AMGA Endorses Medicaid Telehealth Expansion Plan
AMGA today endorsed the Centers for Medicare & Medicaid Services’ (CMS’) proposal to allow states to exempt behavioral health services provided at Medicaid clinics from the “Four Walls Rule” requirement, which otherwise prevents Medicaid from reimbursing clinic services performed outside of a facility's physical location.
Four Walls Rule Limits Access
Alexandria, VA – AMGA today endorsed the Centers for Medicare & Medicaid Services’ (CMS’) proposal to allow states to exempt behavioral health services provided at Medicaid clinics from the “Four Walls Rule” requirement, which otherwise prevents Medicaid from reimbursing clinic services performed outside of a facility's physical location. For telehealth, this requires either the patient or the clinician to be physically present at the clinic. By lifting the Four Walls Rule restriction for behavioral health clinics, CMS can significantly expand access to mental healthcare for populations who face challenges in obtaining services, such as rural residents, individuals with transportation barriers, and those experiencing economic hardship.
“It’s critical telehealth be as accessible as possible, particularly for vulnerable or underserved populations,” said AMGA President and CEO Jerry Penso, MD, MBA. “This proposal is a step in the right direction and builds on the lessons learned about telehealth during the COVID public health emergency.”
The proposed rule also addresses the definition of rural for Medicaid purposes. AMGA recommended CMS provide states with flexibility in how to define rural. This would allow states to design policy solutions that meet the needs of their communities, rather than imposing a one-size-fits-all definition that may not be appropriate for a particular state. AMGA believes that providing states with maximum flexibility in defining rural will result in more effective, equitable policies that better serve the healthcare needs of disadvantaged populations.
The letter is on the AMGA website.
###
About AMGA
AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, please visit www.amga.org.