|Missouri reimbursement for telemedicine|
Missouri Behavioral Health Services Manual describes Telehealth reimbursement starting on page 200
Missouri pays for telepsychiatry + a separate facility fee.
(2) Covered Services.
(A) A Telehealth service shall be covered
only if it is medically necessary.
(B) A Telehealth service shall require use
of two (2)-way interactive video and shall not
include store and forward services. The participant
must be able to see and interact with
the off-site provider at the time services are
provided via Telehealth.
(C) The distant site is the location where
the physician or practitioner is physically
located at the time of the Telehealth service.
Coverage of services rendered through Telehealth
at the distant site is limited to:
1. Consultations made to confirm a
2. Evaluation and management services;
3. A diagnosis, therapeutic, or interpretive
4. Individual psychiatric or substance
abuse assessment diagnostic interview examinations;
5. Individual psychotherapy; or
6. Pharmacologic management.
(D) The participant must be present for the
(3) Eligible Providers.
(A) A health care provider utilizing Telehealth
at either a distant site or an originating
site shall be enrolled as a MO HealthNet
provider pursuant to 13 CSR 70-3.020 and
licensed for practice in Missouri. A health
care provider utilizing Telehealth must do so
in a manner that is consistent with the provisions
of all laws governing the practice of the
(B) A provider agrees to conform to MO
HealthNet program policies and instructions
as specified in the provider manuals and bulletins,
which are incorporated by reference
and made a part of this rule as published by
the Department of Social Services, MO
HealthNet Division, 615 Howerton Court,
Jefferson City, MO 65109, at its website
www.dss.mo.gov/mhd, April 1, 2009. This
rule does not incorporate any subsequent
amendments or additions.
(4) Prior Authorization and Utilization
Review. All services are subject to utilization
review for medical necessity and program
compliance. Reviews can be performed
before services are furnished, before payment
is made, or after payment is made.
(A) Prior Authorization. Certain procedures
or services can require prior authorization
from the MO HealthNet Division or its
authorized agents. Services for which prior
authorization was obtained remain subject to
utilization review at any point in the payment
process. A service provided through Telehealth
is subject to the same prior authorization
and utilization review requirement which
exist for the service when not provided
(B) Eligibility Determination. Prior authorization
of services does not guarantee an
individual is eligible for a MO HealthNet service.
Providers must verify that an individual
is eligible for a specific program at the
time services are furnished and must determine
if the participant has other health insurance.
(A) Reimbursement to the health care
provider delivering the medical service at the
distant site is made at the same amount as the
current fee schedule for the service provided
without the use of a telecommunication system.
(B) The claim for service will use the
appropriate procedure code for the covered
services addressed in (2)(C) and the GT modifier
indicating interactive communication
(C) The originating site is eligible to
receive a facility fee. Facility fees are not
payable to the distant site.
(D) Services provided by practitioners
must be within their scope(s) of practice and
according to MO HealthNet policy.
(E) Reimbursement for services furnished
by interns or residents in hospitals with
approved teaching program or services furnished
in other hospitals that participate in
teaching programs is made through institutional
reimbursement. The division cannot
be billed directly by interns or residents for
(6) Documentation for the Encounter. Patient
records at the distant and originating sites are
to document the Telehealth encounter consistent
with the service documentation described
in MO HealthNet provider manuals and bulletins.
(A) A request for a Telehealth service from
a referring provider and the medical necessity
for the Telehealth service shall be documented
in the participant’s medical record.
(B) A health care provider shall keep a
complete medical record of a Telehealth service
provided to a participant and follow
applicable state and federal statutes and regulations
for medical record keeping and confidentiality
in accordance with 13 CSR 70-
3.030 and 13 CSR 70-98.015.
(C) Documentation of a Telehealth service
by the health care provider shall be included
in the participant’s medical record maintained
at the participant’s location and shall
1. The diagnosis and treatment plan
resulting from the Telehealth service and
progress note by the health care provider;
2. The location of the distant site and
3. A copy of the signed informed consent
4. Documentation supporting the medical
necessity of the Telehealth service.
(7) Confidentiality and Data Integrity. All
Telehealth activities must comply with the
requirements of the Health Insurance Portability
and Accountability Act of 1996, as
amended, and all other applicable state and
federal laws and regulations.
(A) A Telehealth service shall be performed
on a private, dedicated telecommunications
line approved through the Missouri
Telehealth Network (MTN). The telecommunications
line must be secure and utilize a
method of encryption adequate to protect the
confidentiality and integrity of the Telehealth
service information. The Missouri Telehealth
Network must also approve the equipment
that will be used in Telehealth service.
(B) Both a distant site and an originating
site shall use authentication and identification
to ensure the confidentiality of a Telehealth
(C) A provider of a Telehealth service shall
implement confidentiality protocols that
1. Identifying personnel who have
access to a Telehealth transmission; and
2. Preventing unauthorized access to a
(D) A provider’s protocols and guidelines
shall be available for inspection by the department
(8) Informed Consent.
(A) Before providing a Telehealth service
to a participant, a health care provider shall
document written informed consent from the
participant or the participant’s legal guardian
and shall ensure that the following written
information is provided to the participant in a
format and manner that the participant is able
1. The participant shall have the option
to refuse the Telehealth service at anytime
without affecting the right to future care or
treatment and without risking the loss or
withdrawal of a MO HealthNet benefit to
which the participant is entitled;
2. The participant shall be informed of
alternatives to the Telehealth service that are
available to the participant;
3. The participant shall have access to
medical information resulting from the Telehealth
service as provided by law;
4. The dissemination, storage, or retention
of an identifiable participant image or
other information from the Telehealth service
shall not occur without the written informed
consent of the participant or the participant’s
legally authorized representative;
5. The participant shall have the right to
be informed of the parties who will be present
at the originating site and the distant site
during the Telehealth service and shall have
the right to exclude anyone from either site;
6. The participant shall have the right to
object to the videotaping or other recording
of a Telehealth service.
(B) A copy of the signed informed consent
shall be retained in the participant’s medical
record and provided to the participant or the
participant’s legally authorized representative
(C) The requirement to obtain informed
consent before providing a service shall not
apply to an emergency situation if the participant
is unable to provide informed consent
and the participant’s legally authorized representative
For more information see the ATA Wiki page for Missouri here.
|Last Updated on Wednesday, 18 January 2017 16:41|