ALASKA. Recent news, pending action: Medicaid law and regulations:

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1 ALASKA State Recent news, pending actin: Medicaid law and regulatins: Frm Telemedicine fr CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Telehealth Cnnectins fr Children and Yuth: State- Specific Infrmatin The US Substance Abuse and Mental Health Services Administratin within HHS awarded the Alaska Psychiatric Institute a grant t pen a walk- in type pen access clinic, where telemental health services are accessible by vide cnference. Primary care prviders in remte cmmunities can nw request a same day vide cnferencing appintment fr their patients. Als, prviders are able t cnsult n patient cases with behaviral health prfessinals wh treat bth mental health and substance use issues. Prviders in rural Alaska can nw access remte mental healthcare frm API n an as- needed basis withut entering int a lng term frmal agreement. API is part f the Alaska Department f Health and Scial Services, Divisin f Behaviral Health, and prvides a telebehaviral health clinic primarily serving the larger healthcare centers in the state. June Status Reprt n Telehealth and Health Infrmatin Technlgy Prgrams and Initiatives in Alaska, Alaska Department f Health and Scial Services Telemedicine services are cvered and reimbursed under Medicaid, prvided that the services cmply with standards in the Alaskan Statutes, Sectin ( Full Text here ), and the Administrative Cde, , et. seq. (Full Text here). The Administrative Cde sets limitatins fr payment, prvided that the services are delivered in a specified manner: live r interactive; stre and frward; self- mnitring r testing; and ther limitatins described in (b). Cvered services include: Hme health and remte patient mnitring Psychlgists' services Stre- and- frward by sund, images, r images n videtape Others as described in the Medical Assistance fr Needy Persns Guidelines Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide telecnferencing. Services using telemedicine must be within the scpe f Medical Assistance s cverage prvisins, be within the scpe f the health- care practitiner s license, and be a service that is apprpriate fr using a telemedicine methd. Cnditins r Limitatins N reimbursements fr: Hme and cmmunity- based waiver, pharmacy, DME, transprtatin, accmmdatin, ESRD, Midwife, PCA, private duty nursing, and visin (including ptician services). Payments t Nn- physician health care prviders Yes, nurse Practitiners can bill fr telemedicine services. Payment Methd FFS fr prvider type Same as reimbursement fr cvered services furnished in the cnventinal, face- t- face manner.

2 IDAHO Type is at bth ends (hub and spke), hwever presenting prvider can bill nly with interactive telemedicine cnsultatins. Hw Identified in Claims/Use f Mdifiers Apprpriate CPT cdes fr prvider type. Sme telemedicine mdifiers are required GT (interactive methd) and GQ (stre- and- frward methd) exceptin: teleradilgy services dn t require mdifiers. Stre and Frward vs. Live Reimburses fr bth real- time and stre and frward. Frm Telemedicine Reprt (2003) prepared by the Center fr Telemedicine Law: "Alaska began reimbursing in 2003, and will make payments fr telemedicine applicatins as an alternative t traditinal methds f delivering services t Medicaid recipients. The divisin will nly reimburse fr live r interactive applicatins made thrugh camera, vide, r audi cnference n a real- time basis; stre- and- frward services; and self- mnitring r testing where the telemedicine applicatin is based in the recipient s hme and the prvider is nly indirectly invlved in the prvisin f the service. T qualify fr reimbursement, the treating r cnsulting prvider must use applicable mdifiers t bill fr telemedicine applicatins as stated in 7 AAC The divisin will reimburse nly fee- fr- service telemedicine applicatins. is made at bth hub and spke sites, but spke sites are nly eligible fr reimbursement fr live r interactive telemedicine applicatin." Telehealth netwrks: Alaska Federal Health Care Access Netwrk (AFHCAN) Evlutin & Summative Evaluatin f the Alaska Federal Health Care Access Netwrk, Nvember 2004 The Alaska Telemedicine Advisry Cuncil (ATAC) prmtes and imprves access t telehealth initiatives and services. Mre infrmatin abut Alaska s gals fr its telehealth netwrk can be fund n the Health and Scial Services website, here. In additin, the Alaska Rural Telehealth Netwrk is a cllectin f 9 small, rural hspitals and 2 federally qualified health centers dedicated t imprving the telehealth netwrk in Alaska, ffering bth educatinal events and clinical services. Organizatin and peple resurces: Plicy Cntacts in Alaska Mark Dughty Public Health Specialist II Health and Scial Sciences Mark.Dughty@alsaka.gv Phne: Idah Medicaid cvers nly telehealth services fr psychiatric care. Full text available under the Department f Health and Welfare Idah Admin Cde, Sectin Medicaid law and regulatins: Frm Telemedicine fr Type f Service(s) Which Can Be Reimbursed

