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AHCCCS and Telehealth for the PublicHealth Emergency and BeyondSara Salek, MDChief Medical OfficerAHCCCSShreyas HallurResearch InternAHCCCSVikeen Patel, MD, MBAClinical Informatics FellowUA COM - PHX2nd Annual Arizona Telemedicine Policy SymposiumJames Wang, MDClinical Informatics FellowUA COM - PHX
AHCCCS and Telehealth:The Public Health Emergency and BeyondSara Salek, MD, CMO-AHCCCSShreyas Hallur, Research Intern, AHCCCSVikeen Patel, MD, Clinical Informatics Fellow, UACOM-PJames Wang, MD, Clinical Informatics Fellow, UACOM-P
AHCCCS Telehealth CoverageSara Salek, M.D.CMO, AHCCCS
AHCCCS-At-A-GlanceLargest insurer in AZ, covering over2 million individuals and families 50% of all birthsAHCCCS uses federal, state and countyfunds to provide health care coverageto the State’s Medicaid population97,373 RegisteredHealthcare Providers2/3 of nursingfacility daysPayments are made to 15 contractedhealth plans, who are responsible forthe delivery of care to members
Pre-Pandemic Telehealth Updates
AHCCCS Telehealth DefinitionHealthcare services delivered via asynchronous (store andforward), remote patient monitoring, teledentistry, ortelemedicine (interactive audio and video).
October 1, 2019 AHCCCS Telehealth Policy ChangesBroadening of POS allowable fordistant and originating sitesNo restrictions on distant site (where provider is located)Broadening of originating site (where member is located) toinclude home for many service codesBroadening of coverage for telemedicine, remote patient monitoring,and asynchronousNo rural vs. urban limitationsMCOs retained their ability to manage network and leveragetelehealth strategies as they determine appropriate
AMPM 320-I TelehealthPre 10/1/19Implemented 10/1/19Real-time telemedicine limited to 17disciplinesNo restrictions on disciplines
AMPM 320-I TelehealthPre 10/1/19Implemented 10/1/19DermatologyAsynchronous covered in very yNeurologyCardiologyBehavioral HealthInfectious DiseaseAllergy/Immunology
AMPM 320-I TelehealthPre 10/1/19Implemented 10/1/19Telemonitoring limited to CHFNo restrictions on telemonitoring
Pandemic Telehealth Updates
AHCCCS Telehealth Major Policy Changes: COVID-19 Created Temporary Telephonic Code Set Added 150 codes to Telehealth Code Set AHCCCS MCOs required to:ooReimburse at the same rate for services provided “in-person”and services provided via telehealth and/or telephonicallyCover all contracted services via telehealth modalities
AHCCCS Telehealth Coverage SummaryWHATTECHNOLOGYTELEHEALTH MODIFIER1OR APPLICABLE DENTALCODEPLACE OF SERVICE(POS)CODE SET AVAILABLECODE SET AVAILABLEAFTER COVID 19EMERGENCYTelemedicine(Synchronous)Interactive Audio VideoGTOriginating Site2Telehealth Code SetYESAsynchronous(Store Forward)Transmission of recorded health historythrough a secure electroniccommunications systemGQOriginating Site2Telehealth Code SetYESRemote PatientMonitoringSynchronous (real-time) orasynchronous (store and forward)GT-SynchronousGQ-AsynchronousOriginating Site2Telehealth Code SetYESTeledentistrySynchronous (real-time) orasynchronous (store and ting Site2Teledentistry Code Set3YESTelephonicAudioNone02-TelehealthPermanent Telephonic Code Set3,4 YESTelephonic(Temporary)AudioUDOriginating Site2Temporary Telephonic Code Set3,4 UNDER EVALUATION1 All other applicable modifiers apply.2 Location of the AHCCCS member at the time the service is being furnished via telehealth or where the asynchronous service originates3 Adding to master Telehealth Code Set4 Adding audio-only to Telehealth definition; evaluating modifier and POS coding standards
Impact of Implementation of the TemporaryTelephonic Code SetJames Wang, MDClinical Informatics Fellow
Telephonic/Audio-Visual Comparison
Total A/V vs. Telephonic Virtual Visits
Percent A/V vs. Telephonic Claims
Percent A/V vs. Telephonic Visits Pre- and PostTemporary Code Set Implementation (by County)
Relative % change in telephonic claims(by county and region type*)UrbanRural* Based on OMB designation
All Telehealth Visits by Provider Type
Telephonic-Specific
*H0004 – Behavioral health counseling and therapy*99213/99214 – Established office visit*T1015 – All-inclusive clinic visit*H0031 – Mental health evaluation, non-physician
