New guidance declares that states can unilaterally reimburse for telemedicine in schools without further federal approval
SAN FRANCISCO, April 9, 2015 – The Centers for Medicare and Medicaid Services (CMS) recently issued official written guidance announcing that states can unilaterally reimburse for telemedicine without the need for further approval by the CMS. This guidance is significant because now states can easily access federal education funds through a simple regulatory change at the level of their Medicaid department, making telemedicine services more accessible and affordable to students and schools in need.
“This is a big win for schools and students nationwide. This policy is on the right side of equality of access, and will mean that children with special needs will receive better access to the high quality services that they need to unlock their full potential,” said John Hill, Executive Director, National Alliance for Medicaid in Education.
The official policy states: “States are not required to submit a separate State Plan Amendment (SPA) for coverage or reimbursement of telemedicine services, if they decide to reimburse for telemedicine services the same way/amount that they pay for face-to-face services/visits/consultations.” In other words, States may, through a simple regulatory change at the agency level, access Federal funds for schools to provide needed services to children without any new outlays of state funds whatsoever.
CMS further recognized that: “telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care… that states can choose to cover under Medicaid.”
Importantly, CMS has also upheld vital state regulations around licensure and other consumer protections in this policy, requiring that all state requirements for services to be met in order for reimbursement to occur.
“Online therapy has proven to be an effective and highly engaging way for schools and districts to provide special education services and improve student outcomes,” said Clay Whitehead, co-CEO and co-founder of PresenceLearning. “Yet the states’ inconsistent systems for applying for Medicaid reimbursement made it difficult for many schools and districts to afford these services. The clarification of the telemedicine reimbursement policy makes the process more streamlined, which will ultimately help students get the services they need.”
Lack of clear direction on Medicaid reimbursement for telemedicine services has been a major obstacle, disproportionately penalizing schools that chose to utilize new online options to deliver therapy services for students with special needs. Now schools can provide millions more students—especially in rural and hard-to-reach locations—with the therapy services they need to access a free and appropriate public education.
Under federal mandates of IDEA and civil rights statutes, schools are required to provide more than 7 million students with speech therapy, occupational therapy or behavioral or mental health services. With over 10,000 unfilled positions for school-based clinicians nationwide, many schools lack the capacity to provide these services to students in need. Use of live online speech therapy and other related services—also known as telemedicine or telepractice—can put fully qualified professionals wherever they are needed to serve students in need. Dozens of studies have shown that telemedicine services produce similar or better results than onsite services.
Many districts that could have benefited from the use of online services could not afford to forgo Medicaid reimbursements for such services. Instead these districts have relied on grossly inadequate arrangements which were reimbursable by Medicaid—such as once-a-month onsite visits from contractors who travel long distances to under-served areas. With access to Medicaid reimbursements for telemedicine services, schools can now choose services that more appropriately address the needs of their students.
Since 2009, PresenceLearning has helped tens of thousands of children realize their potential through high quality telemedicine services, including behavioral and mental health, speech language pathology, occupational therapy, and assessments. The company performs thousands of sessions each day, working with clients in over 40 states.
PresenceLearning (www.presencelearning.com) is the leading telehealth network of providers of clinical services and assessments to educational organizations. The PresenceLearning care network has provided over one million sessions of live, online speech-language therapy, occupational therapy, behavioral interventions and mental health services, diagnostic services and assessments, and early childhood services for children with special needs.