CONNECTICUT MAINE. State- Specific Information Recent news, pending action:

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1 State CONNECTICUT MAINE State- Specific Information Connecticut currently has no wide- scale programs involving telemedicine services, and Medicaid does not cover or reimburse for telemedicine. Pending legislation: Raised S.B. No. 13 to require health insurance coverage of medical advice, diagnosis, care or treatment provided through telemedicine if such advice, diagnosis, care or treatment is covered then provided through in- person consultation. Medicaid law and In 2012, a new law was enacted to permit a demonstration project to offer telemedicine services as a Medicaid- covered service at federally- qualified health centers. From Telemedicine "The agency is not formally considering a policy change related to telemedicine reimbursement. It initially participated in a pilot project linking primary, acute, and long- term care of the elderly. The goal was development of a comprehensive assessment database to be used by all agencies. The focus was primarily on persons at risk, but not eligible for nursing home care. Due to budget constraints, this project was abandoned prior to completion. The Medicaid Director has 39 been apprised of telemedicine programs in the state and has participated in demonstration projects. Medicaid transportation costs are minimal. Due to budget constraints, the state is cutting back on services. Managed care is used primarily for the younger Medicaid population. Approximately 12,000 clients are involved in a state- funded Medicaid home- care waiver. The agency is aware of a home medication demonstration project through a program at Yale. In this program, if a Medicaid recipient fails to use medications from a preloaded unit, the EMS system can be automatically activated. Yale is conducting another project with elderly clients to study the relationship between falls and medications." April 6, 2010 Maine Governor Takes Next Step in Expanding Health Information Technology Pending legislation: SB 192: Creates a category of pharmacy services, designated as medication therapy management services, for which pharmacists may charge separately from a charge for the prescription drug or a dispensing fee. The bill defines medication therapy management services. Qualified pharmacist: and targets patient. Requires use of electronic medical records. Insurance law and In 2009, the Maine Legislature overwhelmingly passed a bill that mandates all health plans to cover telemedicine services. The law requires interactive audio or video and does not include the audio- only telephone, e- mail, or a fax machine. The key provision is the following: A carrier offering a health plan in this State may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would be covered were it provided through in- person consultation between the covered person and a health care provider. Coverage for health care services provided through telemedicine must be determined in a manner consistent with coverage for health care services provided through in- person consultation. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided through telemedicine as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in- person

2 Medicaid law and From Telemedicine for CSHCN: A State- by- State Comparison of Medicaid Policies and Title V Activities (2005) prepared by Connections for Children and Youth: consultation. MaineCare (Maine Medicaid) requires that there be a compelling benefit for the member to cover and reimburse for telehealth services, as listed under Ch.1, section of the MaineCare Benefits Manual. The only reimbursable services must use two- way audio and video equipment. MaineCare also requires that educational information be provided to the patient at the time the telehealth services are rendered. Covered services include: o Physician Consultations o Other services as provided in the Benefits Manual o The benefit must be related to physical, social or geographic issues that make delivering the service in person difficult. It must not be for the convenience of the provider. The member s record must contain documentation that the member has met one or more of the criteria listed below: o Physical: A member s medical condition makes a face- to- face encounter that entails significant travel inadvisable or impossible. o Social: The family or other support system does not support a member traveling a distance for a face- to- face encounter, or does not allow the member to take the time that travel will require. o Geographic: There is a lack of medical/psychiatric/mental health expertise locally, limited transportation resources, or a long wait for such local care. Type of Service(s) Which Can Be Reimbursed o Physician consultations using interactive video teleconferencing. o Services reimbursed must be medically appropriate. Payments to Non- physician health care providers o Yes, RNs and other allied health professionals that provide a billable service. Payment amount is no different but may change to 80% of physician reimbursement amount in the future. o Providers also can be reimbursed for translation or interpreter services for non- English speaking and deaf/hard of hearing members. Licensure Requirements: o Yes. In addition provider must be enrolled with State as a provider of telemedicine services. Also required is documentation justifying the provision of services via telemedicine instead of face- to- face encounters. 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 No "add ons" (technical support, line charges or depreciation of equipment) are allowed.

