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  • Washington Highlights

    CMS Allows Coverage and Payment for E-consults Under Medicaid, CHIP


    Gayle Lee, Director, Physician Payment & Quality
    Meaghan Quinn, CORE Program Manager, Health Care Affairs
    For Media Inquiries

    The Centers for Medicare & Medicaid Services (CMS) issued a letter on Jan. 5 to state health officials allowing coverage and payment of interprofessional consults under Medicaid and the Children’s Health Insurance Program (CHIP), reversing its previous policy that prohibited coverage and payment to the specialist. The association previously commented to the CMS on e-consult payment policies to promote further scale and sustainability of this clinical innovation [refer to Washington Highlights, Aug. 5 and Sept. 9, 2022]. 

    “Allowing direct payment to consulting practitioners expands and expedites access to specialty care and reduces the administrative burden to treating practitioners,” the CMS letter stated. The agency encouraged states to “take advantage of this flexibility in their Medicaid and CHIP programs.”  

    Interprofessional consultation (often referred to as e-consults) may arise when a treating physician or health care practitioner requests specific specialty expertise of a health care practitioner to assist with treatment advice or an opinion on a case without the need for the patient’s face-to-face contact with the consultant. Through Project CORE, the AAMC works directly with academic medical centers and health systems to improve specialty access and effective coordination of care between primary care providers and specialists in the ambulatory setting, including the implementation of e-consults.