NJSHA’s Response to COVID-19: Updates and Resources

In the two past weeks, twenty-three bills were introduced in NJ and quickly moved through both houses of the Legislature to address COVID-19. NJSHA and our lobbyist have been monitoring these bills and proposing amendments where appropriate. We have also been connecting to relevant state agencies, including the Department of Education (DOE) and the Department of Health (DOH) about issues related to these pieces of legislation and ways that NJSHA members can continue to provide services to our students and patients during these unprecedented times.

Private Practice and Health Care Settings
NJ Legislation
A3843 / S2283, McKeon (D-Essex)/ Vitale (D-Middlesex) – Requires health insurance and Medicaid coverage for testing of coronavirus disease 2019 and for telemedicine and telehealth during coronavirus disease 2019 state of emergency.

https://www.njleg.state.nj.us/2020/Bills/A4000/3843_S1.PDF

Signed into law, P.L. 2020, c. 7.

As originally introduced, this bill only required coverage of the virus testing but telehealth was added on the Assembly floor on Mon, March 16. The bill states that the coverage of telehealth shall be in accordance with the provisions of P.L. 2017, c. 117, legislation that governs telemedicine/telehealth in the state. NJSHA was involved in the process that led to creation of that law, including the explicit inclusion of audiologists and speech therapists.

NONE of the NJ legislation related to telehealth applies to self-funded/ERISA plans.  This starts with P.L. 2017, c. 117 and continues through A3843.  Under no circumstances can NJ law cover self-funded plans because of federal preemption.  The Self-funded plans may choose to do what is applied to fully-funded plans but they are not obligated to do so.  FURTHER, if a plan offered by an employer (fully funded) does not cover a certain service (let’s say speech therapy or PT or whatever), the telemedicine/telehealth-in person equal coverage mandate in P.L. 2017, c. 117 does not apply.  Essentially, you can’t “back in” to getting a certain service covered under telemedicine/telehealth if it was not already covered.

What does this mean for you? It means that any fully funded plan in NJ must cover speech therapy and audiology services during this state of emergency.

A3860 / S2289 , Pinkin (D-Middlesex)/ Vitale (D-Middlesex) – Establishes certain requirements to use telemedicine and telehealth to respond to coronavirus disease 2019 (COVID-19).

https://www.njleg.state.nj.us/2020/Bills/A4000/3860_I1.PDF

Signed into law March 19. P.L. 2020, c. 3.

What does this mean for you? This bill does a few things. It allows a licensed practitioner to provide and bill for telehealth even if rules for their particular practice have not yet been adopted (NOTE: THIS IS VERY IMPORTANT FOR SPEECH AND AUDIOLOGY: WHILE THE AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY LICENSING COMMITTEE PROPOSED THE RULES FOR THE TWO PROFESSIONS– AND NJSHA COMMENTED ON THEM – THEY HAVE NOT BEEN FORMALLY ADOPTED). It also allows an out of state provider to provide telehealth but only related to testing and treatment of COVID -19 unless the provider had a previous relationship with the patient. It allows the DOH to waive privacy requirements.

It removes any regulatory barriers that might exist and allows you to provide teletherapy services as per A3483. It would allow a licensed SLPs/Audiologist from another state to provide teletherapy to a NJ resident, if that therapist has a pre-existing professional relationship with the patient.

School Settings
NJ Legislation

Update from NJDOE on 4.1.20
On April 1, 2020 the NJ Department of Education passed a ruling to allow the use of telepractice to provide related services within the schools. The Notice of Rule Waiver/modification/Suspension which states, “The opportunities provided to students with disabilities shall be consistent with the student’s IEP to the greatest extent possible. Further, during an extended public health-related school closure, related services to students with disabilities shall be provided through electronic communications, virtual, remote, or other online platforms, as appropriate and as required by the student’s IEP to the greatest extent possible.” Notice of Rule Waiver/modification/suspension Approved April 1, 2020.

What does this mean for you?
This means NJ SLSs will likely be directed by administration to begin telepractice services. SLSs must abide by the guidelines set forth by their district with regard to secure platforms, documentation, billing, and parental consent and involvement. If you have never done teletherapy before, there are now many free resources online such as webinars and free materials to get you started. NJSHA will continue to reach out to the NJ DOE- Office of Special Education with members continued concerns as we navigate these uncharted waters.

NJSHA SAC is working closely with the Legislative Committee to provide an FAQ sheet together as more information becomes available.

Update from NJDOE on 3.30.20 – On April 1, the New Jersey State Board of Education plans to pass an emergency resolution that will temporarily allow telepractice for the schools to ensure that special education students have access to related services and therapies as designated in their IEPs. Notice of Rule Waiver/modification/suspension. Check back on April 1 for more information.

A3904, Burzichelli (D-Gloucester)/– Permits use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances.

https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.PDF
https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.HTM

ALERT-UPDATE 3.25.20: A new bill, A3904, which is a replacement for bill A3813, was introduced to address some needed changes to the legislation. The Assembly held a virtual session and A3904 passed unanimously. Speech-language services are still explicitly included in the new bill. We are awaiting an announcement regarding a Senate session as they will need to act on the legislation before it goes to the Governor for signature.

