Maryland Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

Maryland Medicaid covers live video telehealth conducted by specific providers and specific originating sites.

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Definitions

Telemedicine means, as it relates to the delivery of health care services, the use of interactive audio, video, or other telecommunications or electronic technology.

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Live Video

Policy
Reimbursement for telehealth is required for services appropriately delivered through telehealth and may not exclude from coverage a health care service solely because it is through telehealth.

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Eligible Services/Specialties
Covered Services - Somatic and behavioral health services: Providers must contact the participant’s healthchoice MCO or Beacon Health Option with questions regarding prior authorization requirements for telehealth services.

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Eligible Providers
Click for a list of eligible providers.

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Eligible Sites
Click for a list of eligible sites.

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Geographic Limits
Mental Health: To be eligible a beneficiary must reside in one of the designated rural geographic areas or whose situation makes person-to-person psychiatric services unavailable.

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Facility/Transmission Fee
Originating sites may bill for a transmission fee code Q3014.

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Store-and-Forward

Policy
The department may provide reimbursement for services delivered through store-and-forward technology.

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Eligible Services/Specialties
MD Medicaid does not cover store-and-forward. However, dermatology, ophthalmology and radiology are excluded from definition of store-and-forward. They do reimburse for these services according to COMAR 10.09.02.07.

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Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
The department may provide reimbursement for services delivered through remote patient monitoring technology.

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Conditions
Click for a list of eligible conditions.

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Provider Limitations
Click for a list of eligible providers.

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Other Restrictions

Email/Phone/Fax

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.

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Consent

The originating site must obtain consent. If the participant is unable to provide consent, the medical record must contain in writing an explanation as to why the participant was unable to consent to telehealth services.

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Out of State Providers

Miscellaneous

Click for a list of miscellaneous requirements.

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Private Payer Laws

Definitions

Telehealth means, as it relates to the delivery of health care services, the use of interactive audio, video or other telecommunications or electronic technology by a licensed health care provider to deliver a health care service within the scope of practice of the health care provider at a location other than the location of the patient.

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Requirements

Insurers must provide coverage under a health insurance policy for health care services appropriately delivered through telehealth and may not exclude coverage solely because it is provided through telehealth and not in-person.

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Parity

Insurers must reimburse a health care provider for the diagnosis, consultation and treatment of an insured patient that can be appropriately provided through telehealth.

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Professional Regulation/Health & Safety

Definitions

Audiologists, Hearing Aid Dispensers and Speech Language Pathologists: “Telehealth means the use of telecommunications and information technologies for the exchange of information from one site to another, for the provision of health care to an individual from a provider through hardwire or Internet connection.”

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Consent

Click for a list of consent requirements.

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Online Prescribing

A physician-patient relationship can be established through real-time auditory communications or real-time visual and auditory communications.

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Cross State Licensing

Member of the following: Interstate Medical Licensure Compact, Nurse Licensure Compact.

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Miscellaneous

Specific standards apply for physicians utilizing a website to communicate with patients.

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

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