ARKANSAS. Recent news, pending action: Medicaid law and regulations: From Telemedicine for CSHCN: A State- by- State

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1 ARKANSAS State Recent news, pending actin: Medicaid law and regulatins: fr CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Cnnectins fr Children and Yuth: State- Specific Infrmatin June 2, Health Technlgy in Schls: Arkansas Children s Hspital Research Institute Receives $2.2 Millin frm NIH t Explre Hw Can Help Kids Cntrl Asthma. Arkansas Medicaid recgnizes telemedicine services and reimburses fr them fr certain areas. Medicaid recgnizes physician cnsultatins when furnished using interactive vide telecnferencing. Payment is n a fee- fr- service basis, which is the same as the reimbursement fr cvered services furnished in the cnventinal face- t- face manner. is made at bth ends (hub and spke sites) fr the telemedicine services. The state uses specific cdes t identify telemedicine services. Please visit the Arkansas Medicaid website fr specific infrmatin regarding the services, lcated n the Prvider Dcuments page. Other cvered services include: Hme Health and Managed Care Physician Services Psychiatric Services Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide telecnferencing (real time). Payments t Nn- physician health care prviders N, nly physicians. Hwever, state des reimburse facilities (cmmunity mental health centers) fr certain services prvided by qualified mental health prfessinals via telemedicine. The State des nt reimburse the prfessinals, but the facilities where thse prfessinals wrk. Hspital utpatient departments and ambulatry surgical centers may be reimbursed fr services that are, by definitin, telemedicine, but the State currently has n means by which t track payments. Licensure Requirements Only licensed prviders within the state. Payment Methd FFS Same as reimbursement fr cvered services furnished in the cnventinal, face- t- face manner. Type at bth ends (hub and spke). State wuld review "add- n" csts but nne have been presented Hw Identified in Claims/Use f Mdifiers Specific cdes t identify telemedicine services. Befre HIPAA implementatin. State used very few mdifiers, but have since develped unique type f service cdes. Mdifiers need t be develped sn as prviders are currently unable t bill electrnically fr telemedicine services.

2 LOUISIANA Reprt (2003) Center fr licensure: netwrks: Organizatin and peple resurces: Pending legislatin: Insurance law and regulatins Medicaid law and regulatins: fr CSHCN: A State- by- State Stre and Frward vs. Live Reimburses fr real- time nly. N "stre and frward" If a "stre and frward" cnsultatin is medically necessary and meets AMA guidelines fr a cnsultatin, then it is a cvered service, but it is nt reimbursed as telemedicine. "The Medicaid agency recgnizes physician cnsultatins at the hub and spke sites when furnished using interactive vide telecnferencing. Payment is n a fee- fr- service basis, which is the same as the reimbursement fr cvered services furnished in the cnventinal face- t- face manner. is made at bth ends (hub and spke sites) fr the telemedicine services. Medicaid reimbursement t utpatient hspitals and physicians fr telemedicine services will be the same amunt Medicaid allws fr the same services perfrmed in a traditinal manner. CPT cdes must be indicated. The mdifier TM is used t identify a telemedicine service. Physician interpretatins f fetal ultrasunds are cvered expenses if the physician views the echgraphy r echcardigraphy utput in real time, while the patient is underging the prcedure." Arkansas participates in the inter- state Nurse Licensure Cmpact. In an effrt t imprve the quality and access t health care, Arkansas is wrking t imprve its telehealth netwrk thrugh the Arkansas Netwrk prgram under the Rural Health Care Pilt Prgram with funding frm the Federal Cmmunicatins Cmmissin. The prgram is wrking t cnslidate the individual netwrks t create a statewide, intercnnected telehealth netwrk. Mre infrmatin abut the Rural Health Care Pilt Prgram can be fund n the FCC s website. Arkansas ANGELS prgram fr maternal- fetal and nenatal care Arkansas Strke Assistance thrugh Virtual Emergency Supprt (Arkansas SAVES) SR 81 and HR 108: Enacted t create the Legislative Wrkgrup n Electrnic Prescribing t study and make recmmendatins cncerning electrnic prescribing. Luisiana law mandates all health benefit plicies issued after June 16, 1995 t cver and reimburse fr telemedicine services, and the reimbursement payments cannt be less than 75% f the equivalent face- t- face cnsultatin. The Medicaid agency recgnizes physician cnsultatins when furnished using interactive vide telecnferencing. Payment is n a fee- fr- service basis, which is the same as the reimbursement fr cvered services furnished in the cnventinal face- t- face manner. is made at bth ends (hub and spke site) fr the telemedicine services. Physician Assistants are allwed t perfrm the service using telemedicine if they are authrized by a primary physician, which is the nly ne that is authrized t bill. The State uses cnsultative CPT cdes. Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide telecnferencing. Mental health prgram nly live cnsultatins nly- n stre- frward. Otherwise n Medicaid plicy n reimbursement.