What does this mean for you? If the A3904 bill is signed into law, this will allow use of telepractice for the provision of related services, including speech, for the schools. It would be the district’s responsibility to provide a platform that is FERPA compliant.

Replaced by bill A3904 on 3.23.20 for A3813

Background information:
An August 2019 memo from the NJ DOE to all school districts issued a ban on the use of telepractice for the provision of related services, including speech. NJSHA largely supported this prohibition as it arose from abuse in certain school districts. However, with the closure of schools due to the crisis, this document was an impediment to SLSs being able to utilize telepractice to provide virtual services, when appropriate. Led by members of NJSHA School Affairs Committee and working with our lobbyist, NJSHA reached out to the DOE and also the DOH to see if the memo would be temporarily halted. We were told that it would not be. The A3904, Burzichelli (D-Gloucester) would permit use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances, which would include speech-language services.

Update Posted March 26, 2020

A3904, Burzichelli (D-Gloucester)/– Permits use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances.

https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.PDF
https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.HTM

ALERT-UPDATE 3.25.20: A new bill, A3904, which is a replacement for bill A3813, was introduced to address some needed changes to the legislation. The Assembly held a virtual session and A3904 passed unanimously. Speech-language services are still explicitly included in the new bill. We are awaiting an announcement regarding a Senate session as they will need to act on the legislation before it goes to the Governor for signature.

What does this mean for you? If the A3904 bill is signed into law, this will allow use of telepractice for the provision of related services, including speech, for the schools. It would be the district’s responsibility to provide a platform that is FERPA compliant.

Replaced by bill A3904 on 3.23.20 for A3813

Background information:
An August 2019 memo from the NJ DOE to all school districts issued a ban on the use of telepractice for the provision of related services, including speech. NJSHA largely supported this prohibition as it arose from abuse in certain school districts. However, with the closure of schools due to the crisis, this document was an impediment to SLSs being able to utilize telepractice to provide virtual services, when appropriate. Led by members of NJSHA School Affairs Committee and working with our lobbyist, NJSHA reached out to the DOE and also the DOH to see if the memo would be temporarily halted. We were told that it would not be. The A3904, Burzichelli (D-Gloucester) would permit use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances, which would include speech-language services.

Update Posted March 23, 2020

A3813/S2292, Burzichelli (D-Gloucester)/Cardinale (R-Bergen) – Permits use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances. This is no longer a viable bill. See A A3904 above.

A3842/S2281, Greenwald (D-Camden)/Ruiz (D-Essex) – Establishes Bridging the Digital Divide in Schools Grant Program in DOE to provide and expand access to technology and equipment for students in certain school districts.

https://www.njleg.state.nj.us/2020/Bills/A4000/3842_I1.PDF

Passed both houses, on the Governor’s desk.

What does this mean for you? This would provide extra funding to provide and expand access to technology and equipment for students in certain school districts to access remote learning.

Professional and Licensing Boards
A3862 / S2298, Giblin (D-Essex)/ Pou (D-Passaic) – Permits professional and occupational licensing boards to expedite licensure of certain individuals during state of emergency or public health emergency.

https://www.njleg.state.nj.us/2020/Bills/A4000/3862_I1.PDF

Signed into law March 19, 2020

What does this mean for you? It removes the barrier for criminal history checks checks and other delays in order to expedite new licenses.

Update from NJDOE on 4.1.20
On April 1, 2020 the NJ Department of Education passed a ruling to allow the use of telepractice to provide related services within the schools. The Notice of Rule Waiver/modification/Suspension which states, “The opportunities provided to students with disabilities shall be consistent with the student’s IEP to the greatest extent possible. Further, during an extended public health-related school closure, related services to students with disabilities shall be provided through electronic communications, virtual, remote, or other online platforms, as appropriate and as required by the student’s IEP to the greatest extent possible.” Notice of Rule Waiver/modification/suspension Approved April 1, 2020.

What does this mean for you?
This means NJ SLSs will likely be directed by administration to begin telepractice services. SLSs must abide by the guidelines set forth by their district with regard to secure platforms, documentation, billing, and parental consent and involvement. If you have never done teletherapy before, there are now many free resources online such as webinars and free materials to get you started. NJSHA will continue to reach out to the NJ DOE- Office of Special Education with members continued concerns as we navigate these uncharted waters.

NJSHA SAC is working closely with the Legislative Committee to provide an FAQ sheet together as more information becomes available.

Update from the NJ DOE 3.30.20: On April 1, the New Jersey State Board of Education plans to pass an emergency resolution that will temporarily allow telepractice for the schools to ensure that special education students have access to related services and therapies as designated in their IEPs. Notice of Rule Waiver/modification/suspension. Check back on April 1st for more information.

