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Telemedicine

Posted: 10-19-2017

Overview

Telemedicine is defined as the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site.

Effective January 1, 2016, MHCP allows payment for expanded telemedicine services in substance use disorder treatment for services that are otherwise covered as direct face-to-face services. Payment is allowed for interactive audio and video telecommunications which permit real-time communication between the distant site provider’s counselor or practitioner and the recipient. The services must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face encounter.

Eligible Providers

Providers currently authorized to provide services may conduct the same services via telemedicine. To be eligible for reimbursement, providers must self-attest that they meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF).

Eligible Recipients

Telemedicine coverage applies to MHCP recipients in prepaid health plans and fee-for-service programs. Recipients are eligible to receive substance abuse disorder services by telemedicine when:

  • • Telemedicine is determined medically appropriate
  • • The recipient has consented to using a telemedicine method before receiving services
  • Originating Sites

    The originating site is the location of an eligible MHCP recipient at the time the service is being furnished via a telecommunication system. Authorized originating sites are:

  • • Substance abuse disorder treatment facility (residential or outpatient)
  • • Office of physician or practitioner
  • • Hospital (inpatient or outpatient)
  • • Withdrawal management facility
  • • Drug court office
  • • Correctional facility-based office (including jails)
  • • School
  • • Community mental health center (CCBHC)
  • • Residential facility such as a group home and assisted living
  • • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • Covered Services

    Individual, non-residential treatment (H2035) is the only substance use disorder service currently reimbursed when delivered via telemedicine.

    Noncovered Services

    The following services are not covered:

  • • Electronic connections that are not conducted over a secure encrypted web site as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy & Security rules (e.g. Skype)
  • • Prescription renewals
  • • Scheduling a test or appointment
  • • Reporting test results
  • • Non-clinical communication
  • • Communication via telephone, email or facsimile
  • Coverage Limitations

    Note the following limitations:

  • • Payment for telemedicine services is limited to three per week per recipient
  • • Payment is not available to providers for sending materials
  • Documentation Requirements:

    As a condition of payment, each occurrence of a telemedicine service must include the following documentation:

  • • The type of service provided
  • • The time the service began and the time the service ended, including an a.m. and p.m. designation
  • • A description of the provider’s basis for determining that telemedicine is an appropriate and effective means for delivering service to the recipient
  • • The mode of transmission of the telemedicine service
  • • The location of the originating and distant site
  • • Compliance with the criteria attested to by the health care provider
  • Billing

    Refer to the following when billing for services provided through telemedicine:

  • • Services provided via telemedicine have the same service thresholds, authorization requirements and reimbursement rates as services delivered face-to-face
  • • Bill for services delivered by telemedicine with modifier GT (via interactive audio and video telecommunications systems)
  • • Use the place of service code that identifies the location of the recipient when the service is provided
  • • When billing a service with the GT modifier, the provider is certifying that they rendered services to a patient by an interactive audio and visual telecommunications system when the patient was located at an eligible originating site
  • Legal References

    Minnesota Rules 2960.0430-0490
    Minnesota Rules, parts 9530.6405 to 9530.6505
    (Rule 31)
    Minnesota Rules, parts 9530.6510 to 9530.6590
    (Rule 32)
    Minnesota Statutes 245F

    Minnesota Statutes 245G

    Minnesota Statutes 256B.0625, subdivision 3b(b)

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    © 2017 Minnesota Department of Human Services Updated: 10/19/17 1:43 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 10/19/17 1:43 PM