3 From Telemedicine licensure: networks: Organization and people resources: o Reimbursed only if application on file with State and approved as a provider of telemedicine services. How Identified in Claims/Use of Modifiers o Same procedure codes as face- to- face with the "GT" modifier included to distinguish the code as delivered via telemedicine. o The state has experienced difficulty in identifying claims. They are now attempting to use modifiers. Store and Forward vs. Live o Reimburses for real- time only. o No "store and forward". "Effective in January, 2003, Maine adopted a policy to cover services provided via telemedicine by enrolled providers. Transmission costs, consultations between professionals, or attendants instructing a patient in the use of the equipment are not reimbursed. Providers submit a specific description of the procedures and codes that will be used, a statement explaining the rationale for needing telemedicine capabilities, a policy noting criteria to determine when telemedicine services are appropriate, and a quality assurance plan. Services delivered via telemedicine are not billable if the provider does not have a letter of approval. Telemedicine services may not be provided only for the convenience of the provider. The same procedure codes and rates apply as if services where rendered in a face- to- face encounter. Claims must be submitted for review on an individual basis." Maine participates in the inter- state Nurse Licensure Compact. Maine Telemedicine Services, a division of a rural community health center, Health Ways/Regional Medical Center at Lubec (RMCL), has helped to establish a statewide telemedicine network including surrounding states- that has connected over 300 facilities among 150 organizations. New England Consortium, a separate ongoing project, funded in part by HRSA s Office for the Advancement of, is the Northeast Resource Center (NTRC), which is a collaborative effort by Maine, Vermont, and Massachusetts telemedicine programs to enhance telemedicine initiatives in the northeast. Maine Collaborative website - Maine's Office of Rural Health and Primary Care is charged with developing a strategic plan for telehealth infrastructure in Maine. Our aim is to provide greater access to telehealth resources and services to providers, patients and payers. In previous months we interviewed early adopters of telemedicine to understand what has worked and what obstacles persist to further telemedicine development. Many clinicians expressed their desire to learn from each other's experience. This website is a response to that need - a web- based information network of resources, both in Maine and beyond, and collaborative learning opportunities. Contact: Charles Dwyer, Director, Maine CDC Office of Rural Health and Primary Care, Charle.Dwyer@maine.gov,(207)

4 MASSACHUSETTS August 6, Gov. Patrick signed a comprehensive package addressing health costs[1], including a mandate for private insurers operating in the state to reimburse for telehealth- provided covered services and two other references to telemedicine: o Consideration of telemedicine in developing standards for ACO certification: The legislation establishes a process for certain registered provider organizations to be certified as accountable care organizations. The purpose of the ACO certification process shall be to encourage the adoption of integrated delivery care systems in the commonwealth for the purpose of cost containment, quality improvement and patient protection.. and one of the goals of these ACOs shall be to demonstrate an ability to engage and activate patients at o home, through methods such as home visits or telemedicine. Report by the division of insurance and board of registration of medicine: The Division of Insurance is required to conduct a report on the potential for out- of- state physicians to practice telemedicine in the commonwealth. June 12, The House of Representatives approved an amendment for the Board of Registration of Medicine to develop and implement standards for a telemedicine license, for which physicians licensed in any state will be eligible to apply. Pending legislation: SB 438: Provides insurance coverage of telemedicine services SB 487: To recognize telehealth services as an effective means of monitoring and managing home health patients whose medical, functional and/or environmental needs can be appropriately and cost- effectively met through such technology. Reimbursable home telehealth will be fostered to ensure an increased communication with the patient, help early detection of chronic illness, prevent re- hospitalization and subsequent costs, enhance self- management and provide the patient an improved comprehension of his/her condition. SB 520: Establishes a pilot program to test telemedicine capacity to provide quality medical service to inmates at the various county correctional facilities while reducing budgetary expenses for physician services on- site. SB 521: Relates to the use of electronic media for the purpose of diagnosis, consultation, or treatment; provides and active or retired employee who is insured under the group insurance commission benefits can request the application of telemedicine for covered services provided within the scope of practices of a physician or health care provider as a method of delivery of medical care by which an individual shall receive medical services from a health care provider without in person contact with the provider. SB 558: Establishes cost avoidance through care- at- home. Provides reimbursement for telehealth services Medicaid law and MassHealth (Massachusetts Medicaid) does not currently reimburse for telemedicine services. From Telemedicine " for telemedicine has been proposed, but the agency does not currently provide

