Medi-Cal managed care plans required to reimburse for telehealth at same rate as in person services

March 20, 2020
Area(s) of Interest: Public Health Practice Management 

The California Department of Health Care Services (DHCS) on Thursday issued a supplement to all plan letter 19-009 instructing Medi-Cal manage care plans to take immediate steps to allow people to obtain health care via telehealth when medically appropriate to do so.

Plans are required to reimburse providers at the same rate for telehealth services as they would for services provided in person. If the service is one that would otherwise have been provided in-person but is now being provided via telehealth, the plans should reimburse for that service as if it were provided in person. The letter also says that plans must reimburse a service provided telephonically at the same rate as services provided via video. If a physician is capitated, they are already being paid a flat rate to manage the health of the patient, so they will not be eligible to be paid separately to provide services via telehealth.

The letter requires plans to comply immediately and requires plans to ensure their delegated entities comply with these requirements as well.

The Medi-Cal managed care plans are responsible for ensuring their delegated groups comply. CMA is inquiring about whether the requirements apply to the County Organized Health System plans.

It’s important to note that practices must ensure that their documentation matches the requirements of the CPT code they are billing and appropriate use of the place of service code, 02, telehealth.

This supplement expands on the all plan letter the Department of Managed Health Care released on Wednesday, instructing its licensed health plans that they must reimburse telehealth at the same rate as in person services.

CMA has set up a COVID-19 resource page, where you will find links to the latest news, research and developments on the COVID-19 outbreak for physicians and other health care providers


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