E-Consult POLICY: STATE

State telehealth policy impacts the spread of e-consult for the safety net, as states have wide latitude to regulate Medicaid. Ensuring adoption and sustainability of e-consult programs for underserved patient populations to improve access to cost-effective, quality specialty care requires clear and robust state-level Medicaid policy. The E-Consult Workgroup includes payers, providers and patient advocates from across the country that collaborate on policy changes to reach this goal.

Reimbursement and Coverage

CMS response to California 1135 Waiver COVID-19 031620 (3/23/20) CMS currently granted Medi-Cal flexibilities relevant to e-consult include temporary enrollment of providers enrolled in other states’ Medicaid or Medicare agencies as well as reimbursement for their services. In addition, facilities that render services to an unlicensed facility will also be fully reimbursed which enables service provision in alternative settings.

COVID-19 Call-to-Action Letter to Governor Newsom (3/20) This letter requests that Governor Newsom use his emergency powers to direct the Department of Insurance and the California Health and Human Services Agency (CHHS) to promote e-consult use. Recommendations include waiving provider licensing requirements, passing and funding AB 2164 to assist community health networks’ implementation of e-consult and telehealth and ensuring that DHCS include e-consult CPT codes in its implementation of the 1135 waiver proposal.

California 1135 Waiver COVID-19 031620 (3/20) California’s Department of Health Care Services and the office of Governor Newsom have submitted request for section 1135 waiver flexibilities to address the emergency and public health needs that are being impacted by COVID-19.

Medi-Cal Telehealth Provider Manual: 08/19

Medi-Cal All Plan Letter: 08/05/19

Medi-Cal Telehealth Provider Manual Update: Draft 07/19

Connecticut Medical Assistance Program Billing Guidance for Electronic Consults: 12/18

DHCS Feedback on Telehealth Policy Stakeholder Commentary: 12/18

CCHP E-Consult Workgroup Comments Submission on Medi-Cal Telehealth Provider Manual Draft: 11/14/18

Medi-Cal Telehealth Provider Manual Update: Draft 09/28/18

California State Plan Amendment 18-0055: Clarification of Services Rendered Outside of Clinic FacilitiesDraft 10/19/18

Access

AB 2164 Letter of Support (3/20) The focus of AB 2164 is to provide funding for e-consult implementation to FQHCs and RHCs. In a letter to Assembly Health Committee leaders, the E-Consult Workgroup expresses its strong support for the legislation which would expand care access for safety net clinics.

California Department of Managed Health Care Annual Network Reporting Form for Managed Care Plans’ Contracted Network of Telehealth Providers

E-Consult and Managed Care Plan Annual Network Reporting

Frequently Asked Questions Regarding Medi-Cal Managed Care Organization E-Consult Programs

California Health & Wellness: DMHC Electronic Consultation Overview

DMHC Presentation on Managed Care Plans and Access

Summary of California Assembly Bill 205: Medi-Cal Compliance with 2016 Federal Medicaid Managed Care Final Rule

Network Adequacy Background and Definition

CCHP Response to DHCS Call for Public Comment on Network Adequacy Requirements