DELAWARE DISTRICT OF COLUMBIA MARYLAND. State- Specific Information Recent news, pending action:

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1 State DELAWARE DISTRICT OF COLUMBIA MARYLAND State- Specific Information Recent news, June 27, Delaware Medicaid program to reimburse for telemedicine- delivered services beginning July 1. Delaware participates in the inter- state Nurse Licensure Compact. licensure: Medicaid law and Medicaid does not cover or reimburse for telemedicine. regulations: "At this point, the agency is not considering reimbursement for telemedicine. The agency has not received evidence that reimbursing for telemedicine is needed and telemedicine has not been deemed to be widely available or to offer substantial benefit to DC Medicaid recipients." Report (2003) prepared by the Center for Law: The District of Columbia currently has no wide- scale programs involving telemedicine services. National Rehabilitation Hospital provides telerehabilitation services. Recent news, State agencies and multiple task forces filed a comprehensive statewide plan for telemedicine: Recommendations: A Report prepared for the Maryland Quality and Cost Council in December In 2007, a comprehensive study was prepared for the General Assembly, Report on Policies Regarding Use and for Services in Maryland and Other States. May 22, Governor O'Malley signed into law the General Assembly's unanimously approval of a mandate for private health benefits to pay for telehealth- provided covered services in SB 781/HB to be the 13th state with such law. February HB 1399 introduced to authorize for Maryland hospitals the new Medicare credentialing and privileging option for "privilege by proxy." February HB 1400 introduced to expand an exception from licensing by the State Board of Physicians to include a physician who resides in and is authorized to practice medicine by any other state, instead of an adjoining state, and who meets other requirements; establishing an exception from licensing by the Board for a physician who resides in and is authorized to practice medicine by another state and who provides specified services by telemedicine; etc. April, Governor O Malley signed legislation to require the Maryland Health Care Commission to establish a Patient Centered Medical Home (PCMH) pilot program. Insurers, HMOs, managed care organizations and nonprofit health service providers are now authorized to pay a PCMH for providing care and for managing chronic care. Medicaid law and Maryland Medicaid currently does not reimburse for telemedicine services.

2 PENNSYLVANIA regulations: Maryland Medicaid Home and Community- Based Long Term Care Services, Pending telemental health regulations information. Report (2003) prepared by the Center for "Medicaid does not cover telemedicine services and is not aware of any claims or interest in pursuing reimbursement for these services. The agency representative had heard of a remote care project through the University of Maryland. Transportation costs are not a major cost issue for Medicaid. The agency is interested in any services that are cost- effective and meet the needs of their constituents; however, at this time they do not have reimbursement for telehealth on the policy agenda." Law: licensure: Maryland participates in the inter- state Nurse Licensure Compact. Organization and people resources: Recent news, Pending legislation: An intensive care unit (ICU) program, Maryland ecare, is underway at 6 hospitals in Maryland, designed to monitor ICU patients through remote care. The program expects to cover ICU beds by Eagle Hospital Physicians 5901 C Peachtree Dunwoody Road Suite 350 Atlanta, GA EagleHospitalPhysicians.com Phone: Physician Service Organizations May 22, Governor Corbett announced that Pennsylvania Medicaid will recipients access to specialist care by expanding coverage for telemedicine; o Establish the use of real- time interactive technology, such as audio and video equipment as a method of delivering consultation services o Consultations can now occur between all physician specialists like cardiologists, o obstetricians or neurologists Remove the requirement that telemedicine consultations can only be performed with participation from the referring physician. August 29, UPMC among few in state using 'tele' technology; Most hospitals waiting for insurers to cover telemedicine costs, Pittsburgh Post- Gazette October 1, Pennsylvania Department of Aging issued TeleCare service definitions and standards for use in the Aging Waiver and Home and Community- Based Waiver Services program. SB 309: Regulates certain services provided by a nonresident physician, including telemedicine. SB 1357 and HB 1939 for Medicaid payment for all covered services when provided by telehealth. Specifically, it would - - o eliminate any regulation which "requires a health care professional utilizing telehealth to

