Telehealth Guide & Best Practices

Telehealth is defined as the use of synchronous (real-time information sharing) or asynchronous (relay of information with lag time) telecommunications technologies by a telehealth provider to provide healthcare services.

• These include, but are not limited to: the assessment, diagnosis, consultation, treatment and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration.
• Email and fax transmissions are excluded from methods of providing telehealth services.

The Florida Department of Health has more information about telehealth services.

Telehealth visits are considered the same as in-person visits and are paid at the same rate as in-person visits.

Practitioners and providers who provide covered telehealth services (subject to state law) and receive payment can include, but are not limited to: physicians, nurse practitioners (NPs), physician assistants (PAs), nurse midwives, community behavioral health centers (CCBHCs), clinical psychologists (CPs), emergency room departments (EDs), therapists (ST, OT, PT), licensed clinical social workers (LCWs) and registered dietitians (RDs). Telehealth services are covered so long as the provider’s services are within the scope of their practice and they bill appropriately.

When the COVID-19 Public Health Emergency Declaration expired in May 2023, AHCA announced the end of Applied Behavior Analysis (ABA) flexibilities. That means ABA providers can no longer deliver caregiver training via telemedicine technologies.

Lead analysts continue to remain eligible to receive reimbursement for caregiver training delivered remotely. AHCA released policy guidance notifying providers of these changes.

AHCA also shared a list of community behavioral health services still eligible for telemedicine delivery under all Medicaid products, including Sunshine Health Medicaid (MMA), Children’s Medical Services (CMS) Health Plan and Sunshine Health Pathway to Shine Specialty Plan (CWSP). These Community Behavioral Health Telemedicine-Eligible Services continue to be eligible for telemedicine delivery when provided in accordance with AHCA’s telemedicine rule, 59G-1.057 (PDF). Read Provider News for more information about these services.

Risk Adjustment requires that reported diagnoses stem from face-to-face visits between patients and providers.

Telehealth services can be provided via audio-only methods or by using audio and video together.

Sunshine Health generally follows Centers for Medicare & Medicaid Services (CMS) policies on the types of care providers who are eligible to deliver telehealth services.

Sunshine Health Provider Training offers monthly training sessions.

Training Highlights

• Telemedicine guidelines and requirements
• Telemedicine defined
• Methods to provide telemedicine
• Billing guidelines
• Reimbursable services
• Educational material and resources

Webinars

• 2024 Telemedicine Webinars
• Watch Telemedicine Training Video

Brave Health: Virtual mental health services; members must be 13 years of age and up.

• Call or Text: 1-305-902-6347
• Email: referral@bebravehealth.com
• Visit: Bebravehealth.com/referral
• Available to these members: Sunshine Health Medicaid (MMA); Children’s Medical Services (CMS) Health Plan; Sunshine Health Pathway to Shine Specialty Plan (CWSP); Ambetter Marketplace; Wellcare Medicare.

KidzDoc Now: Pediatric clinicians available 24/7; members must be under 18 years of age.

• Visit: Kidzdocnow.us
• Available to these members: Sunshine Health Medicaid (MMA); Children’s Medical Services (CMS) Health Plan; Sunshine Health Pathway to Shine Specialty Plan (CWSP).

Teladoc Health: Virtual healthcare available to members of all ages.

• Call: 1-800-835-2362
• Visit: Teladoc.com/sunshinehealth
• Available to these members: MMA; CMS; CWSP; Ambetter Marketplace; Wellcare Medicare; Wellcare Complete.

Teladoc Health App: A mobile app that offers resources and support for addressing stress, depression, sleep issues and other conditions tailored to each member’s individual needs.

• Apple App Store
• Google Play Store

24/7 Nurse Advice Line: Available 365 days a year.

• Call: 1-866-796-0530
• TTY: 1-800-955-8770

988 Suicide & Crisis Lifeline: Confidential, free, 24/7/365 support from a trained counselor for mental health, substance use or suicidal crisis.

• Call or text: 988
• Chat: 988lifeline.org/chat

Interpreter Services: Non-urgent sign language and language interpreter services.

• Call Provider Services: 1-844-477-8313
• Complete: Provider Interpreter Request Form (PDF)
• Email Form To: InterpreterRequests@centene.com

Keep Sunshine Health Informed: When notifying Sunshine Health about demographic updates or changes, please include whether you offer telehealth services so we can add that information to our Find a Provider tool.

• LOAP/Practitioner Roster Form (Excel): Telehealth offerings can be updated by downloading and completing the LOAP form and emailing it to Sunshine_Provider_Relations@sunshinehealth.com.

Telemedicine does not require a distinct set of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes. Services furnished via telemedicine are reported utilizing the same codes used for in-person visits.

Distant Site Billing (location of servicing provider)

Please note: Level of service can be selected based on medical decision making or provider’s total time on encounter date.

Please note: Level of service can be selected based on medical decision making or provider’s total time on encounter date.

Please note: Location is other than a hospital or other facility where the patient receives care in a private residence. Visit Place of Service Code Set to verify the descriptions for each POS, based on where a member is located.

