ALABAMA

Master Medicaid Telehealth Laws
with the help from GD

Summary

Alabama Medicaid reimburses for live video under some circumstances. The Agency will not reimburse providers for origination site or transmission fees. They make no reference to store-and forward reimbursement, but the program reimburses for In-Home Monitoring through the Patient’s 1st program for diabetes and Chronic Heart failure, although it’s not considered to fall under the telemedicine program.
For all telemedicine services, an appropriately trained staff member or employee familiar with the patient or the treatment plan must be immediately available in-person to the patient.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) & AL Admin. Code r. 560-X-6-.14 (Accessed Mar. 2019).
Definitions

There is no explicit definition of “telemedicine” given in state Medicaid policy. However, the provider manual states, “Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site physician and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the physician, recipient, or a consultation between two physicians).”

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) (Accessed Mar. 2019).

Live Video

Policy

Alabama Medicaid reimburses for live video for certain services.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) & AL Admin. Code r. 560-X-6-.14 (Accessed Mar. 2019).
Eligible Services / Specialties

Alabama Medicaid reimburses for the following services when billed with a GT modifier:
• Consults;
• Office or other outpatient visits;
• Individual psychotherapy;
• Psychiatric diagnostic services;
• Neurobehavioral status exams.
However, for some specialties, special conditions or circumstances must be present for reimbursement to occur.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), & AL Admin. Code r. 560-X-6-.14
(Accessed Mar. 2019).

Telehealth may also be used to deliver Nursing Assessment and Care and Rehabilitative services when certain conditions are met.

Source: AL Medicaid Management Information System Provider Manual, (105-13) (Accessed Mar. 2019).
Eligible Providers

All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In order to participate in the telemedicine program:
• Physicians must be enrolled with Alabama Medicaid with a specialty type of 931
(Telemedicine Service).
• Physician must submit the telemedicine Service Agreement/Certification form.
• Physician must obtain prior consent from the recipient before services are rendered.
This will count as part of each recipient’s benefit limit of 14 annual physician office
visits currently allowed.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) (Accessed Mar. 2019).

For Nursing Assessment and Care services the following providers are eligible:
• Licensed Registered Nurse
• Licensed Practical Nurse
• Certified Nursing Assistant
• MAC Worker

Source: AL Medicaid Management Information System Provider Manual, (105-60) (Accessed Mar. 2019).
Eligible Sites

For rehabilitative services, the originating site must be at:
• Physician’s office;
• Hospital;
• Critical Access Hospital;
• Rural Health Clinic;
• Federally Qualified Health Center;
• Community mental health center (to include co-located sites with partnering agencies);
• Public health department.

 

Source: AL Medicaid Management Information System Provider Manual, (105-13) (Accessed Mar. 2019).
Geographic Limits

For rehabilitative services, the originating site must be located in Alabama. The distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.

 

Source: AL Medicaid Management Information System Provider Manual, (105-13) (Accessed Mar. 2019).
Facility/Transmission Fee

No reimbursement for originating site or transmission fees.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) (Accessed Mar. 2019).

Store-and-Forward

Email / Phone / Fax

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), (Accessed Mar. 2019).
Consent

Physician must obtain prior consent from the recipient before services are rendered, this will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) (Accessed Mar. 2019).
Out of State Providers

Providers must have an Alabama license.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

The Alabama Board of Medical Examiners holds the position that, when prescribing medications to an
individual, the prescriber, when possible, should personally examine the patient. Prescribing medications for patients the physician has not personally examined may be suitable for certain circumstances, including telemedicine.
Licensees are expected to adhere to federal and state statute regarding prescribing of controlled
substances.

 

Source: AL Admin. Code. r. 540-X-9-.11 (Accessed Mar. 2019).
Miscellaneous

Professional Board Telehealth-Specific Regulations
• AL Board of Optometrists (Source: AL Admin Code 630-X-13-.02). (Accessed Mar. 2019).
• AL Board of Nursing (Source: AL Admin Code 610-X-6-.16). (Accessed Mar. 2019).

 

Cross-State Licensing

A special purpose license allowing practitioners licensed in other states to practice across state lines
may be issued.

 

Source: Code of AL Sec. 34-24-502 – 507. (Accessed Mar. 2019)

Professional Board Telehealth-Specific Regulations
• AL Board of Optometrists (Source: AL Admin Code 630-X-13-.02). (Accessed Mar. 2019).
• AL Board of Nursing (Source: AL Admin Code 610-X-6-.16). (Accessed Mar. 2019).

Contact us to discuss your telehealth initiatives in Alabama


[recaptcha]

*Required