The Michigan Department of Health and Human Services (MDHHS) will rescind certain COVID-19 telemedicine flexibilities beginning May 12, 2023, with the conclusion of the federal health public health emergency. Policy MMP 23-10 outlines flexibilities that will remain permanent and which flexibilities will be rescinded. Notable permanent flexibilities include:
Reimbursement: The telemedicine reimbursement rate for allowable services will be the same as the in-person reimbursement rate. Providers must report the place of service as they would if they were providing the service in-person.
Audio-Only: Audio-only services will be allowed for the procedure codes CPT/HCPCS 99441-99443 and 98955-98968. The MDHHS will create an audio-only database for providers to reference.
Prior Authorizations: There are no prior authorization (PA) requirements when providing telemedicine services for fee-for-service beneficiaries or those accessing behavioral health services through prepaid inpatient health plans/community mental health services programs unless the equivalent in-person service requires a PA. The PA requirements for Medicaid health plans (MHP) may vary and providers should refer to individual MHPs for any PA requirements.
MSA 20-09 General Telemedicine Policy Changes will be permanent and remain effective with the Facility Rate subsection redacted.
MSA 21-24 Asynchronous Telemedicine Services will be permanent and remain effect.
The Legislature returned the week of Sept.19 to continue work on several pieces of legislation that the MHA is currently monitoring. Committees met in both the House and Senate, taking up legislation that included several new bills supported by the MHA in the areas of behavioral health, rural emergency hospitals, speech-language pathologist licensure and telemedicine.
In the House Health Policy Committee, initial testimony was taken on new legislation to make changes to the preadmission screening process for behavioral health patients. House Bill (HB 6355), introduced by Rep. Graham Filler (R-St. Johns) and supported by the MHA, would memorialize the requirement for preadmission screening units operated by the Community Mental Health (CMH) services program to provide a mental health assessment within three hours of being notified by a hospital of the patient’s need. If a preadmission screening unit is unable to perform the assessment within the three-hour time frame, HB 6355 would also allow for a clinically qualified individual at a hospital who is available to perform the required assessment.
Kathy Dollard, psychologist and director of behavioral health for MyMichigan Health, joined the committee to testify in support of HB 6355. “Strengthening our behavioral health system includes strengthening our behavioral health workforce and that can start with creative solutions like providing clinically qualified hospital personnel the ability to conduct pre-admission screenings,” said Dollard. No votes were held on HB 6355 at this initial hearing.
MHA staff also provided testimony during committee on HB 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of “Rural Emergency Hospital” (REH) status. A REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to a REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas.
Lauren LaPine, director of small and rural hospital programs, MHA, and Elizabeth Kutter, senior director of advocacy, MHA, testified in support of the legislation. “HB 6380 provides rural hospitals in our state with the ability to continue providing care in our most rural communities,” said LaPine. No votes were taken on HB 6380.
Initial testimony on two bills that were previously reviewed by MHA’s Legislative Policy Panel also occurred during committee. Senate Bill (SB) 811, introduced by Sen. Curt VanderWall (R-Ludington), would extend the length of time for an individual to complete a temporary Speech-Language Pathologist license and extend the length of time those temporary licenses are valid. The MHA is supportive of SB 811, which did not see any votes this week.
House committee members also took initial testimony on SB 450, which would ensure that visitors of cognitively impaired patients are permitted in healthcare facilities. Introduced by Sen. Jim Stamas (R-Midland), the bill would prohibit the director of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.
The Senate Health and Human Services Committee took initial testimony on SB 1135, which was introduced by Sen. Mike MacDonald (R-Macomb Township). SB 1135 would specify that previous expansions to Medicaid telemedicine coverage also apply to the Healthy Michigan Program and Michigan’s medical assistance program. Most notably, the legislation would require continued coverage for audio-only telemedicine services. The MHA is supportive of SB 1135, which would continue virtual care policies that have proved to be effective and safe during the COVID-19 pandemic.
In the Senate’s Regulatory Reform Committee, testimony was taken on another MHA-supported bill to regulate the sale of kratom in Michigan. Kratom is a substance of concern with opiate-like effects that has no approved medical use in the United States. HB 5477, introduced by Rep. Lori Stone (D-Warren), would create a license for kratom sales and manufacturing, require testing of products and require new safety warnings on kratom substances sold in Michigan. While the MHA prefers a federal Schedule I ban of the drug, the association is supportive of HB 5477, which will help limit adolescent addiction and prevent adulterated products from being on the market.
Members with questions on these bills or any other state legislation should contact Adam Carlson at the MHA.
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The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy to update Medicaid coverage of telemedicine services after the conclusion of the federal COVID-19 public health emergency (PHE). The policy outlines several updates, including:
Making permanent policies established during the PHE through bulletins MSA 20-09 (General Telemedicine Policy Changes) and MSA 21-24 (Asynchronous telemedicine services). MSA 20-09 requires either direct or indirect patient consent for all telemedicine services and defines originating and distant sites. MSA 21-24 clarifies Medicaid coverage for asynchronous telemedicine services, including store and forward services, remote patient monitoring and interprofessional consultations.
Not requiring prior authorization unless the equivalent in-person service requires prior authorization. Authorization requirements for Medicaid health plans may vary.
Establishing payment rates for allowable telemedicine services at the same level as in-person services. To effectuate this policy, the provider must report the place of service as they would if they were providing the service in-person, along with modifier 95 – Synchronous Telemedicine Service. *MDHHS varies from Medicare telehealth billing by not using place of service 02 or 10 but aligns in the use of modifier 95.
