh f r om heof ficef or headvancemenoft el eheal h,heal hres our cesandser vi cesadmi ni s r a i on,dhhs.

2 Sae Medicaid Bes Pracice School-based Telehealh July 2013 This documen was made possible by Gran #G22RH from he Office for he Advancemen of Telehealh, Healh Resources and Services Adminisraion, DHHS. None of he informaion conained in he Sae Bes Pracice Series or in his documen consiues legal advice. The informaion presened is informaional and inended o serve as a reference for ineresed paries, and no o be relied upon as auhoriaive. Your own legal counsel should be consuled as appropriae. Page 1

3 Sae Medicaid Bes Pracice School-Based Telehealh Fory-four saes have some form of Medicaid coverage for healhcare services delivered via elehealh using video-conferencing. 1 Ye, varying policies affecing access, coverage and reimbursemen have no allowed sudens and heir providers o leverage he full capabiliies of elemedicine for school-based elehealh. School-based elehealh is one area overlooked by many Medicaid healh plans as a recognized model for qualiy and cos-effecive healhcare delivery. The Use of Telehealh in Schools There are close o 2,000 school-based healh ceners (SBHCs) operaing naionally. Mos are locaed in a school building, while a small percenage of SBHCs are mobile or in separae faciliies on school propery. The goals of SBHCs are o mee he healhcare needs of children, paricularly hose in underserved communiies, wih minimum disrupion o he child's classroom ime or he paren's work day. Alhough elehealh is an ideal means o his end, few SBHCs uilize remoe healhcare echnologies 2 even hough well over 25 million children are currenly eligible for Medicaid services. In a 2009 brief, he Children s Parnership cied 18 sae and communiy-based programs operaing around he counry ha used school-based elehealh. 3 School-based elehealh involves he use of elecommunicaions, including ineracive video conferencing and sore-and-forward ransmissions, o deliver a variey of healh care services o children locaed in a school. School-based elehealh is a delivery mehod ha can be used o improve healh qualiy and academic oucomes, and provide access o a wide specrum of care including primary and acue care, chronic disease managemen, behavioral and menal healh, speech herapy, denal screenings, nuriional counseling, and prevenion and healh educaion. School-based providers, usually regisered nurses, can use elehealh o connec wih anoher provider via video conferencing, or capure, sore and share recorded sounds and images from advanced insrumens such as a digial ooscope or elecronic sehoscope. Sae Opporuniies o Improve Access Using Telehealh in Schools Saes have several opions o improve school-based healh services hrough he use of elehealh. These include enacing legislaion, proposing adminisraive regulaions, or applying for a federal block gran under Tile V of he Social Securiy Ac o improve maernal and child healh or a formula gran under he Individuals wih Disabiliies Educaion Ac (IDEA) o enhance services for children wih special needs. Many school-age Medicaid recipiens are also eligible for services under hese federal programs. Ye, despie he numerous avenues for saes o leverage, exising policy barriers o Medicaid coverage for school-based elehealh are differen when compared o oher healh care services and are someimes difficul o navigae. School-based healh ceners usually offer heir services Page 1

