Maine Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain conditions, and remote patient monitoring for patients with certain risk factors.

Maine Telehealth Summary

Definitions

Telehealth is the use of information technology by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment. Telehealth Services may be either telephonic or interactive (combined video/audio).

Maine Telehealth Definitions

Live Video

Policy
If the Member is eligible for the underlying covered service and providing it via telehealth is medically appropriate and is of comparable quality if it had been delivered in-person, the telehealth service is eligible for reimbursement.

Maine Telehealth Live Video Policy

Eligible Services/Specialties
Eligible Providers
A health care provider is an individual or entity licensed or certified under the laws of the state of Maine to provide medical, behavioral health, and related services to MaineCare Members.

Maine Telehealth Eligible Providers

Eligible Sites
Geographic Limits
No reference found.
Facility/Transmission Fee

Store-and-Forward

Policy
Provider manual indicates coverage of “telehealth services” which is inclusive of store-and-forward, however the manual only discusses interactive telehealth, and remote patient monitoring in detail. Additionally, the manual only discusses the use of the GT modifier (live interactive video), and does not mention the GQ modifier (asynchronous).

Maine Telehealth Store and Forward Policy

Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.

Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Telemonitoring services are intended to collect a member’s health-related data, such as pulse and blood pressure readings, that assist healthcare providers in monitoring and assessing the member’s medical conditions.

Maine Telehealth Remote Patient Monitoring Restrictions

Email/Phone/Fax

Consent

Out of State Providers

Miscellaneous

Private Payer Laws

Definitions

“Telemedicine, as it pertains to the delivery of health care services, means the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. ‘Telemedicine’ does not include the use of audio-only telephone, facsimile machine or e-mail.”

Maine Telehealth Private Payer Law Definitions

Requirements

A health plan may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would have been covered through an in-person consultation between a covered person and a health care provider. Coverage must be determined in a manner consistent with coverage for services provided through in-person consultation.

Maine Telehealth Private Payer Requirements

Parity

A health plan may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would have been covered through an in-person consultation between a covered person and a health care provider.

Maine Telehealth Parity

Professional Regulation/Health & Safety

Definitions

Board of Licensure in Medicine & Board of Osteopathic Licensure: "Telemedicine" means the practice of medicine or the rendering of health care services using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telemedicine shall not include the provision of medical services only through an audio-only telephone, e-mail, instant messaging, facsimile transmission, or U.S. mail or other parcel service, or any combination thereof.

Maine Telehealth Professional Regulation Definitions

Consent

Board of Licensure in Medicine & Board of Osteopathic Licensure: A licensee who uses telemedicine shall ensure the patient provides appropriate informed consent for the health care services provided, including consent for the use of telemedicine, which must be documented in the patient’s medical record.

Maine Telehealth Professional Regulation Consent Requirements

Online Prescribing

Board of Licensure in Medicine & Board of Osteopathic Licensure: Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine in providing health care shall interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient.

Maine Telehealth Professional Regulation Online Prescribing

Cross State Licensing

Miscellaneous

Source: Center for Connected Health Policy
https://www.cchpca.org

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