Medicaid Telehealth Reimbursement
Summary
Minnesota Medicaid provides reimbursement for live video and store-and-forward through their Medical Assistance program for certain providers when patients are located at specific originating sites.
Definitions
Click for a list of Medicaid definitions.
Live Video
Policy
Medical assistance covers medically necessary services and consultations delivered by a licensed health care provider via telemedicine in the same manner as if the service was delivered in-person. Coverage is limited to three telemedicine services per week per enrollee. Telemedicine services are paid at the full allowable rate.
Eligible Services/Specialties
Click for a list of eligible services and specialties.
Eligible Providers
Click for a list of eligible providers.
Eligible Sites
Click for a list of eligible sites.
Geographic Limits
Qualified members who must travel more than twenty miles for enrolled MHCP MTMS provider may have the services delivered via interactive video to an ambulatory care site in which there is no enrolled MTMS provider in the local trade area.
Facility/Transmission Fee
MHCP does not reimburse for connection charges or origination, set-up or site fees.
Store-and-Forward
Policy
Telemedicine may be provided through store-and-forward technology to provide or support health care delivery.
Eligible Services/Specialties
See Live Video Eligible Services section for examples of eligible telemedicine services as well as noncovered services.
Geographic Limits
Click for a list of geographic limits.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
There is reimbursement for “tele-homecare” under Elderly Waiver (EW) and Alternative Care (AC) programs.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reimbursement for email
No reimbursement for phone
No reimbursement for fax
Consent
For alcohol and drug abuse services, the member must have consented to receiving services over telemedicine.
Out of State Providers
Out-of-state coverage policy applies to services provided via telemedicine. See out-of-state providers section of manual.
Miscellaneous
Click for a list of requirements for early intensive developmental and behavioral intervention services.
Private Payer Laws
Definitions
“Telemedicine” means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site.
Requirements
Private payers are required to provide coverage for telemedicine in the same manner, and at the same reimbursement rate, as other services provided in-person.
Parity
A health carrier shall reimburse on the same basis that would apply to those services if the service had been delivered in-person. However, the carrier can establish criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a service via telemedicine. They can also require a health care provider to agree to certain documentation or billing practices to protect against fraud.
Professional Regulation/Health & Safety
Definitions
“Telemedicine” means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site.
Consent
No reference found.
Online Prescribing
A physician-patient relationship may be established through telemedicine
Cross State Licensing
A physician licensed in another state can provide telemedicine services to a patient in Minnesota if their license has never been revoked or restricted in any state, they agree to not open an office in Minnesota, meet with patients in Minnesota, or receive calls in Minnesota from patients and they register with the state’s board.
Miscellaneous
No reference found.
Source: Center for Connected Health Policy
https://www.cchpca.org