A3904, Burzichelli (D-Gloucester)/– Permits use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances.

https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.PDF
https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.HTM

ALERT-UPDATE 3.25.20: A new bill, A3904, which is a replacement for bill A3813, was introduced to address some needed changes to the legislation. The Assembly held a virtual session and A3904 passed unanimously. Speech-language services are still explicitly included in the new bill. We are awaiting an announcement regarding a Senate session as they will need to act on the legislation before it goes to the Governor for signature.

What does this mean for you? If the A3904 bill is signed into law, this will allow use of telepractice for the provision of related services, including speech, for the schools. It would be the district’s responsibility to provide a platform that is FERPA compliant.

Replaced by bill A3904 on 3.23.20 for A3813

Background information:
An August 2019 memo from the NJ DOE to all school districts issued a ban on the use of telepractice for the provision of related services, including speech. NJSHA largely supported this prohibition as it arose from abuse in certain school districts. However, with the closure of schools due to the crisis, this document was an impediment to SLSs being able to utilize telepractice to provide virtual services, when appropriate. Led by members of NJSHA School Affairs Committee and working with our lobbyist, NJSHA reached out to the DOE and also the DOH to see if the memo would be temporarily halted. We were told that it would not be. The A3904, Burzichelli (D-Gloucester) would permit use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances, which would include speech-language services.

Update Posted March 26, 2020

A3904, Burzichelli (D-Gloucester)/– Permits use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances.

https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.PDF
https://www.njleg.state.nj.us/2020/Bills/A4000/3904_I1.HTM

ALERT-UPDATE 3.25.20: A new bill, A3904, which is a replacement for bill A3813, was introduced to address some needed changes to the legislation. The Assembly held a virtual session and A3904 passed unanimously. Speech-language services are still explicitly included in the new bill. We are awaiting an announcement regarding a Senate session as they will need to act on the legislation before it goes to the Governor for signature.

What does this mean for you? If the A3904 bill is signed into law, this will allow use of telepractice for the provision of related services, including speech, for the schools. It would be the district’s responsibility to provide a platform that is FERPA compliant.

Replaced by bill A3904 on 3.23.20 for A3813

Background information:
An August 2019 memo from the NJ DOE to all school districts issued a ban on the use of telepractice for the provision of related services, including speech. NJSHA largely supported this prohibition as it arose from abuse in certain school districts. However, with the closure of schools due to the crisis, this document was an impediment to SLSs being able to utilize telepractice to provide virtual services, when appropriate. Led by members of NJSHA School Affairs Committee and working with our lobbyist, NJSHA reached out to the DOE and also the DOH to see if the memo would be temporarily halted. We were told that it would not be. The A3904, Burzichelli (D-Gloucester) would permit use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances, which would include speech-language services.

Update Posted March 23, 2020

A3813/S2292, Burzichelli (D-Gloucester)/Cardinale (R-Bergen) – Permits use of virtual or remote instruction to meet minimum 180-day school year requirement under certain circumstances. This is no longer a viable bill. See A A3904 above.

A3842/S2281, Greenwald (D-Camden)/Ruiz (D-Essex) – Establishes Bridging the Digital Divide in Schools Grant Program in DOE to provide and expand access to technology and equipment for students in certain school districts.

https://www.njleg.state.nj.us/2020/Bills/A4000/3842_I1.PDF

Passed both houses, on the Governor’s desk.

What does this mean for you? This would provide extra funding to provide and expand access to technology and equipment for students in certain school districts to access remote learning.

Update Posted March 17, 2020

In response to member inquiries about the provision of services in the event of school closings due to Novel Coronavirus (COVID-19) this page will be updated with the most current information received.

New Jersey Department of Education (NJDOE) COVID-19: Frequently Asked Questions (FAQ) Related to School Emergency Preparedness Plans:
This document broadly addresses Special Education and Related Services and references the U.S. Department of Education Q & A document for more details:
COVID-19: Frequently Asked Questions (FAQ) Related to School Emergency Preparedness Plans, Updated March 13, 2020

 

US Department of Education Questions & Answers:
https://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/qa-covid-19-03-12-2020.pdf

 

NJSHA’s lobbyist has reached out to the NJDOE with member question and concerns on delivery of speech-languages and audiological services should school districts close. In the interim, as a professional, be mindful the standard rules and regulations set forth in the special education code must be followed.

Please note that in August 2019, the New Jersey Department of Education (NJDOE) rescinded the guidance on telepractice in the schools, therefore telepractice may not be used as a service delivery model at this time.

NJ Legislation
A3843 / S2283, McKeon (D-Essex)/ Vitale (D-Middlesex) – Requires health insurance and Medicaid coverage for testing of coronavirus disease 2019 and for telemedicine and telehealth during coronavirus disease 2019 state of emergency.

https://www.njleg.state.nj.us/2020/Bills/A4000/3843_S1.PDF

Signed into law, P.L. 2020, c. 7.

