Medicaid (Apple Health)
New and updated CMS
The Washington State Health Care Authority has released guidance,
including CPT codes, to help address your questions on billing Apple
Health (Medicaid) fee-for-service programs and managed care
organizations for services including telehealth: Apple Health (Medicaid) clinical policy and billing for COVID-19. (Updated July 2022)
Note: The FAQ specifies that telemedicine needs to be
delivered via HIPAA-compliant communications; however, the federal
government announced that it has relaxed HIPAA rules for health care
providers using telehealth in response to COVID-19. See
COVID-19 Temporary Legal Changes.
Additional Medicaid telehealth reimbursement guidance and resources:
On April 30, 2020, CMS issued an interim final rule that builds on the
previous regulatory waivers and flexibilities issued on March 17, 2020
and March 30, 2020. These temporary waivers and flexibilities remove
barriers so health care systems and physicians can better respond to
the COVID-19 pandemic.
The Provider Page
HHS Telehealth Toolkit for Providers and Your Patients) contains comprehensive information on the telehealth waivers and
other flexibilities, including HIPAA, cost sharing, and more. It also
provides information on billing and reimbursement, legal
considerations, planning your telehealth workflow, and how to prepare
your patients for telehealth.
Of note: The HHS Office of Inspector General notified
physicians and other practitioners that they will not be subject to
sanctions for reducing or waiving any cost-sharing obligations that
beneficiaries may owe for telehealth services (March 17, 2020).
Additional Medicare telehealth reimbursement guidance and resources:
The Washington State Office of the Insurance Commissioner issued an
on March 5, 2020, indicating that a carrier cannot deny telehealth
reimbursement for use of a non-traditionally HIPAA-compliant platform.
The Washington State Department of Labor and Industries has announced
a temporary telehealth policy. This policy will allow physicians and health care providers to
treat injured workers from their homes with the goal of supporting the
containment of COVID-19.
Read the policy in full. (March 10, 2020)
The U.S. Department of Health and Human Services, through the Health
Resources and Services Administration, launched a new COVID-19
Uninsured Program Portal, allowing physicians and providers who have
conducted COVID-19 testing or provided treatment for uninsured
COVID-19 individuals on or after Feb. 4, 2020 to submit claims for
reimbursement. Access the portal at
COVIDUninsuredClaim.HRSA.gov. The reimbursement was established as part of the federal
Coronavirus Aid, Relief, and Economic Security (CARES) Act.