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Medicare Advantage Risk Adjustment Data Validation Final Rule

Month: January 2024

Medicare Advantage Risk Adjustment Data Validation Final Rule

Posted on by Christie Bowness

The U.S. Department of Health and Human Services ("HHS"), through the Centers for Medicare & Medicaid Services ("CMS"), issued a final rule early last year which, among other things, implemented stricter audits of Medicare Advantage plans, by striking the fee-for-service adjuster from risk adjustment data validation audits. The rule implements changes to the Medicare Advantage Risk Adjustment Data Validation ("RADV") program, which CMS uses to recover improper risk adjustment payments made to Medicare Advantage ("MA") plans.

CMS stated in the corresponding Fact Sheet that the RADV final rule will help CMS to protect the MA program by “addressing instances where Medicare paid Medicare Advantage Organizations ("MAOs") more than they otherwise should have received because the medical diagnoses submitted for risk adjustment payment were not supported in the beneficiary’s medical record.” Specifically, the final rule changed that, as part of the RADV audit methodology, CMS would extrapolate RADV audit findings beginning with payment year 2018. The final rule estimates that the government would not start to collect recoveries for 2018 payments until 2025. CMS reasoned that the final rule protects the program from exploitation through practices such as upcoding schemes.

A year into this final rule, it is likely that entities should start seeing an uptick in audit activity. The full text of the final rule may be accessed here. The audit process itself was modified as explained in our January 16, 2024 blog post.

Real Property Principles: Recordation Status Doesn’t Supplant Actual Notice

Posted on by Christie Bowness

Introduction

After purchasing real property in 2017 in Greenport, New York, Plaintiff JMMJ Development, LLC (“JMMJ”) brought an action to force the Defendant Town of Greenport (“Greenport”) to remove its sewer and water lines crossing the property, which were authorized by a 20-foot permanent easement that was never recorded. Greenport defended its claim to title by contending, among other things, that it had a prescriptive easement and that JMMJ had notice of its claim before closing on the property through surveys reviewed and its title policy. JMMJ lost in the Supreme Court on a summary judgment motion and then appealed to the Appellate Division. Addressing New York Real Property Law Section 291 and case law on prescriptive easements, the Court ruled that Plaintiff had actual notice of the easement and, thus, was not a good faith purchaser without notice.  It then held that Greenpoint had established a prescriptive easement for the proscribed ten-year term.  JMMJ Dev., LLC v. Town of Greenport, 2023 NY Slip Op 06779 (App. Div. 3rd Dept.)

Background

In 1971, Greenport authorized the construction of Sewer District No. 2, which had sewer and water lines crossing the property, together with a 20-foot-wide permanent sewer easement over land now owned by JMMJ, formerly owned by Earl and Ava Stalker. Eight years later, Greenport authorized payment of $13,800 to the Stalkers to acquire property and easement rights for the sewer project. Sewer lines were then installed.  The easement, however, was again never recorded.

In 2013, when Ava Stalker went to sell the property, she commissioned a land surveyor to survey the land. She gave the surveyor a 1979 letter from Greenport offering the $13,800 payment for the sewer easement and a written metes and bounds description of the easement. “The letter stated that [Greenport] had acquired its property interest through the power of eminent domain and that the $13,800 offer was based upon defendant’s highest approved appraisal, in accordance with the [eminent domain law].”

Before purchasing the property from Ava Stalker in 2016, JMMJ hired professional land surveyors to prepare an update to the 2013 survey. The survey confirmed the existence of the 20-foot-wide sewer easement crossing the property, although it was not recorded in the land records. The title policy referenced JMMJ’s 2017 survey identified an unrecorded easement and specifically excepted from coverage “the rights of the Town of Greenport and others in and to the use of said sewer easement.”

JMMJ brought a quiet title action, claiming that there is no valid easement as it was not recorded and that the sewer lines on his property are unlawful, as well as trespass and nuisance claims. Greenport counterclaimed, “seeking a declaration that it has an easement over the property for use of its sewer and water lines” via a prescriptive easement as the pipes had crossed the property for well over the ten-year prescribed time period under controlling New York case law. Allen v Mastrianni, 2 AD3d 1023, 1024, 768 NYS2d 523 (2003). At the conclusion of discovery, Greenport moved for summary judgment and prevailed.

