Pennsylvania Permanently Allows Audio-Only Behavioral Health Services

Pennsylvania Governor Tom Wolf signed House Bill 1630 (P. L. Act 98 of 2022) into law on Oct. 28, 2022, which, among other things, made permanent the relaxation of regulatory requirements regarding telehealth behavioral health services provided on an “audio-only” basis. These changes took effect immediately upon passage.

In response to the COVID-19 pandemic, the Pennsylvania Department of Human Services, Office of Mental Health and Substance Abuse Services (OMHSAS) previously suspended regulations that would have otherwise prohibited Pennsylvania Medical Assistance (Medicaid) reimbursement for certain outpatient psychiatric services, outpatient drug and alcohol services and psychiatric rehabilitation services provided via telephone or other “audio-only” technology. Going forward, Pennsylvania behavioral health providers and facilities will be able to continue to take advantage of this permanent flexibility to provide treatment and supervision either on an in-person basis or by utilizing available video or audio technology. 

For reference, the specific Pennsylvania regulatory sections eliminated were as follows:

  • Outpatient Psychiatric Services
    • 55 Pa. Code § 1153.14. Noncovered services.
      Payment will not be made for the following types of services regardless of where or to whom they are provided: (1) A covered psychiatric outpatient clinic, MMHT or partial hospitalization outpatient service conducted over the telephone.
  • Outpatient Drug and Alcohol Clinic Services
    • 55 Pa. Code § 1223.14. Noncovered services.
      Payment will not be made for the following types of services regardless of where or to whom they are provided: (2) Clinic visits, psychotherapy, diagnostic psychological evaluations, psychiatric evaluations and comprehensive medical evaluations conducted over the telephone, that is, any clinic service conducted over the telephone.
  • Psych Rehabilitation Services (PRS)
    • 55 Pa. Code § 5230.55. Supervision.
      (c)  A PRS director or psychiatric rehabilitation specialist designated as a supervisor shall meet with staff individually, face-to-face, no less than two times per calendar month

On July 1, 2022, OMHSAS issued the “Revised Guidelines for the Delivery of Behavioral Health Services Through Telehealth” (OMHSAS-22-02), which set forth the specific requirements for behavioral health providers enrolled in the Pennsylvania Medical Assistance fee-for-service and/or managed care delivery system to provide services using telehealth technology. The guidelines explain the requirements for licensure, originating sites, services from out-of-state practitioners, in-person service access, clinical appropriateness, technology, billing and consent. Even with the relaxation of the regulations permitting “audio-only” services, the foregoing guidelines nevertheless still apply, so telehealth providers should ensure that any Pennsylvania behavioral health services satisfy all applicable rules and requirements. 

Finally, House Bill 1630 separately provided the Pennsylvania Department of Auditor General with rights to conduct a comprehensive audit and review of any pharmacy benefits manager that subcontracts with Pennsylvania Medical Assistance managed care organizations, and audit rights take effect 60 days after passage (i.e., Dec. 27, 2022).