Top 10 CodesTop UsersH0004BH Outpt Clinic (56%)Integrated Clinics (30%)H0031BH Outpt Clinic (46%)Integrated Clinics (30%)H2027Integrated Clinics (39%)BH Outpt Clinic (34%)90792APPs (33%)BH Outpt Clinic (28%)90837BH Outpt Clinic (21%)FQHC (21%)Lic Prof Counselor (20%)99212FQHC (40%)BH Outpt Clinic (24%)Physician (15%)99213Physician (26%)APPs (26%)FQHC (22%)99214APPs (34%)Physician (30%)BH Outpt Clinic (15%)99215APPs (27%)Physician (24%)BH Outpt Clinic (21%)T1015FQHC (80%)
Rarely* Used Codes (by category)Home visitNeuro/PsychProlonged 219949799498G0296S5100*fewer than 5 claims/month per independent code or code series
SummaryTelephonic modalityadopted more readily inrural areasSeveral new providergroups in telephonic healthdelivery40 temporary telephoniccodes rarely used (33%)
Analysis of 4G Cellular and Broadband Accessand Telehealth UtilizationShreyas HallurAHCCCS Research Intern
r 0.711p 0.003r 0.424p 0.116
r 0.81p 0.001r 0.723p 0.002
r 0.54p 0.038r 0.192p 0.492
SummaryAudio-only is still primarymode of telehealth, evenin urban countiesPandemic expansion oftelehealth has magnifiedthe urban-rural differencesInfrastructure will continueto limit accessto all modalities
Claims Level Complexity Pre/Post PandemicVikeen Patel, MD MBA
Rationale for Claim Complexity AnalysisQuality metrics specific to telehealth is limitedCan there be an apples to applescomparison between two modalities?Compare In-Person to Audio-Visual (A/V)visitsDuring the pandemic was there a transition to increased complexity oftelehealth claims?
Substantial Increase in Utilization of A/VState Pandemic Declaration
Comparing Distribution of A/V to In-Person55%41%
Outpatient Established Code Set (9921x)
Outpatient Established Code Set (9921x)
Breaking Down Providers Using A/V ServicesProvidersCut for lowusage
SummaryCan compare complexitybetween modalities forcertain provider typesAdditional analyses neededto assess consistency ofquality between modalitiesData is limited regardingcertain visit types
AHCCCS Telehealth Policy Planning:Post PandemicSara Salek, M.D.
National Taskforce on Telehealth Policy Effort between the National Committee forQuality Assurance (NCQA), the Alliance forConnected Care, and the AmericanTelemedicine Association 22 industry experts representing clinicians,health systems, telehealth platforms, stateand federal health agencies, insurers andconsumer advocates – including leadershipfrom CMS, HHS, Kaiser, Humana, AARP,among other leading stakeholders.
National Taskforce Policy RecommendationsRecommendationAHCCCS Position/Status post PHELifting geographic restrictions andlimitations on originating sites.Implemented 10-1-19Allowing telehealth for various types ofclinicians and conditions.Implemented 10-1-19Telehealth visits can meet requirements No specific restrictions in AHCCCSpolicy-follow State and Federalfor establishing a clinician/patientregulationsrelationship if the encounter meetsappropriate care standards or unlesscareful analysis demonstrates that, inspecific situations, a previous in-personrelationship is 2020/09/20200914 Taskforce on Telehealth Policy Final Report.pdf
National Taskforce Policy RecommendationsRecommendationAHCCCS Position/Status post PHEEliminating unnecessary restrictions ontelehealth across state lines.AHCCCS covers services rendered byproviders located out of state as long asAHCCCS registered and AZ licensed.Look closely at the effect of expandingprescribing authority to telehealth.No specific restrictions in AHCCCSpolicy-follow State and Federalregulations.AHCCCS follows federal regulationsFully reinstate enforcement of HealthInsurance Portability and AccountabilityAct (HIPAA) patient privacy protectionsthat were suspended at the start of thepublic health emergency.
Major AHCCCS Policy Decisions Remaining Which temporary telephoniccodes become permanent Clinical value of audio-onlyvs. audio-visual care delivery– Minimum in-personrequirement? Contractor/FFS pay parity forin-person vs. telehealthJoin Us:October 29th3-5pmVirtual meeting
AHCCCS Telehealth Resources AHCCCS Telehealth Policy – 320-I AHCCCS Medical Coding Resources– AHCCCS Telehealth Code Set– AHCCCS Telephonic Code Set (Temporary)– AHCCCS Telephonic Code Set (Permanent) COVID FAQs HHS Telehealth Notification Send your Coding Questions to CodingPolicyQuestions@azahcccs.gov
Questions?
AHCCCS. AHCCCS and Telehealth for the Public Health Emergency and Beyond. Shreyas Hallur. Research Intern. AHCCCS. Vikeen Patel, MD, MBA. Clinical Informatics Fellow. . Largest insurer in AZ, covering over 2 million individuals and families 50% of all births. 2/3 of nursing facility days.
