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Florida Medicaid Update on PT/OT Telehealth Services

Provider Type(s): 81, 82, and 83

Telemedicine Guidance for Therapy Services and Early Intervention Services

The purpose of this alert is to provide guidance to providers on Florida Medicaid coverage of therapy services (occupational, physical, and speech-language pathology) and early intervention services via telemedicine during the 2019 novel coronavirus (COVID-19) state of emergency.

Telemedicine Definition

Telemedicine is the practice of health care delivery by a practitioner who is in a site other than the site where a recipient is located, using interactive telecommunications equipment that minimally includes real time, two-way interactive communication between a recipient and a practitioner using audio and video equipment. The Agency’s current telemedicine policy in the fee-for-service delivery system is available at: http://ahca.myflorida.com/medicaid/review/General/59G_1057_TELEMEDICINE.pdf.

Telemedicine Flexibilities During the State of Emergency

It is imperative that services continue for children in need of services. To ensure that Florida Medicaid providers can maintain continuity of care during the state of emergency, the Agency is expanding coverage of therapy services and early intervention services provided through telemedicine. These flexibilities apply to services provided through both the Statewide Medicaid Managed Care program and the fee-for-service delivery system when:

    • Services cannot be delivered because the provider office is closed (when services are delivered in an office setting) and in-home care or delivering services in an alternative location is not an option; or
    • The provider and/or the recipient meet one or more of the self-screening criteria for COVID19 in accordance with the Department of Health guidelines and services cannot be delivered in the home.

Therapy Services

Florida Medicaid will reimburse for evaluation, diagnostic, and treatment recommendations for services included on the respective therapy services fee schedule to the extent services can be delivered in a manner that is consistent with the standard of care and all service components designated in the American Medical Association’s Current Procedural Terminology and the Florida Medicaid coverage policy is provided. Providers must append the GT modifier to the procedure code in the fee-for-service delivery system.

Early Intervention Services

Florida Medicaid will reimburse for the delivery of early intervention sessions via telemedicine when performed by an eligible EIS provider (as defined in the Medicaid coverage policy) to provide family training designed to support the caregiver in the delivery of care. The provider must guide the caregiver in the implementation of certain components of the recipient’s individualized family support plan to promote carryover of treatment gains. Providers are required to ensure caregivers can perform the tasks. Services are covered, as described below:

Service

Procedure Code

Modifier

Limits

Early Intervention Individual Session: Family Training

T1027 SC

GT

Four 15-minute units per day

Provider Telemedicine Requirements (Applies to Therapy and EIS Providers)

Providers using telemedicine as a modality to deliver services must comply with the following:

    • Ensure services are medically necessary and performed in accordance with the service specific policy and fee schedule.
    • The recipient (and their legal guardian) must be present for the duration of the service provided using telemedicine.
    • Telemedicine should not be used by a provider if it may result in any reduction to the quality of care or if the service delivered through this modality could adversely impact the recipient.
    • Documentation regarding the use of telemedicine must be included in the progress notes for each encounter with a recipient. All other documentation requirements for the service must be met as described in the coverage policy.
    • Providers must comply with the Health Insurance Portability and Accountability Act (HIPAA) when providing services; all equipment and means of communication transmission must be HIPAA compliant.
    • Providers must assure that the recipient has compatible equipment and the necessary connectivity in order to send and receive uninterrupted video. Telephone or electronic-based contact with a Florida Medicaid recipient without a video component is not permitted.

Additional EIS Provider Telemedicine Requirements

Early intervention service providers using telemedicine as a modality to deliver services must also comply with the following:

    •  Providers may only utilize telemedicine for existing recipients receiving EIS.
    • Telemedicine services cannot be provided if another EIS provider is in the home on the same date of service.

Reimbursement

In the fee for service delivery system, Florida Medicaid reimburses at the same rate detailed on the respective fee schedule. Please contact the health plans directly to inquire about their telemedicine requirements and reimbursement rates.

Florida Medicaid does not reimburse for the acquisition, installation, and maintenance of telecommunication devices or systems.

Prior Authorization Requirements

Nothing in this alert relieves the provider of any existing prior authorization requirements that currently exist for therapy or early intervention services (in fee-for-service or managed care).

Reference

Florida Medicaid Health Care Alert

March 20, 2020

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