Appeal

A good faith purchaser cannot be bound by an unrecorded easement prior to purchase, but one’s status as a good faith purchaser for value cannot be maintained when that purchaser has notice or knowledge of a prior interest or equity in the property. Real Property Law § 291. Additionally, “Notice sufficient to grant summary judgment has been found where a purchaser, prior to its acquisition of servient land, had actual notice of an easement thereon by virtue of it being excepted in its title insurance policy.” Baiting Hollow Props., LLC v Knolls of Baiting Hollow, LLC, 89 AD3d 776, 778, 932 N.Y.S.2d 160 (2d Dept 2011).

The Third Department sustained the trial court’s grant of summary judgment because it found that Greenport had adequately shown that JMMJ had both actual and constructive notice through the 2017 contract to purchase, the 2013 and 2017 surveys, and the plaintiff’s title insurance policy. Defendant also showed that “its use of the easement was open, notorious, continuous, hostile and under a claim of right for over 30 years prior to plaintiff's purchase.” In turn, JMMJ only relies on the fact that the easement was unrecorded. With that, the Third Department reaffirmed that a purchaser does not maintain its good faith status if it has notice or knowledge prior to purchasing the property. JMMJ commissioned his own land surveyor, which showed the presence of the easement. JMMJ purchased title insurance that specifically mentioned the easement. It had actual notice of the easement prior to purchase.

Takeaways

JMMJ Dev., LLC v. Town of Greenport is a simple and straightforward reminder that purchasers of real estate or a lienholder will be deemed to have accepted encumbrances on property that they have actual notice of, even if those encumbrances are not recorded in the County Clerk’s office.

For a copy of the decision, please contact Michael O’Donnell at modonnell@riker.com, Thomas Persico at tpersico@riker.com, Kevin Hakansson at khakansson@riker.com, or Kori Pruett at kpruett@riker.com.

Information Blocking Final Rule and Proposed Disincentives for Healthcare Providers

Posted on by Christie Bowness

The Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) recently released a final rule (88 FR 42820) for information blocking penalties and subsequently proposed a rule (88 FR 74947) to establish disincentives for healthcare providers found by OIG to have committed information blocking.

The final rule does not impose new information-blocking provisions, but establishes civil monetary penalties (“CMPs”) for certain actors up to $1 million per violation pursuant to the 21st Century Cures Act for “any practice that is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information (“EHI”). Penalties may be imposed on developers of certified health information technology (“IT”), health information exchanges (“HIEs”), and health information networks (“HINs”).

OIG will prioritize investigating conduct that: “(1) resulted in, is causing, or had the potential to cause patient harm; (2) significantly impacted a provider's ability to care for patients; (3) was of long duration; (4) caused financial loss to Federal health care programs, or other government or private entities; or (5) was performed with actual knowledge.” OIG also emphasized that because the definition of a violation uses the word “practice,” each discrete act will count as a separate violation to prevent larger organizations from consuming the cost of a single violation and continuing to engage in information blocking.

As mentioned above, HHS proposed separate rulemaking to establish appropriate disincentives for healthcare providers who knowingly and unreasonably interfere with access, exchange or use of EHI unless a regulatory exception applies. HHS proposes the following disincentives for healthcare providers that OIG determined to have committed information blocking and will refer its determination to the appropriate agency:

  • An eligible hospital or critical access hospital (“CAH”) under the Medicare Promoting Interoperability Program would not meet the requirements as a meaningful electronic health record (“EHR”) user during the applicable EHR reporting period. This would cause a loss of 75% of the annual market basket increase and pay would be reduced by 100% of reasonable costs for CAHs.
  • Under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (“MIPS”), physicians and medical groups would not meet the requirements of a meaningful user of certified EHR technology in a performance period and would receive a score of zero. This category is typically 25% of the total annual MIPS score.
  • Accountable Care Organizations (“ACOs”) would be ineligible to participate in the Medicare Shared Savings Program for at least one year and may result in individual healthcare providers being removed from an ACO or prevented from joining an ACO in the future.

