MARYLAND Telehealth Program Manual

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Telehealth Provider Manual

MARYLAND MEDICAID TELEHEALTH PROGRAM

Updated May 3, 2016

MARYLAND MEDICAID TELEHEALTH PROGRAM

Table of Contents

Scope

Service Model

Covered Services

Program Eligibility

Provider Registration

Technical Requirements

Reimbursement

Condentiality

Medical Records

Appendices

A: MCO and ASO Contacts

B: Provider Scenarios

TOC

MARYLAND MEDICAID TELEHEALTH PROGRAM

Program Scope and Service Model

Scope

This manual contains information about the Maryland Medicaid Telehealth Program. Information included in

this manual is subject to COMAR 10.09.49, Telehealth Services.

The purpose of providing medically necessary services via telehealth is to improve:

· Access to both outpatient specialty care and psychiatric services, thus reducing preventable hospital-

izations and reducing barriers to health care access;

· Access to outpatient and inpatient psychiatric subspecialty consultation, thus improving diagnostic

 clarication,treatmentrecommendations,andplanningforindividuals;

· Health outcomes through timely disease detection and treatment options; and

· Capacity and choice for ongoing outpatient and inpatient treatment in underserved areas of the State.

Effective October 1, 2015, Maryland Medicaid combined the Telemedicine and Telemental Health Programs

and renamed as the Telehealth Program. The Telehealth Program serves Medicaid participants regardless of

geographic location within Maryland.

Telehealth participants may be enrolled in the fee-for-service (FFS) program or a HealthChoice managed care

organization (MCO). Telehealth providers must be enrolled in the Maryland Medical Assistance Program and

Additionally, providers billing for behavioral health services must register with the Department's administrative

service organization (ASO), Beacon Health Options before rendering behavioral health services.

Service Model

Maryland Medicaid’s Telehealth Program employs a “hub-and-spoke” model. The “hub,” or “distant site,” is

the location of provider who will perform the services. The "distant site provider," who is physically present at

the distant site, provides services via telehealth communication to the “spoke,” or “originating site,” where the

participant is located. The "telepresenter," who is physically located at the originating site with the participant,

facilitates the telehealth communication and assists the distant site provider by arranging/moving the tele-

health equipment. Communication between the originating and distant sites involves real-time interaction via a

secure, two-way audio-visual telecommunication system.

The originating site must obtain consent from the patient prior to engaging in telehealth. The participant's

medical record must contain documentation of the participant's consent. If the participant is unable to consent,

the medical record must contain in writing an explanation as to why the participant was unable to consent to

telehealth.

Please review "Provider Scenarios" in Appendix B for more information about appropriate Maryland Medicaid

telehealth service model arrangements.

MARYLAND MEDICAID TELEHEALTH PROGRAM

Covered Services

Services provided through telehealth are subject to the same program restrictions, preauthorizations, limita-

tions and coverage that exist for the service when provided in-person.

Somatic services: Providers must contact the participant's Healthchoice MCO with questions regarding

prior authorization requirements for telehealth services.

Behavioral Health services: Providers must contact Beacon Health Options with questions regarding

prior authorization requirements for telehealth services.

Covered Services: Somatic and Behavioral Health Services

MARYLAND MEDICAID TELEHEALTH PROGRAM

Participant Eligibility

A participant is eligible to receive telehealth services if the individual:

· Is enrolled in the Maryland Medical Assistance Program on the date the service is rendered;

· Consents to telehealth services (unless there is an emergency that prevents obtaining consent);

· Is present at the originating site at the time the telehealth service is rendered; and

· Is authorized to receive services, except for services provided in a hospital emergency department.

Provider Eligibility

Originating Sites

The following provider types may register as originating sites for telehealth:

  ·Acollegeoruniversitystudenthealthorcounselingofce*;

· A community-based substance use disorder provider;

· An elementary, middle, high, or technical school with a supported nursing, counseling or

  medicalofce;

· A local health department;

  ·AFederallyQualiedHealthCenter(FQHC);

· A hospital, including the emergency department;

· A nursing facility;

  ·Aprivateofce(physician,psychiatricnursepractitioner,nursepractitioner,ornursemidwife);

· An opioid treatment program;

· An outpatient mental health center (OMHC);

· A renal dialysis center; or

· A residential crisis services site

Program Eligibility

*RegisteringtobeaMedicaidTelehealthoriginatingsiteproviderdoesnotsupersedetheprocessofgettingtheapprovalof

the Maryland State Department of Education (MSDE) (and/or the local Public School System) to operate in school settings.

Medicaid regulations do not cover this part of the process. Please follow up with MSDE and the local Public School System to

ensure that everything is in compliance and everyone is on the same page.

