Telemedicine Policy. Dr. Melinda Rowe Assistant Medical Director November 17, 2015

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1 Telemedicine Policy Dr. Melinda Rowe Assistant Medical Director November 17, 2015

2 Alabama Medicaid Telemedicine History Began coverage for Psychiatry and Dermatology specialists in mile limitation Expanded to all physician types with Alabama Medical license in mile limitation removed No origination or transmission fees

3 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

4 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 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

5 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, , or fax between physician, recipient, or consultation between two physicians

6 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

7 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

8 Alabama Medicaid Telemedicine Procedure codes covered for telemedicine Consultations ( , ) Office or other outpatient visits ( , ) Individual psychotherapy ( ) Psychiatric diagnostic (90801) Neurobehavioral status exam (96116) Bill procedure codes with modifier GT No reimbursement currently origination site or transmission fees

9 Other State Medicaid Programs Georgia ~ $21 origination fee No information on total spend in budget Oklahoma ~ $22.59 origination fee No information on total spend in budget Facing budget cuts Considering eliminating origination fees

10 Other Payers Medicare pays transmission fee BCBS AL telemedicine policy/coverage Other 3 rd party payers Other Managed Care Organizations

11 Other Events Alabama Board of Medical Examiners 1/2014 Telehealth policy: CURRENTLY ON HOLD 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

12 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

13 AMA Telemedicine Utilization FY 10 $ 4,352 FY 11 $ 7,836 FY 12 $ 10,216 FY 13 $ 19,875 FY 14 $ 33,290 FY15 (through 9/15/15) $ 39,947 Totals: $115,516 Over 5500 claims for Medicaid/Medicare dual eligibles (PSY 32%); 650 Medicaid only and most PSY(57%) for Medicaid only

14 AMA Telemedicine Utilization (cont) Dual eligibles (Medicare/Medicaid) Majority of visits in Community Mental Health Centers ($47,291) Physician Office ($14,456) Medicaid Majority of visits occur in office ($51,993) Skilled nursing facilities ($601)

15 AMA Regional Care Organizations (RCOs) Alabama Code 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 A E

16 AMA RCOs 5 Regions A thru E Smallest region 7 counties Largest region 21 counties

17 AMA RCOs (Continued) 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

18 Medicaid Telemedicine For more details go to Chapter 28 of Alabama Medicaid Provider Manual on website at Questions Thank you