SOUTH CAROLINA

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward is not reimbursed as it does not meet established conditions for the use of telemedicine. The South Carolina Medicaid reimburses for home health monitoring through the Home Aging Program for some conditions when a patient is eligible.

 

Definitions

“Telemedicine is the use of medical information about a patient that is exchanged from one site to another via electronic communications to provide medical care to a patient in circumstances in which face-to-face contact is not necessary.”
“In this instance, a physician or other qualified medical professional has determined that medical care can be provided via electronic communication with no loss in the quality or efficacy of the care.”
“Electronic communication means the use of interactive telecommunication equipment that typically includes audio and video equipment permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the referring site. Telemedicine includes consultation, diagnostic, and treatment services.”

 

Source: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 2-34 (Mar. 2019) & Local Education Manual, p. 2-43. (Jan. 2019). (Accessed Apr. 2019).

Live Video

Policy

South Carolina Medicaid will reimburse for live video and covers telemedicine when the service is medically necessary and under the following circumstances:
• The medical care is individualized, specific, and consistent with symptoms or
confirmed diagnosis of the illness or injury under treatment, and not in excess of
the beneficiary’s need;
• The medical care can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-36 (Mar. 2019) & Local Education Manual, p. 2-44 to 2-45. (Jan. 2019). (Accessed Apr. 2019)

 

If there are technological difficulties in performing a medical assessment or problems in a beneficiaries’ understanding of telemedicine, face-to-face care must be provided instead.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-34 to 2-35 (Mar. 2019) & Local Education Manual, p. 2-43 (Jan. 2019). (Accessed Apr. 2019).

 

Telemedicine equipment and transmission must permit encrypted transmission and the speed and image resolution must be technically sufficient to support the service billed. Staff involved in a telemedicine visit must be trained in the use of the telemedicine equipment and component in its operation.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-37 (Mar. 2019) & Local Education Manual, p. 2-46. (Jan. 2019) (Accessed Apr. 2019).

 

Reimbursement to the health professional delivering the medical service is the same as the current fee schedule amount for the service provided. See appropriate professional manuals for CPT codes. Codes must be billed along with the telemedicine GT modifier.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-38 (Mar. 2019) & Local Education Manual, p. 2-47. (Jan. 2019)(Accessed Apr. 2019).

 

Telepsychiatry
To qualify for reimbursement, interactive audio and video equipment that permits two-way real-time or near real-time communication with the client, consultant, interpreter, and referring clinician.
Additional requirements include:
• Reimbursement requires the “real-time” presence of a client.
• Reimbursement is available for psychiatric diagnosis assessment with Medicaid
and medical evaluation and management codes.
• GT modifier must be used when billing the for telepsychiatric services.
• All equipment must operate at a minimum communication transfer rate of 384
kbps.

Source: SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 2-25 to 2-26. (Jul.2018). (Accessed Apr. 2019).
Eligible Services / Specialties

Eligible services include consultation, diagnostic, and treatment services:
• Office or other outpatient visits;
• Inpatient consultation;
• Individual psychotherapy;
• Pharmacologic management;
• Psychiatric diagnostic interview examination and testing;
• Neurobehavioral status examination;
• Electrocardiogram interpretation and report only;
• Echocardiography.
Services provided by allied health professionals are not covered.
Telemedicine services are not an expansion of covered services, but an option for the
delivery of certain covered services.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-34 to 2-37 (Mar. 2019) & Local Education Manual, p. 2-45. (Jan. 2019). (Accessed Apr. 2019).

 

Telepsychiatry
Psychiatric Diagnostic assessment with medical services to assess or monitor the client’s psychiatric and/or physiological status may be provided via telehealth.
These community mental health services are ineligible:
• Injectables;
• Nursing services;
• Crisis intervention;
• Individual, family, group and multiple family psychotherapy;
• Psychological testing which require “hands-on” encounters;
• Mental health assessment by non-physician; and
• Service Plan Development.

Source: SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 2-26 to 2-28 (July 2018). (Accessed Apr. 2019).

 

Autism Spectrum Disorder
Telehealth is not covered.

Source: SC Health and Human Svcs. Autism Spectrum Disorder Provider Manual, p. 2-33 (Feb. 2019). (Accessed Apr. 2019).
Eligible Providers

Distant site eligible, reimbursed providers:
• Physicians;
• Nurse practitioners;
• Physician Assistants.
Distant (consultant) sites must be located in the SC Medical Service Area, which is the
state of SC and areas in NC and GA within 25 miles of the SC border

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-35 to 2-36. (Mar. 2019) & Local Education Manual, p. 2-43 to 2-44. (Jan. 2019). (Accessed Apr. 2019).

 

Eligible Sites

Eligible originating (referring) sites:
• Practitioner offices;
• Hospitals (inpatient and outpatient);
• Rural Health Clinics;
• Federally Qualified Health Centers;
• Community Mental Health Centers;
• Public Schools;
• Act 301 Behavioral Health Centers.
Referring sites (also known as originating sites) must be located in the South Carolina
Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

Source: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 2-35 (Mar. 2019) & Local Education Manual, p. 2-43 to 2-44. (Jan. 2019). (Accessed Apr. 2019).

