Michigan

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals, for patients located at certain originating sites for specific services. There is no reimbursement for store-and-forward or remote patient monitoring.

 

Definitions

“Telemedicine is the use of telecommunication technology to connect a patient with a health care professional in a different location.”

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1661, Apr. 1, 2019 (Accessed Apr. 2019).

 

Assertive Community Treatment Program (ACT)
Telepractice is the use of telecommunications and information technologies for the provision of psychiatric services to ACT consumers and is subject to the same service provisions as psychiatric services provided in-person.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 347 Apr. 1, 2019 (Accessed Apr. 2019).

 

Behavioral Health Treatment Services (BHT)
Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services
may be prohibitive)

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 474 Apr. 1, 2019 (Accessed Apr. 2019).

 

Medication Therapy Management
Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telepractice must be obtained through real-time interactions between the beneficiary’s physical location (origin site) and the pharmacist provider’s physical location (distant site).

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1592 Apr. 1, 2019 (Accessed Apr. 2019).

 

Speech-Language and Audiology Services; Medication Therapy Management
Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of speech, language and hearing services. Telepractice must be obtained through real-time interaction between the patient’s physical location (patient site) and the provider’s physical location (provider site).

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1752 Apr. 1, 2019 (Accessed Apr. 2019).

Live Video

Policy

Live video telemedicine is reimbursed, and should primarily be used when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services. Where face-to-face visits are required, telemedicine services may be used in addition to the required face-to-face visit, but cannot be used as a substitute.

 

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1661, Apr. 1, 2019 (Accessed Apr. 2019).

Assertive Community Treatment Program
All telepractice interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner from their respective physical location. Psychiatric services are the only ACT services that are approved to be provided in this manner.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 347 Apr. 1, 2019 (Accessed Apr. 2019).
Eligible Services / Specialties

Michigan Medicaid reimburses for the following service categories via live video:
• Inpatient Consults
• Office or other outpatient consults
• Office or other outpatient services
• Psychiatric diagnostic procedures
• Subsequent hospital care
• Training services, diabetes
• End-stage renal disease (ESRD) related services. However, there must be at least
one in-person visit per month, by a physician, nurse practitioner, or physician’s
assistant, to examine the vascular site for ESRD services.
• Behavior change intervention
• Behavior health and/or substance use disorder treatment
• Education service, telehealth
• Nursing facility subsequent care
Procedure codes and modifier information is contained in the MDHHS Telemedicine Services Database.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1661, Apr. 1, 2019.

 

Speech-Language and Audiology Services
Speech, language and hearing services may be reimbursed. Requires an annual referral
from a physician.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1752, Apr. 1, 2019 (Accessed Apr. 2019).

 

Assertive Community Treatment Program
The telepractice modifier, 95, must be used in conjunction with ACT encounter reporting
code H0039 when telepractice is used.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 347 Apr. 1, 2019 (Accessed Apr. 2019).

Telepractice for BHT Services
Telepractice services must be prior authorized. Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection. It is the expectation that providers, facilitators, and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients, and services provided via telepractice are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider.
Qualified providers of behavioral health services are able to arrange telepractice services for the purposes of teaching the parents/guardians to provide individualized interventions to their child and to engage in behavioral health clinical observation and direction (i.e. increase oversight of the provision of services to the beneficiary to support the outcomes of the behavioral plan of care developed by the primary supervising BHT provider).

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 474 Apr. 1, 2019 (Accessed Apr. 2019).
Eligible Providers

Physicians and practitioners are eligible to be distant site providers

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1662, Apr. 1, 2019 (Accessed Apr. 2019).

 

Telepractice for BHT Services
Qualified providers include:
• Board certified behavior analysts
• Board certified assistant behavior analysts
• Licensed psychologists
• Limited licensed psychologists
• Qualified behavioral health professionals
Occupational, physical and speech therapists are not included in this policy.
A facilitator trained in telepractice technology must be physically present with the patient.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 475 Apr. 1, 2019 (Accessed Apr. 2019).

Medication Therapy Management (MTM)
In the event that the beneficiary is unable to physically access a face-to-face care setting, an eligible pharmacist may provide MTM services via telepractice. Services must be provided through hardwire or internet connection.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1592, Apr. 1, 2019 (Accessed Apr., 2019).

 

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 338, Apr. 1, 2019 (Accessed Apr. 2019).