3 CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Telehealth Cnnectins fr Children and Yuth: Frm Telemedicine Reprt (2003) prepared by the Center fr Telemedicine Law: Nte: State cnsidering Medicaid reimbursement at the time f survey. Specific infrmatin nt yet available, but plan is fr physician cnsultatins using interactive vide telecnferencing. Payments t Nn- physician health care prviders N Licensure Requirements Yes, cnsulting physician will need t be licensed and practicing medicine within the state. Payment Methd FFS Same as reimbursement fr cvered services furnished in the cnventinal, face- t- face manner. Type State t reimburse fr a "facility fee" f $20, billed with a HCPCS cde (Q3014 telehealth riginating site facility fee). Hw Identified in Claims/Use f Mdifiers State has chsen three CPT cdes which are billable. These include cdes fr: pharmaclgic management- - cdes 9081M and ) and individual psychtherapy- cde The "GT" mdifier (used by Medicare) is used. "The state is actively cnsidering reimbursement fr telemedicine. Several telemedicine prviders have requested a change in Medicaid plicies t reimburse telehealth. A pilt t assess satisfactin and prvide cst- benefit analysis has been designed but nt funded. A university- based telehealth prject was started several years ag and cntinues t date. A grup f physicians have established a netwrk t prvide behaviral health services t particular indigent ppulatins. Other prjects link medical centers thrugh telehealth. Transprtatin csts are a majr issue due t the gegraphy f the state. Data shwing transprtatin cst savings r ffsets wuld be invaluable. The primary bstacle t reimbursing fr telemedicine is budgetary cncerns. Other apprehensins include ver utilizatin and fraud and abuse. It appears that reimbursement fr cnsultatin culd be initiated withut changing the rules, but reimbursing the facility fee wuld require changing the rules and State Plan." Telehealth licensure: Idah participates in the inter- state Nurse Licensure Cmpact. Telehealth netwrks: Idah State University s Institute f Rural Health prvides research and prjects acrss the state fr varius rural health issues and is funded in part by the Health Resurces and Services Administratin (HRSA). One prgram is the Cperative Telehealth Netwrk (CTN), which perates 8 cities acrss the state in varius hspitals. Mre infrmatin n prjects funded in part by HRSA can be fund n their webpage abut Idah grants. Organizatin and Plicy Cntacts in Idah

4 peple resurces: Neill F. Piland, DrPh Directr and Research Prfessr Institute f Rural Health pilaneil@isu.edu OREGON Laura Tivia, PhD Assistant Directr & Research Prfessr Institute f Rural Health tivilaur@isu.edu Pending legislatin: HB 3650[1]: Establishes Oregn Integrated and Crdinated Health Care Delivery System t replace managed care systems fr recipients f medical assistance; specifies criteria fr crdinated care rganizatins; requires Oregn Health Authrity t seek federal apprval t allw enrllment f individuals wh are eligible fr Medicare and Medicaid int crdinated care rganizatins; requires authrity t establish alternate payment methdlgies fr crdinated care rganizatins. Encurages the use f health infrmatin technlgy Insurance law and regulatins: In 2009, the Oregn State Legislature passed Senate Bill 24[2] t jin the states specifying that insurance plans cannt discriminate against therwise cvered services that are prvided by a telehealth methd. Sectin 743A.058 f the Insurance Cde f Oregn Revised Statutes reads as fllws: 743A.058 Telemedical services. (1) As used in this sectin: (a) Health benefit plan has the meaning given that term in ORS (b) Originating site means the physical lcatin f the patient receiving a telemedical health service. (c) Telemedical means delivered thrugh a tw- way vide cmmunicatin that allws a health prfessinal t interact with a patient wh is at an riginating site. (2) A health benefit plan must prvide cverage f a telemedical health service if: (a) The plan prvides cverage f the health service when prvided in persn by the health prfessinal; (b) The health service is medically necessary; and (c) The health service des nt duplicate r supplant a health service that is available t the patient in persn. (3) An riginating site fr a telemedical health service subject t subsectin (2) f this sectin includes but is nt limited t a: (a) Hspital; (b) Rural health clinic; (c) Federally qualified health center; (d) Physician s ffice; (e) Cmmunity mental health center;

5 WASHINGTON Frm Telemedicine Reprt (2003) prepared by the Center fr Telemedicine Law: Organizatin and peple resurces: Pending/New legislatin: Medicaid law and regulatins: (f) Skilled nursing facility; (g) Renal dialysis center; r (h) Site where public health services are prvided. (4) A plan may nt distinguish between riginating sites that are rural and urban in prviding cverage under subsectin (2) f this sectin. (5) A health benefit plan may subject cverage f a telemedical health service under subsectin (2) f this sectin t all terms and cnditins f the plan, including but nt limited t deductible, cpayment r cinsurance requirements that are applicable t cverage f a cmparable health service prvided in persn. (6) This sectin des nt require a health benefit plan t reimburse a prvider fr a health service that is nt a cvered benefit under the plan r t reimburse a health prfessinal wh is nt a cvered prvider under the plan. "Oregn Medicaid des nt have a telemedicine plicy and des nt d any significant amunt f telemedicine reimbursement. Oregn des participate in a small amunt f reimbursement fr telephne calls in a small smking cessatin prgram and in a small maternity case management prgram. The 72nd Oregn Legislative Assembly drafted Huse Jint Reslutin 4 which calls fr reimbursement fr services when these services are prvided via telecmmunicatins." Telehealth Alliance f Oregn Oregn Center fr Aging and Technlgy (ORCATECH) fsters and stimulates translatinal innvatin thrugh a number f mechanisms including its multi- disciplinary, multi- institutinal Cuncil cmpsed f academic, cmmunity and industry leaders, building new natinal and internatinal research cllabratins, prviding supprt t existing research studies, as well as develpmental supprt thrugh the ORCATECH Living Labratry. Oregn Health Netwrk SB 5708: Prvides that nnresidents f barding hmes may receive technlgy- based mnitring devices, scheduled bld pressure checks, reminders abut health care appintments, medicatin assistance, falls risk assessment, and nutritin management and educatin services, dental services, and wellness prgrams Status: Enacted In the state f Washingtn, telehealth allws fr Medicaid patients imprved access t essential health services that are nt therwise available where the prvider is lcated. Installatin f maintenance telecmmunicatin devices and stre- and- frward telecmmunicatin devices are nt reimbursable. Fee- fr- service clients are eligible fr medically necessary services perfrmed r delivered thrugh telehealth. The referring physician must dcument and determine the needed care via telehealth. The state cvers these services relating t telehealth in the fee- fr- service prgram when it is used t substitute face- t- face [2]. Washingtn statute permits the use f telemedicine in lieu f a skilled nursing face- t- face visit

