Medicaid Managed Care Organizations Guidance for Telehealth Innovation Plans

  • Guidance is also available in Portable Document Format (PDF)

September 2017

Guidance for Mainstream Medicaid Managed Care Plans for the Development and Submission of Telehealth Innovation Plans

As noted in the September 18, 2017 Memorandum to Mainstream Medicaid Managed Care (MMC) plans, New York State Medicaid is rolling out a new initiative that will enable plans to obtain reimbursement for cost–effective alternative telehealth services, often referred to as in lieu of services (ILS). Approved ILS services are expected to facilitate innovative telehealth service delivery to plan members when they need them and where they are.

In conjunction with specific ILS telehealth proposals, Mainstream MMC plans are incentivized to submit a Telehealth Innovation Plan (TIP) outlining how its telehealth projects are expected to result in meaningful improvements in access, quality and outcomes for their members in a coordinated, comprehensive and cost–effective fashion.

Mainstream MMC plans who submit telehealth ILS and TIP by December 1, 2017, which are subsequently approved, will be eligible for bonus points for their next annual Quality Incentive (QI) Award. Specifically, Mainstream MMC plans will earn five (5) bonus points for their annual QI award for an approved TIP. An additional one (1) QI bonus point will be earned if the submission demonstrates enhanced access to services and seeks to improve outcomes for women with high risk pregnancies and/or children in their first 1000 days of life.

The TIP must include the following components to be considered for approval:
Why: Describe the linkages and synergies between the telehealth innovations and the plan´s mission, goals and future state.
What: List and summarize the plan´s portfolio of telehealth projects currently in place and proposed, including ILS requests.
How: Define and outline the design, development and implementation approach of the telehealth projects, including milestones, timelines and adjustments.
Who: Include a description of the plan´s telehealth team and its engagement with providers, partners, members and/or other stakeholders.
Where: Provide a description of the infrastructure that will support the telehealth innovation.

The TIPs will be reviewed and approved by a multi–disciplinary team concurrently with telehealth ILS requests. Mainstream MMC plans who do not submit a TIP will not be eligible for bonus QI points but may submit an ILS request at any time.

Questions and submissions must be sent to: