MONTANA

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Montana Medicaid reimburses for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring based on the definition for telemedicine.

Definitions

Telemedicine is the use of interactive audio-video equipment to link practitioners and patients located at different sites.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2019).

 

Healthy Montana Kids
Telemedicine is “the use of a secure interactive audio and video, or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located. Does not include audio only (phone call), e-mail, and/or facsimile transmission.”

Source: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov., 2017), p. 11. (Accessed
Apr. 2019).

Live Video

Policy

MT Medicaid reimburses for medically necessary telemedicine services to eligible members. Providers must be enrolled as Montana Medicaid providers.
Telemedicine should not be used when face-to-face services are medically necessary.
Members should establish relationships with primary care providers who are available on a face-to-face basis.
The originating and distant providers may not be within the same facility or community. The same provider may not be the “pay to” for both the originating and distance provider.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2019)

 

Eligible Services / Specialties

Healthy Montana Kids
Services provided by telemedicine are allowed for non-surgical medical services and behavioral health outpatient services.

Source: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov., 2017), p. 24 & 30. (Accessed Apr. 2019).

 

Telehealth services are available for Speech Therapy when ordered by a physician or mid-level practitioner. The order is valid for 180 days.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Therapies Manual, Covered Services (Aug. 2017). (Accessed Apr. 2019)
Eligible Providers

The following provider types can bill the originating site fee:
• Outpatient hospital
• Critical access hospital
• Federally qualified health center
• Rural health center
• Indian health service
• Physician
• Psychiatrist
• Mid-levels
• Dieticians
• Psychologists
• Licensed clinical social worker
• Licensed professional counselor
• Mental health center
• Chemical dependency clinic
• Group/clinic
• Public health clinic
• Family planning clinic
The place of service is considered to be the location of the distance provider providing the
telemedicine service.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Jun. 2018). (Accessed Apr. 2019).

 

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

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Jun. 2018). (Accessed Apr. 2019).
Eligible Sites

Telemedicine can be provided in a member’s residence; the distance provider is responsible for the confidentiality requirements.

 

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018) (Accessed Apr. 2019).
Geographic Limits

The originating and distant providers may not be within the same facility or community or have the same tax ID number

 

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018) & Montana Healthcare Programs Notice. July 26, 2017. (Accessed Apr.
2019).
Facility/Transmission Fee

The following provider types can bill the originating site fee:
• Outpatient hospital
• Critical access hospital
• Federally qualified health center
• Rural health center
• Indian health service
• Physician
• Psychiatrist
• Mid-levels
• Dieticians
• Psychologists
• Licensed clinical social worker
• Licensed professional counselor
• Mental health center
• Chemical dependency clinic
• Group/clinic
• Public health clinic
• Family planning clinic
Originating site providers must include a specific diagnosis code to indicate why a member is being seen by a distance provider and this code must be requested from the distance site prior to billing for the telemedicine appointment.
The originating site provider may also, as appropriate, bill for clinical services provided onsite the same day that a telemedicine originating site service is provided. The originating site may not bill for assisting the distant site provider with an examination, including for any services that would be normally included in a face-to-face visit.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2017). (Accessed Apr. 2019).

 

There is no facility fee reimbursement when the originating site is a member’s residence.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Sec. 5.1 (Jun. 2018). (Accessed Apr. 2019).

 

No reimbursement for infrastructure or network use charges.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Billing Procedures (Sep. 2017). (Accessed Apr. 2019).
 

FQHCs and RHCs can bill a telehealth originating site code if applicable.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Rural Health Clinics & Federally Qualified Health Center, Billing Procedures (Feb. 21, 2019). (Accessed Apr. 2019).

Store-and-Forward

Policy

There is no reimbursement for store-and-forward based on the definition for telemedicine restricting the service to interactive audio-video.

 

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2019).
Eligible Services / Specialties

No reference found.

 

Remote Patient Monitoring

Policy

There is no reimbursement for remote patient monitoring based on the definition for telemedicine restricting the service to interactive audio-video.

