MISSOURI

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Missouri Medicaid will reimburse for services delivered via live video.

 

Definitions

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine
shall also include the use of asynchronous store-and-forward technology

Source: MO Revised Statute Title XII Public Health and Welfare Sec. 208.670 which references Title XII Sec. 191.1145. (Accessed Apr. 2019).

 

Telehealth Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.

Source: MO HealthNet, Physician Manual,13-69A p. 286 (Jan. 18, 2019), MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 164 (Mar. 28, 2019) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 211 (Jan 9, 2019). (Accessed Apr. 2019)

Live Video

Policy

Services provided through telehealth must meet the standard of care that would otherwise be expected should such services be provided in-person. Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.

Source: MO HealthNet, Physician Manual, 13.69A p. 286 (Jan. 18, 2019), Provider Manual, Rural Health Clinics, Section 13, p. 164-5 (Mar. 28, 2019) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 211-212 (Jan 9, 2019). (Accessed Apr. 2019).

 

The department of social services shall reimburse providers for services provided through telehealth if such providers can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person. Reimbursement for telehealth services shall be made in the same way as reimbursement for in-person contact; however, consideration shall also be made for reimbursement to the originating site.

Source: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Apr. 2019).
Eligible Services / Specialties

POS 02 should be used for telehealth furnished from the distant site. Distant services provided on school grounds should be billed with POS 03 and a GT modifier

Source: MO HealthNet Provider Bulletin. Vol. 41, No. 10. Aug. 17, 2018. (Accessed Apr. 2019).

 

Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program
Medication services and other services may be provided via telehealth.

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

 

Community Psych Rehab Program
Several services are covered if delivered via telehealth. See manual for specific services.

Source: MO HealthNet, Community Psych Rehab Program Manual, (Nov. 21, 2018), (Accessed Apr. 2019).

 

Home Health
The telehealth may be used in the “face-to-face” requirement of an encounter.

Source: MO HealthNet, Home Health Manual, p. 168. (Apr. 1, 2019), (Accessed Apr. 2019).
Eligible Providers

Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in-person. To be reimbursed for telehealth services health care providers treating patients in this state, utilizing telehealth, must be fully licensed to practice in this state and be enrolled as a MHD provider prior to rendering services.

Source: MO HealthNet, Physician Manual, 13.69A p. 286-7 (Jan. 18, 2019), Provider Manual, Rural Health Clinics, Section 13, p. 165 (Mar. 28, 2019) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Jan 9, 2019). (Accessed Apr. 2019).

 

RHCs must bill with their non-RHC provider number when they are either the distant or originating site to receive the facility fee.

Source: MO HealthNet, Rural Health Clinic, p. 165 (Mar 28, 2019). (Accessed Apr. 2019).

 

Anesthesiologist monitoring telemetry in the operating room is a non-covered service.

Source: MO HealthNet, Physician Manual, p. 211 (Jan 18, 2019). (Accessed Apr. 2019).
Eligible Sites

The department shall not restrict the originating site through rule or payment so long as the provider can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person.

Source: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Apr. 2019).

 

No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient’s medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in-person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

Source: MO Revised Statute Sec. 191.1145(6). (Accessed Apr. 2019).

 

RHCs must bill with their non-RHC provider number (or when the distant site, the RHC provider number can also be used) when they are either the distant or originating site to receive the facility fee.

Source: MO HealthNet, Rural Health Clinic, p. 165 (Mar. 28, 2019). (Accessed Apr. 2019).

 

The originating site is where the MO HealthNet participant receiving the telehealth service is physically located. The originating site and distant site can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility.

Source: MO Department of Social Services. Provider Bulletin. Vol. 40, No. 47. Feb. 2, 2018. (Accessed Apr. 2019).
Geographic Limits

Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site.

 

Source: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Apr. 2019).
Facility/Transmission Fee

Providers can bill Q3014 for the telehealth originating site facility fee.

Source: MO Department of Social Services. Provider Bulletin. Vol. 40, No. 47. Feb. 2, 2018. (Accessed Apr. 2019).

 

FQHCs and RHCs are eligible for an originating site facility fee.

Source: MO Department of Social Services. Provider Bulletin. Vol. 41, No. 21. October 5, 2018. (Accessed Apr. 2019).

