Health Planning and Systems Development

Statutes, Regulations and Policy

Statutes

Regulations

Federal Communications Commission

Policy

Medicaid coverage of telehealth services in Alaska

Article 29
Telemedicine Applications

Section

1200. Scope.

1210. Telemedicine applications; limitations.

1220. Conditions for payment.

1230. Exclusions.

1240. Payment.

1290. Definitions.

7 AAC 43.1200. Scope

(a) The division will make payment for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients as provided in AS 47.07 and this chapter.

(b) To receive payment under 7 AAC 43.1200 - 7 AAC 43.1290, the use of telemedicine applications must comply with the standards set out in AS 47.07 and this chapter for the medical service provided by the type of provider, including provisions that ensure that efficiency, economy, and quality of service and limitations on that service.

History: Eff. 12/15/2002, Register 164

Authority: AS 47.05.010

AS 47.07.030

7 AAC 43.1210. Telemedicine applications; limitations

(a) The division will reimburse for a telemedicine application if the medical services are rendered through one of the following methods of delivery provided in the specified manner:

(1) live or interactive; to be eligible for payment under this paragraph, the service must be provided through the use of camera, video, or audio conference equipment on a real-time basis; medical services provided by telephone or facsimile machine are not eligible for payment under this paragraph;

(2) store-and-forward; to be eligible for payment under this paragraph, the service must be provided through the transference of digital images from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider; store-and-forward method includes transferring information by sound, images, or images on videotape;

(3) self-monitoring or testing; to be eligible for payment under this paragraph, the services must be provided by a telemedicine application based in the recipient's home and a provider is only indirectly involved in the provision of the service.

(b) The division will only make a payment for a telemedicine application if the service is limited to

(1) an initial visit;

(2) a follow-up visit;

(3) a consultation made to confirm a diagnosis;

(4) a diagnosis, therapeutic, or interpretive service;

(5) a psychiatric or substance abuse assessment; or

(6) psychotherapy or pharmacological management services on an individual recipient basis.

History: Eff. 12/15/2002, Register 164

Authority: AS 47.05.010

AS 47.07.030

7 AAC 43.1220. Conditions for payment

(a) The division will reimburse for telemedicine applications provided by a treating, consulting, presenting, or referring provider for a medical service covered by Medicaid and that is provided within the scope of the provider's license.

(b) A treating or consulting provider must use applicable modifiers as described in 7 AAC 43.104 for billing for a telemedicine application.

(c) A presenting, referring, or consulting provider is subject to the conditions for payment that are described in 7 AAC 43.025.

(d) A presenting provider is only eligible to receive Medicaid reimbursement for a live or interactive telemedicine application as described in 7 AAC 43.1210(a)(1).

History: Eff. 12/15/2002, Register 164

Authority: AS 47.05.010

AS 47.07.030

7 AAC 43.1230. Exclusions

The following services may not be provided by telemedicine applications reimbursed by Medicaid:

(1) home and community-based waiver services;

(2) pharmacy services;

(3) durable medical equipment services;

(4) transportation services;

(5) accommodation services;

(6) end-stage renal disease services;

(7) direct-entry midwife services;

(8) private-duty nursing services;

(9) personal care attendant services;

(10) visual care, dispensing, or optician services.

History: Eff. 12/15/2002, Register 164

Authority: AS 47.05.010

AS 47.07.030

7 AAC 43.1240. Payment

(a) Payment for a service rendered by a treating or consulting provider by a telemedicine application will be made in accordance with 7 AAC 43.040 in the same manner as reimbursement is made for the same service provided through a traditional mode of delivery.

(b) The division will reimburse only for fees for professional services for a telemedicine application of service. The division will not reimburse for the use of technological equipment and systems associated with a telemedicine application to render the service.

(c) A presenting provider will be reimbursed a fee for presenting the patient. The fee for a provider enrolled individually or in a group practice is the fee established for a brief evaluation and management of an established patient.

History: Eff. 12/15/2002, Register 164

Authority: AS 47.05.010

AS 47.07.030

7 AAC 43.1290. Definitions

In 7 AAC 43.1200 - 7 AAC 43.1290

(1) "consulting provider" means a provider who evaluates the patient and appropriate medical data or images through a telemedicine mode of delivery upon recommendation of the referring provider;

(2) "presenting provider" means a provider who

(A) introduces a patient to a consulting provider for examination, observation, or consideration of medical information; and

(B) may assist in the telemedicine consultation;

(3) "referring provider" means a provider who evaluates a patient, determines the need for a consultation, and arranges the services of a consulting provider for the purpose of diagnosis or treatment;

(4) "telemedicine" means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data, audio, visual, or data communications that are performed over two or more locations between providers who are physically separated from the patient or from each other.

History: Eff. 12/15/2002, Register 16

Authority: AS 47.05.010

AS 47.07.030

 

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