4 o school-age children a no-cos, and rely on public and privae grans and insurance reimbursemen o susain heir medical pracices. In he case of Medicaid, each sae varies in he ypes of services or providers ha will be covered under heir healh plans. No all Medicaid plans recognize school-based clinics as a covered healh care provider or licensed faciliy; nor do hey allow coverage for all elehealh-provided services. In addiion, a rapidly growing number of Medicaid recipiens are covered under managed care plans ha involve compeiive bidding and capiaed paymens insead of fee-for-service. SBHCs are ofen no eligible for reimbursemen by managed care plans unless hey become a par of heir nework. Moreover, many saes do no classify SBHCs as healh care safey ne providers, hus leaving hem ineligible for guaraneed reimbursemen for he full cos of services provided. These policy barriers limi he coss ha SBHCs can recover for a wide variey of services provided, and also place a srucural bias agains SBHCs seeking some level of coverage for elehealh-provided services. Sae Policy Bes Pracices To improve paien access o healhcare hrough elehealh, ATA has analyzed enaced sae elehealh policies and highlighed hose respecive saes wih he bes policy models for elehealh services. These bes pracice models can be used as benchmarks for oher saes considering new or revising exising elehealh policies. In he area of school-based elehealh, ATA has examined enaced laws, published fiscal noes and bill repors, published regulaions, and Medicaid provider manual guides for he saes wih Medicaid coverage in hose areas. ATA also reviewed sae issued repors and clinical programs demonsraing qualiy and cos-effecive elehealh deploymen and uilizaion. The crieria used o idenify saes wih model policies regarding school-based elehealh include: Georgia Inclusive definiions of echnology wih lile o no resricions on he ypes of echnology approved for use in a clinical service Geographic area served Applicable healh services and condiions Provider eligibiliy Reimbursemen mehodology Level of coverage and affeced healh care plans. Georgia Medicaid reimburses healh care providers when elehealh services are delivered o school-based healh ceners. Alhough SBHCs are no lised as a Medicaid provider in he sae Medicaid manual, SBHCs are eligible o receive a $20.52 originaing sie faciliy fee for elehealh services rendered a heir sie. Claims mus be submied wih a special billing code (Q3014 HCPCS). Page 2

5 Originaing sies recognized under Georgia s elemedicine policy mus have a elecommunicaions sysem ha allows he disan provider o visually examine he paien s enire body including body orifices (such as ear canals, nose, and hroa). 4 Asynchronous ransmission such as sore-and-forward or remoe monioring is no reimbursable. There is no requiremen o formally presen a paien o he disan sie physician or specialis, bu a provider mus be available if clinically appropriae. The only disan sies allowed for a elehealh encouners include: physician/praciioner office, criical access hospial, federallyqualified healh cener, communiy menal healh cener, hospial, rural healh clinic, skilled nursing faciliy, and Georgia public healh clinic. Physicians, physician assisans, clinical psychologiss, nurse praciioners, and clinical nurse specialiss are he only providers allowed o be reimbursed for elehealh-provided services, including hose delivered remoely o a school sie. Nebraska Nebraska enaced a law in 2009 o require Medicaid fee-for-service coverage of elehealhprovided services a he same rae of in-person services. In January 2013, Nebraska lawmakers inroduced a bill o expand Medicaid coverage o include school-based elehealh. LB 556 was inroduced wih he inenion of allowing Medicaid o cover elehealh services for children hrough public schools. Unforunaely his language was sricken from he bill before i was signed ino law. The new law now expands coverage of pediaric elemenal healh services in physician offices. (1) The Deparmen of Healh and Human Services, in collaboraion wih he Sae Deparmen of Educaion, shall adop and promulgae rules and regulaions providing for elehealh services for children hrough he public schools. Such rules and regulaions shall provide a means for school personnel, physicians, and behavioral healh professionals o communicae wih each oher regarding elehealh services for eiher medical or behavioral healh condiions. (2) The rules and regulaions required pursuan o subsecion (1) of his secion shall include, bu no be limied o: (a) School personnel or oher aduls presen when a child is receiving elehealh services a a public school sie need no have medical raining, excep ha a school nurse, a counselor, or anoher person familiar wih he child's reamen plan and able o aend o any emergencies shall be presen wih he child a such sie; (b) Telehealh services may be received by a child a a public school sie regardless of he disance beween such sie and he neares healh care faciliy offering a comparable service; (c) Telehealh services received by a child a a public school sie shall be eligible for coverage under he medical assisance program pursuan o secion ; and Page 3

