IOWA. Recent news, pending action: Pending legislation: Medicaid law and regulations: From Telemedicine for CSHCN: A State- by- State

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1 IOWA State Recent news, pending action: Pending legislation: for CSHCN: A State- by- State Comparison of Medicaid Policies and Title V Activities (2005) prepared by Connections for Children and Youth: Report (2003) prepared by the Center for Law: State- Specific Information August 26, The Iowa Board of Medicine creates ad hoc committee to study broad range of telemedicine. The committee will to study the Board s 1996 policy statement and determine what is needed to make it more relevant to the continually expanding use of telemedicine by physicians. The committee will begin a review of the policy statement and the general topic of telemedicine this fall, but may not complete its work until a parallel nationwide study by the Federation of State Medical Boards is completed in HF 296: Directs the Department of Human Services to submit an amendment to the medical assistance state plan to the US Centers for Medicare and Medicaid Services for approval to include telemedicine as distinct covered services under the Medicaid program; defines telemedicine. Medicaid recognizes physician consultations when furnished using interactive video teleconferencing. Payment is based on the state's fee- for- service rates for covered services furnished in the conventional, face- to- face manner. is made at both ends (hub and spoke sites) for telemedicine services. Specific local codes are used for the add- on payment and CPT codes with the modifier "TM" is used to identify the consultations. Type of Service(s) Which Can Be Reimbursed o Note: Program terminated at time of survey due to insufficient data to support it. State had reimbursed for physician consultations using interactive video teleconferencing. Payment Method o FFS o Same as reimbursement for covered services furnished in the conventional, face- to- face manner. Type o is at both ends (hub and spoke). How Identified in Claims/Use of Modifiers o Specific local codes for the add- on payment and CPT codes with the modifier "TM" to identify the consultations. "The Medicaid agency began reimbursement through a pilot program that was legislatively mandated and upon completion legislatively terminated. The agency recognizes a limited number of physician consultation codes for use of interactive video teleconferencing. Only three providers initially entered into agreement to participate, but only two remain. Many providers indicated that completion of the forms (designed to collect data) was too burdensome. Payment is based on the state's fee- for- service rates for covered services furnished in the conventional face- to- face manner. is made at both the hub and spoke sites for telemedicine services. Specific local codes are used for the add- on payment, and CPT codes with the modifier "TM" is used to identify

2 KANSAS licensure Recent news, pending action: for CSHCN: A State- by- State Comparison of Medicaid Policies and Title V Activities (2005) the consultations. Based on conclusions of the legislative study, it does not appear that the data supports the cost expenditure for telehealth. Some mental health services are provided through a managed care waiver, and since the inclusion of the new mental health CPT code, the agency reimburses limited amounts for telepsychiatry. Services which meet accepted standards of care are paid, so services using telemedicine as a core method of care may be being reimbursed without inclusion of the modifier." Iowa participates in the inter- state Nurse Licensure Compact. The University of Iowa Medical Centers offer some telemedicine services, including nursing home consultations and psychiatric services. In 2010, introduced in the House was HB2427 concerning healthcare; relating to telemedicine and telehealth monitoring; providing for reimbursement. o SB 99: An act concerning electronic transmission of prescription orders; establishing the electronic prescription adoption act. Prescribes standards for electronic transmission of prescriptions. Kansas Medicaid has covered certain telemedicine services since 2004, as shown in this Provider Bulletin. The full General Benefits Provider Manual can be found. Covered services include: o Physician Consultations o Psychotherapy o Pharmacological management services Medicaid recognizes home health care and mental health services already covered by the state plan when furnished using teleconferencing. Home health is limited to certain services. Payment is on a fee- for- service basis for the mental health services, which is the same as the reimbursement for covered services furnished in the conventional manner. Compensation for home health care via telemedicine is made at a reduced rate. is made for only the service furnished at the hub site. Local codes have been established to specifically identify home health services furnished using visual communication equipment. No special modifiers are used for mental health services. Type of Service(s) Which Can Be Reimbursed o Home health care (limited to certain services) and mental health services already covered by the state plan using video equipment Payments to Non- physician health care providers o Yes, any provider that bills for face- to- face visits can do telemedicine. Licensure Requirements o In state only. Some border cities may also out- of- state licensed providers but this must have prior authorization from the State. Payment Method

3 prepared by Connections for Children and Youth: Report (2003) prepared by the Center for the Law: Organization and people resources: o FFS for MH services. o Same as reimbursement for covered services furnished in the conventional manner. o Compensation for home health care via telemedicine made at a reduced rate. Type o at hub site only. o at the originating site (where patient is) is billed as Q3014 (telemedicine originating facility fee) and reimbursed at the rate of $ As a condition of payment, the patient must be present and participating in the telemedicine visit. How Identified in Claims/Use of Modifiers o Local codes identify home health services furnished using visual communication equipment. No special modifies for mental health services. o "GT" modifiers used for telemedicine. o Covered services include: consultation (CPT codes ), office visits (CPT codes ), individual psychotherapy (CPT codes 90801, and 90847), and pharmacologic management (CPT code 90862). Store and Forward vs. Live o Reimburses for real- time only. o No "store and forward". "The state reimburses for home health care and mental health services already covered by the state plan when furnished using video equipment. Payment is on a fee- for- service basis for the mental health services, the same as the reimbursement for covered services furnished in the conventional manner. Home Care services have certain restrictions, and compensation for home health care via telemedicine is made at a reduced rate. is made for only the service furnished at the hub site. Payment is on a fee- for- service basis, the same normally reimbursed in a face- to- face encounter per the fee schedule. Local codes specifically identify home health services furnished using visual communication equipment. No special modifiers are used for mental health services." The University of Kansas Medical Center has a Center for TeleMedicine & TeleHealth which provides telehealth services and conducts research. They are connected to over 60 sites around the state and offer a wide range of specialists. Policy Contacts in Kansas Ryan J. Spaulding, PhD Director Center for & 2012 Wahl Hall Annex (mail stop: 1048) 3901 Rainbow Boulevard Kansas City, Ks 66160

