Pennsylvania

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

The Pennsylvania Medical Assistance Program provides reimbursement for live-video under some
circumstances. There is no reimbursement available for store-and-forward or remote patient monitoring.

 

Definitions

Telemedicine is the use of real-time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering consultation services.

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Apr.2019).

Live Video

Policy

For FQHCs & RHCs
Telepsychiatry Services – Only applicable to Behavioral Health Managed Care delivery
system claims and not fee-for-service delivery. Service is in real-time, interactive audio-video transmission and do not include phone, email or facsimile transmission. Consultation between two healthcare practitioners do not count as a qualifying service. Service providers are limited to psychologists and psychiatrists. Service providers are required to have a service description approved by the Office of Mental Health and Substance Abuse Services and deliverable through the managed care option.

 

Source: PPA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Apr. 2019).
Eligible Services / Specialties

See listing for reimbursable procedure codes when the service is provided via interactive telecommunication technology.

Source: PA Department of Human Services, Medical Assistance Program Fee Schedule for Consultations Performed Using Interactive Telecommunication Technology. (Accessed Apr. 2019).

 

Telepsychiatry Services
PA Medicaid will reimburse licensed psychiatrists and licensed psychologists for telepsychiatry outpatient services including:
• Psychiatric diagnostic evaluations
• Psychological Evaluations
• Pharmacological management
• Consultations (with patient/family)
• Psychotherapy

Source: PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).
Eligible Providers

Pennsylvania Medicaid will provide reimbursement for live video to all Medicaid enrolled
physician specialists.
Eligible Providers (fee for service):
• Physicians
• Certified registered nurse practitioners
• Certified nurse midwives
Providers under a managed care system should contact the appropriate managed care
organization

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Apr. 2019)

 

Providers must have documented endorsement to deliver mental services through telepsych from the county mental health program and the HealthChoices Behavioral Health Managed Care Organization, and this endorsement must be submitted to the PA Office of Mental Health and Substance Abuse Services regional office for final approval.

Source: PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).

 

Telepsych services delivered in FQHCs and RHCs require providers to have a service description approved by the Office of Mental Health and Substance Abuse Services and the service must be deliverable through the managed care option. Telepsych services are limited to psychologists and psychiatrists.

Source: PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Apr. 2019)
Eligible Sites

A patient is allowed to access a telemedicine consultation at any enrolled office of the referring provider or any other participating physicians, certified registered nurse practitioner, or certified nurse midwife.

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Apr. 2019).

 

A site where an individual is receiving telepsych services must have an Office of Mental Health and Substance Abuse Services approved program description and be enrolled in the Medical Assistance Program.

Source: PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).
Geographic Limits

Originating site may bill for facility fee.

 

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012. & PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).
Facility/Transmission Fee

Originating site may bill for facility fee.

 

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012. & PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).

Store-and-Forward

Policy

Pennsylvania Medicaid will not reimburse for store-and-forward because a telemedicine consultation must consist of a two-way, real time interactive communication between the patient and the physician at the distant site.

 

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Apr. 2019)
Email / Phone / Fax

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

 

Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Apr. 2019).
Consent

Informed consent is required from individuals participating in any services utilizing telepsych.

 

Source: PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).
Out of State Providers

When services are provided from a location in another state, the psychiatrist/licensed psychologist must be licensed in Pennsylvania

 

Source: PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014 (Accessed Apr. 2019).
Miscellaneous

No reference found.

 

Professional Regulation /
Health & Safety

Cross-State Licensing

Member of the Interstate Medical Licensure Compact.

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

 

Pennsylvania issues extraterritorial licenses that allow practice in Pennsylvania to physicians residing or practicing with unrestricted licenses in an adjoining state, near the Pennsylvania boundary,
and whose practice extends into Pennsylvania.
Pennsylvania bases the granting of this license on the availability of medical care in the area involved, and whether the adjoining state extends similar privileges to Pennsylvania physicians.

Source: PA Statutes Annotated, Title 63 Sec. 422.34(a) and (c)(2). (Accessed Apr. 2019).

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