North Carolina Medicaid has taken quick action to update the State’s restrictive telemedicine/telepsychiatry clinical coverage policy. The State will be formally rolling out its changes by week’s end. All aspects of the updated policy will be effective immediately for Medicaid funding services. The policy will also eventually apply to State-funded services, but we do not have an effective date for these services at this time. Highlights of the new policy were shared with the LME/MCOs on a conference call on March 17, 2020. Below are the most significant changes to NC Medicaid Clinical Coverage Policy 1-H:
- Requirements around distant and originating sites are being removed. Providers will have the flexibility to furnish telepsychiatric services from their homes and beneficiaries will be able to receive services at their homes or other non-facility-based locations.
- Expands the licensure types that can provide and bill for telepsychiatric services. Licensed Marriage and Family Therapists (LMFTs), Psychological Associates (LPAa), Licensed Clinical Mental Health Counselors (LCMHCs), and Licensed Clinical Addiction Specialists (LCASs) will be able to bill for psychotherapy services under the revised policy.
- Requirements for the use of encrypted communication platforms will be relaxed.
Alliance will add the allowable telehealth GT modifier to eligible services within provider contracts for providers who currently provide outpatient psychotherapy services and/or evaluation and management (E&M) services. We encourage providers to take all necessary steps to begin delivering telepsychiatric services to Alliance Medicaid members. Providers may bill for completing virtual Comprehensive Clinical Assessments, Diagnostic Assessments, and E&M codes for new patients, as well as ongoing covered treatment services. Additional information on the revised policy will be forthcoming from the North Carolina Department of Health and Human Services (DHHS). The Department is planning to review telemedicine/telepsychiatry changes along with other actions that they are taking to promote access to behavioral health care during the COVID 19 pandemic on a webinar this Friday. The time has yet to be announced.
As mentioned in previous communications, Alliance is submitting an alternative telepsychiatry policy to DHHS to create even greater flexibility. In addition to the areas listed above, Alliance is requesting that clinicians licensed at the associate level be allowed to furnish telepsychiatric services and that the delivery of research-based autism spectrum disorder treatment services is allowable through telepsychiatry. These additional flexibilities require DHHS approval before they can be implemented. We will notify you if and when Alliance’s policy is approved by the State.
Please direct any questions about the revised policy and/or concerns about any barriers to implementing telepsychiatric services to the Provider Network Helpdesk.
