Medicaid Telehealth Reimbursement
Summary
Alabama Medicaid reimburses for live video under some circumstances. The Agency will not reimburse providers for origination site or transmission fees. They make no reference to store-and-forward reimbursement, but the program reimburses for In-Home Monitoring through the Patient’s 1st program for diabetes and Chronic Heart failure, although it’s not considered to fall under the telemedicine program.
Definitions
There is no explicit definition of “telemedicine” given in state Medicaid policy. However, the provider manual states service requirements similar to telemedicine.
Live Video
Policy
Alabama Medicaid reimburses for live video for certain services.
Eligible Services/Specialties
Click for a list of eligible specialties.
Eligible Providers
All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients.
Eligible Sites
Click for a list of eligible sites.
Geographic Limits
For rehabilitative services, the originating site must be located in Alabama. The distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.
Facility/Transmission Fee
No reimbursement for originating site or transmission fees.
Store-and-Forward
Policy
No reference found.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
Alabama Medicaid will reimburse remote patient monitoring through the In Home Monitoring Program. The program is a joint effort between the Agency, the University of Alabama and the Alabama Department of Public Health (ADPH). Must be referred to the Patient’s 1st program by any source including a physician, Patient 1st care coordinator, patient care network, patient or caregiver, the Health Department, hospitals, home health agencies or community based organizations.
Conditions
Click for a list of eligible conditions.
Provider Limitations
In home monitoring patient data is transmitted to a web-based data collection and documentation system and monitored by ADPH Nurse Care Managers on a daily basis.
Other Restrictions
The Alabama Department of Public Health (ADPH) Nurse Care Manager evaluates the patient, provides any needed equipment such as a scale, glucometer, blood pressure cuff and phone with a speaker.
Email/Phone/Fax
No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
Consent
Physician must obtain prior consent from the recipient before services are rendered, this will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.
Out of State Providers
Providers must have an Alabama license.
Miscellaneous
No reference found.
Private Payer Laws
Definitions
No reference found.
Requirements
No reference found.
Parity
No reference found.
Professional Regulation/Health & Safety
Definitions
No reference found.
Consent
No reference found.
Online Prescribing
The Alabama Board of Medical Examiners holds the position that, when prescribing medications to an individual, the prescriber, when possible, should personally examine the patient. Prescribing medications for patients the physician has not personally examined may be suitable for certain circumstances, including telemedicine.
Cross State Licensing
“A special purpose license allowing practitioners licensed in other states to practice across state lines may be issued.”
Miscellaneous
Click for a list of professional board telehealth-specific regulations.
Source: Center for Connected Health Policy
https://www.cchpca.org