Medicare Advantage Proposed Rule and Final Inpatient Rule

Posted on by Christie Bowness

Medicare Advantage Proposed Rule for 2025

The United States Centers for Medicare & Medicaid Services (“CMS”) has proposed new rulemaking (88 FR 78476) to revise the Medicare Advantage (Part C) (“MA”) regulations for 2025. CMS is proposing new health equity requirements for prior authorization policies and procedures to aid in the disproportionate access to care for underserved populations. The key proposals include:

  • requiring MA plans to include a health equity expert on their utilization management committees;
  • the utilization management committees would be required to conduct an annual analysis of the plans’ prior authorization policies and procedures to survey the insureds’ social risk factors, such as eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability, and compare it to the enrollees without those risk factors; and
  • payers would be required to post this analysis publicly on their website.

The proposed rule also seeks to improve access to behavioral health for MA beneficiaries by requiring plans to have adequate networks of outpatient behavioral health centers. Specifically, CMS proposed adding a new facility type, which includes marriage and family therapists, mental health counselors and addiction or drug and alcohol counselors. The MA plan would receive a 10% credit if their outpatient behavioral health network includes one or more telehealth providers.

CMS is also proposing changes to the Risk Adjustment Data Validation (“RADV”) appeal regulations so that MA organizations may request a medical record review determination appeal or a payment error calculation error, but not at the same time. Under the current rule, appeals move through each process concurrently, which can result in inconsistent decisions. The proposed rule, however, only allows MA organizations to request payment error calculation after the medical record review determination is completed.

The proposed rule also introduces new standards to limit MA plans’ payments to brokers and limit third-party marketers, which many Medicare beneficiaries rely on when choosing a plan. CMS seeks to reduce inappropriate beneficiary steering that interferes with competition among plans. The proposed rule caps the compensation that plans can pay brokers at $632, eliminating any variability in payments and also prohibits MA plans from paying third-party marketers, or “middlemen,” volume-based bonuses for enrollment into certain plans.

Further, to increase the utilization of benefits, the proposed rule requires MA plans to issue a mid-year notice to its enrollees and make them aware of any supplemental benefits available to them that were not accessed during the first six months of the year. CMS also proposed MA plans to provide special supplemental benefits for the chronically ill and to update marketing requirements to prevent misleading marketing for certain benefits that are not available to everyone.

Finally, the proposed rule would increase the percentage of beneficiaries dually eligible for Medicare and Medicaid who receive integrated services and reduce the number of plans that can enroll dually eligible individuals outside of the open enrollment period to reduce “aggressive” marketing tactics throughout the year.

A fact sheet for the proposed rule may be accessed here.

Inpatient Prospective Payment System Final Rule

CMS recently released the fiscal year (“FY”) 2024 Inpatient Prospective Payment System (“IPPS”) and long-term care hospital (“LTCH”) payment system final rule (88 FR 77211) correcting technical errors in the final rule published August 28, 2023 (88 FR 58640). The rule updates Medicare payment policies and quality reporting programs for inpatient hospital services.

CMS finalized a 3.1% increase to the FY 2024 IPPS payment rates from a 3.3% increase to the market basket percentage estimate, offset by a 0.2% decrease due to productivity adjustments. This will increase IPPS payments to hospitals by $2.2 billion. CMS also decreased the LTCH payment rates by 0.2%, or $6 million.

CMS also will continue policies from FY 2020 to address low-wage index hospitals, which includes many rural hospitals. Additionally, because IPPS payments are based on the use of hospital resources in patients’ treatment, the rule finalizes changes to the Social Determinants of Health (“SDOH”) diagnosis codes for homelessness from non-complication or comorbidity to complication or comorbidity.

The final rule addresses a number of changes to the Hospital Inpatient Quality Reporting Program and Medicare Promoting Interoperability Program and finalized the New COVID-19 Treatments Add-on Payment that was available during the public health emergency to sunset at the end of FY 2023.

A fact sheet for the CMS final rule may be accessed here.

Changes to the Medicare Promoting Interoperability Program

As discussed above, CMS finalized changes to the Medicare Promoting Interoperability Program in the 2024 IPPS final rule. The program was first established to encourage eligible hospitals and critical access hospitals (“CAHs”) to adopt the use of certified electronic health record (“EHR”) technology (“CEHRT”).

