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In response to the COVID-19 public health emergency, the Ohio Department of Health, Department of Medicaid, and Department of Mental Health and Addiction Services issued emergency rules expanding telehealth services and increasing access to healthcare while the public was under a stay-at-home order. On June 10, 2020, the Ohio House of Representatives favorably (91 votes for and 3 votes against) passed House Bill 679 (“HB 679”), establishing new and modifying existing requirements regarding the provision of telehealth services in Ohio. This bill essentially turns the various administrative emergency rules into law and will fundamentally change the way healthcare is delivered in the state.

Introduced on May 26, 2020, the 26-page bill, sponsored by Mark Fraizer (District 71) and Adam Holmes (District 97), now makes it way to the state Senate. Through various amendments and new law enactments, HB 679 expands telehealth reimbursement requirements, access to telehealth services, and allowed providers.

Expanded Insurance Coverage of Telehealth Services

Current insurance law for which providers may be paid for telehealth services applies only to physicians, physician assistants, and advanced practice registered nurses. HB 679 expands insurance law application to include the following: 

• Psychologists and school psychologists
• Audiologists and speech-language pathologists
• Occupational therapists and physical therapists
• Professional clinical counselors, independent social workers, and independent marriage and family therapists
• Independent chemical dependency counselors
• Dietitians

When it comes to insurance cost-sharing, under HB 679, a health benefit plan[1] may not impose a cost-sharing requirement for telehealth services that exceed the cost-sharing requirement for similar in-person health care services. Additionally, a health benefit plan is prohibited from implementing a cost-sharing requirement when all of the following apply: (1) the telehealth communication was initiated by the provider; (2) the patient consented to receive telehealth services from that provider on any prior occasion; and (3) the telehealth communication is for preventative health care services only. Finally, and perhaps most important, HB 679 explicitly requires a health plan issuer to reimburse providers for a covered telehealth service, although it does not set out any specific rates.

Expanded Health Care Professionals Authorized to Provide Telehealth Services 

Allowed Providers

HB 679 authorizes the following health care providers to offer telehealth services (identical list as insurance provisions):

• Physicians and physician assistants
• Advanced practice registered nurses
• Psychologists and school psychologists
• Audiologists and speech-language pathologists
• Occupational therapists and physical therapists
• Professional clinical counselors, independent social workers, and independent marriage
• and family therapists
• Independent chemical dependency counselors
• Dietitians

Each respective professional licensing board is tasked with issuing rules for each profession as it relates to the provision of telehealth services.

Conditions for Providing Telehealth Services

Each health care professional listed above must adhere to the following conditions when providing telehealth services: 

• A provider may deny any patient telehealth services and require an in-person visit
• Use technology during the initial visit, and any subsequent annual visit, that is appropriate for the standard of care required for such visit
• Comply with all state and federal law concerning the protection of patient information
• Ensure that any username, password, or electronic communication are security transmitted and stored
• A physician, physician assistant, or advanced practice registered nurse may provide telehealth services to a patient located outside of Ohio[2] 

Fees and Billing

Under HB 679, telehealth providers are prohibited from charging a facility fee, origination fee, or any fee associated with the cost of equipment used to provide telehealth services. A health care provider is permitted, however, to charge a health plan issuer for durable medical equipment used at a patient or client site. Health care providers do have the autonomy to negotiate with an insurance company to establish a reimbursement rate for fees associated with the administrative costs incurred when providing telehealth services, but this negotiation may not place any portion of financial responsibility on the patient. 

Expanding Providers under Ohio Medicaid

For purposes of the Medicaid program, HB 679 provides that all the following practitioners are eligible to provide telehealth services, subject to the rules set forth by the Ohio Department of Medicaid: 

• Physicians
• Psychologists
• Physician assistants
• Clinical nurse specialists, certified nurse-midwives, and certified nurse practitioners
• Independent social workers, independent marriage and family therapists, and
• professional clinical counselors
• Independent chemical dependency counselors
• Supervised practitioners and supervised trainees
• Audiologists and speech-language pathologists
• Audiology aides and speech-language pathology aides
• Occupational therapists and physical therapists
• Occupational therapy assistants and physical therapist assistants
• Dietitians
• Medicaid school programs
• Any other practitioner considered eligible by the Medicaid Director 

The bill also specifies the types of providers that are eligible to submit a claim to the Department of Medicaid and seek reimbursement for providing telehealth services: 

• Any of the above-identified practitioners, except for a supervised practitioner or supervised trainee, an audiology aide or speech-language pathology aide, and an occupational therapy assistant or physical therapist assistant
• A professional medical group
• A federally qualified health center or rural health clinic
• An ambulatory health care clinic
• An outpatient hospital
• A Medicaid school program
• Any other provider type that the Medicaid Director considers eligible to submit a claim 

Requirements for Community Behavioral Health Providers 

HB 679 implements the following requirements on community behavioral health providers (i.e., mental health and addiction service providers) that are certified by the Ohio Department of Mental Health and Addiction Services: 

• Providers must have written policies and procedures to ensure telehealth staff are fully training in using telehealth equipment
• Providers must establish a contingency plan in the vent of technical difficulties or complications
• A mental health facility or unit serving as a client site must have adequate staff present to handle any equipment malfunctions
• Prior to providing telehealth services, behavioral health providers must inform (and document) the client of the potential risks associated with receiving treatment through telehealth, which include:
  • The clinical aspects of receiving treatment through telehealth services
  • Any security considerations when receiving treatment through telehealth services
  • The confidentiality for individual and group counseling
• Providers must maintain information regarding the local suicide prevention hotline, or the national suicide prevention hotline, as well as the contact information for the local police and fire departments
• Providers have the responsibility of ensuring:
  • Equipment used meets the following standards:
    • Confidential communication between provider and client
    • Interactive communication between provider and client
    • Video or audio sufficient to enable real-time communication between provider and client
  • Any entity the provider contracts with that is involved in the transmission of information through telehealth does so in a manner that maintains the confidentiality of client information 

Videoconferencing in Long-Term Care Facilities

Under HB 679, during any declared disaster, epidemic, pandemic, public health emergency, or public safety emergency, every long-term care facility[3] must provide each resident and their family with a video-conference visitation option, if the Governor, the Director of Health, another governmental official or entity, or the long-term care facility itself determines that allowing in-person visits at the facility would create a risk to the health of the facility’s residents. 

Access to Assistance at Health Care Appointments

HB 679 sets forth new law specifying that during any declared disaster, epidemic, pandemic, public health emergency, or public safety emergency, any individual with a developmental disability (or other permanent disability) who is in need of surgery or another health care procedure, test, or any clinical care visit must have the opportunity to have at least one parent or legal guardian present during the procedure, test, surgery, or other care visit if the parent or legal guardian’s presence is necessary to help alleviate a negative reaction by the individual.

House Bill 679 can be found in its entirety here. Please contact a BMD healthcare attorney if you have any questions regarding HB 679, general questions regarding telehealth, or any other healthcare questions.

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[1] A policy, contract, certificate, or agreement offered by a health plan issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

[2] If permitted to do so by the laws of the state in which the patient is located.

[3] (1) a nursing home, residential care facility, home for the aging, nursing facility, or skilled nursing facility, (2) a residential facility licensed by Ohio Department of Mental Health and Addiction Services, (3) a residential facility licensed by the Ohio Department of Developmental Disabilities, and (4) a facility operated by a hospice care program or any facility in which a hospice care program provides care for hospice patients.