Medicaid Telehealth Reimbursement
Summary
Mississippi Medicaid reimburses certain providers for live video telehealth when there is a telepresenter with the patient. They also reimburse for store-and-forward teleradiology, and for remote patient monitoring for patients with certain chronic conditions.
Definitions
Telemedicine means the delivery of health care services such as diagnosis, consultation, or treatment through the use of interactive audio, video or other electronic media. Telemedicine must be “real-time” consultation, and it does not include the use of audio-only telephone, e-mail or facsimile.
Live Video
Policy
Mississippi Medicaid and private payers are required to provide coverage for live video consultations.
Eligible Services/Specialties
The Division of Medicaid covers medically necessary telehealth services as a substitution for an in-person visit or encounter for consultations, office visits and/or outpatient visits.
Eligible Providers
Any enrolled Medicaid provider may provide telehealth services at the originating site.
Eligible Sites
Click for a list of eligible sites.
Geographic Limits
No reference found.
Facility/Transmission Fee
The Division of Medicaid reimburses the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission.
Store-and-Forward
Policy
Private payers, MS Medicaid and employee benefit plans are required to provide coverage at the same extent as in-person consultation for store-and-forward telemedicine services.
Eligible Services/Specialties
Store-and-forward includes, but is not limited to teleradiology. The Division of Medicaid covers one technical and one professional component for each teleradiology procedure only for providers enrolled in MS Medicaid and when there are no geographically local radiologist providers to interpret the images.
Geographic Limits
MS Medicaid only covers teleradiology when there are no geographically local radiologist providers to interpret images.
Transmission Fee
No transmission fee.
Remote Patient Monitoring
Policy
Private payers, MS Medicaid and employee benefit plans are required to provide coverage for remote patient monitoring services for Mississippi-based telehealth programs affiliated with a Mississippi health care facility.
Conditions
Click for a list of criteria conditions.
Provider Limitations
Remote patient monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines. Must be ordered by a physician, physician assistant or nurse practitioner.
Other Restrictions
Remote patient monitoring prior authorization request form must be submitted to request telemonitoring services.
Email/Phone/Fax
No reimbursement for email.
No reimbursement for telephone.
No reimbursement for facsimile
Consent
Signed consent for using telehealth is required.
Out of State Providers
For teleradiology, consulting and referring provider is a licensed physician (or PA or NP for referring providers) who interprets the radiological image, at the distant site and who must be licensed in the state within the United States in which he/she practices.
Miscellaneous
See documentation requirements.
Private Payer Laws
Definitions
Telemedicine means the delivery of health care services such as diagnosis, consultation, or treatment through the use of interactive audio, video or other electronic media. Telemedicine must be “real-time” consultation, and it does not include the use of audio-only telephone, e-mail or facsimile.
Requirements
A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.
Parity
All health insurance plans must provide coverage for telemedicine services, including live video and store-and-forward, to the same extent as in-person consultations. Remote patient monitoring is also reimbursed based on the criteria outlined in MS code.
Professional Regulation/Health & Safety
Definitions
Click for a list of telehealth definitions in professional regulations.
Consent
The physician should obtain the patient’s informed consent before providing care. The patient should be provided with information relative to treatment, the risk and benefits of being treated via a telemedicine network and how to receive follow-up care or assistance.
Online Prescribing
A prescription for a controlled substance based solely on a consumer’s completion of an online medical questionnaire is not a valid prescription.
Cross State Licensing
No person may engage in the practice of medicine across state lines in Mississippi unless they first obtain a license to do so from the State Board of Medical Licensure and meet all educational and licensure requirements as determined by the Board.
Miscellaneous
A physician treating a patient through a telemedicine network must maintain a complete record of the patient’s care.
Source: Center for Connected Health Policy
https://www.cchpca.org