Medicaid OIG Reports – Parts 1 and 2 of a three-part report on tele-behavioral health and Medicaid

Medicaid OIG Reports – To-date, OIG has released parts 1 and 2 of a three-part report on tele-behavioral health and Medicaid. Below we summarize the key findings, particularly noting successful findings on access and cost. HHS OIG currently has eight different national audits, evaluations and inspections of telemedicine services under the Medicare and Medicaid programs – which we have summarized below.

Increased access and positive effects – Among states who evaluated their telehealth programs, both found positive effects, and among those basing their judgements on experience, more than half reported telehealth increased access.
Produced savings – In addition, one of the states that also analyzed its data on access—found that, prior to the pandemic, telehealth produced savings of $8,600 in emergency room avoidance for one managed care plan, as well as $484,000 in reduced transportation costs for another managed care plan.
Recommending licensure reciprocity – OIG recommended states examine the use of licensure reciprocity and compacts – and specifically used the nursing compact as an example of a successful compact.

States Reported Multiple Challenges with Using Telehealth to Provide Behavioral Health Services to Medicaid Enrollees – This report examined challenges states reported prior to the pandemic on the use of telehealth for behavioral health services in Medicaid. States reported several challenges with using telehealth, some of them more operational, such as lack of training for providers and enrollees, limited connectivity, and cost of infrastructure. Interestingly though, states also reported challenges with licensing, and the burdensome process for providers to become licensed to practice in another state. The report recommends states examine the use of licensure reciprocity and compacts – and specifically used the nursing compact as an of example of a successful compact.
Opportunities Exist to Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid – The second report examined the effects of telehealth on access, cost and quality of tele-behavioral health services. A few states reported that they were unable to identify which services were being provided via telehealth versus in-person. To that concern, HHS OIG recommended that CMS support Medicaid programs in distinguishing between in-person and telehealth services. The second big takeaway on the access and cost side is that HHS OIG found that – among the two states who were able to evaluate the effects of telehealth in their state – these states found that telehealth increased access and reduced costs. Note that two states reported they were able to adequately evaluate the effect of telehealth – other states supported their evaluation based on experiences. Remarkably, both of the states who were able to conduct specific evaluations found positive effects, and among those basing their judgements on experience, more than half reported telehealth increased access. In addition, one of the states that also analyzed its data on access—found that, prior to the pandemic, telehealth produced savings of $8,600 in emergency room avoidance for one managed care plan, as well as $484,000 in reduced transportation costs for another managed care plan.