To address the burgeoning Medicaid costs for the state’s most chronically ill residents, New York enacted a demonstration project to deliver care via home remote monitoring in 2007. Due to the success of the demonstration, New York enacted legislation covering home telehealth services. Home telehealth services are covered when provided by a certified home health agency, long-term health care program or AIDS home care programs. The agency and its specific technology must be pre-approved by the Department of Health. An in-person riskassessment, conducted by the telehealth provider and physician’s approval, are required before the initiation of services. Patient eligibility is determined by “conditions or clinical circumstances including but not limited to congestive heart failure, diabetes, chronic pulmonary obstructive disease, wound care, polypharmacy, mental or behavioral problems limiting self-management, and technology dependent care such as continuous oxygen, ventilator care, total parenteral nutrition or enteral feeding.” 10 Services are reimbursed based on a tiered-pricing system determined by the technology’s level of interoperability:
- Tier 1: $8.88/day – FDA approved class II device capable of interoperability with point of care (POC) software
- Tier 2: $10.19/day – Interconnected with POC Software
- Tier 3: (rate to be developed) – Interconnected with EMR and statewide health information network
- Installation Fee – Providers can bill for a one-time installation fee of $50 for each telehealth user.
- Monitoring of patient vital signs
- Patient education
- Medication management
- Equipment management
- Review of patient trends and/or other changes in patient condition necessitating professional intervention
- And other activities deemed necessary and appropriate according to the plan of care
New York State is restructuring their Medicaid program and transitioning all Medicaid beneficiaries to managed care plans in phases. Adults with Medicare and Medicaid residing in New York City, Nassau, Suffolk and Westchester counties must enroll in the state’s managed long term care plan. The state has contracted with the Medicaid managed care and managed long term care plans to cover home telehealth, but prior authorization is required. Home health agencies will now receive a bundled payment for the home health visit, and the base rate includes home telehealth and equipment installation.
Source: Home TeleHealth, page 7