6 New Mexico (d) Transmission coss and relaed services for elehealh services received by a child a a public school sie shall be reimbursed under he medical assisance program as provided in secion New Mexico Medicaid has reimbursed for school-based healh services delivered via videoconferencing since There are 20 school-based healh clinics ha have insalled videoconferencing sysems o enable elehealh encouners for school-aged children. According o sae regulaions, elehealh-provided services are covered a he same rae of inperson services. All services are covered o he same exen he service and he provider are covered when no provided hrough elehealh. 5 The following medically necessary healh services are covered when using real-ime ineracive audio-video echnology o faciliae a school-based elehealh encouner: consulaions, evaluaion and managemen services, individual psychoherapy, pharmacologic managemen, psychiaric diagnosic inerview examinaions, and individual medical nuriion services. Medicaid also covers an exensive lis of providers, including school-based healh ceners, who are eligible for reimbursemen of elehealh-provided services if hey are licensed in he sae and enrolled as a Medicaid provider: (1) physicians licensed o pracice medicine or oseopahy; (2) podiariss; (3) faciliies licensed as diagnosic and reamen ceners by he New Mexico deparmen of healh (DOH), communiy menal healh ceners, core service agencies, hospials, rural healh clinics, school-based healh ceners, and federally qualified healh ceners; services performed in hese faciliies mus be furnished by individual praciioners who are enrolled as providers; (4) cerified nurse praciioners and regisered nurses may provide services in collaboraion wih a physician or as independen providers wihin he scope of heir pracice; (5) cerified physician assisans; (6) nurse midwives licensed by he board of nursing as regisered nurses and licensed by he deparmen healh as cerified nurse midwives; (7) pharmacis clinicians; (8) individuals licensed as clinical nurse specialiss may provide services in collaboraion wih a physician or as independen providers wihin he scope of heir pracice; (9) psychologiss (Ph.D., Psy.D. or Ed.D.) licensed or board eligible as clinical psychologiss; (10) licensed independen social workers (LISW) licensed by he New Mexico board of social work examiners, licensed professional clinical counselors licensed by, and Page 4

7 marriage and family herapiss licensed by New Mexico counseling and herapy pracice board; (11) regisered dieiians or nuriion professionals when furnishing services wihin he scope of heir pracice as defined by sae law under he direcion of a licensed physician; (12) Indian healh service and ribal 638 faciliies; (13) physical herapiss; (14) occupaional herapis; or (15) speech pahologiss. 6 School-based healh ceners in he sae are also recognized as qualified originaing sies. Alhough New Mexico does no include geographic or disance limiaions as a condiion for reimbursemen delivered by he disan sie/provider, only cerain originaing sies are eligible for a faciliy fee reimbursemen. A elehealh originaing-sie communicaion sysem fee is covered if he eligible recipien was presen a and paricipaed in he elehealh visi a he an originaing-sie locaed in a healh professional shorage area (HPSA); a couny no classified as a meropolian saisical area (MSA); a primary medical care healh professional shorage area for physicians, nurse praciioners, and physician assisans; primary behavioral healh care professional shorage area for psychiariss and clinical psychologiss; a medical specialis shorage area for non-primary care medical specialies; an IHS or ribal 638 faciliy, a federally qualified healh cener or rural healh clinic or a federal or sae elemedicine demonsraion projec area. 7 Ohio and Virginia (Speech-Language Therapy Services) Speech-language herapy is an allied healh service ha can be successfully adminisered in schools o rea children wih speech and language delay. Ohio and Virginia Medicaid programs have covered school-based speech-language herapy delivered via elehealh since Boh saes reimburse he disan provider for he elehealh-provided service under he fee-for-service model and use of a GT modifier. Virginia will reimburse a qualified school aide who is presen wih he child during he elemedicine encouner, and he aide may be billed as a personal care assisan using he following code, Q3014. Ohio, for covered speech herapy services, reimburses for video-conferencing by speechlanguage pahologiss. Virginia Medicaid classifies elehealh-provided speech-language herapy as elepracice. Telepracice, as i is used here, is he delivery of speech herapy services by a DMAS approved provider hrough he use of videoconferencing o a child a a remoe locaion. Telepracice delivered services are subjec o he same DMAS requremens as when speech herapy services are delivered wihou elemedicine services such as provider qualificaions, service requiremens, confidenialiy of informaion and documenaion of services. 8 Page 5

