Updating Telehealth Services In 2022
In support of our members and employer groups during the ongoing national public health emergency (PHE) and in line with the new Administration’s information to expect the PHE to continue for the duration of 2022, we are expanding the telehealth services that we will cover through the end of 2022. This means we are not limiting coverage to the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) permanent lists.
Instead, providers are able to deliver expanded telehealth services beyond the CMS and AMA telehealth lists, including, but not limited to:
- Applied behavior analysis (ABA) services
- Partial hospitalization programs (PHP)
- Physical therapy (PT)
- Occupational therapy (OT)
- Speech therapy (ST)
We have not changed our clinical viewpoint that the AMA and CMS provide an industry standard for determining the appropriateness of telehealth services and that many services can only be effectively delivered in person. We realize that flexibility is important to help our members continue to access services in various ways during this unusual time, so here's what you need to know:
- The change will be retroactive to Jan. 1, 2022.
- It applies to our fully insured members and ASO customers.
- Member cost share will still apply, except in Illinois where cost-share continues to be waived pursuant to the Executive Order.
- Medicare members’ telehealth benefits are determined by CMS.
- Medicaid members’ telehealth benefits are defined by state Medicaid requirements.
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