*Applicable when patient presents to a medical facility as originating site. This fee does not apply when the home serves as the originating site.

Virtual check-ins are short (5-10 minutes), patient-initiated communications with a practitioner for patients to check in with their doctor to determine whether an office visit or other service is needed, or for the remote evaluation of recorded video and/or images submitted by the patient.*

*The communication should not be related to a medical visit within the previous 7 days and should not lead to a medical visit within the next 24 hours (or soonest appointment available), otherwise it will be bundled into the evaluation and management (E/M) service.

Documentation: Verbal consent should be noted in the medical record for each service. Providers should document 5-10 minutes of medical discussion and include a statement that the patient does not require a visit unless there is a problem.

• Established patient/provider relationship
• Originating Site
  • Geographic area: All areas
  • Patient Location: All locations, including patient’s home
• Technology
  • Communication may take place via several methods, including synchronous discussion over the phone or exchanging information via video or imaging technologies. The practitioner may respond to the patient’s concerns by phone, audio/video, secure text messaging, email or via the patient portal

E-visits are patient-initiated communications through an online patient portal. Once a patient generates the initial inquiry, communications can occur over a 7-day period.

E-Visit Requirements

• Established patient/provider relationship
  Originating Site
  • Geographic area: All areas
  • Patient Location: All locations, including patient’s home
• Technology: Patient Portal

Phone visits are non-face-to-face, patient-initiated audio services.

The communication should not be related to a medical visit within the previous 7 days and should not lead to a medical visit within the next 24 hours (or soonest appointment available).

Practitioners who can conduct phone visits include physicians, nurse practitioners (NPs), physician assistant (PAs), and other clinicians who are able to bill for evaluation and management (E/M) services independently, plus physical therapists (PTs), occupational therapists (OTs), clinical psychologists (CPs), registered dietitians (RDs) and other healthcare professionals who are unable to bill evaluation and management (E/M) services independently.

Physical or Occupational Therapy (OT), Speech-Language Pathology (SL), Clinical Psych

Telehealth has become the fastest growing modality for providing healthcare services. The Board of Directors of the National Committee for Quality Assurance (NCQA) has approved adjustments to 40 widely used Healthcare Effectiveness Data and Information Set (HEDIS) measures.

The NCQA has more information about COVID-Driven Telehealth Surge Triggers Changes to Quality Measures.

The appropriate medical documentation must appear in the member’s medical record to justify the medical necessity for the level of services reimbursed. Record must reflect the level of service billed and must be legible.

• Documentation must be maintained at both the origination and distant sites to substantiate the services provided.
• Services must be clearly and separately identified in the member's medical record.
• Documentation must indicate the services were rendered via telemedicine and the location of the originating and distant sites.
• All chronic, active, or status (amputations, dialysis status, etc.) conditions that impact the current date of service should be clearly documented.
• Ensure member’s verbal consent is obtained and clearly documented in the members’ medical record.
• All other Florida Medicaid and Medicare documentation guidelines apply to services rendered via telemedicine. Examples include, but are not limited to: chart notes; start and stop times; date of visits; provider’s signature; service provider’s credentials; signed member consent form; physician findings; diagnosis; illness; prescribed treatment; and more.

Please remember telehealth providers must use the same standard of maintaining patient medical records as used for in-person services. Providers must also keep medical records confidential, as required in ss. 395.3025(4), F.S.

Telemedicine is the use of interactive audio, video or other electronic media by a practitioner or provider located at a site other than the site where a member is located for the purposes of evaluating, diagnosing and/or treating a patient as defined by Florida Administrative Rule 59G-1.057 on Telemedicine.

• Improves access and quality of care for members who are homebound or live in rural areas
• Strengthens physician-patient relationships
• Increases care coordination and communication
• Reduces healthcare costs
• Enhances coverage for primary care physicians, specialists and behavioral health providers

Yes, telehealth services are available to recipients of the Statewide Medicaid Managed Care (SMMC) and fee-for-service programs by using interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time, interactive communication between a recipient and a practitioner.

No, not unless the provider is delivering services that normally require prior authorization.

• Physicians
• Nurse practitioners (NPs)
• Physician assistants (PAs)
• Certified registered nurse anesthetists (CRNAs)
• Clinical nurse specialists (CNS)
• Clinical psychologists (CPs)
• Community behavioral health centers (CCBHCs)
• Emergency room departments (EDs)
• Licensed clinical social workers (LCWs)
• Nurse-midwives
• Registered dietitians (RDs) or nutrition professionals
• Therapists (ST, OT, PT)

Sunshine Health will cover services provided via telemedicine to the same extent that Sunshine Health covers the same services in person. The provider must be licensed within the State of Florida and a member must be present and participating in the visit. Services rendered must be within the scope of the practitioner or provider.

The initial cost of telemedicine equipment to receive and transmit services is not covered, as well as:

• Telephone conversations
• Chart reviews
• Electronic mail messages
• Facsimiles
• Services rendered via a webcam or Internet based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance
• Video cell phone interactions
• Failed or unsuccessful transmissions