CMS adopted a 180-day EHR reporting period in calendar year (“CY”) 2025 and for new participating hospitals, changed the payment adjustment period to two years after the CY in which the reporting period occurs. CMS also finalized a requirement for eligible hospitals to report an annual self-assessment of nine Safety Assurance Factors for EHR Resilience (“SAFER”) Guides.

For both the Medicare Promoting Interoperability Program and the Hospital IQR Program, CMS added three new electronic clinical quality measures (“eCQMs”) that participating hospitals can select from as one of three self-selected eCQMs: (1) Hospital Harm — Pressure Injury eCQM; (2) Hospital Harm — Acute Kidney Injury eCQM; and (3) Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Hospital Level — Inpatient) eCQM.

This will begin in the CY 2025 reporting period. A fact sheet for the CMS final rule may be accessed here.

State Court Prioritizes Taxpayer ID in Adverse Possession of Unimproved Land Case

Posted on by Christie Bowness

Introduction

The Court of Appeals for Arkansas, Second Division, recently affirmed the dismissal of a complaint seeking to quiet title a tract of undeveloped land between two neighbors on the Little Red River in Alma, Arkansas, on theories of adverse possession and acquiescence. Linder v. Gertsch, 2023 Ark. App. 484, 678 S.W.3d 635 (Ct. App. 2023). The case highlights the basic principles of the doctrines of adverse possession and boundary line by acquiescence in a colorful fashion and emphasizes the critical nature of credibility determinations by a factfinder in applying those doctrines.

Background

Lisa and Michael Gertsch (the “Gertsches”) owned Lot 1 of Hidden Valley Estates in Alma, Arkansas, since 1982. Their neighbors, Kathy and Perry Linder (the “Linders”), purchased their farm in 1992.

In 2018, the Gertsches purchased an adjoining undeveloped 1.63-acre parcel of real property along the Red River (the “Property”) from the estate of Fleda Shearer.

After the Gertsches bought the Property, the Linders claimed title to the Subject Property under theories of adverse possession and acquiescence. The two families undertook acts of dominion over the Subject Property, such as the Gertsches installing a fence and “the Linders cut the fence to brush hog the Subject Property, the Linders painted blazes on the trees and posted no-trespassing signs, and the Gertsches removed them.”

The Trial

At trial, Perry Linder “testified that when he bought his farm, he received a survey at closing identifying a triangle consisting of 12.68 acres that was not being conveyed, and the Property lay at the eastern end of that triangle. Perry also that claimed he later acquired title to the Subject Property through a quitclaim deed executed in 1999 from Ricky Whisnat.” However, Whisnat never testified at trial, the quitclaim deed was indefinite in that it did not identify the conveyed property, and there was no indication in the public record that the Linders ever owned any interest in the Subject Property.

Perry Linder further testified about a meandering fence traversing the Subject Property that represented the boundary line between his property and the property formerly owned by the Shearers. He also “introduced a statement from J.C. Shearer (deceased) regarding the fence that was alleged to have stood to the west of Gum Springs Creek.”  Perry Linder stated that J. C. Shearer recognized the existence of the fence and had no issue with it. Kathy Linder claimed she had paid ad valorem taxes on the Subject Property but had no evidence to support it.

The title agent who closed the sale of the Subject Property to the Gertsches in 1982 stated that “nothing in the public record indicated any interest of the Linders to the Subject Property.”  Moreover,  the taxes assessed against the Subject Property had been paid by the Shearers and the Shearer Estate—not the Linders. The agent completed his testimony by stating “ [t]here was no hint of any dispute between the parties prior to the Gertsches’ purchase of the Subject Property.”

The trial court found the Linders’ testimony not credible and thus rejected all of the claims made by the Linders.  The court also found that based on the continuous payments of taxes by the Gertsches and Shearers before them and because of the wild, unimproved, and unenclosed nature of the Subject Property, the Gertsches were deemed to be in possession of the Subject Property. The trial, therefore,  quieted title of the Subject Property to the Gertsches.

Appeal

On appeal, the Court of Appeals first detailed that to prevail on a boundary line by acquiescence, there are  “three essential elements—(1) a tacit agreement between the parties; (2) recognition of the boundary for a long period of time; and (3) a fixed line that is definite and certain.” Thurlkill v. Wood, 2010 Ark. App. 319, 374 S.W.3d 790. In addressing this, the Court agreed with the trial court that a statement by a deceased witness, J.C. Shearer, lacked credibility. The Court noted that there was never any evidence that J.C. Shearer and the Linders were ever neighboring property owners, such that J.C. Shearer could have tacitly accepted the fence line and, thus, the property line. A boundary line by acquiescence depends on the totality of the facts and the landowner's conduct over time, and nothing presented by the Linders supports the claim that the Shearers ever recognized a forfeiture of their property.

