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Cross-agency Telehealth Guidance

On March 6, 2020, Governor Wolf issued an emergency disaster declaration, in response to the
presence of the novel coronavirus (COVID-19) in Pennsylvania. The issuance of this disaster declaration
has allowed the Wolf Administration to identify regulations and requirements that can be temporarily
waived or suspended to allow for the flexibility needed to respond to this crisis.

Given the potential for widespread transmission of COVID-19 across Pennsylvania, many health care
providers and patients are considering the expanded use of telehealth rather than in-person health care
services to limit the spread of the virus. Therefore, the Administration has taken a number of steps to
ensure that patients in need of these vital services are receiving them in a timely, appropriate manner.

Expanded Role of Providers

Governor Wolf granted the Department of State authority to allow health care professionals from out-
of-state to treat Pennsylvania residents using telehealth, when appropriate, due to COVID-19. This new
guidance applies to the following boards:

o Chiropractic
o Dentistry
o Medicine
o Nursing
o Optometry
o Pharmacy
o Podiatry
o Psychology
o Osteopathic Medicine
o Nursing Home Administrators
o Occupational Therapy Education and Licensure
o Physical Therapy
o Social Workers, Marriage and Family Therapists, and Professional Counselors
o Examiners in Speech-Language Pathology and Audiology
o Veterinary Medicine

Additionally, the Department of State is working with the Governor’s Office, the Department of Health,
and the Department of Human Services to identify regulations and requirements that can be waived to
give medical providers and facilities the flexibility essential to respond to this crisis. These will be
published on the Department of State website as they become available. We encourage providers and
insurers to check these updates frequently.

Governor Wolf also granted the Department of State’s request for a waiver to allow licensed
practitioners in other states to provide services to Pennsylvanians via the use of telehealth without
obtaining a Pennsylvania license, for the duration of the emergency. Out-of-state practitioners must
meet certain criteria before being granted this authorization.

Although authorization to engage in telehealth from a professional licensing standpoint is separate and
apart from any insurance coverage or payment issue that falls under the Department of Health, the
Department of Human Services, the Insurance Department, or any other state or federal agency, the

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Administration has taken several proactive steps to address access and affordability issues so that
Pennsylvanians are able to get the care they need.

Expanding Reimbursement for Telehealth Services

Pennsylvania Medical Assistance (Medicaid)

On March 20, 2020, the Office of Medical Assistance Programs (OMAP) issued telehealth guidelines and
on March 24, 2020, updated a set of FAQs outlining Medical Assistance (MA) Program coverage of
COVID-19 testing and related services. This FAQ also provides pertinent information for out-of-state
providers who would like to enroll in the MA Program. Guidelines on telehealth for CHIP can also be
found in the CHIP FAQs that were issued on March 27, 2020.

The guidance advises providers that telehealth may be used to provide services to MA fee-for-service
beneficiaries and Physical HealthChoices Managed Care Organization (MCO) members. There is no
requirement for a physician or other healthcare professional to be physically present at the originating
site, where the member is located, and telehealth services may be provided by any means that allows
for two-way, real-time interactive communication, such as through audio-video (A/V) conferencing
hosted by a secure mobile application.

Given the Governor’s emergency disaster declaration and the CDC’s recommendations related to
quarantine and isolation, OMAP announced in its telehealth guidelines a preference for use of telehealth
as a delivery method for medically necessary healthcare services, and explained that telephone only
services may be used where video technology is not available. Telehealth services will be paid at the
same rate as if they were delivered in person. For specific coverage information, please contact the MA
fee-for-service program, or your MCO if you are enrolled in Physical HealthChoices. This contact
information can be found at the bottom of the FAQ.

Pennsylvania Insurance Department (PID)

The Pennsylvania Insurance Department issued Notice 2020-03, setting forth the Insurance
Department’s expectations that, among other things, health insurance carriers in the Commonwealth
would make telehealth services more widely available. That provision recognizes the communicable
nature of COVID-19 and advocates for the use of telehealth to stem the rapid spread of COVID-19 while
still allowing members to access vital treatment. Those services include all health care services, not only
those specific to the evaluation and diagnosis of COVID-19. The Insurance Department asks that insurers
review their respective participating telehealth service provider agreements, provide coverage of costs
related to telehealth services, and be prepared to meet any increased demand for that means of
delivery.

