On October 7, 2019 new amendments to Maryland Medicaid’s telehealth regulations will take effect. During the comments period after these changes were proposed, MTel, jointly with the Maryland Rural Health Association, submitted comments in support of some and in opposition to others.

The positive changes will:

  1. Eliminate type of practice restrictions for distant site providers. Previously only 6 explicitly named provider types were permitted to be distant site providers. Now any provider may “render services via telehealth within the rendering provider’s scope of practice.”
  1. Eliminate restrictions on what types of provider sites may be designated as distant sites. Previously only 4 types of sites were qualified to act as a distant site for Medicaid purposes. Now any site may act as a distant site so long as it meets the general requirements for participation in Medicaid.

Unfortunately, the Department has not proposed eliminating or even loosening restrictions on types of originating sites. We encouraged reconsideration of this restriction pointing out that a patient’s need for health care can occur anywhere at any time, not just in designated originating sites.

  1. Eliminate registration requirements. Previously originating and distant telehealth providers and sites were required to register separately with Medicaid to provide telehealth service. The change has eliminated this administrative burden.

The negative change eliminates the originating site transmission fee. The rationale given is that it will help offset costs from expected increased utilization of care caused by the other changes.

Despite having 6 years of telehealth utilization experience and data, the Department of Health stated that it was unable to estimate potential increased utilization rate costs or the costs it expects to save by eliminating the originating site fee.

In our comments, we provided specific information from 2 originating sites explaining how vital these fees are to the continued existence of their telehealth programs. Instead of an increase in utilization, these programs expressed concern that the opposite would occur if they cannot continue their telehealth programs or expand them to meet the need that exists in those communities.

We have asked the Department to quantify the proposed impact of these proposed regulations by working with its MCOs to gather and analyze the data it has or should have and that this information be made publicly available.