Husky updates as of May 12th, 2023:
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providers must have the ability to service husky clients in person “to the full extent that is clinically appropriate for their patients and to the full extent necessary if the HUSKY Health member does not consent” to telehealth.
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All Telehealth services must meet statutory definition of medical necessity (section 17b-259b of the Connecticut general Statutes and all other applicable federal and state statues). Currently medical necessity in statute is defined as:
For purposes of the administration of the medical assistance programs by the Department of Social Services, “medically necessary” and “medical necessity” mean those health services required to prevent, identify, diagnose, treat, rehabilitate or ameliorate an individual's medical condition, including mental illness, or its effects, in order to attain or maintain the individual's achievable health and independent functioning provided such services are: (1) Consistent with generally-accepted standards of medical practice that are defined as standards that are based on (A) credible scientific evidence published in peer-reviewed medical literature that is generally recognized by the relevant medical community, (B) recommendations of a physician-specialty society, (C) the views of physicians practicing in relevant clinical areas, and (D) any other relevant factors; (2) clinically appropriate in terms of type, frequency, timing, site, extent and duration and considered effective for the individual's illness, injury or disease; (3) not primarily for the convenience of the individual, the individual's health care provider or other health care providers; (4) not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the individual's illness, injury or disease; and (5) based on an assessment of the individual and his or her medical condition.
“(1) clinically appropriate to be provided by means of telemedicine, (2) cost-effective for the state, and (3) likely to expand access to medically necessary services where there is a clinical need for those services to be provided by telehealth or for HUSKY Health members for whom accessing appropriate in-person health care services poses an undue hardship.”
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Specific procedure codes eligible to be billed will be available on the CMAP website. This is located under the “Telehealth information” tab from the homepage. Most typical provider codes are currently listed as acceptable codes.
Audio-only cannot be used for: intake assessments, family psychotherapy sessions, or group.
Audio only can only be used on established clients and cannot be billed more than 1 time per week per patient.
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Providers must ensure HIPAA compliance, including use of HIPAA compliant platforms
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Providers must develop and implement procedures to verify provider and patient identity prior to provision of Telehealth services. Providers must ensure that Husky clients are in an appropriate, secure and private location for Telehealth services.
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Providers must obtain informed consent in writing (electronic consent is acceptable) before providing services and annually thereafter from HUSKY client. Provider must ensure client is aware they can opt out or refuse Telehealth at any time.
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If the Husky member is a minor (under 18), a parent or legal guardian must be present for services in the same extent as it would be required for in-person services. In addition, informed consent for telehealth services must be obtained by parent or legal guardian prior to the provision of such services and obtained annually thereafter
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Modifiers to be used:
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GT and 95 are both acceptable for behavioral health sessions done via virtual video (GT: interactive audio and video telecommunication system; 95: synchronous telemedicine services rendered via real-time interactive audio and video telecommunication systems)
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For audio only telephone services no longer use CR and instead use Modifier FQ
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Place of Service Codes should be that which is applicable to the location of the member at the time of Telehealth services
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Telehealth reimbursement rates will be the same rate as if the service was rendered in-person
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No changes to prior auths