03/17/2025

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Extensions of Telehealth Access Options

The Federal government took a range of steps to expedite the adoption and awareness of telehealth. Some of the telehealth flexibilities have been made permanent while others are temporary. Telehealth policies allow:

• Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through September 30, 2025.
• There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through September 30, 2025.
• Telehealth services can be provided by all eligible Medicare providers through September 30, 2025.
• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as Medicare distant site providers for non-behavioral/mental telehealth services through September 30, 2025. For an encounter furnished using interactive, real-time, audio and video telecommunications technology or for certain audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology services, payment to RHCs and FQHCs are subject to the national average payment rates for comparable services under the physician fee schedule (PFS) through December 31, 2025.
• An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, is not required through September 30, 2025. For FQHCs and RHCs, the in-person visit requirement for mental health services furnished via communication technology to beneficiaries in their homes is not required until January 1, 2026.
• Non-behavioral/mental telehealth services in Medicare can be delivered using audio-only communication platforms through September 30, 2025. Interactive telecommunications system may also permanently include two-way, real-time audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system, but the patient is not capable of, or does not consent to, the use of video technology.

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Inpatient Admissions Criteria
HAP Criteria for Inpatient Admissions and HAP Clinical Surgical Criteria can now be found in our Benefit Admin Manual. Just log in at hap.org:

• Select More
• Select Benefit Admin Manual
• Search for:
  
  • HAP Criterial for Inpatient Admissions
  • HAP Clinical Surgical Criteria

Update - Payment of Observation Hospital Stays
February 13, 2025

In January, we advised that effective May 1, 2025, HAP will deny all services when the date(s) of services exceeds the 48-hour observation stay date range. Services include, but are not limited to labs, X-rays, pharmacy, etc.

This policy will not be implemented at this time.

Keep Provider Information Updated in NPPES
It’s important to ensure your data in the National Plan & Provider Enumeration System (NPPES) is accurate. The Centers for Medicare & Medicaid Services (CMS) is encouraging health plans to use NPPES as a resource for online provider directories. By using NPPES database for provider directories, we could decrease the frequency we contact you for this information.

To verify your information, log in at the NPPES website. When reviewing, pay close attention to:

• Provider name
• Mailing address
• Telephone and fax numbers
• Specialty
• Taxonomy

Be sure to remove any practice locations no longer in use and only include addresses where:

• You practice
• You actively see patients
• Patients can call and make an appointment

Reminder! You can submit demographic updates directly to HAP via our Provider Change Form.