Allowing audio-only telemedicine services only for select situations where the beneficiary does not have access to audio/visual capabilities. These codes are currently represented as CPT codes 99441-99443 and 98966-98968.
The fiscal year (FY) 2023 state budget bills were approved by the Michigan Legislature July 1. House Bill (HB) 5783 and Senate Bill (SB) 845, which provide for the FY 2023 budget, now go to the governor’s desk for final review and signature into law.
In a statement released July 1, MHA CEO Brian Peters said, “The fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.”
These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals that treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates, all of which support access to healthcare services in rural areas. Each of these areas are instrumental in keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.
The budget also supports MHA and hospital priorities with new funding to improve and enhance state behavioral health facility capacity and address the healthcare workforce. Michigan lacks adequate capacity to treat patients with behavioral and mental illness, and this new funding is an important and necessary step to address the shortage. The investment of state funds to expand access to Bachelor of Science in nursing degree programs at the state’s community colleges is a significant movement toward replenishing Michigan’s healthcare talent pipeline.
In other action, the House of Representatives supported legislation to create an opt-out grant program for hospitals to establish medication-assisted treatment (MAT) for substance use disorders in their emergency departments. SB 579, introduced by Sen. Curt VanderWall (R-Ludington), now returns to the Senate for a final concurrence vote before it is sent for the governor’s signature. Hospitals provided MAT programs prior to introduction of the bill, and the MHA has already partnered with the Michigan Department of Health and Human Services (MDHHS) to implement the first round of grants provided under this legislation. No hospitals would be required to participate in the program.
The full Senate advanced to the House of Representatives a bill to register certain medical laboratories in Michigan. SB 812, also introduced by VanderWall, would create a registry for interventional pain management, kidney access and vascular laboratories. As currently written, SB 812 would not provide any form of oversight or clinical requirements for the registered labs, and the MDHHS would not have authority to deny or remove registered labs from the list. The MHA has not taken a position on the bill but is closely monitoring any changes.
Finally, a bill related to telemedicine was introduced in the Senate. SB 1135, introduced by Sen. Mike MacDonald (R-Macomb Township), would amend the state’s Social Welfare Act to ensure that recent expansions in telehealth visit coverage also apply to the Medicaid Medical Assistance Program and Healthy Michigan Program. The bill would specify that recipients are covered equally for telehealth visits, expand the “distant site” definition, and ensure that providers are reimbursed at an equal rate to in-person services. The MHA is reviewing the legislation and has not yet taken a position on the bill. The association will keep members apprised of future action.
Members with questions on state legislation related to healthcare should contact Adam Carlson at the MHA.
Significant changes were recently made to the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) regarding regulatory standards of telemedicine because of the COVID-19 pandemic. These standards, along with 1135 telemedicine waivers and new tag numbers assigned for critical access hospitals in 2020 and 2021, have impacted how medical staff must document services provided to patients.
The MHA Health Foundation webinar CMS CoPs and The Joint Commission Standards, Credentialing and Privileging will review regulations and CMS interpretive guidelines that are part of hospital CoPs on telemedicine credentialing, what hospitals must include in telemedicine contracts to maintain compliance, and more.
The webinar is scheduled from 10 a.m. to noon March 22. MHA members can register for a connection fee of $200. Members with questions should contact Erica Leyko at the MHA.
The Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) recently made significant changes to regulatory standards of telemedicine because of the COVID-19 pandemic. These standards, along with 1135 telemedicine waivers and new tag numbers for critical access hospitals will be reviewed in The MHA Health Foundation webinar CMS Hospital CoPs and TJC Telemedicine Standards, Credentialing and Privileging as well as CMS interpretive guidelines that are part of hospital CoPs telemedicine credentialing.
Members can register for a $200 connection fee. Members with questions should contact Erica Leyko at the MHA.
In November 2019, the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation made significant changes to the transparency bill, discharge planning and hospital improvement rule related to medical staff. More than 2,180 deficiencies were identified by the CMS related to the medical staff section, demonstrating the level of misunderstanding of the rules.
CMS has also recently made several changes to regulatory standards of telemedicine during the COVID-19 pandemic. These standards, along with 1135 telemedicine waivers, and new tag numbers for critical access hospitals in 2020 and 2021, have impacted how medical staff must document services provided to patients.
The MHA webinar series on leadership approaches to assist with post-pandemic strategic planning continues June 3 from noon to 1 p.m. with the webinar titled Diversity and Inclusion featuring Kim Blue, the global head of People Experience Partners at Zoom. Blue will describe how to create and execute organizational diversity and inclusion strategies based on her experience with Zoom, ESPN and Microsoft. Whether she is consulting one-on-one or leading training for hundreds of people, Blue coaches people to step beyond the shore of diversity and really explore the ocean that is inclusion.
On April 29, the series kicks-off with the webinar Technology Post-COVID-19: Technology, Telemedicine, Hospital at Home and Expansion of Technology, and the series continues through August with future topics on supply chain, resilience and emotional well-being, and rural healthcare delivery. Each session will be held from noon to 1 p.m. By attending the webinar series offered by the MHA, participants may earn up to one ACHE Qualified Education Hour per session toward initial certification or recertification of the Fellow of the American College of Healthcare Executives (FACHE) designation.
Members can register for a single webinar for $50 or all five webinars at a discounted rate of $200. A health system can register for an unlimited number of logins for a single webinar for a flat-rate fee of $200 or register for an unlimited number of logins for all five webinars at a flat-rate fee of $750. Questions about the webinar series should be directed to Erin Steward at the MHA.