OIG to audit use of telehealth for Medicaid behavioral health services

The agency also will review how states monitor and oversee how these services are provided by managed care organizations.

The Department of Health and Human Services’ Office of Inspector General plans to review how states are using telemedicine to provide behavioral health services in Medicaid managed care.

“All 50 states and the District of Columbia currently provide some coverage under Medicaid of telehealth; however, limited information is available about how states use telehealth to provide behavioral health services to Medicaid managed care enrollees,” OIG announced on Thursday in the agency’s updated work plan, which assesses relative risks in HHS programs and operations to identify those areas most in need of attention.

According to the agency, it will conduct an audit focusing on selected states that will analyze how they and managed care organizations (MCOs) leverage telehealth to provide behavioral healthcare.

“It will also review selected states’ monitoring and oversight of MCOs’ behavioral health services provided via telehealth,” OIG revealed. “Finally, it will identify states’ and MCOs’ practices on how to maximize the benefits and minimize the risks of providing behavioral healthcare via telehealth.”

Results of a survey, released in December 2018 by law firm Epstein Becker Green, show that the current nationwide opioid epidemic has contributed to the increasing adoption of telehealth and telemental health services.

The law firm noted that the Centers for Medicare and Medicaid Services in June 2018 encouraged states to leverage telemedicine and telepsychiatry to support coordinated care for Medicaid recipients.

Last year, CMS specifically urged state Medicaid directors to “consider telehealth optimized Medication Assisted Treatment given access considerations,” adding that “virtual treatment centers or remote counseling options integrated into care coordination technology might help with addressing provider shortages, particularly in rural areas.”

Also See: CMS asks state Medicaid directors to use HIT to fight opioid crisis

Currently, Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services.

In addition, Medicaid has openly endorsed telemedicine as a “cost-effective alternative to the more traditional face-to-face way of providing medical care” and claims that states have the flexibility to determine whether or not to cover certain services such as behavioral health.

Nonetheless, Epstein Becker Green contends that “despite Medicaid’s fewer restrictions on telehealth coverage as compared to its Medicare counterpart, there is limited federal guidance or information regarding the implementation of telehealth services in state Medicaid programs or coverage parameters for states choosing to offer such services.”

As a result, the law firm warns that “healthcare practitioners who treat Medicaid populations are at risk for steep penalties for noncompliance, including fines and the potential loss of their professional licenses.”

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