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Telemedicine Policy Dr. Melinda Rowe Assistant Medical Director October 17, 2014

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APT Conference 2014

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Page 1: Melinda Rowe Alabama Medicaid

Telemedicine Policy

Dr. Melinda RoweAssistant Medical Director

October 17, 2014

Page 2: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• History– Began coverage for Psychiatry and Dermatology

specialists in 2010• 50 mile limitation

– Expanded to all physician types with Alabama Medical license in 2012

• 50 mile limitation removed

– No origination or transmission fees

Page 3: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• All physicians with– Alabama medical license– Enrolled as Alabama Medicaid provider– Regardless of location

• Are eligible to participate in Telemedicine Program to provide– Medically necessary telemedicine services to

Alabama Medicaid eligible recipients

Page 4: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• In order to participate in Alabama Medicaid Agency (AMA) telemedicine program:– Physicians must be enrolled with AMA with

specialty type 931 (Telemedicine Service)– Physician must submit the Telemedicine Service

Agreement/Certification form located on AMA website at http://mediciaid.alabama.gov

– Physician must obtain prior consent from recipient/patient before services are rendered; counts as part of benefit limit of 14 annual physician office visits currently allowed

Page 5: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• Telemedicine services must be administered via interactive audio and video telecommunications system with 2-way communication between distant site physician and origination site where recipient is located

• Does not include phone, e-mail, or fax between physician, recipient, or consultation between two physicians

Page 6: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• Telemedicine health care providers shall ensure telecommunication technology and equipment used at both physician and recipient sites is sufficient to allow appropriate evaluation, diagnosis, and/or treatment of recipient for services billed

• Transmissions must employ acceptable encryption to protect confidentiality/integrity of transmission information and acceptable authentication/identification procedures for sender/receiver

Page 7: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• Provider shall maintain appropriately trained staff immediately available in person to recipient receiving telemedicine service to attend to any emergencies that may occur during session

• Physician shall implement confidentiality protocols that specify individuals who have access to electronic records, usage of unique passwords, ensure system to prevent unauthorized access, ensure system to track/record access to electronic medical info

Page 8: Melinda Rowe Alabama Medicaid

Alabama Medicaid Telemedicine

• Procedure codes covered for telemedicine– Consultations (99241-99245, 99251-99255)– Office or other outpatient visits (99201-

99205, 99211-99215)– Individual psychotherapy (90804-90809)– Psychiatric diagnostic (90801)– Neurobehavioral status exam (96116)

• Bill procedure codes with modifier GT• No reimbursement currently—origination

site or transmission fees

Page 9: Melinda Rowe Alabama Medicaid

Other Events

•Alabama Board of Medical Examiners 1/2014 Telehealth policy: −CRNP, CNM, PA can provide services if within scope of their practice, their license and collaborative agreement−Distant site provider must comply with all applicable laws/rules in jurisdiction where patient resides or seeks medical care−May not use to prescribe non-malignant pain with scheduled/controlled medications

Page 10: Melinda Rowe Alabama Medicaid

Other Events (continued)

• American Medical Association guiding principles June 2014: − Must provide face to face exam before

telemedicine visits start − Physician must have licensure within state

where patient resides and service is being performed

− Same standard of care that applies to traditional health care setting should also apply to telemedicine

Page 11: Melinda Rowe Alabama Medicaid

AMA Telemedicine Utilization 2010 - 2014

FY 10 $ 3,800FY 11 $ 4,300FY 12 $ 5,900FY 13 $18,000FY 14 $31,800

Over 4000 claims for Medicaid/Medicare dual eligibles; 306 Medicaid only and most PSY

Page 12: Melinda Rowe Alabama Medicaid

AMA Telemedicine Utilization (cont)

• Dual eligibles (Medicare/Medicaid)− Majority of visits in Community Mental

Health Centers ($29,674)− Physician Office ($5,469)

• Medicaid− Majority of visits occur in office ($10,372)− Skilled nursing facilities ($249)

Page 13: Melinda Rowe Alabama Medicaid

AMA Regional Care Organizations (RCOs)

• Alabama Code § 22-6-150 et seq—creation of provider-based nonprofit corporations paid on capitated basis to provide – full scope of Medicaid benefits, – care coordination, and – a medical home for Medicaid beneficiaries

• 5 Regions AE

Page 14: Melinda Rowe Alabama Medicaid

AMA RCOs

5 Regions − A thru E− Smallest region

7 counties− Largest region

21 counties

Page 15: Melinda Rowe Alabama Medicaid

• 9/30/14: 12 Probationary RCO applications

• 4/1/15: RCO provider networks in place

• 10/1/16: RCO accepts capitation payments from Alabama Medicaid

• RCO can provide more than essential benefits

AMA RCOs (Continued)

Page 16: Melinda Rowe Alabama Medicaid

Medicaid Telemedicine

• For more Telemedicine details go to Chapter 28 of Alabama Medicaid Provider Manual on website at www.medicaid.alabama.govFor RCO details, click on RCO icon

• Questions

• Thank you