By Eric Wicklund, mHealth Intelligence | September 11, 2019
A bill to expand Medicaid reimbursement for telehealth and telemental health programs has been vetoed by North Carolina Governor Roy Cooper, a casualty in the Democratic governor’s ongoing battle with Republican lawmakers over a state budget and Medicaid expansion.
HB 555 would have, among other things, required the state’s Department of Health and Human Services to make several changes in how the state mandates funding for connected health services. The so-called Medicaid Transformation Bill called for:
- Reimbursement for “telemedicine and telepsychiatry services performed in a recipient’s home or delivered from a licensed practitioner’s home.”
- Eliminating a required referral for telehealth services.
- Coverage for both phone-based and video-based telehealth services.
- Allowing both referring and receiving practitioners to bill for facility fees related to telehealth services provided on the same date.
- Mandating that telehealth services “must not be subject to the exact same restrictions as face-to-face contacts,” and that a clinical coverage policy “must be updated to align the policy with best practices for telemedicine and telepsychiatry.”
- Enabling behavioral health providers who are directly enrolled as providers in the Medicaid and NC Health Choice programs, including licensed professional counselors, licensed marriage and family therapists, certified clinical supervisors and licensed clinical addictions specialists, for bill for telehealth services.
Cooper vetoed a $24 million budget bill on June 24, then shot down HB 555 on August 30 as the state Legislature sought to create a series of mini-budgets to keep the state going.
“Passing mini-funding bills that simply divvy up the vetoed Republican budget is a tactic to avoid a comprehensive budget that provides for healthcare and other important needs like education,” the governor said in his veto statement. “Healthcare is an area where North Carolina needs us to do more, and to do it comprehensively.”
The Legislature overrode Cooper’s veto Wednesday morning, with Republicans unexpectedly bringing up the measure for a vote after reportedly assuring Democratic lawmakers that they could attend a 9/11 memorial service and not miss any important votes.
Prior to that vote, the Legislature had been continuing with its strategy of drafting bills to cover specific parts of the budget. According to the Carolina Journal, four new mini-budgets were introduced this week, covering issues that include prison reform, hurricane recovery, reducing the backlog of untested rape kits and school safety. Two earlier bills, calling for a drawdown of federal funds and raises for state highway patrol officers, have passed.
The governor’s veto of HB 555 was scheduled to be discussed this week.It was not included in Wednesday’s veto override.
Meanwhile, another bill calling for expanded Medicaid coverage for telehealth passed the House in May and is currently before the Senate.
HB 721 would require the DHHS to:
- Promote telehealth for Medicaid and NC Health Choice recipients.
- Require prior authorization requests for specialty care to be processed by the patient’s primary care provider.
- Require all Medicaid providers who provide healthcare services to be licensed to provide those services.
- Require facilities that provide telehealth services to protect patient confidentiality. o Submit the necessary waivers to implement this act.
- Report to the Joint Legislative Medicaid and NC Health Choice Oversight Committee and the Fiscal Research Division on expected changes, costs, savings, and outcomes.
The bill would also prevent the department from requiring that providers:
- Be physically present with the patient, unless necessary.
- Conduct a telehealth consultation if an in-person consultation is reasonably available.
- Require a prior authorization for a telehealth consultation if it would not be required for an in-person consultation.
- Be part of a telehealth network.
It would also prevent private health plans and the State Health Plan from excluding telehealth coverage solely because those services are provided by virtual care.