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On July 17, 2020, Governor DeWine signed Executive Order 2020-29D, which allowed the Ohio Department of Medicaid (“ODM”) to immediately rescind old provisions and file a new rule (5160-1-18) and the Ohio Department of Mental Health and Addiction Services (“OhioMHAS”) to amend their current rule (5122-29-31), both expanding telehealth and introducing even more flexibility into Ohio’s healthcare system. 

Both rules will expire on November 14, 2020, unless adopted through the normal JCARR process. This is a significant move for ODM as they were previously operating off of a newly added emergency rule (“Telehealth During a State of Emergency”), but the department is now transitioning these expanded telehealth rules directly into their rule that existed prior to the public health emergency. 

In general, if a service does not have some type of in-person requirement (surgery, procedure, test etc.), then it most likely is appropriate to conduct via telehealth. 

ODM – 5160-1-18 

• Telehealth can either be:
  • Synchronous, interactive, real-time electronic communications using both audio and video; or
  • Asynchronous activities that do not have both audio and video (calls, emails, images through fax) 

• Patient site and practitioner site – the physical location of each at the time of service 

• Eligible Providers:
  • Physician
  • Psychologist
  • Physician assistant
  • Certified nurse specialist, certified nurse-midwife, certified nurse practitioner
  • LISW, LIMFT, LPCC
  • LICDC
  • Supervised practitioners and supervised trainees
  • Audiologist, speech-language pathologist, speech-language pathology aids, and audiology aids
  • Occupational and physical therapist and occupation and physical therapist assistants
  • Home health and hospice aids
  • Private duty registered nurse or licensed practical nurse in a home health or hospice setting
  • Dentists
  • Dietitians
  • Behavioral health practitioners 

• Provider types eligible to bill for services rendered through Telehealth:
  • Any practitioner
  • Professional medical group
  • Professional dental group
  • FQHC/RHC
  • Ambulatory health care clinics
  • Outpatient hospitals
  • Private duty nurses
  • Home health and hospice agencies
  • Behavioral health providers 

• Requirements:
  • Must comply with current HIPAA guidance from Office of Civil Rights
  • Practitioner site responsible for maintaining appropriate documentation
  • Patient and practitioner sites should be consistent with CPT and HCPCS guidelines for the service being provided 

• Payment may be made for all of the following services in the appendix here. 

• Claims should be submitted in accordance with Telehealth billing guidance and those detailed provisions in subparagraph (E) of this new rule 

OhioMHAS – 5122-29-31

Telehealth means real-time audiovisual communications with quality to permit accurate and meaningful interactions and includes asynchronous modalities that do not have both audio and video elements 

• Originating site (client) and distant site (provider) are where each are located at the time of service 

• No initial in person visit is necessary to initiate services using telehealth 

• Prior to initiating services, a provider must inform the patients of potential risks of telehealth and document that patient understood and agrees to those risks (clinical aspects, security considerations and confidentiality considerations) 

• Services:
  • General services
  • CPST
  • Therapeutic behavioral services and psychosocial rehabilitation
  • Peer recovery
  • SUD case management
  • Crisis intervention
  • ACT
  • IHBT 

• Provider must have a physical location in Ohio or have access to a physical location in Ohio where individuals may opt to receive services that are being provided by telehealth modalities 

Please contact a BMD healthcare attorney if you have any questions regarding these telehealth rules, any telehealth questions in general, or any other healthcare questions.