Telehealth for Infant Toddler Early Intervention Procedures

On March 21, 2020, the Office of Child Development and Early Learning issued guidance for the use of
tele-intervention for Early Intervention services while face-to-face interactions are limited during the
COVID-19 pandemic.

The term tele-intervention is being used to describe Early Intervention services that are being provided
using audio/video technology and where that technology is not available, the use of a telephone. Tele-
intervention for the purpose of Early Intervention services are services consistent with and by the

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provider types that are identified in the OMAP telehealth guidelines, where they are referred to as tele-
medicine. The provider types identified in that document are those for physical therapy, occupational
therapy and speech therapy. In addition, tele-intervention can also be used by Early Intervention
services provided by all special instruction provider types, and state or maintenance funded
occupational, speech and physical therapy.

Telehealth for Behavioral Health

Recognizing the importance of the continued delivery of behavioral health care during this difficult time,
the Administration has taken special steps to ensure that behavioral health services will continue to be
delivered to Pennsylvanians, including through telehealth.

Department of Human Services Actions

The Office of Mental Health and Substance Use Disorder (OMHSAS) issued telehealth guidelines related
to COVID-19. OMHSAS has temporarily suspended certain requirements for providing behavioral health
services via telehealth. Changes to existing telehealth regulations include:

• Staff may deliver telehealth services via telephonic and video communication application such
as FaceTime or Skype available on smart phones, and through telephonic only devices when
video technology is not available;
• Telehealth services may be provided in the home and without provider staff being physically
present with the individual receiving services;
• Practitioner types who can provide telehealth services is expanded beyond what is typically
permitted;
• Both Behavioral HealthChoices and fee-for-service providers may bill for telehealth;
• Typical face-to-face contact percentages may be met with the use of telehealth;
• Programmatic limits for the amount of service that may be provided through telehealth are
temporarily suspended.

Providers that are currently approved to provide services through telehealth technology may
immediately begin to implement the expanded use of telehealth. Providers that are not currently
approved to provide services through telehealth technology may immediately begin to implement the
use of telehealth. Additional information can be found in the OMHSAS telehealth guidelines.

Pennsylvania Insurance Department Actions

It is the Insurance Department’s expectation that expanded telehealth access be made available for all
services, whether medical/surgical or behavioral health. Thus, all insurers should make telehealth
behavioral health services available to their insureds with as few barriers as possible. PID further expects
that this flexibility will extend to all types of licensed professions. PID recognizes that many insurers use
behavioral health vendors; the insurers are expected to work with their vendors to update their systems
and processes as needed so as to avoid barriers to telehealth access.

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Department of Drug and Alcohol Programs Actions

The Department of Drug and Alcohol Programs (DDAP) granted Single County Authorities the ability to
use grant funds they have received from DDAP for outpatient substance use disorder treatment facilities
to provide counseling and other clinical services using telehealth technology. Substance use disorder
counselors who meet the qualifications listed under 28 Pa. Code § 704.7(b) are able to provide
telehealth in licensed drug and alcohol outpatient clinics. The guidance can be found here. DDAP also
issued two licensing alerts specific to narcotic treatment programs (NTPs). These alerts temporarily
suspend the regulation requiring NTPs to make face-to-face determination prior to beginning
buprenorphine treatment, as well as the regulation requiring on-site NTP physician services.

In addition, DDAP released a policy bulletin that allows providers who have a grant agreement with
DDAP to provide outpatient problem gambling services to use those grant funds to provide assessments
and outpatient counseling for clients using telehealth.

Additional information, including DDAP clarification on federal and state SUD confidentiality concerns
when using telehealth and DEA clarification on teleprescribing controlled substances (e.g. methadone,
buprenorphine) during a public health emergency can be found here and here, respectively.

Additional Resources

Please continue to review the Pennsylvania Department of Health and CDC websites for the most up to
date information on COVID-19.

Additional telehealth resources are available at:

PA Department of State List of Professional Licensing Waivers: https://www.dos.pa.gov/Pages/COVID-


19-Waivers.aspx

CMS/CCIIO webpage: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs#COVID-19

FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in
Response to Coronavirus Disease 2019 (COVID-19): https://www.cms.gov/files/document/faqs-
telehealth-covid-19.pdf

Department of Drug and Alcohol Programs COVID-19 page:


https://www.ddap.pa.gov/Get%20Help%20Now/Pages/Coronavirus.aspx

United States Department of Health and Human Services non-enforcement policy:


https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-
enforcement-discretion-telehealth/index.html

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