The California Department of Health Care Services has updated its telehealth and mHealth coverage policy, providing residents and providers new opportunities to embrace the advancement in connected healthcare. 

The notice of the change became official in July but was publicly announced earlier this month. Overseeing the Medi-Cal program as well as several managed care plans, the CDHCS outlined three major changes to the coverage guidelines:

  • Healthcare providers can choose what type of telemedicine modality (real-time audio-visual or asynchronous [store-and-forward]), meeting the Medi-Cal guidelines, can be delivered via telemedicine technology, conforming to the appropriate CPT or HCPCS code. Asynchronous consultations initiated by the patient, including through mHealth apps, do not qualify for reimbursement. 

  • An originating site for a telehealth service is defined to explicitly include the home, with leeway included for other non-traditional settings, no longer requiring a care provider be physically with the patient during telehealth usage.

  • eConsults are now included as an asynchronous telehealth service, with specific requirements care providers must meet to qualify for reimbursement.

Additionally, the Department has finalized a policy that leaves it up to the distant site provider as to whether the interaction should take place via live video, store-and-forward or in-person, based on the provider’s belief it is clinically appropriate due to evidence-based medicine and best practices. All benefits or services are covered under Medi-Cal, including any Treatment Authorization Request (TAR) requirements. 

For the telehealth delivered service to be eligible for Medi-Cal reimbursement, it must:

  • Be a service Medi-Cal reimburses for in general;

  • The service meets the general definition and components of the CPT or HCPCS code used;

  • All laws regarding confidentiality of healthcare information and patient’s rights to medical information are met.

The Center for Connected Health Policy (CCHP) has created a chart, along with a fact sheet, to describe the new guidelines in more detail.

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