As originally introduced, this bill only required coverage of the virus testing but telehealth was added on the Assembly floor on Mon, March 16. The bill states that the coverage of telehealth shall be in accordance with the provisions of P.L. 2017, c. 117, legislation that governs telemedicine/telehealth in the state. NJSHA was involved in the process that led to creation of that law, including the explicit inclusion of audiologists and speech therapists.

NONE of the NJ legislation related to telehealth applies to self-funded/ERISA plans.  This starts with P.L. 2017, c. 117 and continues through A3843.  Under no circumstances can NJ law cover self-funded plans because of federal preemption.  The Self-funded plans may choose to do what is applied to fully-funded plans but they are not obligated to do so.  FURTHER, if a plan offered by an employer (fully funded) does not cover a certain service (let’s say speech therapy or PT or whatever), the telemedicine/telehealth-in person equal coverage mandate in P.L. 2017, c. 117 does not apply.  Essentially, you can’t “back in” to getting a certain service covered under telemedicine/telehealth if it was not already covered.

What does this mean for you? It means that any fully funded plan in NJ must cover speech therapy and audiology services during this state of emergency.

A3860 / S2289 , Pinkin (D-Middlesex)/ Vitale (D-Middlesex) – Establishes certain requirements to use telemedicine and telehealth to respond to coronavirus disease 2019 (COVID-19).

https://www.njleg.state.nj.us/2020/Bills/A4000/3860_I1.PDF

Signed into law March 19. P.L. 2020, c. 3.

What does this mean for you? This bill does a few things. It allows a licensed practitioner to provide and bill for telehealth even if rules for their particular practice have not yet been adopted (NOTE: THIS IS VERY IMPORTANT FOR SPEECH AND AUDIOLOGY: WHILE THE AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY LICENSING COMMITTEE PROPOSED THE RULES FOR THE TWO PROFESSIONS– AND NJSHA COMMENTED ON THEM – THEY HAVE NOT BEEN FORMALLY ADOPTED). It also allows an out of state provider to provide telehealth but only related to testing and treatment of COVID -19 unless the provider had a previous relationship with the patient. It allows the DOH to waive privacy requirements.

It removes any regulatory barriers that might exist and allows you to provide teletherapy services as per A3483. It would allow a licensed SLPs/Audiologists from another state to provide teletherapy to a NJ resident, if that therapist has a pre-existing professional relationship with the patient.

Professional and Licensing Boards

A3862 / S2298, Giblin (D-Essex)/ Pou (D-Passaic) – Permits professional and occupational licensing boards to expedite licensure of certain individuals during state of emergency or public health emergency.

https://www.njleg.state.nj.us/2020/Bills/A4000/3862_I1.PDF

Signed into law March 19, 2020

What does this mean for you? It removes the barrier for criminal history checks checks and other delays in order to expedite new licenses.

Governor Murphy Announces Departmental Actions to Expand Access to Telehealth and Tele-Mental Health Services in Response to COVID-19 3.22.20

Private Insurance Coverage of Telehealth

Below is information that has been provided from several insurance companies. Please keep in mind that since a teletherapy session is still a speech therapy session, each session counts towards annual limits and/or authorization limits. Also, even for plans that are waiving copays, if patient has a deductible, the deductible continues to apply and must be satisfied before copay waiver takes effect.
The stated coverage of speech therapy provided by teletherapy assumes that face to face speech therapy would be covered. If the plan does not cover speech therapy provided face to face, then it will not cover speech therapy provided by teletherapy.

The insurance companies are currently making many changes and working with limited staff. We have been advised that automated systems are in the process of being updated, and claims may be denied because the systems updates are not completed with so many changes that are occurring. Denials may need to be manually reviewed and reprocessed.

Fully funded plans MUST comply with P.L. 2017, c. 117 which mandates that if speech therapy is covered for face to face therapy then it must be covered the same as teletherapy.

NJ Department of Banking and Insurance, Telehealth Response, 3/30/20

Cigna
Update 3.28.20
Cigna has issued the following update:
https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html
The following virtual physical, occupational, and speech therapy (PT/OT/ST) services will be allowed through May 31, 2020 when appended with a GQ modifier and billed with a standard place of service code. These services will be reimbursed consistent with the standard fee schedule.

Speech Therapy

Code Description
92507 Speech/hearing therapy
92526 Oral function therapy

Important notes

  • Only the codes listed above are eligible for virtual care reimbursement at this time.
  • Please note that while we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time.
  • We maintain all current medical necessity review criteria for virtual care at this time.

Aetna
The following was in a bulletin sent from Aetna: “Aetna Commercial patients pay $0 for covered telemedicine visits until June 4, 2020. Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members , so they can receive the care they need from you without leaving their homes. With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video.”

Aetna has stated that all plans, whether fully funded or self funded, will cover teletherapy services with no pay until 6/4/20.

This does not apply to Aetna Meritain, which as of now does not cover teletherapy.