 

The originating site is only eligible to receive a facility fee for the Telehealth service. Claims should be submitted with HCPCS code Q3014 (Telehealth originating site facility fee). Procedure code Q3014 is used by the originating site to receive reimbursement for the use of the facility while Telehealth services are being rendered.

Source: MO HealthNet, Physician Manual, 13.69A p. 287 (Jan. 18, 2019) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Jan 9, 2019). (Accessed Apr. 2019).

Store-and-Forward

Policy

Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate had the service been provided in-person.

 

Source: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Apr. 2019).

Remote Patient Monitoring

Policy

Subject to appropriations, the department shall establish a statewide program that permits reimbursement under the MO HealthNet program for home telemonitoring services.

 

Conditions

Eligible conditions:
• Pregnancy
• Diabetes
• Heart disease
• Cancer
• Chronic obstructive pulmonary disease
• Hypertension
• Congestive heart failure
• Mental illness or serious emotional disturbance
• Asthma
• Myocardial infarction; or
• Stroke
The beneficiary must also exhibit two or more the following risk factors:
• Two or more hospitalizations in the prior twelve-month period;
• Frequent or recurrent emergency department admissions;
• A documented history of poor adherence to ordered medication regimens;
• A documented history of falls in the prior six-month period;
• Limited or absent informal support systems;
• Living alone or being home alone for extended periods of time;
• A documented history of care access challenges; or
• A documented history of consistently missed appointments with health care providers

 

Source: MO Revised Statute Sec. 208.686. (Accessed Apr. 2019).

 

Personal Emergency Response Systems (an electronic device that is programmed to signal a response center once the help button is activated) is available for patients at high risk of being institutionalized.

Source: MO HealthNet, Provider Manual, Developmental Disabilities Waiver Manual, Section 13, p. 30 (Mar. 11, 2019). (Accessed Apr. 2019).
Other Restrictions

If, after implementation, the department determines that the program established under this section is not cost effective, the department may discontinue the program and stop providing reimbursement under the MO HealthNet program for home telemonitoring services.
The department shall promulgate rules and regulations to implement the provisions of this section.

Source: MO Revised Statute Sec. 208.686. (Accessed Apr. 2019).
Provider Limitations

The program must ensure the home health agency or hospital shares telemonitoring clinical information with participant’s physician.

 

Source: MO Revised Statute Sec. 208.686. (Accessed Apr. 2019).
Consent

Prior to the provision of telehealth services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the
school year.

 

Source: MO Revised Statute. XII Public Health and Welfare. Ch. 208, Sec. 208.677. (Accessed Apr. 2019).
Out of State Providers

Payment cannot be made to entities outside of the US, and US territories.

 

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 58 (Jan. 9, 2019); MO HealthNet, Physician Manual, Telehealth Services, p. 65 (Jan. 18, 2019) & MO HealthNet, Rural Health Clinic, p. 56 (Mar. 28, 2019), (Accessed Apr. 2019).
Miscellaneous

Special documentation requirements apply.

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Jan. 9, 2019); MO HealthNet, Physician Manual, Telehealth Services, p. 287 (Jan. 18, 2019) & MO HealthNet, Rural Health Clinic, p. 165 (Mar. 28, 2019), (Accessed Apr. 2019).

 

A telehealth service must be performed on a private dedicated telecommunications line approved through the Missouri Telehealth Network (MTN).

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 213 (May 23, 2018) & MO HealthNet, Rural Health Clinic, p. 167 (May 23, 2018). (Accessed Apr. 2019).

Private Payer Laws

Requirements

Health carriers shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.
A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient.
A health carrier shall not be required to reimburse a telehealth provider or a consulting provider for site origination fees or costs for the provision of telehealth services; however, subject to correct coding, a health carrier shall reimburse a health care provider for the diagnosis, consultation, or treatment of an insured or enrollee when the health care service is delivered through telehealth on the same basis that the health carrier covers the service when it is delivered in-person.
A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.

Source: MO Revised Statutes § 376.1900. (Accessed Apr. 2019).

 

Missouri Consolidated Health Care Plan (State employees and retirees health plan)
Telehealth services are covered on the same basis that the service would be covered when it is delivered in-person. Telehealth site origination fees or costs for the provision of telehealth services are not covered.

