Clarifying Information on Telepractice

Kathleen DeLapp-Cohen, MSHA Past-President, has been working hard to keep her own practice and MSHA updated on COVID-19 and Telepractice.

Hi All,

I wanted to email this morning so we can continue passing information along to our MSHA members, co-workers, and administrators.  With information constantly changing and evolving, misinterpretations and rumors are running rapid.  Our private practices in the state with all 3 disciplines are hurting and scrambling.

Below are the 3 main topics of phone calls that we are fielding.  We are constantly contacting ATA, C-TEL, CCHP (Center for Connected Health Policy) and others trying to get answers to questions that we are unsure of.

1. President Trump announced that penalties for violating HIPAA will not be enforced which allows the flexibility for practitioner to communicate with their patients through telehealth.  What does this mean? 

It means that providers do not have to have a BAA platform and can use means such as Facetime, Skype, and other free or lower cost platforms. It does NOT mean meeting with patients/clients via telepractice in your living room with your family around and kids jumping around in the background.  It is the responsibility of the clinician to keep that student's or patient's session and information private, just like you would if they were in-person.  Remember also to "lock" your meetings, on whatever platform you are using, so people that you don't know won't “come in”. (check with your platform providers on how to do this). Continue to practice the most compliant, privacy policy that you can to protect your patients and students. This has not changed.

(Note:  We have a BAA and as we continued to work and meet this week, some of us have had a few messages pop up on our screen that someone, we don't know the name, is waiting in our virtual waiting room. This has never happened to us before.  Our rep told me it is probably just the "wrong number"  and with the millions of people that are meeting like this now, someone just accidentally entered the wrong URL when they wanted another.  (Just like at home, don't answer the door to strangers!)

2. Medicare is NOT now allowing teletherapy services by ST, OT, PT. 

We have never been providers, and even at this time, Medicare's hands are tied legally and can't allow ST, PT, OT teletherapy unless Congress passes a bill.  While the categories of practitioners were broadened and mentioned SLPs, Medicare only allows SLPs to do e-visits which are not considered teletherapy. These e-visits have to be conducted on a secure online patient portal  (hospitals and rehab facilities), and the patient would need to be the one to initiate contact and we would only be allowed to troubleshoot problems with them. We are not allowed to do treatment. There are 3 G codes that can be used, but you are limited in how often you use the G code. Again, it is allowing us to "check-in" with patients, but they have to be the ones to initiate it.

3. Private Practice- Yes, we can bill private insurance for all 3 disciplines for delivering telehealth services. 

We are a parity state with the telehealth legislation passed in the 63rd legislation session in 2013 and became effective January 1, 2014.  It specifically listed PT, OT, and ST as providers.  What this means is that if a patient qualifies for in-person services and a private insurance plan will pay for that service, then that plan has to pay for services via teletherapy.

4. Montana Medicaid- the restrictions that were lifted were mainly the geographical restriction which stated that some providers (MDs and other “essential” providers) could not see patient that were in close vicinity to them (same county).  It did not add other providers that weren't already approved. 

****Medicaid pays for ST delivered by teletherapy. 

****PT passed legislation, and it was just waiting to get in the Medicaid books as Tele-Providers yet, and unfortunately isn't payable yet (per Medicaid).

****OTs do not have any legislation at all and they are NOT approved for Medicaid reimbursement for telehealth delivery. Yes, this holds true for Medicaid services in the schools as well.

Take Care of yourselves and your families- we will all get through this difficult time!

Kathleen