The state’s Department of Health Care Services has amended its connected health coverage guidelines to include, among other things, eConsults, asynchronous telehealth and home-based care.

By Eric Wicklund

August 27, 2019 – California’s Department of Health Care Services has made some significant changes to its telehealth and mHealth coverage, giving both residents and providers new opportunities to embrace connected health care.

In a notice that became official in July but was made public this month, the CDHCS, which oversees the Medi-Cal Medicaid program and several managed care plans, announced three major adjustments to its coverage guidelines:

  • Healthcare providers can now choose what type of telemedicine modality – real-time audio-visual or asynchronous (store-and-forward) – to use, as long as it meets Medi-Cal guidelines, can be delivered via telemedicine technology and conforms to the appropriate CPT or HCPCS code. Asynchronous consultations initiated by the patient, including through mHealth apps, do not qualify for reimbursement.
  • The definition of an originating site for a telehealth service now explicitly includes the home, with some leeway included for other non-traditional settings, and there is no longer a requirement that a care provider be physically with the patient at the time that telehealth is used.
  • eConsults are now included as an asynchronous telehealth service, with specific requirements that the care provider must meet to qualify for reimbursement.

The adjustments refer specifically to the MediCal program, and to a lesser extent are applicable to an All-Plan Letter for Managed Care (APL); Indian Health Services’ Memorandum of Agreement (IHS/MOA); Family Plan, Access and Care of Treatment (Family PACT); federally qualified health centers (FQHCs) and rural health clinics (RHCs); local education agencies (LEAs) and the Vision Care plan.

For example, eConsults are not separately reimbursable for FHQCs, RHCs and HIS/MOAs, while asynchronous telehealth services are only covered for established patients of FHQCs and RHCs, unless those patients are homeless or homebound.

The Center for Connected Health Policy (CCHP), one of two national resource centers in the 14-member National Consortium of Telehealth Resource Centers (NCTRC), has created a chart and a fact sheet that describes the new telehealth guidelines in more detail.

The changes are similar to those made in several states and by the Centers for Medicare & Medicaid Services (CMS) to expand telehealth and mHealth coverage, particularly in remote patient monitoring and asynchronous programs.

In addition, the addition of eConsults points to a growing interest in the telemedicine platform as means of facilitating specialist consults – though restrictions placed on that service for FHQCs and RHCs could hinder adoption and reduce the effectiveness of a program that could significantly benefit underserved populations.

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