 

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2019).
Email / Phone / Fax

Telemedicine reimbursement does not include:
• Consultation by telephone
• Facsimile machine transmissions
• Crisis hotlines

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2019).

 

No reimbursement for telephone services in home.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Audiology Svcs., Covered Services (Sep. 2017); Rural Health Clinics & Federally Qualified Health Center, Covered Services (Feb 21, 2019); Physical Therapy, Occupational Therapy and Speech Therapy, Covered Services (Sep. 2017); Hospital Outpatient Services, Covered Services (Jun. 2018); Hospital Inpatient Services, Covered Services (Jun. 2018). (Accessed Apr. 2019).
Out of State Providers

Providers must be licensed in the state of Montana.

 

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2019).
Miscellaneous

Effective Jan. 1, 2017 the new place of service code is “02”.

Source: MT Dept. of Public Health and Human Svcs., Program Notice. Feb. 7, 2017. (Accessed Apr. 2019).

 

If a rendering provider’s number is required on the claim for a face-to-face visit, it is required on a telemedicine claim.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2018).

 

Confidentially requirements apply (see manual).

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Jun. 2018). (Accessed Apr. 2018).

Private Payer Laws

Requirements

Eligible providers under the parity law include:
• Physicians
• Physician Assistants
• Podiatrists
• Pharmacists
• Optometrists
• Physical Therapists
• Occupational Therapists
• Speech-language Pathologists and Audiologists
• Psychologists
• Social Workers
• Licensed Professional Counselors
• Nutritionists
• Addiction Counselors
• Registered professional nurse
• Advanced practice registered nurse
• Genetic counselor certified by the American board of genetic counseling
• Diabetes educator certified by the national certification board for diabetes
• Dentists & Dental Hygienists
Eligible facilities under this law include:
• Critical access hospital
• Hospice
• Hospital
• Long-term care facility
• Mental health center
• Outpatient center for primary care
• Outpatient center for surgical services
A private insurer is not:
• Required to provide coverage for services that are not medically necessary, subject to the terms and conditions of the policy
• Permitted to require a health care provider to be physically present with the patient at the site where the patient is located unless the distant site provider determines that the presence of a health care provider is necessary.

 

Source: MT Code Sec. 33-22-138. (Accessed Apr. 2019).
Definitions

Telemedicine means the use of interactive audio, video, or other telecommunications technology that is:
• Used by a health care provider or health care facility to deliver health care services at a site other than the site where the patient is located; and
• Delivered over a secure connection that complies with the requirements of HIPPA.
• The term includes the use of electronic media for consultation relating to the health
care diagnosis or treatment of a patient in real-time or through the use of store-andforward technology.
• The term does not include the use of audio-only telephone, e-mail, or facsimile transmissions.

 

Source: MT Code Annotated Sec. 33-22-138(6)(d). (Accessed Apr. 2019).

Parity

Service Parity

Private payers are required to provide coverage for services delivered through telemedicine if the services are otherwise covered by the policy, certificate, contract, or agreement.
Coverage must be equivalent to the coverage for services that are provided in-person by a
health care provider or health care facility.

 

Source: : MT Code Sec. 33-22-138. (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Definitions

Telemedicine means the practice of medicine using interactive electronic communication, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine typically involves the application of secure videoconferencing or store-and-forward technology, as defined in 33-22-138.
The term does not mean an audio-only telephone conversation, an e-mail or instant messaging conversation, or a message sent by facsimile transmission.

 

Source: MT Code Sec. 37-3-102(13). (Accessed Apr. 2019).
Cross-State Licensing

Member of the Interstate Medical licensure Compact.

Source: The IMLC. Interstate Medical Licensure Compact. (Accessed Apr. 2019).

 

Member of the Nurse Licensure Compact.

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

 

Member of the Physical Therapy Compact.

Source: Compact Map. Physical Therapy Compact. (Accessed Apr. 2019).
Miscellaneous

Professional Board Telehealth-Specific Regulations
• MT Board of Speech-Language Pathology (MT Admin Rules, Sec. 24.222.9 (Accessed Apr. 2019).

 

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