Pennsylvania Permanently Permits Audio-Only Behavioral Health Services | Steven & Lee

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Pennsylvania Governor Tom Wolf signed into law House Bill 1630 (PL Act 98 of 2022) on October 28, 2022, which, among other things, made permanent the relaxation of regulatory requirements for telehealth behavioral health services provided on an “audio only”. base. These changes took effect immediately after the switch.

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 otherwise have prohibited Pennsylvania Medical Assistance (Medicaid) reimbursement for certain outpatient psychiatric services, outpatient drug and alcohol treatment services, and psychiatric rehabilitation services provided by telephone or other “audio-only” technologies. Going forward, behavioral health providers and facilities in Pennsylvania can continue to take advantage of this ongoing flexibility to provide treatment and supervision either in person or using available video or audio technology.

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

  • Outpatient psychiatric services
    • 55 Pa. Code § 1153.14. Services not covered.
      No payment will be made for the following types of services, regardless of where and to whom they are provided: (1) A covered psychiatric outpatient clinic, MMHT, or partial hospitalization outpatient service performed by telephone.
  • Drug and alcohol addiction outpatient clinic services
    • 55 Pa. Code § 1223.14. Services not covered.
      No payment will be made for the following types of services, regardless of where and to whom they are provided: (2) Clinic visits, psychotherapy, diagnostic psychological assessments, psychiatric assessments, and comprehensive medical assessments conducted over the telephone, ie any clinical service conducted by telephone.
  • Psychological Rehabilitation Services (PRS)
    • 55 Pa. Code § 5230.55. Surveillance.
      (c) A PRS director or psychiatric rehabilitation specialist designated as supervisor must meet with staff individually, face to face, at least twice per calendar month

On July 1, 2022, OMHSAS released the “Revised Guidelines for the Delivery of Behavioral Health Services Using Telehealth” (OMHSAS-22-02), which outlines specific requirements for behavioral health providers enrolled in the telehealth program. Pennsylvania Medical Assistance. managed care delivery service and/or system for providing services using telehealth technology. The guidelines explain licensure requirements, sites of origin, out-of-state practitioner services, access to in-person services, clinical relevance, technology, billing and consent. Even with the relaxation of regulations allowing “audio-only” services, the above guidelines still apply, so telehealth providers should ensure that all behavioral health services in Pennsylvania meet all of the applicable rules and requirements.

Finally, House Bill 1630 separately provided the Pennsylvania Department of the Auditor General with the right to conduct a full audit and review of any pharmacy benefit manager who contracts with Pennsylvania Medical Assistance managed care organizations, and audit rights take effect 60 days after passage (c. July 27, 2022).

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