United Healthcare
Update 3.28.20
United Healthcare has posted the following update:
https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-pt-ot-st.html

According to ASHA, UHC applied the policy to their self-funded plans as their default position. Thus, unless an employer explicitly opts out, self funded plans would also follow this policy.

COVID-19 Physical, Occupational and Speech Therapy Telehealth
Last update: March 26, 2020, 11:00 p.m. CDT
United Healthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio/video technology. State laws and regulations apply. Benefits will be processed in accordance with the member’s plan.

This change is effective immediately for dates of service March 18 through June 18, 2020.

Reimbursable codes are limited to the specific set of physical, occupational and speech therapy codes listed below. United Healthcare will reimburse eligible codes when submitted with a place of service code 02 and modifier 95.

Speech Therapy 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder
Speech Therapy 92521 Evaluation of speech fluency
Speech Therapy 92522 Evaluation of speech sound production
Speech Therapy 92523 Evaluation of speech sound production
Speech Therapy 92526 Treatment of swallowing dysfunction and/or oral function for feeding
Speech Therapy 96105 Assessment of Aphasia and Cognitive Performance Testing
Speech Therapy 97129 Therapeutic interventions that focus on cognitive function
Speech Therapy 97130 Each additional 15 minutes (use in conjunction with 97129)

https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/COVID19-Telehealth-Services-PT-OT-ST.pdf

Tricare/Humana
Update 3.28.20
Tricare/Humana has posted the following update:
https://www.humanamilitary.com/provider/education-and-resources/quick-access/policy-updates-and-alerts/COVID-19-telemedicine-031320

Coronavirus Disease (COVID-19) and TRICARE’s telemedicine benefit
March 18, 2020
**Update: If a beneficiary meets all other criteria for a covered service for speech therapy and for continuation of PT/OT, (but not initiation of PT/OT), it is covered using telemedicine, using any coding modifiers as you would for a TRICARE network provider office visit.

Check the link for more details.

Horizon
All Horizon plans will cover speech therapy provided by teletherapy. Fully funded plans and NJX plans will waive copay. Self funded plans may or may not waive the copay.

Updated 3.27.20
Horizon recently posted an update to clarify which plans will cover teletherapy and which plans will waive the copay.  The codes are currently being loaded and may take a few weeks to configure the systems in order for the claims to process correctly.  However, you can still provide the service and submit your claim to Horizon and the claim will process correctly once the system is configured. The CPT codes that were added to the Horizon telehealth reimbursement policy are as a result of the COVID-19 crisis and the need to expand telemedicine services.  The codes will remain eligible for telemedicine with the modifiers until further notice.

Here is a link to the most recent update:
https://www.horizonblue.com/providers/news/news-legal-notices/providing-telephonic-care-no-costs-members

Updated 3.23.20
Our lobbyist reached out to Horizon and gained confirmation that this insurer will be covering audiology and speech pathology services provided via telehealth and will be waiving co-pays. NJSHA provided Horizon with CPT codes under audiology and speech to ensure when the claims are submitted, they process correctly. We are awaiting confirmation that this coverage will be for all plans, including self-funded plans. In the meantime, we do have confirmation that the effective date will be the date of service driven, and the date when the system will be ready to accept these claims will be forthcoming in the next few days (info received 3/23/20). Horizon will be issuing a press release when the changes are ready and will also be providing a link to their updated policy. A letter was received by some providers 3/23/20 titled: COVID-19 UPDATE #4: Relaxing Rules to Enable Telephonic Visits

This states the new policy and verifies the information that teletherapy is covered, at the same rates and copays are waived.

“Speech Pathologists and Audiologists are eligible provider types to render telehealth services. Horizon does have a telehealth policy posted on our website.” It is:
https://www.horizonblue.com/providers/policies-procedures/policies/reimbursement-policies-guidelines/telemedicine-services

and this which waives copay during COVID 19

https://www.horizonhealthnews.com/horizon-eliminates-cost-sharing-for-qualified-in-network-telemedicine-services/

Horizon is in the process of adding the following CPT codes used by SLPs and audiologists to its system for teletherapy. We will notify our members once we receive this has been completed.

Codes Horizon will Cover by Teletherapy
Speech-language pathology codes: 92523, 92521, 92522, 92507, 92610, 92526, 92520, 92524

Audiology codes: 92592, 92593, 99211, 92625 Medicare

ASHA Insurance Coverage
Updated 3.28.20
The following resources can be found on ASHA’s website:

Commercial healthcare plans in the USA:
https://www.asha.org/uploadedFiles/COVID-19-Commercial-Insurance-Telepractice-Policy-Tracking.pdf

Medicaid
https://www.asha.org/uploadedFiles/COVID-19-State-Medicaid-Telepractice-Policy-Tracking.pdf

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Medicare (updated March 31, 2020)
CMS issued the following bulletin today.
https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf?fbclid=IwAR1o6En7YQnvvjnXM5CpII7HzkKw3dUq55KQmiju4yMie2UJZsyCYQrrPUg

Among other changes, it specifically adds speech language evaluations and therapy to covered telehealth services under Medicare. The document states:

