Maine Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain conditions, and remote patient monitoring for patients with certain risk factors.

Definitions
Telehealth is the use of information technology by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment. Telehealth Services may be either telephonic or interactive (combined video/audio).

Live Video
Policy
If the Member is eligible for the underlying covered service to be delivered, and if delivery of the covered service via telehealth is medically appropriate, as determined by the health care provider, the member is eligible for telehealth services.

Eligible Services/Specialties
There is a specific list of codes provided in the manual.

Eligible Providers
Click for a list of eligible providers.

Eligible Sites
FQHCs, RHCs or IHCs may be originating sites.

Geographic Limits
No reference found.

Facility/Transmission Fee
A facility fee is provided to a health care provider at the originating site.

Store-and-Forward
Policy
Provider manual indicates coverage of “telehealth services” which is inclusive of store-and-forward, however the manual only discusses interactive telehealth, and remote patient monitoring in detail. Additionally, the manual only discusses the use of the GT modifier (live interactive video), and does not mention the GQ modifier (asynchronous).

Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
Policy
ME Medicaid provides coverage for telemonitoring services (which may or may not take place in real time) under certain circumstances.

Conditions
Click for a list of eligible conditions.

Provider Limitations
Telemonitoring only reimbursed when provided by a certified Home Health Agency. See regulations for specific requirements of Home Health Agencies utilizing telemonitoring services. Click for a list of provider limitations.

Other Restrictions
Telemonitoring services are intended to collect a member’s health-related data, such as pulse and blood pressure readings, that assist healthcare providers in monitoring and assessing the member’s medical conditions. Click for a list of other restrictions.

Email/Phone/Fax
Services may not be delivered through electronic mail.

Consent
Providers must deliver written educational information to patients at their visit.

Out of State Providers
Healthcare Providers must be licensed or certified in the state of Maine.

Miscellaneous
The Department is required to report on the utilization of telehealth and telemonitoring services within the MaineCare program annually beginning in 2018.