To succeed on an adverse possession cause of action, the Linders had to show actual possession for at least seven years, with possession being actual, open, notorious, continuous, hostile, and exclusive. The trial court found none of these elements were present on the wild, unimproved, and unenclosed Property.

Further fatal to the Linders’ claims was  Arkansas Code provides that “[u]nimproved and unenclosed land shall be deemed and held to be in possession of the person who pays the taxes thereon if he or she has color of title thereto, but no person shall be entitled to invoke the benefit of this section unless he or she, and those under whom he or she claims, shall have paid the taxes for at least seven (7) years in succession.” Arkansas Code Annotated section § 18-11-102 (Repl. 2015)

Takeaways

This case is fact-specific, but it is an interesting exposition of the principles of adverse possession and boundary line by acquiescence and how fact-specific these claims can be.  It is also a reminder for those in jurisdictions that require payment of taxes to plead the doctrine that determining who paid the taxes should be one of the first things one should do in defending against such claims.

For a copy of the decision, please contact Michael O’Donnell at modonnell@riker.com, Thomas Persico at tpersico@riker.com, Kevin Hakansson at khakansson@riker.com, or Kori Pruett at kpruett@riker.com.

Federal Telehealth Changes and Fraud Toolkits

Posted on by Jessica Civetta

Many waivers and flexibilities were put into place by federal and state governments to better ensure necessary services could be provided to patients during the COVID-19 pandemic. With the end of the public health emergency, the federal and state governments have had to review and revise such policies, including telehealth access and services. Some flexibilities have expired and were not renewed. For example, the Office of Civil Rights (“OCR”) previously revoked four notifications (88 FR 22380) regarding its enforcement discretion as to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), such as, when OCR allowed providers to use non-public facing on-line or web-based applications to conduct telemedicine visits that were not HIPAA compliant.

Other tools have been released to provide guidance on telehealth. The below topics discuss such policies in further detail on the federal level. Our previous posting addressed New Jersey’s extension of payment parity for telemedicine through December 31, 2024.

CMS Final Rule regarding Telehealth Flexibilities for 2024

On November 2, 2023, the Centers for Medicare and Medicaid Services ("CMS") issued its calendar year ("CY") 2024 Medicare physician fee schedule ("PFS") final rule, which specifically clarifies questions with regard to telehealth services. The policy changes within the PFS are effective on or after January 1, 2024. The below subtopics cover a majority of the policy changes and clarifications within the telehealth space.

Telehealth Remote Patient Monitoring Services and Extension of Telehealth-Related Flexibility

For CY 2024, health and well-being coaching services will be added to the Medicare Telehealth Services List on a temporary basis for CY 2024, and Social Determinants of Health Risk Assessments on a permanent basis. The final rule removes some ambiguity by extending certain telehealth flexibilities that were within CMS’ discretion and implementing statutory extensions that were included in the Consolidated Appropriations Act ("CAA"), postponing a permanent decision on such flexibilities another year. The PFS, which governs Medicare payment for physician services, sets forth facility and non-facility rates for payment.

With regard to the CAA and the PFS, and as discussed in a CMS telehealth webpage, some flexibilities were extended to December 31, 2024 and some were made permanent, including:

  • the temporary expansion of the scope of telehealth originating sites for services furnished via telehealth to include any site in the United States where the beneficiary is located at the time of the telehealth service, including an individual’s home, has been extended through December 31, 2024;
  • the expansion of the definition of telehealth practitioners to include qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists, and qualified audiologists has been extended through December 31, 2024;
  • the continued payment for telehealth services furnished by Rural Health Clinics (“RHC”) and Federally Qualified Health Centers (“FQHC”) using the methodology established for those telehealth services as distant site providers during the COVID-19 PHE has been made permanent;
  • delaying the requirement for an in-person visit with the physician or practitioner within six months prior to initiating mental health telehealth services, and again at subsequent intervals as the Secretary determines appropriate, as well as similar requirements for RHCs and FQHCs, has been extended through December 31, 2024; and
  • Rural Emergency Hospitals ("REHs") as eligible originating sites for telehealth has been made permanent.