  • “Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161- 97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)
  • Radiation Treatment Management Services (CPT codes 77427)”
  • “Licensed clinical social worker services, clinical psychologist services, physical therapy services, occupational therapist services, and speech language pathology services can be paid for as Medicare telehealth services. A complete list of all Medicare telehealth services can be found here: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

 
Medicare: Updated March 26, 2020
E visits for Medicare Part B:
In response to the spread of Corona Virus Disease 2019 (COVID-19), the Centers for Medicare & Medicaid Services (CMS) announced that “clinicians who may not independently bill for evaluation and management visits (for example, physical therapists, occupational therapists, speech-language pathologists, clinical psychologists)” can now bill for three Medicare G-codes for “e-visits,” effective immediately. The e-visit codes allow some qualified nonphysician health care professionals to report and receive payment for non-face-to-face digital communications that require a clinical decision. Prior to this announcement, audiologists, SLPs, and most other nonphysician groups could not bill Medicare for these services. It is important to note that the e-visits are not considered telepractice services. Here are the key things you need to know right now.

State Medicaid programs and commercial plans may allow audiologists and SLPs to report e-visits, but aren’t required to. (new 3/23/20)

The following information outlines Medicare guidance and policy. State Medicaid agencies and commercial insurance plans have the flexibility to develop their own coverage policies related to e-visit services. Check with your payers directly to ask about coverage and payment for e-visits by audiologists or SLPs. You can direct them to this page for further information about use of these codes.

ASHA confirmed that audiologists may not bill for e-visits to the Medicare program. (updated 3/23/20)

In its press release, CMS included SLPs as an example of clinicians who may now report e-visit services, but did not mention audiologists. ASHA reached out to CMS to determine whether audiologists may also report these services for Medicare beneficiaries and strongly urged that CMS provide equal access to these codes for audiologists. However, in subsequent communications with ASHA, CMS staff confirmed that audiologists may not report these services for Medicare beneficiaries, noting that e-visits are outside of the audiology diagnostic benefit category. Check with other non-Medicare payers to determine whether they will cover e-visits provided by audiologists.

The e-visit codes describe specific online communications that require a clinical decision and must meet specific criteria for appropriate billing.

The Medicare G-codes for e-visits are G2061-G2063 and include very specific parameters to determine whether an e-visit can be included on a Medicare Part B (outpatient) claim for payment.

  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  • G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes

To correctly report G2061-G2063, the online assessment and management services must be:

  • initiated by an established/existing patient,
  • conducted through a patient portal,
  • medically necessary (requires clinical decision-making and is not for administrative or scheduling purposes), and
  • documented and stored to reflect the clinical decision-making and amount of cumulative time spent providing e-visit services to each patient.

Clinicians may report an e-visit code only once per seven consecutive days. Select the appropriate G-code based on the cumulative time spent providing e-visit services to each patient, through a patient portal, over the course of the seven days. Day one of the seven days begins on the first date you provide an e-visit. Telephone calls do not count towards the time for e-visits.

See ASHA’s website for clinical scenarios describing examples of services that could be reported using G2061-G2063.

CMS provides additional guidance on appropriate use of these codes in its March 17, 2020, press release.

Append the modifier GN to indicate services provided by an SLP. (new 3/23/20)

CMS staff confirmed that SLPs should include the GN modifier on claims for e-visits. To append the GN modifier, place it in the “modifier” section of the claim, on the same line as the G-code.

Use the place of service (POS) code that reflects the location of the billing provider.

When entering a POS code on a claim to describe where services occurred, clinicians should use the code that reflects where you provided the service, not where the patient received the service. For example, if a clinician provides the e-visit service from their private practice, enter POS 11 for “office”. Do not enter POS 12 for the patient’s home.

Check directly with your local Medicare Administrative Contractor (MAC) to clarify additional billing and claims processing guidelines. (new 3/23/20)

ASHA provides the following information based on published guidance from CMS and discussions with CMS staff. Contact your local MAC for specific information and guidance related to implementation and payment for e-visit services.

The e-visit codes do not replace other services, such as evaluation and treatment of speech, language, swallowing, or hearing disorders. (updated 3/23/20)

The e-visit codes do not represent real-time interactions and do not replace evaluation or treatment services described by existing Current Procedural Terminology (CPT ® American Medical Association) codes. These codes are limited in scope and reflect brief, patient-initiated check-ins or consultations that require clinical decision-making. Do not report these codes for services you would normally report using CPT codes, such as 92523 for a comprehensive speech and language evaluation. Additionally, CMS indicated the e-visits must be conducted via a patient portal, meaning that other forms of real-time or digital communication, such as e-mails outside of a portal, telephone calls, or text messages are not billable with these codes. CMS provided no additional guidance regarding the definition of a patient portal. Clinicians should check with their local MACs directly to verify whether there is flexibility to provide these services without a patient portal.

This is not an expansion of telepractice services.

