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Updated Guidance on Ohio Department of Medicaid Telehealth Rules During the Covid-19 Public Health Emergency

Client Alert

In its initial response to the COVID-19 public health emergency, the Ohio Department of Medicaid (“ODM”) issued emergency rule 5160-1-21, which dramatically expanded reimbursable telehealth services, telehealth providers, allowable technology, location of both providers and patients, and covered billing provider types. See BMD’s initial COVID-19 and Telehealth Resource Guide here. This emergency rule provides wide flexibility for patients to receive necessary healthcare services while Ohio’s Stay-At-Home Order remains in place. Regulations are continually changing in response to the public health crisis, and on April 13, 2020, ODM issued new guidance further expanding telehealth services reimbursable under Ohio’s Medicaid program.

  1. Expanded Telehealth Services, Providers, and Billing Provider Types

First, ODM is now covering the following telehealth services:

  • Limited oral evaluation
  • Hospice home care and long-term care
  • Direct skilled nursing services in the home health or hospice setting
  • Services of home health or hospice aides
  • Additional occupational therapy, physical therapy, speech language pathology, and audiology services
  • End stage renal disease (ESRD) related services

Second, the following practitioner types are now allowed to provide telehealth services and seek reimbursement from ODM:

  • Dentists
  • Registered Nurses and Licensed Practical Nurses working in a hospice or home health setting
  • Licensed and credentialed health professionals working in a hospital or nursing facility setting
  • Home health and hospice aides

Finally, the following provider types may now bill for covered services:

  • Professional dental groups
  • Home health and hospice agencies 
  1. Updated Billing Guidance

Most important in this update is the new billing guidance from ODM. This guidance will help ensure that providers are appropriately reimbursed for services provided to Medicaid beneficiaries through telehealth during this emergency. For all services, excluding ESRD-related services and some skilled therapy services (which will be updated at a later date), the telehealth changes found in 5160-1-21 will be implemented in the claims processing systems on Wednesday, April 15, 2020. This will be updated for fee-for-service, the Managed Care Plans, and MyCare Ohio Plans.

Once the system updates are in place, providers are encouraged to follow the new billing guidelines, which can be found here for non-OHMAS certified providers, and here for OHMAS certified providers. 

  1. Reminder on Previous Medicaid Telehealth Expansion

Pursuant to the emergency rule from ODM, the definition of telehealth now includes the use of telephone calls, fax, email, and other communication methods that may not have audio and video elements. Medicaid beneficiaries can be in any location and receive telehealth services, including homes, schools, temporary housing, hospitals, nursing facilities, group homes, and any other location, except for a prison or correctional facility. Likewise, eligible providers can deliver telehealth services from any location, including their own home offices and other non-institutional settings. Telehealth services are available even if the patient and provider do not have a pre-existing relationship.

For more information of Medicaid reimbursement during the COVID-19 public health emergency, please visit the Updated Telehealth Rule FAQs or contact a BMD health care attorney. 


Pregnant Employee Protections - New Requirements for Employers

New protections are coming to the workplace for pregnant employees in 2023! In the most sweeping changes since the Pregnancy Discrimination Act of 1978, two new federal laws were recently passed: (1) the PUMP for Nursing Mothers Act (otherwise known as the Pump Act), and (2) the Pregnant Workers Fairness Act. The requirements of these statutes will require employers with more than 15 employees to implement new policies for their handbooks.

Five Common Pitfalls for Employers to Watch Out for Under the Fair Labor Standards Act

The Fair Labor Standards Act (FLSA) sets forth requirements for employers including, but not limited to, minimum wage, overtime pay, and recordkeeping for covered employees. These requirements are not as simple as they may appear on their face, which leads many employers to fall into compliance issues that they did not realize even existed.

The NLRB Limits the Reach of Confidentiality and Non-Disparagement Provisions in Severance Agreements Overruling Trump-Era Policies

Employers should exercise caution and closely examine the content of severance agreements to ensure compliance with a recent National Labor Relations Board (“NLRB”) decision.  On February 21, 2023, the NLRB restricted the breadth of permissible language of confidentiality and non-disparagement clauses when it issued its decision in McLaren Macomb and overruled its Trump-era decisions in Baylor University Medical Center and IGT d/b/a International Game Technology.

Ohio Medical Board Releases New Telehealth Rules

On Tuesday, February 21, 2023, the State Medical Board of Ohio released its final telehealth rules to implement Ohio’s telehealth statute (O.R.C. 4743.09) for physicians, physician assistants, dieticians, respiratory care professionals and genetic counselors. Ohio’s advanced practice registered nurses (“APRNs”) should also take note of these rules. While the Medical Board does not govern APRNs directly, those APRNs who are required to have a collaborating physician and standard care arrangement (namely nurse practitioners, certified nurse midwives, and clinical nurse specialists) are still affected by the rules. Generally, if an APRN’s collaborating physician is limited in their practice, then the APRN will also be limited.

The End of the Public Health Emergency is (Finally) Here

The COVID-19 Public Health Emergency (“PHE”) that has been in effect for over three years is finally slated to end on May 11, 2023.[1] With the end of the PHE will come many changes for healthcare providers to be aware of; however, some changes may not come until much later.