Resources for Physicians

Telemedicine is a way to provide physical and behavioral health services virtually, such as through video conferencing or over the phone. In Pennsylvania, Medical Assistance (MA) enrolled providers have been allowed to provide physical health and behavioral health services since 2007 and 2011, respectively, but the option was not widely used until many providers had to deliver services via telemedicine during the COVID-19 pandemic. Similarly, commercial health insurance plans may have had individual policies allowing for reimbursement for services provided via telemedicine but there is no statute in Pennsylvania that explicitly authorizes the use or disallowance of telemedicine in Pennsylvania or that sets reimbursement rates for services delivered by telemedicine.

With regard to licensed healthcare practitioners and the use of telemedicine, there is currently no statute in Pennsylvania that explicitly authorizes its use, nor one that explicitly prohibits it. This was true even before the pandemic. The purpose of the telemedicine waiver issued by the Department of State at the beginning of the COVID-19 disaster declaration was to address significant confusion and make it clear that licensees under the Department’s Bureau of Professional and Occupational Affairs (BPOA) health-licensing boards can provide services within their existing scopes of practice via the use of telemedicine when appropriate, provided it is done according to accepted standards of care.

While engaging in telemedicine is allowable from a professional licensing standpoint, it is important to note that there may be additional issues to consider − such as, for example, insurance coverage, payment and reimbursement, and the intersection of telemedicine services with existing facility licensing requirements that must be met by hospitals or other licensed health care facilities.

These additional considerations are not within the purview of the Department of State.  Rather, such issues fall within the purview of other state and federal agencies, such as the Pennsylvania Department of Human Services (DHS), the Pennsylvania Insurance Department, the Pennsylvania Department of Drug and Alcohol Prevention (DDAP), and the Pennsylvania Department of Health (DOH).

Act 30 of 2022 extended certain COVID-19 waivers — including the BPOA telemedicine waiver — until October 31, 2022, unless terminated sooner by the agencies that issued them. The Department of State has no plans to expire its telemedicine waiver prior to October 31, 2022. When the telemedicine waiver does expire, it will not affect licensees’ continued use of telemedicine from a professional licensing standpoint. It will continue to be allowable in the same way it was allowable prior to the pandemic.

Act 30 of 2022 also extended suspended regulations for DHS, DOH, DDAP, and DOS, including extending the suspended regulations tied to the federal Public Health Emergency (PHE) until the PHE or federal authorization of the flexibility allowed under the PHE ends. A full list of suspended regulations across agencies can be found here.

Yes. The Department of Human Services (DHS) has allowed services to be provided via telemedicine since 2007 and has allowed MA-enrolled providers to bill MA for these services. MA enrolled providers should consult the Office of Medical Assistance Programs (OMAP) and Office of Mental Health and Substance Abuse Services (OMHSAS) telemedicine bulletins for more information on service delivery and billing (see question 7 below). DHS will continue allowing physical health and behavioral health services to be provided via telemedicine delivery and will continue to reimburse at the same rate as services delivered in-person in the fee for service program. The Managed Care Organizations (MCOs) may, but are not required to, allow for the use of telemedicine. MA MCOs may negotiate payment for services rendered via telemedicine.

The federal government waived certain telemedicine restrictions in the Medicare program during the PHE, which has been extended through October 13, 2022. Information from the Center for Medicare and Medicaid Services on telehealth is available here: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth

In addition, US Health and Human Services Office of Civil Rights has provided information regarding enforcement of the Health Insurance Portability and Accountability Act (HIPAA) and telehealth services during the PHE, which is available here: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-audio-telehealth/index.html

The MA program will continue to reimburse both physical health and behavioral services delivered via telemedicine after October 31, 2022, when the suspended regulations expire.

Act 98 of 2022 permanently abrogated the two DHS regulations that prohibited payment specifically for audio-only telehealth service delivery—outpatient psychiatric clinics (which includes Mobile Mental Health Treatment and Partial Hospitalization Outpatient Services) under 55 Pa. Code § 1153.14(1), and Outpatient Drug & Alcohol Clinic Services under 55 Pa. Code § 1223.14(2). Providers will no longer be required to submit waiver requests for audio-only telehealth service delivery when delivered in accordance with DHS telehealth bulletins (see question 7).

