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Medicaid Telehealth Reimbursement Policy Changes
Submit Comments TODAY!

The Health and Human Services Commission has published for comment its draft of Medicaid Reimbursement Policy Changes to align with SB 670 (86R) related to telehealth and telemedicine. Changes to current HHSC policy are indicated by underlined text. 

Deadline to submit comments is TODAY – Monday, June 29, 2020.  

Send comments to List “Telehealth Policy Comments” in your email subject line.  

TCA suggests you focus comments on the following sections: 

Statement of Benefits, Subsection 3

  • Add language to require that MCOs provide HHSC with the methodology used to exclude a service from reimbursement thirty (30) days before the exclusion of such services takes effect and to make that information available to Medicaid providers and clients.

Rationale: SB 670 requires MCOs to use cost- and clinical- effectiveness to determine which telehealth services to cover. This language will provide HHSC with the data they need to provide effective oversight to ensure that MCOs use appropriate methodology and analysis to set reimbursement rates. It also requires MCOs to disclose that information to Medicaid providers and clients. 

Reimbursement, Section 38

  • Add language to prohibit MCOs from reimbursing telehealth services at a lower rate than face-to-face services. 

Rationale: Providers’ costs to operate their practices do not change whether they deliver face-to-face or telehealth sessions. Reimbursement rates should not be reduced either. Emergency rules currently require insurance providers to reimburse telehealth services at the same rate as face-to-face. These rules should be permanent. 

While TCA has submitted written comments, your action today will impact the decisions made by HHSC.  

They need to hear from YOU

For additional information contact