8 Evidence-Based Oucomes for School-based Telehealh Numerous sudies have demonsraed he value of school-based elemedicine programs in chronic disease managemen, ye similar findings have also shown significan paren saisfacion and reducion in abseneeism School-based healh programs have shown successful oucomes as a resul of inegraing elehealh For example, 99 percen of parens repored ha he elehealh-provided services offered hrough he Kansas TeleKidcare program were beer or jus as good as in-person care. 14 A 2009 published peer-reviewed aricle included a sudy on he effecs of elemedicine as effecive ool o improve Type 1 diabees managemen in school-aged children. Over he course of he sudy, school nurses and children ages 5 o 14 received remoe diabees care managemen from a specialy eam hrough videoconferencing sysems se up in he school. As a resul of he elemedicine inervenion, heir Hgb A1c levels lowered, and hey experienced fewer hospial and ER rips during he school year. 15 Oher research has shown he effeciveness of using school-based elemedicine o enhance psychiary services, paricularly hrough video-conferencing. A program in rural Georgia has used elemedicine o connec child and adolescen menal healh specialiss o assess and rea children condiions including aenion defici hyper aciviy disorder (ADHD) and auism specrum disorders. In some cases, he use of school-based elehealh has also been used in siuaions involving children wih suicidal houghs or making suicidal aemps. 16 Model Medicaid Policy Consideraions Based on sae bes pracices, ATA suggess he following basic provision for policymakers and healh care sakeholders o sar from in developing school-based elehealh policies o fi heir needs. Medicaid will provide coverage for elemedicine services a a school-based healh cener o he same exen ha he services would be covered if hey were provided hrough inperson consulaion. Since mos Medicaid plans make significan use of managed care plans, ofen wih he incenives of fixed rae paymens, i is imporan ha such plans have he flexibiliy o fully uilize schoolbased elehealh for heir enrollees. 1 Sae Telehealh Laws and Reimbursemen Policies. Cener for Conneced Healh Policy. June School-Based Healh Ceners: Naional Census School Year Naional Assembly on School-Based 3 School-based Telehealh: An Innovaion Approach o Mee he Healh Care Needs of California s Children. The Children s Parnership. Ocober GA Dep. of Communiy Healh, GA Medicaid Telemedicine Handbook, p. 2, (Nov. 2012). 5 New Mexico Adminisraive Code Secion Ibid. Secion Ibid. 8 Virginia Deparmen of Medical Assisan Services, Medicaid Provider Manual, Local Educaion Agency Provider Manual, Covered Svcs. and Limiaions, p. 13 (Oc. 24, 2012). Page 6

9 9 McConnochie KM, Wood NE, Herendeen NE, en Hoopen CB, and Roghmann KJ. Telemedicine and e-healh. June 2010, 16(5): doi: /mj McConnochie KM, Wood NE, Kizman HJ, Herendeen NE, Roy J, and Roghmann KJ. Pediarics Vol. 115 No. 5 May 1, 2005 pp (doi: /peds ). 11 Polovoy, C. Telepracice in Schools Helps Address Personnel Shorages. ASHA Leader, McCullough A. Viabiliy and effeciveness of eleherapy for pre-school children wih special needs. Inernaional Journal of Language and Communicaion Disorders, McGrah Davis, e al. Journal of Pediaric Psychology February Spaulding, R. J., Cook, D. J., & Doolile, G. C. (2006). School-based elemedicine in Kansas: Paren percepions of healh and economic benefis. In J. N. Yfanopoulos, G. T. Papanikos & Z. Bousioli (Eds.), Healh Care Issues: An inernaional perspecive(pp ). Ahens Insiue for Educaion and Research. 15 Daniels, Sephen R. School-cenered elemedicine for ype 1 diabees mellius. The Journal of Pediarics. Sepember 2009; 155(3): A2. 16 Knopf, Alison. School-based Telehealh Brings Psychiary o Rural Georgia. Behavioral Healhcare. 10 January Page 7