6 hme health visit, and impses n restrictins n the types f technlgy that can be used during a telemedicine visit. Interactive vide cnferencing and remte telemnitring are bth reimbursable services under their Medicaid prgram [3]. Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide telecnferencing. Patient must be present and participating in the telehealth visit. Hme vide cnferencing Hme patient telemnitring Cnditins r Limitatins Only fee- fr- services enrllees are eligible fr the reimbursement. Hme health telemedicine services are nly reimbursable by certified hme health agencies. Hme health telemedicine patients must have a diagnsis(es) where there is a high risk f sudden change in medical cnditin which culd cmprmise health utcmes. Will nt pay fr chrnic lng- term care skilled nursing visits r specialized therapy visits. The Medicaid Agency des nt pay fr the purchase, rental, repair, r maintenance f telemedicine equipment and assciated csts f peratin f telemedicine equipment. Payments t Nn- physician health care prviders Yes, ARNPs nly. Yes, certified hme health agencies licensed in Washingtn state Payment Methd FFS Same as reimbursement fr cvered services that are delivered face- t- face. The Medicaid Agency pays fr ne telemedicine interactin, per eligible client, per day based n the rdering licensed practitiner s hme health plan f care. Type Full reimbursement at hub site nly. Referring prvider is reimbursed a $20 facility fee per cmpleted transmissin. The reimbursement rate fr hme health telemedicine services is $77 per visit as cmpared t the $87 rate fr a face- t- face visit. Hw Identified in Claims/Use f Mdifiers Use f apprpriate CPT cde with the "GT" mdifier. Cnsultatins: CPT cdes ; Office r ther utpatient visits: CPT cdes ; Psychiatric intake and assessment: CPT cde 90801; Individual psychtherapy: CPT cdes , and Pharmaclgic management: CPT cdes Prviders must use revenue cde 0559 when billing the Medicaid Agency fr hme health services delivered thrugh telemedicine. Stre and Frward vs. Live

7 Reimburses fr real- time Reimburses fr real- time and telemnitring in hme when delivered by certified hme health agency N "stre and frward" Telehealth licensure: The Statute, as written, implicitly allws fr telemedicine. Additinally, the state requires license t practice medicine, but telehealth is nt specifically addressed. N persn may practice r represent himself r herself as practicing medicine withut first having a valid license t d s. Rev. Cde Wash (2003). Nthing in this chapter shall be cnstrued t prhibit: (6) The practice f medicine by any practitiner licensed by anther state r territry in which he r she resides, prvided that such practitiner shall nt pen an ffice r appint a place f meeting patients r receiving calls within this state. Rev. Cde Wash (2003). This des nt require a full license fr telehealth law. It allws it withut mentining this area by name. Telehealth netwrks: The state f Washingtn, member f the Nrthwest Reginal Telehealth Netwrk Resurce Center, allws fr prviding technical assistance in rural and underserved cmmunities thrugh telehealth applicatins. This netwrk als includes telestrke as an imprtant area f clinical care. These services include: prviding technical assistance fr new prgrams and applicatins, increasing expsure t telehealth as a healthcare delivery tl, imprving access t specialty care thrugh reginal cllabratin, develping infrmatin n best practices and telehealth tlkits and addressing reginal regulatry, plicy, and reimbursement issues. The Washingtn Telehealth Cnsrtium (WTC) cntinues t seek creative slutins fr the Washingtn Telehealth Exchange. This prject includes diverse prfessinals with fcuses n designing, funding and implementing a statewide telehealth netwrk thrugh cnnectin and facilitatin in its pre- existing telecmmunicatins infrastructure. Organizatin and peple resurces: Washingtn State Health Technlgy Assessment Prgram Frm Telemedicine fr CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Telehealth Cnnectins fr Children and Yuth Surce: American Telemedicine Assciatin (2013). State Telemedicine Plicy Center. Retrieved frm