Issue #23-05

The purpose of this Alert is to inform SSHSP providers of the SSHSP Medicaid policy for the continued provision of telehealth services, including the use of audio-only technology after the COVID-19 public health emergency, which officially ends on May 11, 2023. However, guidance issued in Medicaid Alert 20-02 and Addendum will continue to be in force for services rendered until July 1, 2023.

Effective for services rendered on and after July 1st of 2023 the SSHSP guidance issued in Medicaid Alert 20-02 and Addendum, https://www.oms.nysed.gov/medicaid/medicaid_alerts/alerts_2020/20_02_Addendum.html, will expire and be replaced by this Alert.

New York State Medicaid SSHSP will continue to reimburse telehealth services provided to Medicaid eligible students with a current IEP when appropriate, and when such student and their legally responsible caregiver chooses to receive telehealth services in lieu of an in-person visit. Telehealth visits must contain all elements of the billable procedure codes or rate codes and all required documentation.

Audio-only services will continue to be covered when audio-visual services are not available or when the member chooses audio-only services in lieu of audio-visual telehealth or an in-person visit. Audio-only visits must contain all elements of the billable procedure codes or rate codes and all required documentation. Providers must document the reason in the service documentation that audio-only services were used for each audio-only encounter.

Written consent by the NYS Medicaid member is not required, but the provider must document informed consent before or during the first visit in which telehealth services are provided. Telehealth sessions/services shall not be recorded without the consent of the member.

Informed consent means that telehealth practitioners provide members with sufficient information and education about telehealth to assist them in making an informed choice to receive telehealth services. This must include the following:

1. The telehealth provider must confirm that the NYS Medicaid member is aware of the potential advantages and disadvantages of telehealth, be given the option of not participating in telehealth services and information regarding their right to request a change in service delivery mode at any time.
2. The telehealth provider must inform NYS Medicaid members that they will not be denied services if they do not consent to telehealth devices or request to receive services in-person.
3. Where the NYS Medicaid member is a minor, consent shall also be provided by the parent/guardian or other person who has legal authority to consent to health care on behalf of the minor.

The existing approved set of Medicaid-reimbursable SSHSP services will continue to be reimbursed under current rates when delivered through:

• Two-way audio/video communication.
• Video, including technology commonly available on smart phones and other devices; and/or
• Telephonic communication (to the extent the service can reasonably be delivered over the phone).

All SSHSP Medicaid qualified providers who are authorized to provide in-person services, are authorized to provide such services via telehealth if such telehealth services are appropriate to meet the needs of the student and are within the scope of practice of the provider.

Medicaid may be billed for services delivered in person or via telehealth, including telephonically, provided in accordance with the IEP and written order/referral. Procedure code modifier '95' should be reported on SSHSP claims for services delivered via telephonic/telehealth. IEPs, written orders, and referrals to support Medicaid claiming do not need to be amended to indicate telehealth delivery. Please see guidance issued by the NYS Education Department Office of Special Education for additional information regarding the provision of services to students with disabilities, Provision of Services to Students with Disabilities During Statewide School Closures Due to Novel Coronavirus (COVID-19) Outbreak in New York State.

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or at SSHSP@health.ny.gov, the NYS Education Department, Medicaid Unit at medined@nysed.gov.