3 Medicaid law and regulations: be in the physical presence of the patient in order for Medicaid reimbursement to occur," and o broadly defines "health care professional" to be an individual licensed, certified or otherwise regulated to provide health care services by the state. HB 223: Amends the Insurance Code; provides for health care coverage for telehealth. HB 238: Provides for Medicaid payments, including payments for telemedicine services. March 17, The House unanimously passed House Bill 816 establishing State funding for the Heart Disease and Stroke Program within the Department of Health that would include telehealth. June 29, The House passed House Bill 1 that includes a private insurance requirement for telehealth. Home and Community Based Services Pennsylvania Department of Aging administers an Aging Waiver and Home and Community- Based Waiver Services program to enable qualifying residents to continue to live in your home and community with support and services, including TeleCare. TeleCare is defined to cover a broad range of technology- enabled services, including health status measuring and monitoring, activity and sensor monitoring, and medication dispensing and monitoring. Services included o Health Status Measuring and Monitoring o Activity and Sensor Monitoring o Medication Dispensing and Monitoring Eligibility guidelines A primary physician, physician asst, or nurse practitioner must order Health Status Measuring and Monitoring Service. Not necessary for Activity and Meds Monitoring. o Hospitalization in the past year o Medical diagnosis of depression or mental health issues o Use of the ED in the past year o Poor adherence to physician orders or medications o Formal or informal support systems are limited or absent o History of falls in the past 6 months that resulted in injury o Lives alone or is at home alone for extended periods of time o Services access challenges o RPM- $10 per day $90 one- time install/un- install o Activity/Sensor- $80/mo $200 one- time install/un- install o Meds Dispensing- $50/mo Reports: The State of Technology in Aging Services in Pennsylvania, published October 2008.

4 VIRGINIA Recent news, Insurance law and regulations: Medicaid law and regulations The state's Medicaid program, which has been reimbursing providers for telemedicine services since 2003, reports a 2011 annual expenditure for telehealth services of $182, The Department of Human Resources Management reports that in 2011, (since coverage of state employees began), only 82 claims have been paid for telemedicine services for state employees. October The Bay Rivers Alliance awarded a grant from OAT to establish a number of new telehealth sites to support expanded mental, behavioral, and geriatric patient care throughout the Northern Neck, Middle Peninsula, and Eastern Shore, from medical specialists located in Hampton Roads and Richmond. April Department of Medical Assistance Services (DMAS) announced coverage and reimbursement for telepractice in the schools and other settings. Coverage includes speech therapy services listed in an individualized education program, which are delivered to a child at school using videoconferencing by a speech therapist at a remote location. will cover the speech therapist at the remote location and a qualified school aide with the child during the telepractice session. December Report and recommendations of the Virginia Health Reform Initiative Advisory Council. April 7, Governor signs unanimously passed insurance coverage for telemedicine services. Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for the cost of telemedicine services when the services are appropriately provided through such means. " services" means the use of interactive audio, video, or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. Decisions denying coverage of services provided via telemedicine will be subject to utilization review procedures. o Evaluation of HB 2191 and SB 1458: Mandated Coverage of Services, Joint Legislative Audit and Review Commission The Department of Medical Assistance Services has recognized the use of telemedicine services since Physicians and some other providers may utilize telemedicine for real- time or near real- time exchange of information for diagnosing and treating medical conditions. Virginia was one of the first states to allow reimbursement of telemedicine services through Medicaid. According to the DMAS, the objectives for covering telemedicine through Medicaid are (1) improved recipient access to health care services; (2) improved recipient compliance with treatment plans; (3) medical services rendered at an earlier stage of disease, thereby improving long- term patient outcomes; and (4) reduced costs for covered services such as hospitalizations and transportation. Virginia Medicaid currently covers telemedicine for real- time or near real- time exchange of information for diagnosing and treating medical conditions. It does not cover telemedicine when used in the store- and- forward or home health monitoring capacity, though the Department of