Distant sites

Originating site providers may engage in agreements with the following distant site providers enrolled

as a Maryland Medicaid provider for telehealth services:

· A nurse midwife;

· A nurse practitioner;

· A psychiatric nurse practitioner;

· A physician; or

· An outpatient mental health center (OMHC)

MARYLAND MEDICAID TELEHEALTH PROGRAM

Provider Registration

Every Telehealth provider must complete an on-line registration. To register as a telehealth distant or originat-

ing site provider, please visit https://mmcp.dhmh.maryland.gov/Pages/telehealth.aspx. Scroll down and select

either: distant site provider registration form if you are registering as a distant site provider or originating site

provider registration form if you are registering as an originating site provider.

To complete the registration process, you will need:

· Your Maryland Medical Assistance provider number;

 ·YourNationalProviderIdentication(NPI)number;and

· An email account to receive for communications from the Telehealth team.

AfterMedicaidveriesyourregistrationinformation,youwillreceiveaconrmationemail.UntilMedicaidcon-

rmsyourregistration,providersshouldnotbillfortelehealthservices.

If you have any questions, you may email dhmh.telemedicineinfo@maryland.gov.

Provider Registration and Technical Requirements

MARYLAND MEDICAID TELEHEALTH PROGRAM

Technical Requirements

A provider of health care services delivered through telehealth shall adopt and implement technology in a

manner that supports the standard of care to deliver the required service.

Providers shall, at a minimum, meet the following technology requirements:

1. A camera that has the ability to manually, or under remote control, provide multiple views of a

patient with the capability of altering the resolution, focus, and zoom requirements according to

the consultation;

 2.Havedisplaymonitorsizesufcienttosupportdiagnosticneedsusedinthetelehealthservice;

 3.Bandwidthspeedandimageresolutionsufcienttoprovidequalityvideotomeetaminimumof

15 frames per second, or higher, as industry standards change;

4. Audio equipment that ensures clear communication and includes echo cancellation; and

5. Creates audio transmission with less than 300 millisecond delay.

MARYLAND MEDICAID TELEHEALTH PROGRAM

Reimbursement

Per COMAR 10.09.02.04, providers may only bill for services that they or their employees perform. Providers

may not bill on behalf of their telehealth partner.

Registered telehealth providers will submit claims in the same manner the provider uses for in-person services

(i.e., paper CMS 1500 forms or 837 electronic submissions).

Professional services rendered via telehealth are reimbursed the same as in-person services and on a fee-for-

service basis.

Registered originating site providers

Registered originating site providers may bill for the following:

· The telehealth transmission fee code Q3014; or

· If a Maryland-based hospital, the telemedicine revenue code 0780; or

· If an out-of-state hospital, the telehealth transmission fee code Q3014.

Registered distant site providers

As explained above, telehealth services must be provided through two-way audio-visual technology

assisted communication with an approved originating site where the participant is physically located.

 Registereddistantsiteprovidersmustbillandaccountforteleheathservicesusingthe“-GT”modier.

Reimbursement Limitations

The Program will not reimburse telehealth providers for the following reasons:

 ·Whentechnicaldifcultiespreventthedeliveryofpartorallofthetelehealthsession;

· Consultation that occurs during ambulance transport;

· Services that require in-person evaluation or cannot be reasonably delivered via telehealth;

· Distant site providers billing the transmission fee or facility fee;

· Use of telehealth services for home health monitoring;

· Use of “store-and-forward” service delivery models;

· Telecommunication between providers without the participant present;

· An audio-only telephone conversation between a provider and participant;

· An electronic mail message between a provider and participant;

· A facsimile transmission between a provider and participant;

· A telephone conversation, electronic mail message, or facsimile transmission between the originating

and distant site providers; or

· Claims submitted by the originating site on behalf of the telehealth distant site provider and vice versa.

Reimbursement

MARYLAND MEDICAID TELEHEALTH PROGRAM

Condentiality

Both originating and distant site providers must comply with the laws and regulations concerning the privacy

and security of protected health information under Health-General Article, Title 4, Subtitle 3, Annotated Code

of Maryland and the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Particularly, providers:

1. Shall ensure that all interactive video technology-assisted communication complies with HIPAA pa-

tient privacy and security regulations at the originating site, the distant site, and the transmission

process;

2. May not disseminate any participant images or information to other entities without the participant’s

consent, unless there is an emergency that prevents obtaining consent; and

3. May not store at originating or distant sites the video images or audio portion of the telehealth ser-

vice for future use.

Medical Records

The originating and distant site providers must maintain documentation in the same manner as during an

in-person visit or consultation, using either electronic or paper medical records, per the Health-General Article,

§4-403, Annotated Code of Maryland. Participants shall have access to all transmitted medical information, with

the exception of live, interactive video, as there is often no stored data in such encounters.

Reminder: originating site providers must document in the participant’s medical record if an emergency situa-

tion prevents obtaining consent for telehealth services.