CMS classifies G2061-G2063 as technology-based communication services, rather than as telepractice services. As a result, CMS has the authority to expand use of the e-visit codes to Medicare providers who are not authorized, by law, to provide telepractice services to Medicare beneficiaries. CMS has not extended telepractice services to audiologists and SLPs at this time. ASHA continues to advocate for expanded telepractice coverage across payers and will provide updates on the webpage on payment and coverage of telepractice services during COVID-19.

You may notify your patients regarding the availability of these services.

Although the patient must initiate the e-visits, clinicians can notify patients that these services are now available and authorized by Medicare. It is also important to note that the patient must verbally consent to the e-visit prior to initiation of services.

Medicare Part B (outpatient) pays for these services through the Medicare Physician Fee Schedule (MPFS).

The following table lists the national Medicare Part B payment rates for the e-visit G-codes. Actual rates will vary slightly depending on your locality. Although CMS waived cost-sharing requirements for telepractice services, the e-visits are still subject to Medicare’s 20% coinsurance payment from the patient because they are not part of the telepractice benefit. The MPFS does not deduct this amount, so the actual payment by Medicare is 20% less than outlined below. You must make reasonable efforts to collect the 20% coinsurance from the Medicare beneficiary.

2020 MPFS Payment Rates

G-Code Descriptor National Payment Rate ($)
G2061 Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes  $12.27
G2062     11–20 minutes  $21.65
G2063     21 or more minutes $33.92

Resources

Contact reimbursement@asha.org for additional information. Monitor ASHA’s website for the latest national and federal developments related to Medicare, Medicaid, and commercial insurance coverage of telepractice services during COVID-19.

Update Posted March 23, 2020

CMS recently came out with an exception allowing Medicare participants to access healthcare through telemedicine.

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

This guidance allows for G codes for e-consultations for speech language pathology but doesn’t speak to 92507. NJSHA reached out to CMS and ASHA for clarification. We received the following response from Sarah Warren, MA, Director, Health Care Policy, Medicare, ASHA.

“At this time the federal legal restrictions that prevent audiologists and SLPs from providing services via telehealth have not been waived. Therefore at this time services cannot be provided to Medicare beneficiaries via telehealth.

On Tuesday some waivers were made that would allow PTs, OTS, and SLPs to provide e-visits but this is not considered telehealth under federal law and e-visits do not replace or complement treatment such as swallowing or speech treatment.

On the ASHA website, ASHA has summarized the waiver that allows SLPs to provide e-visits and this includes some clinical vignettes to help our members understand the appropriate use of the e-visit codes.

https://www.asha.org/About/Coronavirus-Updates/

ASHA is engaging congress and Medicare to expand access to telehealth during this health crisis. All updates and these efforts will be posted to the same page referenced above that contains all of ASHA’s Covid-related updates. Please consider using our take action site to contact your members of congress to advocate for telehealth when provided by audiologists and SLPs.

https://takeaction.asha.org/asha/Telehealth” 

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

Update Posted March 17, 2020

Information continues to change daily. If you are having concerns about COVID-19 and seeing patients in your private practice, NJSHA recommends that you contact your local board of health in the town your facility is located.
https://www.nj.gov/health/cd/topics/covid2019_schoolbusiness.shtml

Telepractice is allowed in New Jersey. NJSHA was involved in the passage of the Telemedicine/Telepractice bill which was signed in 2018. To read about it go to https://www.njsha.org/advocacy/triumphs/. The bill itself can be found at: Telemedicine/Tele-practice (2017) P.L. 2017, c 117. While the 2017 telepractice law does state that services rendered by teletherapy should be reimbursed the same as in person therapy, this is a New Jersey law and only applies to insurance plans written in NJ that are under Dept of Banking and Insurance (DOBI) oversight. Self-funded plans and federal health plans fall under federal oversight (ERISA). Thus, for those plans, NJSHA advises you to check with the insurance company regarding reimbursement for teletherapy.

If you plan to use teletherapy keep in mind the following:

  • SLPs who provide telepractice must comply with HIPAA, which means only HIPAA compliant platforms may be used. In order to be HIPAA compliant, the provider/organization must have a Business Associates Agreement (BAA) with the videoconferencing company. (Note there may be a change to this requirement, NJSHA is investigating this and will update this posting as appropriate).

Licensure laws require that the provider hold a license in both the state where the provider is located as well as the state where the client/patient is located.

ASHA has excellent guidelines which can be found at https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/

ASHA’s guidelines include the following:

  • Both you and the client/patient must have sufficient internet speed to engage in videoconferencing. Both need to have a camera and microphone.
  • For many patients/clients, someone else will need to be physically present with them during the session.

NJSHA’s lobbyist has obtained a copy of a new telemedicine/telehealth bill that is part of a package of legislation passed by the Assembly yesterday to address issues raised by the pandemic. It is expected to be considered by the Senate on Thursday. Its intent is to facilitate the use telemedicine/telehealth. NJSHA will provide updates as more information becomes available.