3 Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Cnnectins fr Children and Yuth Reprt (2003) Center fr netwrks: Tertiary care facilities d prvide telemedicine services and bill as if face- t- face- n mdifiers, etc. Payments t Nn- physician health care prviders Yes, RNs and ther allied health prfessinals Physician Assistants are allwed t perfrm the service using telemedicine if they are authrized by a primary physician. Licensure Requirements Yes Payment Methd FFS Same as fr cvered services furnished in the cnventinal, face- t- face manner. Type at bth ends (hub and spke). Hw Identified in Claims/Use f Mdifiers Cnsultative CPT cdes Mdifier fr mental health CPT cdes Stre and Frward vs. Live Mental Health prgram nly live cnsultatins nly- n stre and frward. Otherwise n Medicaid plicy n reimbursement. Tertiary care facilities d prvide telemedicine services and bill as if face- t- face- n mdifiers, etc. "The state reimburses fr any health care service, including, but nt limited t, diagnstic testing, treatment, referral, r cnsultatin, and such health care service is perfrmed via transmitted 32 electrnic imaging r telemedicine. Only physicians are reimbursed fr telemedicine cnsults, but a physician assistant may perfrm the service using telemedicine equipment if a primary physician authrizes them. The state pays fr telecnsultatin using interactive vide cnferencing equipment. The state will nt pay fr stre and frward cnsultatins. shuld nt be less than 75% f the reasnable and custmary amunt f an intermediate ffice visit t a licensed physician. is n a fee- fr- service basis and is made at bth the hub and spke sites. N changes are anticipated except perhaps expansin f mental health services. The prgram is nt aware f a single physician with a telemedicine system in their ffice. They are aware f ne psychiatrist with a mnitr wh was ding grup therapy in a develpmental hme, even thugh the state has sme restrictins n payment fr grup therapy. a cntinuing educatin perspective, all state medical schls are linked t Charity Hspital in New Orleans. Luisiana uses cnsultative CPT cdes." The Luisiana Rural Health Infrmatin Exchange is linking 24 rural hspitals t the Luisiana State University Health Science Center in Shreveprt and will prvide specialized health services t patients acrss the state.

4 NEW MEXICO Organizatin and peple resurces: Pending legislatin: Insurance law and regulatins: Reprt (2003) Center fr licensure: netwrks: Anther netwrk is the Cmmunity Hspital Cnsrtium (CHTC), which includes Lake Charles Memrial Hspital and three ther nn- prfit hspitals. CHTC has received funding frm HRSA as well. Plicy Cntact in Luisiana Mary Mrris, MA Directr Lake Charles Memrial Hspital 1701 Oak Park Blvd. Lake Charles, LA Phne: Fax: HB 591: Relates t health care cverage; enacts the insurance cde, the health maintenance rganizatin law and the nnprfit health care plan law t require cverage fr telemedicine services; prvides fr utilizatin review and appeal rights fr denials f telemedicine cverage. The New Mexic Act, available here, encurages health care prviders t utilize telemedicine services t better serve rural areas. Hwever, nthing is mandated t prvide cverage r reimbursement fr these services "New Mexic is in the beginning stages f reimbursement with frmal plicies currently being develped. prviders participated in a cmprehensive apprach tward addressing statewide health issues. After being tld that cst was an issue, a cntract was issued t a university schl f management t develp a business frecast shwing cst savings based n use f telemedicine. The cllabrative apprach has resulted in representatives f nn- telemedicine rganizatins, such as managed care, becming champins fr telemedicine. Even thugh all managed- care rganizatins have agreed t reimburse fr telemedicine, the reprt f the ttal statewide health plan will be released n July 9, Participants in this prcess are extremely psitive abut the value f invlving the Medicaid agency, managed care and ther prviders. The value f hard facts accmpanied by quantitative and qualitative analysis was withut dispute. Tailring the facts with a plan fcused n meeting the health needs f state prduced psitive respnse t telemedicine reimbursement." New Mexic participates in the inter- state Nurse Licensure Cmpact. Physicians wh are licensed with the New Mexic Medical Bard d nt require additinal special licensing t prvide telehealth services within the state. The New Mexic Alliance is cmprised f varius health care rganizatins with the aim f assessing New Mexic s telehealth needs and crdinating resurces t imprve services. Their webpage has nt been updated, but mre infrmatin abut the available prgrams in the state can be fund here.

5 OKLAHOMA Organizatin and peple resurces: Recent news, pending actin: Insurance law and regulatins: Medicaid law and regulatins: fr CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Cnnectins fr Children and Yuth University f New Mexic Center fr and Cybermedicine Research Prject ECHO Plicy Cntacts in New Mexic New Mexic Alliance 5921 Jeffersn NE Albuquerque, NM Phne: Fax: Nne since Amended by Laws 2008, c. 432, 2, eff. Nv. 1, All health care service plans, disability insurer prgrams, wrkers cmpensatin prgrams, r state Medicaid managed care prgram cntracts are t include cverage fr telemedicine services, where apprpriate as determined be a health care practitiner. services are reimbursed at the same rate as the fee- fr- service prvisins f the state Medicaid managed care prgram. There are varius services cvered, which include amng thers: Mental health services Hme health Endcrinlgy Others Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide cnferencing. Payments t Nn- physician health care prviders Yes, any prvider wh is a Medicaid prvider. is the same amunt regardless f type f prvider. Licensure Requirements: Yes, nly in- state prviders are reimbursed. Payment Methd FFS Same as reimbursement fr cvered services that are delivered face- t- face. Type is at bth ends (hub and spke) N "add ns" (technical supprt, line charges r depreciatin f equipment) are allwed. Hw Identified in Claims/Use f Mdifiers Cnsultative CPT cdes. D nt use mdifiers t keep track f telemedicine reimbursement. Teleradilgy is used a lt but n mdifier is used. Stre and Frward vs. Live

6 TEXAS Reprt (2003) Center fr netwrks: Organizatin and peple resurces: Recent news, pending actin: Pending legislatin: Reimburses fr real- time nly. N, "stre and frward" "Oklahma reimburses fr physician cnsultatins when furnished using interactive vide telecnferencing and fr teleradilgy. Payment is n a fee- fr- service basis, which is the same as the reimbursement fr cvered services furnished in the cnventinal face- t- face manner. is made at bth the hub and spke sites. The state uses cnsultative CPT cdes. Each nt- fr- prfit hspital in this state can receive free f charge, upn written request, ne telecmmunicatins line r wireless cnnectin sufficient fr prviding such telemedicine services as the hspital is equipped t prvide. The telecmmunicatins carrier is entitled t reimbursement frm the Oklahma Universal Service Fund fr prviding the line r cnnectin. In n case can the reimbursement frm the Fund be made fr an Internet subscriptin fee. Under the 1115 Medicaid waiver demnstratin (Urban Managed Care Plans), ne f the gals is t develp a referral system with a minimum f 25 rural sites. Few, if any, f the plans have chsen this ptin." and distance learning at Oklahma State University Center fr Health Sciences Plicy Cntacts in Oklahma Candace Shaw Directr Center fr Candace- shaw@uhsc.edu Phne: June 17, SB 293[1] enacted regarding telemedicine medical services, telehealth services, and hme telemnitring services prvided t certain Medicaid recipients. Octber Texas Medical Bard apprves final changes fr telemedicine services. SB 7: Prvides fr the prmtin and principles f Patient- Centered Medical Hmes fr recipients. Prvides that the patient's care is crdinated acrss health care facilities and the patient's cmmunity and is facilitated by registries, infrmatin technlgy, and health infrmatin exchange systems t ensure that the patient receives care when and where the patient wants and needs the care. SB 219: Relates t health and mental health services fr children in fster care and kinship care. Includes explring pssibilities fr the use f telemedicine. SB 773 Telecmmunicatins Service Discunts Relates t telecmmunicatins service discunts fr educatinal institutins, libraries, hspitals, and telemedicine centers. SB 967 and HB 1605: Relates t the use f Medicaid telemnitring. HB 7: Prvides fr the prmtin and principles f Patient- Centered Medical Hmes fr recipients. Prvides that the patient's care is crdinated acrss health care facilities and the patient's cmmunity and is facilitated by registries, infrmatin technlgy, and health infrmatin exchange

