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

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1 ILLINOIS 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 HB 107: intrduced t amend the Medical Assistance Article f the Public Aid Cde. Requires the Department f Healthcare and Family Services t reimburse the practice f telemedicine by medical services prviders, including, but nt limited t, physicians, advanced practice nurses, federally qualified health centers, r psychiatrists. Further prvides that the Department shall establish (i) criteria fr the services t be reimbursed and (ii) a methd t reimburse prviders fr services prvided by telemedicine. HB 1426: Requires the Department n Aging t investigate the cst f cmplying with the Act s prvisins cncerning the expansin f lder adult cmmunity- based services, and t reprt these findings t certain cmmittees; prvides fr the determinatin f pririty service areas; changes the types f prjects included in the Older Adult Service Demnstratin Grants Prgram; prvides fr certain hme care, managed lng- term care, and respite care prjects. Includes telemedicine devices. Illinis Medicaid cvers telemedicine cnsultatins and reimburses the hub and spke sites. The cvered services include: Stre- and- frward Applicatins Near/Real Time Physician Cnsultatins Telepsychiatry Services The full text and details f the telemedicine services can be fund in the Physician Handbk, under. The Department f Healthcare and Family Services recently expanded cverage and added a new sectin t the Illinis Public Aid Cde. Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide telecnferencing Cnditins r Limitatins Services must be prvided in the hspital emergency rm r hspital utpatient setting fr emergent and nn- emergency situatins. Payments t Nn- physician health care prviders Yes, the hub site may use a physician r ther medical persnnel (PA, ARNP r ther RN) perating under written prtcl established by the physician t present the patient. Licensure Requirements Cnsulting physicians must meet the State's requirements fr cnsultatins. Payment Methd FFS Same as reimbursement fr cvered services furnished in the cnventinal, face- t- face manner. Type is at bth ends (hub and spke)

2 Reprt (2003) Organizatin and peple IDPA will reimburse ne prvider at the spke site and ne r mre prviders at the hub site depending n medical necessity. Hw Identified in Claims/Use f Mdifiers Specific cdes t identify telemedicine services. Assigned cdes have a crsswalk t CPT cdes and use an apprpriate, site- specific (hub r spke) telemedicine "W" cde. Stre and Frward vs. Live Reimburses fr bth real- time and "stre and frward". "The Medicaid agency recgnizes physician cnsultatins when furnished using interactive vide telecnferencing. Payment is n a fee- fr- service basis, the same as the reimbursement fr cvered services furnished in the cnventinal face- t face manner. Illinis reimburses fr stre and frward encunters meeting certain cnditins. Hub and spke sites are bth eligible fr reimbursement fr telemedicine services. CPT cdes with the mdifier TM identify telemedicine cnsultatins." The Illinis Rural Health Netwrk Cnsrtium cnsists f health care prviders and universities develping a statewide telemedicine prgram, after btaining a grant frm the FCC. HRSA has als given grants t sme telehealth prgrams in Illinis, such as the OSF Saint James Medical Center Netwrk, which aims t cnnect 4 sites t the OSF Saint James Medical Center. Plicy Cntacts in Illinis Tamara Tanzill Hffman Chief f Staff Illinis Department f Healthcare and Family Services 201 Suth Grant Avenue E. 3 rd Flr Springfield, IL Phne: Alan Kraus Nrthern Illinis University Phne: akraus@niu.edu Brian Schfield Phne: Fax: Brian.schfield@sfhealthcare.rg

3 INDIANA MICHIGAN Pending SB 511: Specifies cnditins that an electrnically transmitted prescriptin and an electrnic data legislatin: transmissin device must meet. Reprts, studies: in Indiana, Purdue University, Regenstrief Healthcare Engineering, March 2006 (als a gd verview f US telemedicine) Medicaid law and Indiana recgnizes certain telemedicine services under its Medicaid prgram. Hwever, there are regulatins: specific criteria t qualify as telemedicine under the Indiana rules, such as hub and spke sites must be greater than 20 miles apart and real- time, interactive videcnferencing is required. The Indiana Rural Health Assciatin created the Indiana Netwrk, which received funding frm the Federal Cmmunicatins Cmmissin Rural Health Care Pilt Prgram, t create and expand its telehealth netwrk t 35 hspitals in the state. Mre infrmatin abut the state s prgress can be fund n the website. Recent news: June 6, The Legislature gave final and unanimus apprval t HB 5408[1] and 5421[2] specify that health insurers culd nt require face- t- face cntact between a health care prvider and patient fr services apprpriately prvided thrugh telemedicine. Senate fiscal analysis flr summary. Medicaid law and regulatins: fr CSHCSN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Cnnectins fr Children and Yuth: Michigan Medicaid cvers and reimburses fr certain telemedicine services, as shwn in the Michigan Department f Cmmunity Health s Bulletin. The telemedicine service must use interactive audi/vide technlgy, as the beneficiary must be able t see and interact with the ff- site practitiner. Cvered services include: Physician cnsultatins Psychtherapy Pharmaclgic management Other services Type f Service(s) Which Can Be Reimbursed Physician cnsultatins using interactive vide telecnferencing. Payments t Nn- physician health care prviders Yes, bth RNs and allied health prfessinals. Licensure Requirements Yes, must be registered as a Michigan prvider Payment Methd FFS Same as fr cvered services furnished in the cnventinal, face- t- face manner. 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 Bth CPT cdes and mdifiers

4 MINNESOTA Reprt (2003) licensure: Organizatin and peple resurces: Recent news, pending actin: Medicaid cverage and reimbursement: Stre and Frward vs. Live Reimburses fr real- time nly. N "stre and frward". "Accrding t the directr f and Management Develpment with the Upper Michigan Netwrk, since Michigan is a managed- care state, there is little reimbursement ccurring. Hwever, Michigan is reimbursing n a case- by- case basis, althugh there have been few t n requests made. Blue Crss agreed t reimbursement that will begin in August r September by fllwing Medicaid guidelines, which includes facility fees. The Michigan Plicy Grup was frmed t help push frward a telehealth agenda which includes requests fr reimbursement fr pilt prgrams in the Upper Peninsula. There is n current push fr state legislatin regarding." Michigan is the nly state that requires an ut- f- state physician t hld a full Michigan medical license even if the physician is merely prviding remte, cnsultative services. Upper Peninsula Netwrk f Michigan - - Michigan's mst extensive telehealth netwrk prvides cre services in clinical telemedicine, prfessinal educatin and administrative meetings t residents f the Upper Peninsula and Nrthern Great Lakes Regin. The University f Michigan s Research Center enhances the medical services prvided thrugh the University s Health Systems by facilitating access t telemedicine services and prviding researching resurces t faculty at the University. Plicy Cntact in Michigan Rashid Bashshur, PhD Directr Resurce Center Nrth Ingalls Building 8B Nrth Ingalls Ann Arbr, MI Phne: August 17, Minnesta Department f Health certifies state s first health care hmes : First step tward statewide transfrmatin f primary care. Minnestans with cmplex and chrnic care cnditins can begin t enrll in a medical hme as the first 11 certified health care hmes are in several regins f the state, include bth urban and rural clinics and range frm single- physician t large systems clinics. Medicaid cvered telehealth services include: Physician cnsultatins Stre and frward The Medicaid agency recgnizes physician cnsultatins (medical and mental health) when furnished using interactive vide r stre- and- frward technlgy. Interactive vide cnsultatins

5 fr CSHCN: A State- by- State Cmparisn f Medicaid Plicies and Title V Activities (2005) prepared by Cnnectins fr Children and Yuth: may be billed when there is n physician present in the emergency rm, if the nursing staff requests a cnsultatin frm a physician in a hub site. Cverage is limited t three cnsultatins per beneficiary per calendar week. Payment is n a fee- fr- service basis, suing the same payment rate as fr cvered services furnished in a cnventinal, face- t- face manner. Payment is made at bth the hub and spke sites. N payment is made fr transmissin fees. Minnesta uses cnsultatin CPT cdes with the mdifier "CT" fr interactive vide services and the mdifier "WT" fr cnsultatins prvided thrugh stre- and- frward technlgy. Emergency rm CPT cdes are used with a "GT" mdifier fr interactive vide cnsultatins dne between emergency rms. Type f Service(s) Which Can Be Reimbursed Physician cnsultatins (medical and mental health) using interactive vide telecnferencing r stre- and- frward technlgy. Interactive vide cnferencing may be billed when there is n physician present in the ER, if the nursing staff requests a cnsultatin frm a physician in a hub site. Cverage limited t three cnsultatins per beneficiary per calendar week. made fr nly ne reading r interpretatin f diagnstic test such as x- rays, lab tests, and diagnstic assessments. nw included hme telemedicine Cnditins r Limitatins Only fr Medicaid recipients in fee- fr- services prgrams. Prepaid health plans may r may nt chse t pay fr services delivered in this manner. Payments t Nn- physician health care prviders Reimbursed at 90% f the physician's rate. Midwives are reimbursed at 100% f the physician's rate. Licensure Requirements Authrizatin prir t the service being prvided. Out- f- state prviders can enrll in the telemedicine prgram but they must have a Minnesta license t be reimbursed. Payment Methd FFS Same as fr cvered services furnished in the cnventinal, face- t- face manner. Type is at bth ends (hub and spke). N payment made fr transmissin fees Hw Identified in Claims/Use f Mdifiers Cnsultatin CPT cdes with mdifier "CT" fr interactive vide services and mdifier "WT" fr stre- and- frward technlgy cnsultatins Emergency Rm CPT cdes are used with a "GT" mdifier fr interactive vide cnsultatin dne between ER rms.

6 The state has experiences difficulty in determining the vlume f TM as prviders d nt cnsistently use mdifiers. "The Medicaid agency recgnizes physician cnsultatins (medical and mental health) t recipients in the MN Health Care Prgram when furnished using interactive vide r stre- and frward technlgy. Interactive vide cnsultatins may be billed when there is n physician present in the Reprt (2003) emergency rm, if the nursing staff requests a cnsultatin frm a physician in a hub site. Cverage is limited t three cnsults per beneficiary per week. Payment is n a fee- fr- service basis, the same as a face- t- face encunter. Payment is made at bth the hub and spke sites. N payment is made fr transmissin csts. A cmmunicatin between tw physicians that slely cnsists f a telephne cnversatin is nt a telemedicine cnsultatin. CPT cdes with the mdifier CT are used fr interactive vide services and the mdifier WT fr cnsultatins prvided thrugh stre- and- frward technlgy. Emergency rm CPT cdes are used with a GT mdifier fr interactive vide cnsultatins dne between emergency rms. The referring prvider can be a physician, nurse practitiner, clinical nurse specialist, physician assistant, pdiatrist, mental health practitiner, r certified nurse midwife. The hub prvider must be a specialty physician r ral surgen. The ut- f- state cverage plicy applies t services prvided via telemedicine. A request fr and the need fr a cnsultatin must be dcumented in the patient s recrd. The patient recrd must include a written pinin frm the cnsulting physician prviding the telemedicine cnsultatin. Funding is prvided fr telehmecare devices, if the patient qualifies fr the MN Alternative Care Prgram." The Minnesta Netwrk is a partnership between several rganizatins t bring telemedicine prgrams t rural facilities in Minnesta and parts f Nrth Dakta. There are currently ver 20 sites and several mre future sites t cme. The Netwrk ffers bth educatinal prgrams and services fr patients. Reprts: State f Technlgy in Aging Services in Minnesta, published September 2009 in Minnesta: At a Crssrads, Spring 2007 Organizatin and Minnesta Registry peple resurces: Plicy Cntacts in Minnesta Cindy Uselman, RN, BSN Manager/Prject Directr Tri- Cunty Hspital Wadena, MN Phne: Cindy.uselman@tricuntryhspital.rg Tricuntyhspital.rg Stuart M. Speedie, PhD

7 OHIO WISCONSIN Recent news, pending actin: Reprt (2003) licensure: Recent news, pending actin: Medicaid law and regulatins: telemedicine Reprt (2003) Prject Evaluatr University f Minnesta Medical Schl Phne: Speed002@umn.edu May 10, State Medical Bard Psitin Statement n Pending in the General Assembly is S.B. N. 28 that- - Prhibits health insurers frm excluding cverage fr a telemedicine service slely because the service is nt prvided thrugh a face- t- face cnsultatin. Requires the Department f Jb and Family Services t establish and ensure certain practices with respect t the prvisin f telemedicine services t Medicaid recipients. "Accrding t the agency representative, the Ohi Medicaid is nt actively cnsidering reimbursement fr telemedicine and des nt anticipate any such cnsideratin in the near future." Full licensure fr telehealth required by law and special purpse license. July 20, Several nnprfit health rganizatins acrss Wiscnsin will receive grants ttaling $1 millin frm the state's Universal Service Fund prgram, Gv. Dyle annunced. The prgram awards grants annually t nnprfit medical clinics, hspitals and public health agencies, which help clinics and hspitals purchase telecm equipment t prmte advanced medical services and enhance access t medical care in underserved areas. Wiscnsin Medicaid reimburses fr almst all services cvered under standard Medicaid reimbursement plicies, des nt use an riginating site cncept nr an eligible practitiner, and pays the facility fee. (Nina M. Antnitti, Directr, TeleHealth, Marshfield Clinic, authr f primary regulatry language fr Medicaid reimbursement in 2006 and expanded legislatin in 2007.) "Accrding t agency interpretatin, language in state law prhibits paying fr telemedicine since it is delineated as a nn- cvered benefit. The agency is aware f the telemedicine utreach thrugh the Marshfield Clinic. Current debate n the state budget includes a prvisin that there will be n rate increase and n expansin within the Medicaid prgram. A special legislative cmmittee is lking at a number f health issues including telemedicine."

8 licensure: Wiscnsin participates in the inter- state Nurse Licensure Cmpact. Marshfield Clinic TeleHealth Netwrk(MCTN), alng with the CDC Office f Rural Health, initiated a 1997 Rural Grant. In 2000, the grant received additinal funding frm the Office fr the Advancement f TeleHealth, HRSA. This prject was instrumental by fcusing and making ut int the cmmunity with access t telehealth. The MCTN is affiliated with the Marshfield Clinic, a grup f mre than 750 physicians in Nrth and Central Wiscnsin. MCTN initiated an internal reimbursement grup t lk at reimbursement prcesses and billing ptins fr telehealth. e- Care f Wiscnsin - - UW Health critical care medicine dctrs and experienced critical care nurses prvide an additinal level f patient care t enhance patient safety and reduce cmplicatins in participating ICU's acrss the regin. Surce: American Assciatin (2013). State Plicy Center. Retrieved frm