4 MISSOURI NEBRASKA Pending legislation: Organization and people resources: Insurance law and Phone: SB 303: Requires that, prior to prescribing any drug, controlled substance, or other treatment through the internet, a physician shall establish a valid physician- patient relationship, including maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient's consent, to the patient's other health care professionals; and including the electronic prescription information as part of the patient's medical record. HB 732: Requires that, prior to prescribing any drug, controlled substance, or other treatment through the internet, a physician shall establish a valid physician- patient relationship. This relationship includes including the electronic prescription information as part of the patient's medical record HB 821: Establishes provisions regarding pharmacy services. Provides standards for electronic prescribing. MO Healthnet Division (Missouri Medicaid) covers medically necessary telehealth services, but Healthnet requires the use of 2- way interactive video so that the patient can see and interact with the provider. The full text of the Missouri Rule covering telehealth services can be found on page 27. Covered services include: o Physician consultations o Psychotherapy o Pharmacologic management o Other services The Missouri Network, partly funded by HRSA, has over 150 sites in 48 counties across the state. For FY2008, MTN has saved over $300,000 in travelling costs, according to its website. The Network offers a wide range of clinical services, including: psychiatry, endocrinology, dermatology, and surgical follow- ups, among others. Policy Contacts in Missouri Rachel Mutrux Director of Missouri Network 2401 Lemone Industrial Boulevard, DC Columbia, Missouri Phone: Statutes Relating to Nebraska Act, Nebraska Department of Health and Human Services, 2007 In- person contact between a health care practitioner and a patient shall not be required under Medicaid for health care services delivered through telehealth that are otherwise eligible for

5 State- by- State Comparison of Medicaid Policies and Title V Activities (2005) prepared by Connections for Children and Youth: reimbursement. The reimbursement rate for a telehealth consultation shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in- person consultation. The department shall establish rates for transmission cost reimbursement for telehealth consultations, considering, to the extent applicable, reductions in travel costs by health care practitioners and patients to deliver or to access health care services and such other factors as the department deems relevant. This also applies to managed care plans to the extent that: o Health care services delivered through telehealth are covered by and reimbursed under the Medicaid fee- for- service program; and o Managed care contracts are amended to add coverage of health care services delivered through telehealth and any appropriate capitation rate adjustments are incorporated. Type of Service(s) Which Can Be Reimbursed o Most state plan services when using interactive video teleconferencing. In general, services are covered so long as a comparable service is not available within a 30- mile radius of the patient's home. Conditions or Limitations o Mental Health and dermatology o Excluded: DME and supplies, orthotics, prosthetics, personal care aides, pharmacy services, medical transportation services, MHSA, Home & Community based waiver services. Payments to Non- physician health care providers o Yes. ARNPs, Physician Assistants, mental health providers, dentists, ancillary services/therapists. Licensure Requirements: o Yes, must follow state regulations of the state that the procedure is occurring. Payment Method o FFS o Same as for covered services furnished in the conventional, face- to- face manner. Type o is at both ends (hub and spoke). o Payment for transmission costs are set at the lower of the billed charge or the state's maximum allowable rate. o Note: Also included a transmission fee of $.05 per minute. How Identified in Claims/Use of Modifiers o Code requirements vary depending on billing for service and claim forms used o The state has experienced billings <$1,000 in the past two years. Store and Forward vs. Live o Reimburses for real- time only. o No "store and forward"

6 Report (2003) prepared by the Center for the Law: licensure: "The Medicaid agency recognizes most state plan services when furnished using interactive video teleconferencing. Services are covered as long as comparable service is not available to a client within a 30- mile radius of his/her home. Services specifically excluded include medical equipment and supplies, orthotics and prosthetics, personal care aide services, pharmacy services, medical transportation services, mental health and substance abuse services, and home and community- based waiver services provided by persons who do not meet practitioner standards for coverage. Payment is on a fee- for- service basis, the same as face- to- face. is made at both the hub and spoke site. Payment for transmission costs is set at the lower of the billed charge or the state s maximum allowable amount. Billing and coding requirements vary based on the provider and the claim form is used. transmission is reimbursed at a rate of $.08/minute based on the highest Universal Service Fund subsidized monthly rate and the expected usage availability. Medicaid will reimburse for mileage to transport a client to a telehealth site. Out- of- state practitioners may provide services to clients in Nebraska if they comply with licensure, registration, and certification regulations and are enrolled with the Nebraska Medicaid. Service occurs at the client s location. Nebraska Law 692 allowed for 10% of the NE Health Care Cash Fund to be for grants for health infrastructure including telemedicine. Nebraska covers all services that would be covered if occurring face to face. Transmissions fees can be included on hospital cost reports. No special codes are used, but based on billing instructions, use of telemedicine should be visible. On an annual basis, less than $1,000 is paid out for all telemedicine services. According to Dr. Chris Wright, nobody is using it. Nine telehealth sites are enrolled, with 103 eligible practitioners. In 2002, 631 encounters occurred. In Nebraska, the urban medical centers are only about 60 miles apart. Large budget deficits will impact the Medicaid program, but probably not telemedicine. It is interesting to note that the Nebraska legislature defined the practice of medicine as occurring where the patient is physically located. The billing and coding requirements will vary depending on who bills for the service and which claim form is used." Nebraska participates in the inter- state Nurse Licensure Compact. Nebraska Statewide Network Source: American Association (2013). State Policy Center. Retrieved from