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More COVID-19 Updates from DHCS BH

More COVID-19 Updates from DHCS BH

Dear Colleagues,

DHCS appreciates everyone’s efforts to ensure critically needed services continue during this state of emergency.

This email is to alert you to new FAQs from DHCS and to answer questions about recent COVID-19 guidance. Please refer to the DHCS COVID-19 Response website for up-to-date information.

Updated NTP FAQThe attached NTP FAQ was updated to reflect new federal guidance, including:

  • Clarification from the U.S. Department of Health and Human Services Office of Civil Rights that they will use enforcement discretion regarding HIPAA violations when providers use telehealth in good faith, including guidance about which common tablet and phone apps are appropriate for use. The website lists specific HIPAA-compliant applications by name, and only excludes public-facing apps (like Facebook) from telehealth use.

CLICK HERE for a PDF of the UPDATED NTP FAQ.

Please note: DMC-ODS distinguishes telephone from telehealth services. NTP services by telephone are reimbursable in all DMC-ODS counties.

NTP services by telehealth (live video) require approval by the county, but the same billing codes may be used as in-person visits.


New DUI FAQthe attached FAQ provides guidance for DUI programs, in particular about managing leaves of absence. CLICK HERE for a PDF of the FAQ.

Reminder about services by telephone and telehealth:

DHCS considers services by telehealth and telephone equivalent to in-person services. The DHCS BH Information Notice 20-009 makes the following clear:

  • DHCS strongly encourages all counties to work with providers to maximize the number of services provided by telephone and telehealth to minimize community spread of COVID-19, as well as to protect the behavioral health workforce from illness.
  • DMC-ODS counties that have NOT previously included telehealth in their program should allow providers to bill for services via telehealth during the period of heightened COVID-19 concern. County approval of services via telehealth is sufficient; contract changes are not required.
  • Licensed providers and non-licensed staff may provide services via telephone and telehealth as long as the service is within their scope of practice.
  • For DMC-ODS, no additional billing code is required for telehealth or telephone. The service provided should be claimed with the appropriate procedure code. SMHS services should apply the GT modifier for telehealth.

 

Q and A on COVID-19 and BH

Please see response to questions received to date.  Please note, the answers to these questions are based on today’s information. DHCS asked for additional flexibility in a federal 1135 waiver, and we will share with you new developments as they unfold.


Q: Our county system is not set up with DMC ODS telehealth billing codes.

A: DMC-ODS uses the same billing code for services, whether in-person, via telephone, or via telehealth. DMC-ODS counties should allow providers to bill for telephone and telehealth services without requiring changes in billing practices (BHIN 20-009, p 4).

 

Q: Our county only allows licensed providers to provide telehealth services.

A: You do not need to be a licensed clinician to provide reimbursable services through telehealth in SMHS and DMC-ODS.

To prevent COVID-19 spread and ensure patients get needed treatment, DHCS encourages counties and providers to deliver all possible services by telehealth and telephone. DMC-ODS and specialty mental health services (SMHS) services provided by licensed AND unlicensed staff are reimbursable services. If a service is within the scope of practice for an non-licensed staff person to do in-person, it is allowable by telephone or telehealth. Due to expected workforce shortages, DHCS encourages providers to deploy all staff (licensed and non-licensedto meet patient needs (BHIN 20-009, p 3 and 4).

 

Q: My county requires us to set up detailed policies and procedures and an authorization form before we can provide services by telephone or telehealth.

A: We are in a public state of emergency. DHCS encourages counties and providers to move quickly to allow all possible services to be provided by telephone and telehealth to minimize spread of COVID-19. The situation is changing daily, and we encourage counties and providers to streamline administrative processes and respond quickly to the changing situation. DHCS considers in-person, telephone and telehealth services equivalent. The standard of care is the same, no matter how the service is delivered (BHIN 20-009, p 2).

 

Q: We are hearing that DHCS will not allow group visits by telehealth. Is this true?

A: For SMHS and DMC-ODS, group visits are allowable through telephone and telehealth as long as providers are compliant with HIPAA and 42CFR part 2.

BHIN 20-009, p 3: “Any DMC-ODS service that is clinically appropriate by telephone is currently reimbursable in all DMC-ODS counties.” 

State Plan DMC Counties (not opted into DMC-ODS) cannot provide telephone and telehealth services at this point; DHCS is seeking an 1135 waiverto allow State Plan DMC counties to provide services via telehealth (p. 6). 

 

Q: We are concerned about treatment capacity – many of our community-based providers are struggling financially and some are already preparing to close.

A: DHCS is open to hearing ideas and solutions for how to help providers stay open and provide services.

Quickly moving to telephone and telehealth is a way for providers to continue to serve beneficiaries and seek reimbursement.

Social isolation, chronic stress, and financial instability due to the COVID-19 emergency will likely increase rates of mental health conditions and SUD over time, leading to increasing demands for services. We will need a robust provider network to continue to serve our beneficiaries. 

We count on providers and counties to work together to quickly identify solutions.

 

Q: Many of our providers have never done telehealth and don’t have equipment that is HIPAA-compliant.  What apps can be used to provide services?

A: The U.S. Department of Health and Human Services Office of Civil Rights (OCR) provided clarification that they will use enforcement discretion regarding HIPAA violations when providers use telehealth in good faith.

The OCR website also provides detailed guidance about which common tablet and phone apps are appropriate for telehealth, and which public-facing apps cannot be used.

 

Q: Can a provider do an intake by telephone?

A: Yes, an intake can be done by telephone for SMHS and DMC-ODS. At this point, in DMC-ODS, the initial clinical diagnostic assessment must be done by video or in-person; subsequent services can be done by telephone or telehealth. SMHS allows assessments, including mental status exams, to be done by telephone or telehealth. ASAM re-assessments can be done by telephone or telehealth. 

 

Q: Some providers are refusing new patients until further notice.  Can we deploy our county staff to see patients and claim for the services?
A: SMH, DMC-ODS and DMC services can be provided anywhere in the community by county staff.

 

Q: Our staff doesn’t have time right now to prepare for audits.  Can we get some relief?

A: DHCS Audits and Investigations is pausing all audit activity (MHP, MHSA, DMC, medical compliance) until April 17.  We are discussing next steps internally, should the emergency continue and further deferrals are needed. Guidance will be released soon regarding the EQRO.

 

We appreciate this is a time of great uncertainty, and DHCS is happy to provide clear guidance where we can.

 

Please take care of your health,

All my best, 

Kelly Pfeifer, M.D.
Deputy Director, Behavioral Health
California Department of Health Care Services

1501 Capitol Avenue, MS 4000
Sacramento, CA 95899-7413
916-345-7554 (W)
Kelly.Pfeifer@dhcs.ca.gov