Source: MO Consolidated State Reg. 22:10-3.057. (Accessed Apr. 2019).
Definitions

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine
shall also include the use of asynchronous store-and-forward technology.

 

Source: MO Revised Statute Title XXIV Business and Professions, Sec. 376.1900, which references Sec. Title XII Public Health and Welfare Sec. 208.760 which references Title XII Sec. 191.1145. (Accessed Apr. 2019).

Parity

Payment Parity

No explicit payment parity.

 

Service Parity

A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient. A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.

 

Source: MO Revised Statutes § 376.1900. (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

Prescribing or dispensing drugs without sufficient examination is prohibited.

Source: MO Revised Statutes § 334.100(4)(h) (2012). (Accessed Apr. 2019).

 

A telemedicine encounter can establish a physician-patient relationship if the standard of care does not require an in-person encounter and in accordance with evidence-based standards of practiceand telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.
In order to establish a physician-patient relationship through telemedicine:
• The technology utilized shall be sufficient to establish an informed diagnosis as though the
medical interview and physical examination has been performed in-person; and
• Prior to providing treatment, including issuing prescriptions, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.

Source: MO Revised Statute Ch. 191 Sec. 191.1146. (Accessed Apr. 2019).

 

In addition, in order to prescribe, the relationship includes:
1. Obtaining a reliable medical history and performing a physical examination of the patient,
adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contraindications to the treatment recommended or provided;
2. Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
3. If appropriate, following up with the patient to assess the therapeutic outcome;
4. Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to the patient’s other health care professionals; and
5. Maintaining the electronic prescription information as part of the patient’s medical record.
The requirements of subsection 1 (see above) may be satisfied by the prescribing physician’s designee when treatment is provided in:
• A hospital;
• A hospice program;
• Home health services provided by a home health agency;
• Accordance with a collaborative practice agreement;
• Conjunction with a physician assistant licensed;
• Conjunction with an assistant physician;
• Consultation with another physician who has an ongoing physician-patient relationship
with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications; or
• On-call or cross-coverage situations.
No health care provide shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician, such physician’s on-call designee, an advanced practice registered nurse in a collaborative practice arrangement with such physician, a physician assistant in a supervision agreement with such physician, or an assistant physician in a supervision agreement with such physician may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.
No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

Source: MO Revised Statute Sec. 334.108. (Accessed Apr. 2019).
Consent

Collaborative Care Arrangement
Telehealth providers (including Advanced Practice Registered Nurses who providing nursing
services under a collaborative practice arrangement) are required to obtain patient (or the patient’s guardian’s) consent and document consent in patient’s record.

 

Source: MO Code of State Regulation. Title 20, 2150-2.240 & Sec. 20, 2150-5.100 & MO Revised Statute Title XXII Occupations and Professions Ch. 335.175. (Accessed Apr. 2019).
Definitions

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine
shall also include the use of asynchronous store-and-forward technology.

Source: MO Revised Statute Sec. 191.1145. (Accessed Apr. 2019).

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Licensing of Physicians and Surgeons
Telehealth means the use of medical information exchanged from one site to another via electronic communications to improve the health status of a patient.

Source: MO Code of State Regulation. Title 20, 2150-2.001. (Accessed Apr. 2019).
Cross-State Licensing

In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their
respective professional boards.
Does not apply to:
• Informal consultation performed by a health care provider licensed in another state,
outside of the context of a contractual relationship, and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;
• Furnishing of health care services by a health care provider licensed and located in another state in case of an emergency or disaster; provided that, no charge is made for the medical assistance; or
• Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state.

“Source: MO Revised Statute Ch. 191 Sec. 191.1145. (Accessed Apr. 2019).

 

Member of Psychology Interjurisdictional Compact (PSYPACT).

Source: PSYPACT Website. (Accessed Apr. 2019).

 

Member of Physical Therapy Compact.

Source: PT Compact Map. (Accessed Apr. 2019).

 

Member of Nurses Licensure Compact.

Source: Nurse Licensure Compact. Current NLC States and Status. NCSBN. (Accessed Apr. 2019).

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