CondentialityandPatientMedicalRecords

MARYLAND MEDICAID TELEHEALTH PROGRAM

Amerigroup

For preauthorization and administrative questions: 800-454-3730

Clinical Contact: Dr. Andrew Bergman, 410-981-4012

Jai

Marvin Council, Director of Regulatory Compliance

Phone: 410-433-2200

Email: marvin.council@jaimedical.com

Kaiser Permanente

Kenya Onley

Email: Kenya.c.onley@kp.org

Phone: 301.816.6564

Maryland Physicians Care

LindaDietsch,ComplianceOfcer

Phone: 410-401-9452

Fax: 860-907-2527

Email: Linda.Dietsch@marylandphysicianscare.com

MedStar

For preauthorization: Care Management: 800-905-1722

For enrollment: Lesley Wallace, AVP Regulatory Affairs, Network Development and Marketing

Email: Lesley.Wallace@medstar.net

Phone: 410-933-3013

Priority Partners

Clinical Contact: Dr. Robert Kritzler

Phone: 301-762-5925

Email: Rkritzler@jhhc.com

Sue Phelps

Email: sphelps@jhhc.com

Riverside

Jose Vazquez

Email: jvazquez@myriversidehealth.com

Phone: 443-552-3270

United Healthcare

Members: 800-318-8221

Providers: 877-842-3210

Beacon Health Options

Provider Relations: 800-888-1965

marylandproviderrelations@beaconhealthoptions.com

Fee-for-Service

dhmh.telemedicineinfo@maryland.gov

Appendix A: MCO and ASO Contacts

MARYLAND MEDICAID TELEHEALTH PROGRAM

Scenario One: Appropriate Use of Telehealth – Somatic Services

A16-year-oldboycomesintohispediatrician’sofceforasickvisit.HissymptomsalignwithbothIrritable

Bowel Syndrome (IBS) and Crohn’s Disease. There are several tests available for narrowing down the diagno-

sis, but his doctor is unsure which is appropriate. The doctor connects with his gastroenterologist telehealth

partner at a regional academic medical center. The gastroenterologist is located hours away from the boy and

his pediatrician, but through telehealth audio/video technology-assisted communication, the specialist is able

to examine the boy.

The gastroenterologist examines the boy’s medical record, which the pediatrician shares through a secure portal.

After asking the patient a series of questions about his symptoms and eating habits, the two doctors are able to

discuss options for testing, share opinions, and decide upon the most appropriate diagnostic test. The pediatri-

cian bills both the appropriate E&M code for the in-person services delivered and the Q code for the telehealth

originatingsitetransmissionfee.ThegastroenterologistbillstheE&Mcodewiththe–GTtelehealthmodier.

Scenario Two: Appropriate Use of Telehealth – Behavioral Health Services

AparticipantvisitsaStudentHealthCounselingOfceforatherapysession.Duringthesession,theLCSW

determines that a telehealth consultation with a psychiatrist is necessary to discuss the participant’s medication.

The LCSW sets up a telehealth consultation with a psychiatrist at a distant site. The psychiatrist confers with

the participant about her current medication. The LCSW does not participate in the telehealth session with the

participant, but enables the telehealth session by initiating the connection.

Followingthetelehealthsession,theStudentHealthCounselingOfcebillstheQ-codefororiginatingsite

transmissionfee.ThepsychiatristbillstheappropriateE&Mcodewiththe–GTtelehealthmodier.

Scenario Three: Appropriate Use of Telehealth – Behavioral Health Services

A9-yearoldparticipantseesapsychiatricnursepractitionerataprivateofcetoreviewhiscurrentdiagnosis,

medication, and behaviors. The psychiatric nurse practitioner is considering prescribing new medication, but

would like to consult with a child psychiatrist. Via telehealth, the psychiatric nurse practitioner and patient con-

nect with a child psychiatrist at a distant site to discuss the child’s clinical picture and medication options. Both

the psychiatric nurse practitioner and the psychiatrist are actively involved in the telehealth session.

Following the telehealth session, the psychiatric nurse practitioner bills the appropriate E&M code for the men-

tal health service and Q-code for originating site transmission fee. The psychiatrist bills the appropriate E&M

codewiththe–GTtelehealthmodier.

Scenario Four: Appropriate Use of Telehealth- Buprenorphine Services

Anindividualwithadiagnosedsubstanceusedisorderhaselectedtouse,andisidentiedasagoodcandi-

datefor,buprenophrinetohelpinhis/herrecoveryfromaddiction.IndividualisseenbyaCertiedAddictions

Program.TheCertiedAddictionsProgramcoordinatesburprenorphrineserviceswithaData2000waiver

physician who is enrolled with Medicaid and registered with the ASO. The physician, who is located at a distant

site, would bill for the buprenorphrine and the appropriate E&M codes for induction and maintenance using

the–GTmodiertoindicateservicesarebeingprovidedviatelehealthfromthedistantsite.TheCertiedAd-

dictions Program, as the originating site, may bill the Q-code.

TheCertiedAddictionsProgramobtainsauthorizationfortheirservicesthroughtheASO.ThePhysician

billing for buprenorphine must obtain authorization to bill the E&M codes but the level of intensity of the E&M

code should be congruent with the clinical level of need and will be subject to review.

Appendix B: Provider Scenarios

MARYLAND Telehealth Program Manual

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