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

Client Alert
April 15, 2020

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. 

Ohio Department of MedicaidCOVID-19 Telehealth ProgramTelehealth
Client Alert

HHS Provider Relief Funds Reporting Requirements: Important Updates Every Provider Should Know

November 4, 2020HHS continues to revise its reporting requirements for the use of the Provider Relief Funds. Providers with more than $10,000 in Provider Relief Fund payments must report on the use of the funds through December 31, 2020. The reporting window will begin on January 15, 2021 and providers must complete reporting obligations for FY 2020 by February 15, 2021 through a portal designed by HHS. However, providers that have unexpended funds as of December 31, 2020, will have an additional 6 months to use the remaining funds through June 30, 2021. These providers must submit a second and final report no later than July 31, 2021.Client Alert

Should I Apply for Phase 3 Funds? Important Considerations Every Provider Should Know

November 2, 2020On October 1, 2020, the Department of Health and Human Services (“HHS”) announced an additional $20 billion in new funding for providers through a Phase 3 distribution. Importantly, providers that previously received HHS Provider Relief Funds or already received payments of approximately 2% of annual revenue from patient care are eligible to apply. Eligible providers have until November 6, 2020 to apply for these Phase 3 Funds. However, the question from providers continues to be: Should I Apply for Phase 3 Funds?Client Alert

CISA Ransomware Practices

October 29, 2020On October 28, 2020, the United States Cybersecurity and Infrastructure Security Agency (CISA) issued an alert warning of imminent threats to US hospitals and healthcare providers. The specific threat involves RYUK Ransomware attacks. RYUK is a novel ransomware that goes undetected by commercial anti-virus/malware detection programs. Once deployed, RYUK encrypts all data and disables systems. In short, it cripples all functionality down to phone systems and automated doors. Healthcare providers should alert their employees to remain hyper-vigilant and report any suspicious activity seen in email or on networks. It has been reported healthcare providers in New York, Pennsylvania and Oregon have been targeted in the last 48 hours. If your organization encounters issues, BMD can assist in mobilizing a response team and has contacts with forensic IT firms that are familiar with RYUK. It is advisable to engage professionals with experience dealing with this specific threat.Client Alert

HHS Announces an Additional $20 Billion In Provider Relief Grants

October 5, 2020The U.S. Department of Health and Human Services (“HHS”) announced an additional $20 billion in new funding for providers on October 1, 2020. Eligible providers include those that have already received Provider Relief Fund payments as well as previously ineligible providers, such as those who began practicing in 2020, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic. The new Phase 3 General Distribution is designed to balance an equitable payment of 2% of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.Client Alert

DOL Proposes New Rule Regarding Independent Contractor Status - But How Will the Election Affect Its Future?

September 24, 2020On September 22, 2020, the U.S. Department of Labor announced a new proposed rule regarding employee and independent contractor status under the Fair Labor Standards Act. The full text of the proposed rule is available here. The rule's drafters intend to reduce uncertainty and enhance the precision and predictability of the long-standing "economic reality" test, which currently relies on a multifactor balancing test.
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