Wachler & Associates Health Law BlogMichigan Medicaid Releases New Telemedicine Policy
The use of telemedicine for patient care exploded during the COVID-19 pandemic. While telemedicine services were generally a limited and niche practice prior to the pandemic, social distancing measures, lock-downs, and fear of spreading the disease combined with a desire for widespread testing for the disease created a tremendous need for the use of telemedicine for the delivery of many kinds of healthcare services.
Government programs, like Medicare and Medicaid, and commercial insurance carriers, which had all long restricted the use of telemedicine, scrambled to change their rules to allow telemedicine services in the face of this need. Many of these changes were made in a temporary manner, to expire at the end of the pandemic, with permanent changes to be determined later. Throughout the pandemic, telemedicine services proved to be safe, effective, and convenient. Therefore, healthcare providers and patients generally concurred that permanent changes to telemedicine policies should allow more widespread use.
The Michigan Medicaid program recently released an important update clarifying its permanent, post-pandemic policies regarding which providers are authorized to render services via telemedicine under the Michigan Medicaid program. First, as a general rule, a healthcare provider must be licensed or otherwise authorized to practice in the state where the patient is located. Usually, this will include a Medicaid patient in Michigan and a provider located outside of Michigan. In this situation, the provider must be licensed in Michigan in order for the services to be reimbursed under Michigan Medicaid. Although not a condition of Michigan Medicaid, the provider should also be mindful of the licensing requirements of the state in which they are located, which may require that the provider be licensed there as well. Under limited circumstances, Michigan Medicaid may also cover telemedicine services provided by providers who are licensed in another state to Michigan Medicaid patients if the patient is in the state where the provider is licensed. In either case, the provider must be enrolled in Michigan Medicaid and also have the ability to refer the patient to another provider of the same type or specialty who can see the patient in-person when necessary.
Telemedicine providers who do not have a physical location for treatment, but are Michigan-licensed and meet all other Michigan Medicaid enrollment requirements, are considered “virtual-only”, and are permitted to render services to Michigan Medicaid patients. However, such “virtual providers” are subject to additional restrictions, including prior authorization requirements and place of service coding rules.
Psychology and behavioral health services are often delivered via telemedicine. Michigan Medicaid will generally reimburse services by Authority to Practice Interjurisdictional Telepsychology (APIT) certified providers, subject to the general telemedicine rules and prior authorization requirements. Telemedicine providers who are rendering services within the Michigan Medicaid specialty behavioral health system must follow all PIHP/CMHSP enrollment procedures. These PIHP/CMHSP providers are required to be affiliated with the beneficiary’s care team (via a shared medical record or a referral relationship) to ensure that the beneficiary has reasonably frequent and periodic in-person evaluations.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to telemedicine or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.