DHS will continue to reimburse services delivered via telemedicine at the same rates as in-person delivered services for the MA Fee-for-Service (FFS) Program.

MA MCOs may negotiate payment for services rendered via telemedicine in the MA HealthChoices managed care program. To date, all MCOs are reimbursing for services delivered via telemedicine. DHS cannot require the MCOs to have payment parity for services delivered via telemedicine, as MCOs are allowed to negotiate rates. Our understanding is that the MCOs are reimbursing for telemedicine currently and most, if not all, are currently paying the same rates for services delivered via telemedicine. DHS will be surveying the MCOs to determine if they plan to continue reimbursing at the same rate for services delivered via telemedicine.

• Physical Health: MA Bulletin 99-22-02 
• Behavioral Health: OMHSAS-22-02 – Revised Guidelines for Delivery of BH Services Through Telehealth 7.1.22.pdf
• Dental Health: MAB2022061301.pdf (pa.gov)  

Coverage for, and reimbursement of, services delivered via telemedicine will be dependent on each commercial insurer’s coverage and operational policies, as well as the terms of any applicable provider contracts.  This includes payment rates, as there are no insurance laws or regulations requiring payment parity.  The Pennsylvania Insurance Department (PID) surveyed the commercial insurers and determined that all insurers were covering telehealth services to some extent at the time of the survey. The Department has not been made aware of any significant changes since the survey was completed. Moreover, no insurer has reported that it is planning major changes for telehealth coverage post-PHE, but many of them indicated they will likely re-evaluate their policies at the end of the PHE.

Coverage for, and reimbursement of, services delivered via telemedicine will continue to be dependent on each commercial insurer’s coverage and operational policies, as well as the terms of any applicable provider contracts. Insurers may have policy limitations that prohibit coverage for school-based services. The only exception is that for fully-funded coverage subject to PA insurance law, autism services may not be denied solely on the basis that the service is provided in a school setting.

OMAP’s May 2022 Update of the School-Based ACCESS Program (SBAP) Handbook allows telehealth for most school-based services. More information on the ACCESS Program can be found here.

Yes, as clarified in MA Bulletin 99-22-02, telemedicine remains a mode of service deliveries that providers can utilize.  FQHCs that are licensed by the Office of Mental Health and Substance Abuse Services should refer to bulletin OMHSAS-22-02 – Revised Guidelines for Delivery of BH Services Through Telehealth 7.1.22.pdf (pa.gov) when rendering the behavioral health services for which they are licensed.  In addition, DHS recently issued MA Bulletin 08-22-13, 27-22-07 related to teledentistry services that is also relevant to FQHC providers that offer dental services.

After October 31, hospitals will continue to be permitted to provide telehealth/telemedicine services in accordance with the Pennsylvania Department of Health’s Telemedicine Survey Guidelines. Hospitals providing health care services via telehealth/telemedicine should refer to the guidelines for information on the conditions under which the services can be provided.

A licensee can be disciplined for a violation of a provision in a practice act or regulations of the Board. Health care practitioners must also practice within the acceptable and prevailing standard of care. Because the practice acts and regulations do not currently address the provision of health-related services by telehealth/telemedicine, there could be no violation for simply using telehealth/telemedicine after October 31, 2022, and in general there is nothing that would prohibit licensees from using telehealth/telemedicine so long as doing so complies with the standards of acceptable and prevailing medical practice. This was true even prior to the pandemic. It is possible, however, that violations of certain regulations could occur in some circumstances where telemedicine is used. For example, there are regulations that specifically call for a physical examination to be conducted. If a Pennsylvania-licensed practitioner instead “examines” the patient via telemedicine, there could be a violation of the regulation. The violation would not be for the practitioner’s use of telemedicine, but rather the practitioner’s failure to conduct the required physical examination.

​As was the case prior to the pandemic, practitioners wishing to provide services to individuals in Pennsylvania need to be licensed in Pennsylvania in order to practice in Pennsylvania. This holds true whether the provision of services occurs in-person or via an electronic interaction such as a telehealth consultation. Practitioners who are not licensed in Pennsylvania and wish to provide services to individuals in Pennsylvania via telemedicine or otherwise may apply for licensure here: https://www.pals.pa.gov.