New Tele-Behavioral Health Guidelines

On February 20, 2020, the Pennsylvania Department of Human Services, Office of Mental Health and Substance Abuse Services (“OMHSAS”), issued Bulletin OMHSAS-20-02 – “Guidelines for the Use of Telehealth Technology in the Delivery of Behavioral Health Services” that updated prior OMHSAS guidelines for delivering behavioral health services using telehealth technology. Prior to the issuance of this Bulletin, only Medicaid-enrolled psychiatrists and licensed psychologists in the Behavioral Health HealthChoices Program were covered to use telehealth technology to provide behavioral health services. With the issuance of this Bulletin, psychiatrist, licensed psychologists, Certified Registered Nurse Practitioners, Physician Assistants certified in mental health, Licensed Clinical Social Workers, Licensed Professional Counselors, and Licensed Marriage and Family Therapists can now provide behavioral health services using telehealth technology under both the Medical Assistance Fee For Service delivery system (“FFS”) and the Behavioral Health HealthChoices Program managed care delivery system (“BH-MCOs”).

The Bulletin clarifies that under the FFS delivery system, tele-behavioral health services will only be reimbursed in the following three settings: (1) Psychiatric Outpatient Clinics, (2) Psychiatric Partial Hospitalization Programs, and (2) Drug & Alcohol Outpatient Clinics. The Bulletin includes a list of procedure codes, and modifiers, for services that may be provided using tele-behavioral health in the FFS delivery system. A provider would need to obtain a waiver from OMHSAS to provide tele-behavioral health services in a different setting.

In the managed care delivery system, the billing procedures and protocols of the BH-MCOs control.

The Bulletin also sets forth specific guidelines regarding:

• the consent the provider must obtain from the individual prior to utilizing telehealth and related privacy considerations;
• the telehealth technology used by the provider and the provider’s responsibility for ensuring confidentiality and security in the transmission and storage of health information;
• the provider’s staffing of the originating telehealth site;
• out-of-state practitioners providing telehealth treatment to Pennsylvania residents;
• medical record documentation for telehealth services;
• written quality protocols and procedures for the operation and use of telehealth equipment and technical difficulties; and
• periodic review of the provider’s quality protocol and delivery of telehealth services.

Providers that want to provide tele-behavioral health services are required to complete and submit Attachment B – “Telehealth Attestation Form” to the electronic resource account RA-PWTBHS@pa.gov and to the appropriate OMHSAS Field Office. The provider will be notified when it is approved to utilize tele-behavioral health services.