Changes under NY Medicaid

Originating Site 

There has been an expansion on the eligible originating sites under NY Medicaid. Now, the list includes:
  • General hospitals, diagnostic and treatment centers, and nursing homes (licensed facilities under PHL’s Article 28)
  • Hospice programs (licensed facility under PHL’s Article 40)
  • Facilities classified under the Mental Hygiene Law (includes clinics certified under Articles 16, 31 and 32) 
  • Residential programs (certified and non-certified) operated by OPWDD
  • Private practices (physician or dentist) within the state of New York
  • All types of adult care facilities (licensed under Title 2 of SSL’s Article 7)
  • Elementary and secondary schools (public, private, & charter) within the state of New York
  • School-age child care programs within the state of New York
  • Child daycare centers located within the state of New York
  • A member’s place of residence within the state of New York (or temporary residence if currently outside the state)
As of 2019, NY Medicaid added patient’s home as eligible Originating site!

Distant Site

A distant site is any secure location within the fifty United States or United States' territories where the provider is currently located. These providers deliver their healthcare services to their patients through telehealth.

Telehealth Providers

The list of healthcare providers qualified to perform telehealth services has also expanded. Here are some of the healthcare practitioners allowed to render telehealth services to NYS Medicaid members:
1. Physicians
2. Physician assistants
3. Dentists
4. Nurse practitioners
5. Registered professional nurses (when such nurse is receiving patient-specific health information or medical data at a distant site by means of RPM)
6. Podiatrists
7. Optometrists
8. Psychologists
9. Social workers
10. Speech language pathologists
11. Audiologists
12. Midwives
13. Physical therapists
14. Occupational therapists
15. Certified diabetes educators
16. Certified asthma educators
17. Genetic counselors
18. Credentialed alcoholism and substance abuse counselors (CASAC) credentialed by OASAS or by a credentialing entity approved by such office pursuant to Section 19.07 of the MHL
19. Providers authorized to provide services and service coordination under the Early Intervention (EI) Program pursuant to Article 25 of PHL

(Note: The EI Program will issue program-specific guidance regarding the use of and reimbursement for EI services delivered via telehealth.)

Practitioners providing services via telehealth must be licensed or certified, and currently registered in accordance with NYS Education Law or other applicable laws. They should also be enrolled in NYS Medicaid. 

Telehealth services must be delivered by providers acting within their scope of practice. Reimbursements will be made in accordance with existing Medicaid policy related to supervision and billing rules and requirements.

Changes under Medicare

An originating site is the location where a Medicare beneficiary gets physician or practitioner medical services through a telecommunications system. The beneficiary must go to the originating site for the services located in either (a) a county outside a Metropolitan Statistical Area (MSA), or (b) a rural Health Professional Shortage Area (HPSA) in a rural census tract. 

Authorized originating sites include:
• Physician and practitioner offices
• Hospitals
• Critical Access Hospitals (CAHs)
• Rural Health Clinics
• Federally Qualified Health Centers
• Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
• Skilled Nursing Facilities (SNFs)
• Community Mental Health Centers (CMHCs)
• Renal Dialysis Facilities
• Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis

For the list of 2019 Medicare Telehealth Services, please click here

Effective July 1, 2019, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removed the riginating site geographic conditions. Instead, it added an individual’s home as a permissible originating telehealth services site for treatment of a substance use disorder or a co-occurring mental health disorder.

Beginning January 1, 2019, the Bipartisan Budget Act of 2018 removed the originating site geographic conditions and added eligible originating sites (Mobile Stroke Units) to diagnose, evaluate, or treat symptoms of an acute stroke as well.

For information on Medicare coverable Interprofessional Internet Consultations refer to our WCH Insights April issue

It is important to note that Medicare does not apply originating site geographic conditions to hospital-based and CAH-based
renal dialysis centers, renal dialysis facilities, and beneficiary homes when practitioners furnish monthly home dialysis
ESRD-related medical evaluations. Independent Renal Dialysis Facilities are not eligible originating sites. A physician, NP, PA,
or CNS must furnish at least one ESRD-related “hands-on visit” (not telehealth) each month to examine the beneficiary’s
vascular access site.

Distance Site Practitioners

Distant site practitioners who can furnish and get payment for covered telehealth services (subject to State law) are:
• Physicians
• Nurse practitioners (NPs)
• Physician assistants (PAs)
• Nurse-midwives
• Clinical nurse specialists (CNSs)
• Certified registered nurse anesthetists
• Clinical psychologists (CPs) and clinical social workers (CSWs)
• Registered dietitians or nutrition professional.

Reference links: