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By: Todd Lacksonen & Brandon Smith

In Part 1 of this series, we discussed the general impact of the currently-ongoing pandemic on telemedicine. In this part, we will address the changes already implemented by the Ohio Department of Medicaid and the State Medical Board of Ohio as well as the changes proposed by House Bill 679.

Ohio Department of Medicaid

In response to the COVID-19 pandemic, the Ohio Department of Medicaid adopted a new rule (5160-1-18) covering telehealth. This rule combines all the flexibility of the previous emergency telehealth policies and ensures that flexibility continues to be provided to providers and to covered individuals in need of care. This policy includes additional covered telehealth services, additional covered practitioners, and additional covered billing providers:

Additional covered telehealth services:

• Limited oral evaluation provided by a dentist;
• Hospice home care and long-term care;
• Direct skilled nursing services in the home health or hospice setting;
• Services of home health or hospice aides;
•  Additional occupational therapy, physical therapy, speech language pathology, and audiology services;
• End stage renal disease (ESRD) related services;
• Originating site fee for the practitioner site.

Additional covered rendering practitioners:

• Dentists o Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a hospice or home health setting;
• Licensed and credentialed health professionals working in a hospital or nursing facility setting;
•  Home health and hospice aides.

Additional covered billing provider types:

• Professional dental groups;
• Home health and hospice agencies.

In additional, the definition of “telehealth” now includes additional forms of communication during a state of emergency including phone calls, fax, e-mail, and other communication methods that may not have audio or visual elements. The rule also permits eligible providers to practice telehealth from their home office or other non-institutional settings.

State Medical Board of Ohio

The State Medical Board of Ohio (“SMBO”) has also involved themselves into the telemedicine area in response to the COVID-19 pandemic. Effective March 9, 2020, providers can use telemedicine in place of in-person visits. Throughout the declared COVID-19 emergency, the SMBO will not enforce in-person visit requirements normally required in SMBO rules. Suspension of these enforcement requirements includes, but is not limited to:

• Prescribing controlled substances
• Prescribing for subacute and chronic pain
• Prescribing to patients not seen by the provider
• Pain management
• Medical marijuana recommendations and renewals
• Office-based treatment for opioid addiction

Providers must document their use of telemedicine and meet minimal standards of care. The Medical Board will provide advance notice before resuming enforcement of the above regulations when the state emergency orders are lifted.

Additionally, the board has provisions permitting out-of-state telemedicine in the following circumstances:

• Physicians treating patients who are visiting Ohio and unable to leave because of the emergency
• Physicians in contiguous states that have existing patient relationships with Ohio residents

House Bill 679

Finally, the General Assembly has indicated some interest in involving itself in the formulation of telemedicine regulations. House Bill 679 passed the House on June 10, 2020 and was referred to the Senate Committee on Insurance and Financial Institutions on September 23, 2020. If it becomes law, House Bill 679, in its current form, would do the following:

• Expand the list of providers allowing telehealth to include specialties such as: psychologists, physical therapists, dietitians, social workers, speech-language pathologists, licensed counselors
• Require providers offer secure tech that protects passwords and e-communications with patients
• Set provider reimbursement procedures 
• Ensure patients see no changes in out-of-pocket
• Clarifies any additional costs incurred by providers must be negotiated only between provider and health plan

In Part 3 of this series, we will discuss the lingering issues in telemedicine and where the pandemic may yet take us.