7 Insurance law and regulatins: Medicaid law and regulatins: Physician Standards fr : fr CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Cnnectins fr Children and Yuth: systems t ensure that the patient receives care when and where the patient wants and needs the care and in a culturally and linguistically apprpriate manner. HB 2333: Relates t the practice f telemedicine. HB 3171: Relates t imprved efficiency in the delivery f Medicaid services t certain recipients, including recipients with chrnic diseases, thrugh the use f telemedicine, telehealth, and hme telemnitring services and certain disease management initiatives. HB 3258: Relates t telecmmunicatins service discunts fr educatinal institutins, libraries, hspitals, and telemedicine centers HB 3277: Relates t creatin f prtable insurance plans. Requires cverage fr telehealth services Texas Insurance Cde, Sectin 1455, mandates that all health benefit plans cver telemedicine services; hwever, there are sme exceptins, as listed in the same sectin. Texas Medicaid, is mandated by Texas law t prvide fr cverage and reimbursement fr certain telemedicine services. The Texas Health and Human Services Cmmissin released a reprt and detailed descriptin f the feasibility f telemedicine services in Texas. Currently, cvered services include: Medicatin management Psychtherapy Physician cnsultatins Texas Administrative Cde (Texas Medical Bard) Pending Prpsal fr Physician Standards- Prpsed in Octber 2 Texas Register fr public cmment with amended language t define "patient site lcatin" t be limited t medically underserved areas and that "patient site presenters" be defined t require that they be licensed in the state as an advanced practice nurse, physician assistant, r physician. Type f Service(s) Which Can Be Reimbursed Physician cnsultatins (telecnsultatins) using interactive vide telecnferencing. Als reimbursed are services withut face- t- face cntact current using telemedicine- teleradilgy and telepathlgy. Cnditins r Limitatins Limited t physician services in rural r underserved areas. Payments t Nn- physician health care prviders Yes, D.O.s, ARNPs, and certified nurse midwives. Licensure Requirements: Yes, must be licensed within the state f Texas Payment Methd FFS Same as fr cvered services furnished in the cnventinal, face- t- face manner. Type

8 Reprt (2003) Center fr licensure: netwrks: is at bth ends (hub and spke) N "add ns" (technical supprt, line charges r depreciatin f equipment) are allwed. Hw Identified in Claims/Use f Mdifiers Cnsultative CPT cdes with a TM mdifier Stre and Frward vs. Live Als reimbursed are services withut face- t- face cntact current using telemedicine- teleradilgy and telepathlgy. "The Medicaid agency recgnizes physician cnsultatins (telecnsultatins) when furnished using interactive vide telecnferencing. Payment is n a fee- fr- service basis, the same as reimbursement fr cvered services furnished in the cnventinal face- t- face manner. is made at bth ends (hub and spke site) fr the telemedicine services. Other health care prviders, such as advanced nurse practitiners and certified nurse midwives are allwed t bill, as are Rural Health Clinics and Federally Qualified Health Centers. The State uses cnsultative CPT cdes with the mdifier "TM" t identify telemedicine services. Under the Medicaid Prgram f Texas, telemedicine medical services are reimbursable in cunties with a ppulatin f under 50,000 r in area designated as medically underserved. Cvered services are interactive vide cmmunicatin at the hub and remte site, unless service may be reimbursed using telemedicine, withut face- t- face cntact like teleradilgy and telepathlgy. Other health care prviders eligible t bill fr services are advanced nurse practitiners, nurse midwives, and dctrs f stepathy, as are Rural Health Clinics and Federally Qualified Health Centers. Payment is made n a fee- fr- service basis, the same as fr face- t- face encunters. The state uses cnsultative CPT cdes with a TM mdifier. Stre and frward reimbursement is available under the medical assistance prgram fr services prvided with the use f imaging by way f still image and capture in cnnectin with a vide cnference cnsultatin. 37 The Texas Medicaid telemedicine prgram has prvided cnsultatin fr many ther states that are develping telemedicine reimbursement plicies. Mental health is prbably the fastest grwing telemedicine area fr the Medicaid prgram. New legislatin will include additin f any services that can be prven t be clinically effective as well as cst- effective. A review prcess will be included in the prcedure fr adding services. Cncern was expressed that many f the telemedicine prgrams in Texas knw very little abut the services available thrugh the state Medicaid prgram, and thus utilizatin is lw. In light f a state budget deficit f ver $10 billin, the agency anticipates cutbacks, but since the telemedicine prgram can demnstrative cst effectiveness, it is nt anticipated that the prgram will be negatively impacted." Texas participates in the inter- state Nurse Licensure Cmpact. The University f Texas Medical Branch Electrnic Health Netwrk (UTMB) and Texas Tech University Health Sciences Center (TTUHSC) bth feature telemedicine centers which ffer

9 Organizatins and peple resurces: researching resurces and sme medical services. Eagle Hspital Physicians 5901 C Peachtree Dunwdy Rad Suite 350 Atlanta, GA EagleHspitalPhysicians.cm Phne: Texas e- Health Alliance Texas Tech Center fr Cntact: Debbie Vyles, Directr f, TTUHSC, Debbie.Vyles@ttuhsc.edu Center fr Research and Plicy at UTMB Cntact: Alexander V, PhD UTMB Featured n Discvery Channel Prfile Series Cntact: Alexander V, PhD Eagle Hspital Physicians Physician Service Organizatins Plicy Cntacts in Texas Center fr Research and Plicy Electrnic Health Netwrk UTMB 301 University Blvd. Galvestn, TX Phne: Surce: American Assciatin (2013). State Plicy Center. Retrieved frm