HCA supports increased telehealth options for Medicaid clients, public and school employees
OLYMPIA – The Washington State Health Care Authority (HCA) is committed to multiple health care service delivery options to help ensure access to care during the COVID-19 pandemic. There are three main ways to deliver health care services:
- Audio and video
- Audio only by phone
During the COVID-19 pandemic, HCA has taken several steps to support expanded use of telehealth, including: providing services through telephone interaction; online digital interaction through a patient portal; and video-based evaluation and management health services.
These steps support continuity of care while avoiding congregation of individuals in health care settings.
“During this pandemic, we know the usual ways of providing care and billing for services may not be feasible,” said HCA Director Sue Birch. “In the interest of public health, we are working to be as flexible as possible and creating policies that allow providers to offer medically necessary services and bill as appropriate.”
The following is a summary of telehealth payment information that is relevant to the outbreak—both policies specifically put into place for the outbreak, as well as applicable pre-existing policies:
Apple Health (Medicaid) (serves more than 1.8 million clients)
- Policies put into place for the outbreak: We have increased the fee paid to matched audio (phone) only visits and online digital services through a patient portal (both not considered telemedicine per state rule, but considered telehealth) to in-person visit rates. This will support patients’ access to services through the telephone.
- Existing policies to support telehealth: HCA will continue reimbursing telehealth clinical services (evaluation and management procedure codes) for Apple Health clients in cases where face-to-face visits may not be a feasible option, and when it is medically appropriate for the member to be evaluated and managed by telehealth. HCA was already paying the same as in-person visits for telemedicine services as described in WAC 182-531-1730 (audio and video together, not audio alone) for Medicaid fee-for-service and managed care before COVID-19, and will continue doing so afterward. HCA has provided billing codes and guidance for providers.
Public and school employees (serves more than 700,000 members)
- Uniform Medical Plan (UMP)—HCA’s self-insured plan that serves more than 353,000 Washingtonians through our Public Employees Benefits Board and School Employees Benefits Board programs—has updated its telehealth guidance for providers. HCA will reimburse telehealth services at the same rate as the same services provided for in-person; and telephone-only care is reimbursable for counseling visits during the pandemic. Find more information on the Regence COVID-19 webpage (Regence is HCA’s third-party administrator for UMP).
- HCA is working with the fully insured carriers (Premera, Kaiser Permanente NW, Kaiser Permanente WA) for PEBB and SEBB to ensure they also implement telehealth services and are reimbursed appropriately.
HCA has purchased Zoom telehealth technology licenses to support providers who may not already have access to a Health Insurance Portability and Accountability Act (HIPAA)-compliant tool. We are prioritizing distribution of licenses to providers who:
- Serve a meaningful number of Medicaid clients,
- Do not already have other HIPAA or 42 CFR Part 2-compliant video capabilities,
- Are in smaller practices with less infrastructure,
- Serve children, adolescents, pregnant or parenting women or tribal members,
- Opioid treatment programs,
- Prescribe or support prescribers of medications to people diagnosed with significant mental illness or substance use disorder, or
- Serve as community mental health centers.
Providers should visit HCA’s COVID-19 response page for the latest information about billing and clinical policy.