5 NEW HAMPSHIRE Networks: Organization and people resources: Insurance law and Medicaid law and From Telemedicine payment. Because of telemedicine programs within the state, the agency anticipates the topic will continue to be on the policy agenda. Through a home care pilot, a number of projects are funded through elder service agencies. Some local providers, such as Partners Health Care, are 41 promoting telehealth and are funding state specific programs. The agency covers transportation, but is unsure of the impact on the overall Medicaid budget. Massachusetts Senate Bill 503, introduced in January 2003, authorizes and directs the Division of Health Care Finance and Policy and the Division of Medical Assistance to establish a rate of reimbursement for home health agencies that allow for the use of technology." The Connected Health provides research and new strategies for delivering technology- enabled health care services. The Center works with health care providers and patients to improve health care throughout New England. The Massachusetts General/Logan International Airport Medical Station, established in 1967, provided occupational health services to airport employees and to deliver emergency care and medical attention to travelers. Physicians at MGH provided medical care to patients at the airport using a two- way audiovisual microwave circuit. Nurses staffed the Medical Station 24 hours a day, supplemented by in- person physician attendance during four hours of peak passenger use. Evaluation of diagnosis and treatment of the nurse- selected patients was made by participating personnel and independent physician observers. Policy contacts in Massachusetts Connected Health 25 New Chardon St, Suite 400D Boston, MA connectedhealth@partners.org Phone: New Hampshire Program o S.B. 138 Passed into law Requires insurance coverage for telemedicine services if the service would normally be covered by the insurer if the service were provided through in- person consultation. Recently passed legislation mandates insurance coverage for telemedicine services. New Hampshire Medicaid does not reimburse for telemedicine services. The Provider Services website has nothing about telemedicine or telehealth coverage. "The agency is not reimbursing and is not considering reimbursement, since no requests for reimbursement have been submitted to the Medicaid agency to date."

6 RHODE ISLAND VERMONT licensure: networks: New Hampshire participates in the inter- state Nurse Licensure Compact. Dartmouth College and other health care organizations launched the New Hampshire Program (NHTP) in an effort to assess the possibility of implementing a statewide telehealth network. The contact information is not updated on the website. Assessment of Needs and Potential Uses of Services in New Hampshire, Report of the New Hampshire Program, 2006 Planning and Implementing a Statewide Program in New Hampshire: A White Paper, 2005 New England Consortium Pending legislation: S 2556 and H 7796 for private health benefits plans to pay for telehealth- provided covered services. (Introduced 2/28/2012.) S 770: Recognizes that, in a patient centered medical home, care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. Recognizes that a PCMH ensures the use of health information technology and systematic follow- up, including the use of patient registries. H 5276: Creates the "Rhode Island All- Payer Patient- Centered Medical Home Act;" incorporates the use of health information technology and health information exchange. From Telemedicine licensure: networks: "The agency representative indicated that he is aware of the concept of remote monitoring, but not aware of any programs in the state. To date, there have not been requests for reimbursement of these services. Transportation costs comprise a very small percentage of overall Medicaid costs." April 28, The Vermont Legislature completed approval of a mandate for all health plans, including Medicaid to pay for telehealth- provided covered services in H to be the 14th state with a private payer mandate. The state of Vermont makes no mention of telemedicine specifically, but it requires a license to practice medicine. There is a consultation exception. Legal consequences may apply such as imprisonment and fines up to $200 for falsification. 23 V.S.A does provide applicable laws relating to medical licensure for physicians and nurses. New England Consortium Source: American Telemedicine Association (2013). State Telemedicine Policy Center. Retrieved from