University students, faculty, and staff are grappling with a difficult reality, and have many questions about how clinical clock hours can be obtained in the context of COVID-19. With regard to telesupervision, we encourage members to follow ASHA and CAA guidance on this matter, as clinical supervision guidelines are not governed by individual states. With regard to telepractice however, in addition to ASHA and CAA guidelines, all state certification and licensure policies must also be adhered to.

We have gathered some of the pertinent information here, for your reference. ASHA’s Council for Clinical Certification (CFCC) released a special statement related to telepractice and telesupervision during the COVID-19 pandemic on March 13, 2020. They state:

“Graduate student clinicians enrolled in CAA-accredited and CAA-candidacy programs can engage in service delivery through telepractice when the clinical educator provides 100% direct supervision of the sessions in real time, either side-by-side with the student or with the student, the clinical educator, and the client/patient in different locations. This allowance is for both audiology and speech-language pathology programs.”

Read the full statement here: https://www.asha.org/Certification/COVID-19-Use-of-Telepractice-and-Telesupervision/. Universities should contact their compliance officers and check the most recent federal guidance in order to determine which telepractice platforms would be considered HIPAA-compliant.

Additionally, students may obtain up to 75 clock hours via simulation, and asynchronous supervision of simulations is permissible, as long as the supervisor follows best practice guidelines for de-briefing at least 15 minutes per hour of service (25% supervision). See the CFCC statement on supervision of simulations here: https://www.asha.org/certification/certification-standards-for-slp–clinical-simulation/#supervision

ASHA Links and Information 

FREE ASHA benefit for limited time to Learning Pass, several on Telepractice
https://learningcenter.asha.org/diweb/catalog/o/-d 

 

COVID-19 Updates

The SIG 18 Coordinating Committee compiled the following list of resources and hyperlinks to them for consideration before engaging in telehealth services.

  1. Consider the appropriateness of telehealth for meeting the needs of individuals.
  2. The organization must have a Business Associates Agreement (BAA) with the videoconferencing company.
  3. A Business Associates Agreement (BAA) is an agreement between your videoconferencing company and your employer that assures that the transmission of information from provider to client and client to provider is encrypted. Encryption is necessary to provide the first level of compliance with HIPAA & FERPA laws. (See ASHA’s Telepractice Practice Portal page for further information on HIPAA & FERPA). Encryption provides the SLP & employer a great assurance of providing client confidentiality.
  4. HOWEVER, A BAA IS NOT ENOUGH. To ensure that you are providing services that are compliant with HIPAA & FERPA you will need to implement the following:
    • a secure location for providing services that is not interrupted (e.g., having others walk into the room where you are providing service)
    • remote access to electronic documentation must be considered to protect client privacy and confidentiality at both sites.
    • Consult your state’s teacher certification and SLP/AuD licensure laws regarding use of telehealth.
    • Verify that you and the client have necessary equipment and internet speed to engage in a videoconference session.
    • Verify that someone will be physically present with the client/patient/student who can support your services.
    • Verify contact information for the client/patient/student including a phone number, email, physical address and relevant local emergency services.

ASHA members are encouraged to be informed and to advise stakeholders and other decision-makers on the implementation of telehealth.

Additional Resources Can Be Found At:

Information for Education Settings

FERPA:

(March 12, 2020), the U.S. Department of Education released guidance that pertains to serving students with disabilities during the COVID-19 pandemic. In addition, they provided information on FERPA and COVID-19 and the impact of COVID-19 on assessments and accountability under ESSA

The U.S. Department of Education provides guidance letters for a variety of topics, including missed sessions. State and local education agencies can use those guidance letters to inform their advice to IEP teams charged with evaluating the impact of missed sessions on the provision of free appropriate public education (FAPE) for students.

Here are a list of links (including the ones above) that will be included on the ASHA Coronavirus/COVID-19 Updates page:

A new Telepractice Evidence Map has been added to ASHA’s Evidence Maps tool.

ASHA- Telepractice – General overview

NJ DOE Links

State of New Jersey Office of the Ombudsman for Individuals with Intellectual or Developmental Disabilities and Their Families: New Jersey COVID-19 Resources

US DOE Links
New Jersey Department of Education (NJDOE) COVID-19: Frequently Asked Questions (FAQ) Related to School Emergency Preparedness Plans:
COVID-19: Frequently Asked Questions (FAQ) Related to School Emergency Preparedness Plans, Updated March 13, 2020

US Department of Education Questions & Answers:
https://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/qa-covid-19-03-12-2020.pdf

Related Information
Health and Safety:
Infection Control Resources for Audiologists and Speech-Language Pathologists

FREE Webinars:

NJSHA also recommends regularly checking the CDC website for general guidance at Coronavirus Disease 2019-CDC is closely monitoring the novel coronavirus outbreak

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The information contained on this webpage is accurate to the best of our knowledge as of the date of posting. The web page is informational only and may change without notice at any time. It should not be construed as legal advice. Please consult with an attorney for issues of legal significance.