MetroPlusHealth Telehealth Updates During the COVID-19 Emergency

MetroPlusHealth Telehealth Services for Network Providers

In accordance with New York State Department of Health guidance, MetroPlusHealth is allowing all Network Providers to offer telehealth services to existing members in cases where face-to-face visits may not be recommended, and it is appropriate for the member to be evaluated and managed by telephone.  MetroPlusHealth providers will be reimbursed for the services and members should not be billed.

MetroPlusHealth is applying the Medicaid Guidance to all Medicaid, Exchange, and Commercial Products

During the New York State COVID-19 State of Emergency, MetroPlusHealth has waived cost sharing on all telehealth services provided to members for all lines of business.  Payment will be made for the service, and members should not be billed for telehealth services.  Providers should follow billing guidelines outlined in the Medicaid Telehealth FAQ for information regarding POS codes, modifiers, and acceptable service types. View the FAQ page here.

NYSDOH has provided guidance to support the policy that members needing care should be treated through telehealth, including telephonically. All Medicaid qualified practitioners and service providers should offer telehealth services wherever possible to avoid member congregation with potentially infected patients. Telephonic communication will be covered when provided by a qualified practitioner or service provider. All telephonic encounters documented as appropriate by the provider would be considered medically necessary for payment purposes in Medicaid FFS or Medicaid Managed Care. Additional information can be found here.

MetroPlusHealth is following CMS Guidance for Telehealth for Medicare Advantage Products

CMS guidance will now allow Medicare patients to use telecommunication technology for office visits, hospital visits and other services that generally occur in-person. MetroPlusHealth will apply this guidance for our Medicare Advantage lines of business.

The CMS fact sheet regarding telehealth for Medicare beneficiaries can be found here.

MetroPlusHealth Telehealth through NYC Health + Hospitals ExpressCare

On January 31, 2022, MetroPlus Health Plan’s Telehealth program, MetroPlusHealth Virtual Visit, can be accessed through ExpressCare. Virtual Visit offers telehealth medical and mental health visits to our membership. MetroPlusHealth Virtual Visit is not a replacement for primary care doctor visits – it is a free, supplemental service for members to use for low acute illnesses that can be treated online like UTI, pink eye, rashes, depression, anxiety. Learn more about the program here.

Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency

Comprehensive updated guidance regarding use of telehealth (including telephonic services) and billing guidance and criteria following the end of the Coronavirus Disease 2019 Public Health Emergency on May 11,2023, released by the New York State Department of Health, can be found here.

Providers must comply with the DOH, OMH, OASAS, and OPWDD issued Billing Updates to applicable codes, modifiers, and Place of Service (POS) requirements, for Medical and Mental Health Services.

Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency

Additional Telehealth Information

Medicare Telehealth Provider Alert
last updated: May 22, 2024

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