Colorado Expands Medicaid Telehealth Access

On July 6, 2020, the Colorado legislature passed Senate Bill (SB) 212 to expand access to Medicaid telehealth services. The bill expands Medicaid coverage for telehealth services to include reimbursement at parity with in-person services at rural health clinics (RHCs), federally qualified health centers (FQHCs), and the Indian Health Service facilities. The list of covered Medicaid telehealth services is expanded from health care and mental health care services to include speech therapy, physical therapy, occupational therapy, hospice care, home health care, and pediatric behavioral health care. Additionally, home health care provider organizations will be able manage telehealth services for Medicaid beneficiaries.

Mental health centers and addiction treatment centers are not listed among the provider organization types affected by the legislation. However, community mental health centers are among the types of provider organizations that are eligible to provide Medicaid fee schedule medical and other professional services for Colorado’s Medicaid program. Publicly funded telemedicine is covered for behavioral health provider organizations under the capitated behavioral health benefit administered by the Regional Accountable Entities (RAEs).

SB 212 also prohibits private payers from requiring an in-person exam before a physician can treat a new consumer via telehealth. Private payers cannot impose limitations on location, certification, or training as a condition of reimbursement. Additionally, SB 212 prohibits private payers from imposing any requirement or limitations on the use of HIPAA-compliant technologies to deliver telehealth.

The definition of telehealth was expanded from being synchronous (real-time) interaction-only between a consumer at an originating site and a health care professional located at a distant site to include remote monitoring technologies and store-and-forward transfers. Remote monitoring is defined as “the use of synchronous or asynchronous technologies to collect or monitor medical and other forms of health data for individuals at an originating site and electronically transmit that information to clinical professionals at a distant site so providers can assess, diagnose, consult, treat, educate, provide care management, suggest self-management, or make recommendations regarding a covered consumer’s health care.” The state will post data on telehealth use by August 6, 2020.

A link to the full text of “Colorado Senate Bill 212: Reimbursement For Telehealth Services” may be found in the OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/070620coSB212.htm.

A link to the full text of “Telehealth Utilization In Health First Colorado From July 1, 2019 Through May 16, 2020” may be found in the OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/072920cotelehealthstats.htm.

For more information, contact: Marc Williams, Public Information Officer, Colorado Department of Health Care Policy & Financing, 1570 Grant Street, Denver, Colorado 80203; 303- 866-2993; Fax: 303-866-2803; Email: marc.williams@state.co.us; Website: https://www.colorado.gov/pacific/hcpf/telemedicine.