Medicaid Telehealth Reimbursement
Summary
Kansas Medicaid covers live video telemedicine for certain services. Additionally, they also cover remote patient monitoring that is in real-time through home health agencies and with prior authorization.
Definitions
“Telemedicine is the use of communication equipment to link health care practitioners and patients in different locations. This technology is used by health care providers for many reasons, including increased cost efficiency, reduced transportation expenses, improved patient access to specialists and mental health providers, improved quality of care, and better communication among providers.”
Live Video
Policy
Kansas Medicaid will reimburse for live video for certain services
Eligible Services/Specialties
Click for a list of eligible services and specialties.
Eligible Providers
Click for a list of eligible providers.
Eligible Sites
No reference found.
Geographic Limits
No reference found.
Facility/Transmission Fee
The originating site may bill code Q3014 for the originating site fee with the appropriate POS code.
Store-and-Forward
Policy
Kansas Medicaid requires the patient to be present at the originating site indicating store-and-forward will not be reimbursed.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
Kansas Medicaid will reimburse for home telehealth.
Conditions
Providers may use T1030 and T1031 for the provision of telehealth visits to provide long-term care home health services and to assist beneficiaries in managing their diabetes.
Provider Limitations
Services must be provided by a registered nurse or licensed practical nurse. Agencies may bill skilled nursing services on the same date of service as telehealth services.
Other Restrictions
Providers must submit literature to the fiscal agent’s Provider Enrollment team pertaining to the telecommunication equipment the agency has chosen that will allow thorough physical assessments such as: assessment of edema, rashes, bruising, skin conditions, and other significant changes in health status.
Email/Phone/Fax
No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
Consent
Written consent for telehealth home services is required.
Out of State Providers
No reference found.
Miscellaneous
The Department of Health and Environment is required to prepare an impact report that assesses the financial and social effects of Kansas Medicaid’s coverage of speech-language pathology and audiology services via telemedicine on or before January 13, 2020.
Private Payer Laws
Definitions
‘‘Telemedicine,’’ including ‘‘telehealth,’’ means the delivery of healthcare services or consultations while the patient is at an originating site and the healthcare provider is at a distant site.
Requirements
Insurers cannot exclude from coverage a service solely because the service is provided through telemedicine, rather than in-person contact or based upon the lack of a commercial office for the practice of medicine, when such service is delivered by a healthcare provider.
Parity
Payment can be limited to only services that are medically necessary, subject to the terms and conditions of the covered individual’s health benefits plan.
Professional Regulation/Health & Safety
Definitions
‘‘Telemedicine,’’ including ‘‘telehealth,’’ means the delivery of healthcare services or consultations while the patient is at an originating site and the healthcare provider is at a distant site.
Consent
No reference found.
Online Prescribing
The same laws and regulations that apply to the prescribing of drugs by means of in-person contact shall apply to the prescribing of drugs by means of telemedicine.
Cross State Licensing
Member of the following: Nurse Licensure Compact and Interstate Medical Licensure Compact.
Miscellaneous
No reference found.
Source: Center for Connected Health Policy
https://www.cchpca.org