Maine Reimbursement for telemedicine PDF Print E-mail

Chapter 101:
MaineCare Benefits Manual
(formerly Maine Medical Assistance Manual)
Provided by:
APA Office
Department of the Secretary of State (Maine) See Ch. I - Section 1 - General Administrative Policies and Procedures (see page 20)

 

1.06-2  Telehealth 

 

  1. Telehealth is defined as interactive, visual, real-time telecommunication.

 

            Telehealth must be a medically appropriate means of provider-patient interaction.

 

  1. Services provided via telehealth must utilize equipment that is capable of two-way video and audio (i.e., telephone, facsimile interactions and

electronic mail delivered services are not reimbursable).


2.         There must be a compelling benefit for the member in order for telehealth services to be appropriate.  The benefit must be related to physical, social or geographic issues that make delivering the service in person difficult.  It must not be for the convenience of the provider.  The member’s record must contain documentation that the member has met one or more of the criteria listed below:

 

a.         Physical:  A member’s medical condition makes a face-to-face encounter that entails significant travel inadvisable or impossible.

 

b.         Social:  The family or other support system does not support a member traveling a distance for a face-to-face encounter, or does not allow the member to take the time that travel will require.

 

c.         Geographic:  There is a lack of medical/psychiatric/mental health expertise locally, limited transportation resources, or a long wait for such local care.

 

3.         Providers who want to provide and bill for services via telehealth must submit a specific description of the telehealth services and must be enrolled as a provider of the service that they wish to provide via telehealth.  They may not be reimbursed for services provided via telehealth until they have received approval from the Department to do so.

 

4.         MaineCare reimburses for services delivered via telehealth by approved MaineCare providers only when those services are defined in the MaineCare Benefits Manual as a covered service.

 

B.         Provider Responsibilities

 

When requesting approval to provide services via telehealth, providers must submit the following information to MaineCare:

 

1.         The names, provider numbers and licensure level of individual providers who utilize telehealth to provide services;

 

2.         A list of the procedure codes that will be utilized;

 

3.         A statement explaining the rationale for needing telehealth capabilities for the service(s) being proposed;

 

4.         A statement explaining the specific criteria utilized in determining when telehealth services are more appropriate than face-to-face services;

 

5.         A plan for quality assurance activities specifically related to patient satisfaction and outcomes related to telehealth service; and

 

6.         Educational information that will be provided to the MaineCare member at the time of the member’s visit.  This information should be written at a sixth grade comprehension level and at a minimum it should include the following information:

 

  1. Description of the telehealth equipment and what to expect;

 

b.         Explanation that the use of telehealth for this service is voluntary and that the same service is available in a face-to-face setting;

 

c.         Explanation that the member is able to stop the telehealth visit at any time and request a face-to-face service;

 

d.         Explanation that MaineCare will pay for transportation to a distant appointment if needed and;

 

  1. HIPAA compliance information regarding the telehealth encounter.

  

C.         Reimbursement for Telehealth

 

1.         MaineCare does not reimburse for any charge related to the technical aspect of the telehealth service or for personnel at the originating or receiving site, nor may a member be billed for such charge.

 

2.         MaineCare will not reimburse for the use or upgrade of technology, transmission charges, and any charges for an attendant who instructs a patient or caretaker in the use of the equipment or supervises/monitors a patient during the telehealth encounter, or for consultations between professionals.

 Reimbursement for telehealth is limited to those services already being provided by that provider in compliance with the MaineCare Benefits Manual.

 

 

5.         Services are to be billed in accordance with applicable sections of the MaineCare Benefits Manual.  Providers must submit claims in accordance with Department billing instructions.  The same procedure codes and rates apply as for services delivered in person.

 

6.         The GT (Interactive Telecommunication) modifier must be used when billing for services provided via telehealth.

 

D.                 Documentation

 

1.         Services delivered via telehealth are held to the same standard of documentation as non-telehealth services.

 

  1. Each instance of telehealth service will require documentation as to why telehealth was utilized to deliver that service.

 

 

For more information see the ATA Wiki page for Maine here.

 

Last Updated on Wednesday, 22 June 2016 12:51