SPECIAL BULLETIN COVID-19 #20: Telehealth Provisions for Enhanced Behavioral Health Services

NOTE: SPECIAL BULLETIN COVID-19 #20 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #35: Telehealth Clinical Policy Modifications - Enhanced Behavioral Services

Effective March 30, 2020 through the conclusion of the declared North Carolina State of Emergency related to COVID-19, the Division of Health Benefits (DHB) and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) is temporarily modifying the following Enhanced Behavioral Health policies to better enable the delivery of remote care to Medicaid and State funded beneficiaries:

8A. Enhanced Mental Health and Substance Abuse Services

• Intensive In-home Services
• Multisystemic therapy
• Mobile Crisis Management 

8A-1. Assertive Community Treatment (ACT) 
8A-6. Community Support Team (CST) 
8G-1. Peer Supports Services (PSS) 

These changes are in effect retroactive to March 10, 2020 and will remain in effect until the State of Emergency is declared over or when this policy is rescinded. Once the declared State of Emergency has ended, all face-to-face elements of the service shall again be required to be performed in person. Providers will be able to bill for services allowed as described in this policy bulletin beginning March 30, 2020, for dates of service on or after March 10, 2020.  

It is the Department’s goal to support the continuation of quality, medically necessary services for beneficiaries and reduce the number of disruptions in care which could lead to increased anxiety and exacerbation of symptoms.  The declaration of the State of Emergency related to COVID 19 may affect the location where a beneficiary resides. As such, the following protocols should be employed for the community based behavioral health services listed below unless the beneficiary refuses an in person visit:

1. Beneficiary should be screened either over the phone or in person from 6 feet away for symptoms of COVID-19 (i.e. fever, cough, shortness of breath) as well as for close contact with a person diagnosed with COVID-19 in the past 14 days. If screen is negative, then proceed with an in person visit, as clinically indicated. See Center for Disease Control Guidance for Risk Assessment and Public Health Management of Person with Potential Coronavirus Disease.
2. If beneficiary screens positive, assist the beneficiary in connecting to an appropriate medical provider if not already done. Then, as clinically appropriate, offer HIPAA compliant two-way real–time interactive audio and video telehealth appointment to proceed with the behavioral health intervention(s). (Note: please see OCR guidance relaxing technology requirements). If that option is not available, offer non-HIPAA audio and video telehealth appointment with documented beneficiary or legal guardian consent.  If two-way audio-visual options are not accessible to the beneficiary, offer a telephonic appointment. See Special Bulletin COVID-19 #9 Telehealth Provisions for eligible technologies. 
3. All visits, regardless of modality of communication, must be clinically necessary to work on treatment goals as outlined in the Person-Centered Plan and to support beneficiary stabilization, safety and coordination of care.
4. Visit documentation must include the modality of communication used, the rationale for that modality, duration of intervention, and that the beneficiary or legal guardian provided informed consent.
5. Interventions performed via these alternate modalities (i.e. not in person) may be provided by any treating staff within their scope and with appropriate and clinical supervision as required by treatment service definition.

HCPCS Codes

Modifiers

Provider(s) shall follow applicable modifier guidelines.
Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.
Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT and HCPCS codes listed in this policy to relax frequency limitations defined in code definitions.

Billing Unit

Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).

Place of Service

Telemedicine and telepsychiatry claims should be filed with place of service 02 (telehealth) and will be reimbursed at the same rates as if the service was performed in person.