CurrentFidelis CarePolicy N/A

Telemental Health Authorization and Regulatory Waiver for Disaster Emergency

This document governs temporary authorization and administrative waivers allowing licensed NYS mental health providers to deliver telemental health services during a declared disaster emergency; it affects New York State mental health providers and recipients.

Policy Summary

PayerFidelis Care

PolicyTelemental Health Authorization and Regulatory Waiver for Disaster Emergency

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit a Self-Attestation containing specified elements to Amy.Smith@omh.ny.gov and retain a copy on file for review.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Self-Attestationprovider action to be authorized

95 or GTbilling modifier required

Part 596 waivedregulatory waivers enabled

Time-limitedauthorization duration

Telemental Health Authorization & Waivers

Policy Summary

PayerFidelis Care

PolicyTelemental Health Authorization and Regulatory Waiver for Disaster Emergency

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit a Self-Attestation containing specified elements to Amy.Smith@omh.ny.gov and retain a copy on file for review.

SourceLink

On This Page

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Provider must submit a Self-Attestation containing the required elements to Amy.Smith@omh.ny.gov and retain a copy on file for review.

Submission and retention required for authorization.

Provider must possess a current, valid NYS license, permit, or limited permit to practice in NYS.

Transmission linkages used for telemental health must be dedicated, secure, and meet minimum federal and NYS requirements.

Confidentiality must be maintained in accordance with NYS Mental Hygiene Law Section 33.13 and HIPAA (45 CFR Parts 160 and 164).

Providers must use claim modifier '95' or 'GT' on each claim that represents a service delivered via telemental health.

Waivers enabled

Written approval process and need for policy and procedures (Section 596.5(b)).
Presence requirements for ACT services (Section 596.5(c)(4)(ii)).
Recipient location restrictions for PROS (Section 596.5(c)(3)(ii) & (iv)).
Requirement for an in-person initial assessment prior to telemental health (Section 596.6(b)(1)).

Authorization is time-limited and expires at the end of the declared disaster emergency.

Purpose: Allows continuity of care despite mandatory or self-imposed quarantines.

What Providers Must Do

Prior Authorization

Submit Self‑Attestation to Amy.Smith@omh.ny.gov

Submit a Self‑Attestation with the required elements to Amy.Smith@omh.ny.gov and retain a copy on file for review.

Self‑Attestation must include certification that practitioner(s) possess a current, valid NYS license, permit, or limited permit.
Self‑Attestation must certify that transmission linkages are dedicated, secure, and meet minimum federal and NYS requirements.
Self‑Attestation must certify that confidentiality will be maintained in accordance with NYS Mental Hygiene Law Section 33.13 and 45 CFR Parts 160 and 164 (HIPAA).
Self‑Attestation must certify that claim modifiers '95' or 'GT' will be used on each telemental health claim.

Billing Rule

Apply modifier '95' or 'GT' to telemental health claims

Use the claim modifier '95' or 'GT' on every claim that represents a telemental health service.

Modifier '95' or 'GT' must be applied on each claim representing a service delivered via telemental health.

Key Definitions

Self-Attestation

DefinitionA Self-Attestation is a provider-submitted certification containing specified elements that, when complete, authorizes delivery of telemental health services for a time-limited period not to exceed the disaster emergency.

Required attestationsPractitioner(s) possess a current, valid NYS license, permit, or limited permit to practice in New York State.

Submission and recordkeepingSubmit the Self-Attestation to Amy.Smith@omh.ny.gov and retain a copy on file for review.

DurationAuthorization granted by the Self-Attestation is time-limited and expires at the end of the disaster emergency.

PurposeEnables rapid authorization to deliver telemental health services during the declared disaster emergency.

Telemental health

DefinitionTelemental health services delivered via transmission linkages that are dedicated, secure, and meet minimum federal and New York State requirements.

Confidentiality requirementsConfidentiality must be maintained in accordance with NYS Mental Hygiene Law Section 33.13 and 45 CFR Parts 160 and 164 (HIPAA).

Billing requirementUse claim modifier '95' or 'GT' on each claim that represents a service delivered via telemental health.

Scope of useAuthorized for use by providers who submit a complete Self-Attestation during the declared disaster emergency.

OpenPayer

Telemental Health Authorization and Regulatory Waiver for Disaster Emergency

Telemental Health Authorization & Waivers

Billing Modifiers for Telemental Health

What Providers Must Do

Key Definitions

95	Synchronous telemedicine service rendered via real-time interactive audio and video
GT	Via interactive audio and video telecommunications systems