COVID-19 and the Rise of Telehealth in California Home Care

When the coronavirus hit, AlayaCare went to work researching how states were quickly adapting to keep patients safe in their homes.  

In California, here are key changes we have observed in the state’s service delivery models:

1) Permit payment for services rendered by family caregivers or legally responsible individuals.  

The money has to keep flowing and providers need liquidity to pay their caregivers to ensure care continuity. The accounting can be squared away later.

2) Modified provider qualifications to permit unlicensed Waiver Personal Care Services (WPCS) providers as long as they are currently IHSS members. 

3) Modified provider types to enable Certified Nurse Assistants to provide private duty nursing, in addition to currently authorized HCBS Waiver Nurse Providers (Registered Nurses, Licensed Vocational Nurses, and Certified Home Health Aide (CHHA)) and Home Health Agencies. 

During a time of crisis we can relax where we set the bar on credentials. It’s more important to provide sufficient care for the most number of people.

4) Modified licensure or other requirements for settings where waiver services are furnished: specifically, allowing telehealth (telephonic, or virtual live video conferencing) as an alternative to face-to-face interactions.

5) Modified processes for waiver eligibility level of care evaluations and reevaluations via telehealth as an alternative option to face-to-face interactions, in accordance with HIPAA requirements. 

Whatever can be done through technology (though not as effective as in person) should be considered to keep everyone safe and distanced.

6) Temporarily allow spouses/parents of minor children to provide WPCS when authorized providers are unavailable due to COVID-19. 

By temporarily allowing participants to receive personal care services from family members residing with them, participants reduce their exposure risk to the virus. 

7) Temporarily allowing forms that require participant or legal representatives’ signatures to be signed, scanned, and emailed to the Waiver Agency, or for the documents to be signed digitally, through June 30, 2020. Hard copies with wet signatures can be kept in the member’s residence file until agencies can retrieve them.

Additionally, a letter from the Department of Managed Health Care, referencing the California Emergency Services Act, enforced the the following:

1. Health plans shall reimburse providers at the same rate for in-person and telehealth appointments, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim. For example, if a health plan reimburses a mental health provider $100 for a 50-minute in-person therapy session, the plan shall reimburse the provider $100 for that same session conducted via telehealth.

2. For services provided via telehealth, a health plan may not subject enrollees to cost-sharing greater than the same cost-sharing if the service were provided in person. 

3. Health plans shall provide the same amount of reimbursement for a service rendered via telephone as they would if the service is rendered via video, provided that the chosen modality is medically appropriate for the enrollee. 

What About Insurance Providers?

We also found a letter issued by the California Insurance Commissioner that mandated insurers to:

1. Relax limitations on waiting periods between refills so that insureds can maintain at least a 30-day supply of medication. Also manage, in collaboration with pharmacists and providers, patient safety risk associated with early refills for certain drug classes, such as opioids, benzodiazepines, and stimulants. 
2. Permit conversion of 30-day prescriptions with multiple refills into one larger prescription. For instance, a 30-day order with three refills may be filled as a single 90-day supply. 
3. Relax insurer-imposed fill or refill supply limits where the provider has indicated that a larger fill or refill amount is appropriate for the patient. 
4. Waive delivery charges for home delivery of prescription medications. 
5. Assure access by streamlining or eliminating processes for requesting prior authorization, step therapy exceptions, and exceptions for obtaining off-formulary drugs when a drug is unavailable (due to supply chain disruptions or other issues).

I was personally heartened to see that health systems are capable of swift changes that are in the best interests of the people: relaxing standards and guidelines, quickly adopting and paying for technology, and enabling the best care available rather than no care at all.  

While this crisis has shaken the world in a serious way, especially in the home care industry, it may prove to be a catalyst for positive change.   

How did I get all this information? Well, our team at AlayaCare put together a Regional Telehealth & Virtual Care Guide covering every state and province in North America, so you can see how California compares to other jurisdictions. 

In response to changes to our industry, AlayaCare developed a Virtual Care Suite to support agencies. If you’d like to learn more, please contact me anytime and I can walk you through it.