 

An appropriate certified or licensed health care professional at the referring site is required to present (patient site presenter) the beneficiary to the physician or practitioner at the consulting site and remain available as clinically appropriate.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-37 (Mar. 2019) & Local Education Manual, p. 2-46. (Jan. 2019). (Accessed Apr. 2019)

 

Telepsychiatry
Psychiatric diagnostic assessments (via telepsychiatry) may be provided in:
• A client’s home;
• An inpatient or outpatient general hospital;
• A Community Mental Health Center;
• School;
• Nursing Facility; or
• Other approved facility

Source: SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 2-29 (Apr. 2019). (Accessed Apr. 2019).
Geographic Limits

Distant (consultant) sites must be located in the SC Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-35. (Mar. 2019) & Local Education Manual, p. 2-43. (Jan. 2019). (Accessed Apr. 2019).

 

Facility/Transmission Fee

The referring site is only eligible to receive a facility fee for telemedicine services. Claims are submitted with HCPCS code Q3014. If a provider performs separately identifiable service for a beneficiary on the same day as telemedicine, documentation of both services must be clearly and separately identified in the medical record and both services are eligible for reimbursement.
RHCs and FQHCs are eligible to receive a facility fee for telemedicine services when operating as the referring site. They may not bill encounter T1015 code if these are the only services being rendered.
Hospital providers are eligible to receive a facility fee for telemedicine when operating as the referring site. Claims must be submitted with revenue code 780.

 

Source: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 2-38 – 2-39 (Mar. 2019) & Local Education Manual, p. 2-47 to 2-48. (Jan. 2019). (Accessed Apr. 2019).

Store-and-Forward

Policy

South Carolina Medicaid will not reimburse for store-and-forward due to the requirements that the beneficiary must be present and participating in the visit and interactive audio and video telecommunication must be used.

 

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-37 (Mar. 2019) & Local Education Manual, p. 2-46. (Jan. 2019). (Accessed Apr. 2019).
Email / Phone / Fax

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

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-37 (Mar. 2019) & Local Education Manual, p. 2-45. (Jan. 2019). (Accessed Apr. 2019).

 

Licensed Independent Practitioner’s Rehabilitative Services.
Service Plan Development, crisis management and consultations between sychologists/LPES to families, schools or other health care providers can be provided telephonically.

Source: SC Health and Human Svcs. Dept. Licensed Independent Practitioner’s Rehabilitative Provider Manual, p. 2-33 to 2-34 & 2-36 to 2-37. (Mar. 2017). (Accessed Apr. 2019).

 

Telephone contact related to office procedures or appointment times are not covered.

Source: SC Health and Human Svcs. Dept. Licensed Independent Practitioner’s Rehabilitative Provider Manual, p. 2-41. (Mar. 2017). (Accessed Apr. 2019).
Consent

A patient’s written consent is required prior to the dissemination of any of their images or information to other entities.

 

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-38 (Mar. 2019) & Local Education Manual, p. 2-47. (Jan. 2019). (Accessed Apr. 2019).

 

A patient may withdraw from the use of telemedicine at any time.

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-37 (Mar. 2019). & Local Education Manual, p. 2-46. (Jan. 2019). (Accessed Apr. 2019).
Miscellaneous

If a beneficiary is a minor child, a parent and/or guardian must present the child for telemedicine services unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telemedicine session unless attendance is therapeutically appropriate.
Documentation to substantiate the services provided must be maintained at the medical records at referring and consulting locations. The documentation must include an indication that services were rendered via telemedicine and all other Medicaid documentation guidelines apply. The beneficiary has access to all transmitted medical information, with the exception of live interactive video, as there is often no stored data in such encounters

 

Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 2-37 & 2-39 (Mar. 2019). & Local Education Manual, p. 2-46 & 2-48 (Jan. 2019). (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Definitions

Telemedicine means the practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening practitioner.

Source: SC Code Annotated Sec. 40-47-20(52). (Accessed Apr. 2019).

 

South Carolina law addresses telemedicine under veterinary services, stating, “telemedicine is an audio, video, or data communication of medical information.”

Source: SC Code Annotated Sec. 40-69-20(15). (Accessed Apr. 2019).
Online Prescribing

A licensee shall not establish a physician-patient relationship by telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.
Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications.
To establish a physician-patient relationship via telemedicine, the provider must:
• Comply with state and federal laws on patient confidentiality
• Adhere to current standards of practice
• Provide an appropriate examination
• Verify the identity and location of the patient and be prepared to inform the patient of the licensee’s name, location and professional credentials
• Establish a diagnosis through the use of accepted medical practices
• Ensure availability of follow-up care
• Prescribe within a practice setting fully in compliance with the law
• Maintain a complete record of the patient’s care
• Maintain the patient’s records’ confidentiality
• Be licensed to practice in South Carolina
• Be trained in the use of telemedicine
• Discuss with the patient the value of having a primary care medical home and, if the
patient requests, provide assistance in identifying available options for a primary care medical home.
Schedule II and III prescriptions are not permitted except as specifically authorized by the board.

 

Source: SC Code Annotated Sec. 40-47-37. (Accessed Apr. 2019).
Miscellaneous

Professional Board Telehealth Specific Regulations
• SC Board of Occupational Therapy (Source: SC OT Board eNews. (Apr. 2010) (Accessed Apr. 2019)

 

Cross-State Licensing

The physician must be licensed in South Carolina; however, they do not need to reside in South Carolina.

Source: SC Code Annotated Sec. 40-47-37(C)(9). (Accessed Apr. 2019).

 

Member of the Physical Therapy Compact.

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

 

Member of the Nurse Licensure Compact.

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

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