 

Speech-Language and Audiology Services
Eligible providers:
• Licensed speech-language pathologist
• Licensed Audiologist in Michigan
• Speech language pathologist and/or audiology candidate under the direction of a
qualified SLP or audiologist
• A limited licensed speech language pathologist under the direction of a fully licensed SLP or audiologist

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1752, Apr. 1, 2019 (Accessed Apr. 2019).
Eligible Sites

Eligible originating sites:
• County mental health clinics or publicly funded mental health facilities;
• Federally Qualified Health Centers;
• Hospitals (inpatient, outpatient, or Critical Access Hospitals);
• Physician or other providers’ offices, including medical clinics;
• Hospital-based or CAH-based Renal Dialysis Centers;
• Rural Health Clinics;
• Skilled nursing facilities;
• Tribal Health Centers.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1752, Apr. 1, 2019 (Accessed Apr. 2019).

 

Speech-Language and Audiology Services
The patient site may be located within the school, at the patient’s home or any other established site deemed appropriate by the provider.
The room must be free from distractions so as not to interfere with the telepractice session.
A facilitator must be trained in the use of the telepractice technology and physically present at the patient site during the entire telepractice session to assist the patient at the direction of the SLP or audiologist.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1752, Apr. 1, 2019 (Accessed Apr. 2019).

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 338, Apr. 1, 2019 (Accessed Apr. 2019).

Behavioral Health Therapy
Eligible patient site:
• Center
• Clinic
• Patient’s home
• Any other established site deemed appropriate by the provider
Room must be free of distractions. A trained facilitator must be present at the patient site.

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 334, Oct. 1, 2018 (Accessed Apr. 2019).
Facility/Transmission Fee

Originating site may bill for a facility fee. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen

 

Source: Dept. of Community Health, Medicaid Provider Manual, p. 269, Apr. 1, 2019 (Accessed Apr. 2019).

Store-and-Forward

Policy

Telecommunication systems using store-and-forward technology are not included in MI Medicaid’s telemedicine policy

 

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1661, Apr. 1, 2019 (Accessed Apr. 2019).
Out of State Providers

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

 

Source: Dept. of Community Health, Medicaid Provider Manual, p. 514, Apr. 1, 2019 (Accessed Apr. 2019).

Behavioral Health Therapy
Must be fully licensed in MI or be a practitioner who holds a limited license and is under the direction of a licensed psychologist.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 474, Apr. 1, 2019 (Accessed Apr. 2019).
Miscellaneous

No reimbursement for remote access for surgical procedures, and use of robotics

 

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1661, Apr. 1, 2019 (Accessed Apr. 2019).

Private Payer Laws

Requirements

Insurers and group or nongroup health care corporations shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health care corporation. Telemedicine services shall be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine
services are subject to all terms and conditions of the contract.

 

Source: MI Compiled Law Services Sec. 500.3476(1) & Sec. 550.1401k(1). (Accessed Apr. 2019).
Definitions

Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine, the health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system, and the patient must be able to interact with the off-site health care professional at the time the services are provided.

 

Source: MI Compiled Law Svcs. Sec. 500.3476(2)(b) & 550.141k(2). (Accessed Apr. 2019).

Parity

Service Parity

Insurers and health care corporations must cover services appropriately provided through telemedicine, as determined by the insurer or health care corporation.

 

Source: MI Compiled Law Services Sec. 500.3476 & Sec. 550.1401k. (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

Providers must have an existing physician-patient or dentist-patient relationship

Source: MI Compiled Laws Sec. 333.17751(2)(a). (Accessed Apr. 2019).

 

Schedule 2 to 5 controlled substances cannot be prescribed unless the prescribing is in a bona fide prescriber-patient relationship with the patient. A “bona fide prescriber-patient relationship” means a treatment or counseling relationship between a prescriber and a patient in which both of the
following are present:
• The prescriber has reviewed the patient’s relevant medical or clinical records and completed a full assessment of the patient’s medical history and current medical condition, including a relevant medical evaluation of the patient conducted in-person or through telehealth.
• The prescriber has created and maintained records of the patient’s condition in accordance with medically accepted standards.

Source: MI Compiled Laws Sec. 333.7303a. (Accessed Apr. 2019).
Consent

Consent must directly or indirectly be obtained by a health care professional utilizing telehealth.

 

Source: MI Compiled Laws Sec. 333.16284. (Accessed Apr. 2019).
Miscellaneous

The MI Department of Health and Human Services required to study the use of telemedicine to perform competency examinations by forensic psychiatrists.

 

Source: SB 270 (2017). (Accessed Apr. 2019).
Definitions

“Telehealth” means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, “telemedicine” means that term as defined in section 3476 of the
insurance code of 1956, 1956 PA 218, MCL 500.3476.

 

Source: MI Compiled Laws Sec. 333.16283(c). (Accessed Apr. 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 Michigan


[recaptcha]

*Required