5 Pending legislation: Medical Assistance Services (DMAS) is currently assessing whether to expand coverage to these forms of telemedicine. There are also limitations on the types of providers and procedures that are covered when provided through telemedicine. DMAS indicates that physicians, nurse practitioners, nurse midwives, clinical nurse specialists, clinical psychologists, clinical social workers, Community Service Boards, and licensed professional counselors may utilize telemedicine for the delivery of covered services. The telemedicine procedures that are covered by Medicaid include the following: o Consultations o Office visits o Individual psychotherapy o Pharmacologic management o Colposcopy o Obstetric ultrasound o Echocardiography, fetal o Cardiography interpretation and report only o Echocardiography More information about the available services and their reimbursement can be found in the provider manuals, located on the Department s website. HJ 171: Establish a joint subcommittee to study reducing Medicaid costs by using telemedicine Past: for CSHCN: A State- by- State Comparison of Medicaid Policies and Title V Activities (2005) prepared by Connections for Children and Youth Services reimbursed o Medical and mental health services already covered by the state plan when furnished using interactive video teleconferencing. o Office visits, individual psychotherapy and full range of consultations covered. Conditions and limitations o Only for those enrollees in Medicaid FFS programs, coverage doesn't extend to those enrollees in capitated plans. Payments to non- physician health care providers o Yes, ARNPs, Nurse Midwives, Clinical Nurse Specialists, Clinical Psychologists, Clinical Social Workers, Licensed Professional Counselors- any provider participating in the state's Medical Assistance Program. 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) for only medical services.

6 WEST VIRGINIA licensure: Organization and people resources: Pending legislation: for CSHCN: A State- by- State Comparison of Medicaid Policies and Title V Activities (2005) prepared by Connections for Children and How identified in claims/use of modifiers o Specific local does to identify telemedicine services. Use of "GT" as modifier. o Hub provider bills for consultation and referring provider bills a HCPCS telemedicine code for presenting patient. o Consultations: CPT ; office visits, CPT codes ; individual psychotherapy; CPT codes ; Pharmacologic Management: CPT codes 90862; other specific tests; CPT codes 57452, , 57460, 76805, 76810, 76825, 93010, 99307, 99308, 99321, Store and Forward vs. Live o Reimburses for real- time only. o No "store and forward" Virginia participates in the inter- state Nurse Licensure Compact. In addition to the University of Virginia Health System s Resource Center, the Virginia Network is promoting the use of telehealth services across the Commonwealth in support of an expansion of the existing network. Eagle Hospital Physicians 5901 C Peachtree Dunwoody Road Suite 350 Atlanta, GA EagleHospitalPhysicians.com Phone: Physician Service Organizations HB 3123: Encourages the use of telemedicine, telepsychology and video conferencing to make child welfare system more effective. Type of Service(s) Which Can Be Reimbursed o Physician consultations using interactive video teleconferencing. Patient must be present at time of the consultation. Payment Method o FFS o Same 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. How Identified in Claims/Use of Modifiers o Consultative CPT codes with a TV "GT" modifier. Store and Forward vs. Live o Reimburses for real- time only.

7 Youth: o No "store and forward". Report (2003) prepared by the Center for Law: "West Virginia recognizes physician consultations when furnished using interactive video teleconferencing. Payment is made on a fee- for- service basis, the same as face- to- face encounters. is made at both the hub and spoke site. The state uses consultative CPT codes with the modifier GT to identify telemedicine services. The agency perceives telemedicine as a beneficial way of providing services, but continues to be aware of low utilization. This may be in part due to the fact that, at the outset, the University of West Virginia Medical Center was pushing telemedicine, but they seem to have backed off. The geography of the state lends itself to use of telemedicine. There seems to be some reluctance on the part of physicians to use telemedicine. The agency pays claims, but not many people send bills. lends itself to care for people in remote geographic areas, but with surrounding state health facilities, not too many people have difficulty accessing the health system. State budget issues are impacting the entire Medicaid program, but not as dramatically as many other states. Budget issues are important but not a priority. The agency does not anticipate the budget impacting reimbursement for telemedicine." Mountaineer Doctor Television (MDTV): o Established in 1992 to better serve rural West Virginians through the advancements of technology. The Robert C. Byrd Health Sciences Center located in Morgantown, WV is the home of our primary service provider site. MDTV has a secondary service provider site located at the WVU Health Sciences Center- Charleston Division. MDTV delivers services to 34 sites throughout the state of West Virginia including one in the state of Maryland. We are a secured independent telehealth network that provides telemedicine, educational and administrative videoconferencing services through a private DS- 3 network supporting both H.323 (IP) and H.320 (ISDN) protocols. West Virginia Alliance Source: American Association (2013). State Policy Center. Retrieved from