COVID-19 & Mental Health
Ohio Department of Insurance
Issued a bulletin that specified the following regarding telehealth:
- Insurers that provide coverage for services delivered via telemedicine are expected to provide such coverage for COVID-19 testing and treatment
- Requests that issuers comply early with telehealth law scheduled to take effect 1/2021 that prohibits denials of a service just because it was delivered through telehealth and requires telehealth to be covered "on the same basis and to the same extent."
Ohio Department of Health
Issued a director's order regarding health screening for admission to state psychiatric facilities and youth service facilities. Potential psychiatric admittees and youth services admittees:
- Must be screened for COVID-19 prior to admission
- Answer questions about exposure
- Will be refused admittance if meeting criteria and do not have negative COVID-19 test results
- Must have medical clearance attestation from physician stating negative results within prior 48 hours
- Presumably, positive test allows disallows admission
Ohio Department of Mental Health and Addiction services
Issued emergency order to reduce restrictions on telemedicine
- In partnership with the Ohio Department of Medicaid, Director Criss announced emergency orders that reduce restrictions on telehealth, ensuring that every Ohioan has access to behavioral health Care via telehealth services by landline or cell phone.
State Medical Board of Ohio
Effective March 9, 2020 until Executive Order 2020-01D expires, providers can use telemedicine in place of in- person visits, without enforcement from SMBO. This includes, but is not limited to:
- Prescribing controlled substances
- Prescribing for subacute and chronic pain
- Prescribing to patients not seen by the provider
- Pain management
- Medical marijuana recommendations and renewals
- Office-based treatment for opioid addiction
Providers must document their use of telemedicine and meet minimal standards of care. The Medical Board will provide advance notice before resuming enforcement of the above regulation when the state emergency orders are lifted.
Emergency Licensure: The Medical Board will partner with the Ohio Emergency Management Agency (EMA) or other necessary government entity if the need arises to temporarily license out-of-state physicians and physician assistants.
The Department of Health (ODH) issued an order specifying the following:
- All adult day support or vocational habilitation services for those with IDD cannot be provided in a congregate setting with more than 10 people
- This does not apply to residential settings
ODH issued an order specifying the following regarding nursing homes and similar facilities:
- No visitors shall be admitted except for end-of-life situations
- Personnel may only be admitted after being screened for COVID-19 each time they attempt to enter
- Points of access to each facility should be limited to as few as possible
- Access will be granted only to those with official state or federal identification
The Ohio Department of Medicaid (ODM) issued an emergency rule specifying the following about telehealth:
- No limitations on location of originating or distant site
- Broadened definition of telehealth to include phone, fax, and email
- Broadened type of providers who may be reimbursed for telehealth (no apparent scope expansion)
- Providers may use telehealth technologies that do not fully comply with HIPAA specifications
- Providers should still try to obtain and review medical records to the greatest extent possible
- Originating and distant sites should be "consistent with" CPT and HCPCS guidelines for services delivered
- Initial visit face-to-face encounter requirement is suspended
- Services performed by a resident outside of a teaching facility are permitted
- Assertive community treatment (ACT) may bill for telephone only and secure video transmission service delivery
- Intensive home-based treatment may bill for telephone only and secure video transmission service delivery
- Therapeutic behavioral services and psychosocial rehabilitation may be reimbursed through telehealth
- Behavioral health crisis intervention may be provided through telehealth
- Peer support may be delivered through telehealth if the facility can demonstrate that initiation of peer support in person occurred before the COVID-19 emergency
- Practitioners may bill for an originating fee and an E&M fee on the same day
- Reimbursement for telehealth Medicaid services are allowed even if they are otherwise payable under the Medicaid school program
- The face-to-face requirement for FQHCs and rural health centers is waived
ODH issued an order that closes all adult day care services and senior centers. The order does specify that these facilities may still provide non-congregate services in the community to assist seniors but does not specify what that may entail.
The Board of Pharmacy is authorizing the delegation to an Ohio-licensed APRN who is designated as a certified nurse practitioner (CNP), clinical nurse specialist (CNS), certified nurse midwife (CNM) or physician assistant (PA) the management of a pharmacist consult agreement. The delegation authorized in this resolution is limited to consult agreements in hospitals (inpatient/ambulatory) and other institutional facilities.
CMS Approve 1135 Waiver for Ohio:
- Temporarily suspends Medicaid FFS prior authorization.
- Extends pre-existing authorizations
- Suspends pre-admission screening and annual resident review (PASRR) level I and II assessments for 30 days. After 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources are available.
- May enroll providers who are enrolled in another State Medicaid Agency or Medicare.
- Allows for billing in alternative settings for patients in psychiatric residential treatment facilities
- Temporarily allows service provided under certain state waiver programs to be provided in settings that have not been determined to meet the home and community-based settings criteria.
SAMHSA has announced grants awarded for enhanced mental health and substance abuse treatment during the emergency.