Additionally, beginning in CY 2024, telehealth services furnished to patients in their homes will be paid by Medicare at the non-facility PFS rate, with a new modifier, "POS 10."

CMS will continue to define direct supervision to permit the presence and immediate availability of the supervising practitioner through real-time audio and video interactive telecommunications through December 31, 2024. CMS stated that it believes that this extension will align the timeframe of this policy with many of the previously discussed PHE-related telehealth policies that were extended under provisions of the CAA.

Telehealth Services in Teaching Settings, OTPs, and DSMT

To be consistent with the telehealth policies that were extended under the CAA, CMS exercised enforcement discretion through the end of CY 2023 and are finalizing a policy to continue to allow teaching physicians to use audio/video real-time communications technology to be present when a resident furnishes Medicare telehealth services in all residency training locations through the end of CY 2024. This virtual presence will meet the requirement that the teaching physician be present for the key portion of the service.

For CY 2024, CMS will allow Opioid Treatment Programs ("OTPs") to bill Medicare under the Part B OTP benefit for furnishing periodic assessments via audio-only telecommunications when video is not available to the beneficiary, to the extent that the use of audio-only communications technology is permitted under the applicable SAMHSA and DEA requirements at the time the service is furnished, and all other applicable requirements are met.

CMS will allow the entirety of Diabetes Self-Management Training ("DSMT") Services furnished by Registered Dietitians ("RDs") and Nutrition Professionals services to be furnished via telehealth.

The above changes are reflected in the 2023 version of the Consolidated Appropriations Act, and the CMS CY 2024 Physician Fee Schedule, as discussed above. The temporary flexibilities extension was effective January 1, 2024, and are now scheduled to end December 31, 2024.

The full text of the final rule can be accessed here and the CMS Fact Sheet discussing the final rule can be accessed here.

OIG Federal Toolkit to Assess Telehealth Program Integrity Risks

The U.S. Department of Health and Human Services ("HHS") Office of the Inspector General ("OIG)" previously released a federal toolkit, Analyzing Telehealth Claims to Assess Program Integrity Risks, which aims to help healthcare stakeholders analyze their telehealth claims data to assess program integrity risks associated with telehealth services. The toolkit aims to help public and private sector partners, such as Medicare Advantage plan sponsors, private health plans, and State Medicaid Fraud Control Units, in analyzing their own telehealth claims data to assess the integrity risks associated with telehealth-related billing.

The toolkit, by helping stakeholders get a better understanding of program integrity risks associated with telehealth services, will help them to develop necessary safeguards and address individual cases of potential fraud, waste, and abuse. OIG felt this necessary due to the large increase in telehealth usage during and following the COVID-19 pandemic, which has increased the risk of potential fraud and abuse.

Specifically, the toolkit details five steps stakeholders should take when analyzing telehealth claims and provides seven measures that stakeholders can use to analyze claims data.

The full text of the toolkit can be accessed here.

New Jersey Extends Telemedicine Payment Parity

Posted on by Christie Bowness

The New Jersey telehealth reimbursement parity extensions were set to expire on December 31, 2023. On December 21, 2023, amended legislation was passed which extends the State’s telehealth parity flexibilities to December 31, 2024. Bill Number A5757/S4127 (“Bill”) extends the requirement that a health benefits plan provide coverage and payment for healthcare services delivered to a covered person through telemedicine or telehealth at a provider reimbursement rate that equals the provider reimbursement rate that is applicable for an in-person visit. There are two exceptions to this requirement.

First, the parity requirement does not apply to a healthcare service provided by a telemedicine or telehealth organization that does not provide the healthcare service on an in-person basis in New Jersey. Second, it does not apply to a healthcare service that was provided through real-time, two-way audio without a video component, including through audio-only telephone conversations, in which case the reimbursement rate has to be at least 50% of the contract rate for an in-person visit, but this does not apply to a behavioral healthcare service. In other words, audio-only telemedicine visits for behavioral health services should be reimbursed at the same rate as an in-person visit.

The full text of the Bill may be accessed here.

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