Remote Patient Monitoring
POLICY
Remote patient monitoring services provided through telehealth may be used by patients who meet the requirements of this Section and are capable and willing to use home telehealth and can maintain performance of needed tasks or have the availability of informal caregivers to help with remote patient monitoring through telehealth.
SOURCE: LA Statute Title 40, Sec. 1221.4 (Accessed Jun. 2025).
“Remote patient monitoring services” means the delivery of in-home healthcare services using telecommunications technology to enhance the delivery of in-home health care, including but not limited to all of the following:
- Monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, and other condition-specific data, such as blood glucose and activity trackers.
- Medication adherence monitoring.
- Interactive video conferencing with or without digital image upload.
“Telehealth” has the same meaning as defined in R.S. 40:1223.3.
SOURCE: LA Statute Title 40, Sec. 1227.3 (Accessed Jun. 2025).
Remote patient monitoring services through telehealth may consist of all of the following:
- An assessment, problem identification, and evaluation which includes all of the following:
- Assessment and monitoring of clinical data, including but not limited to appropriate vital signs, pain levels, and other biometric measures specified in the plan of care and an assessment of responses to previous changes in the plan of care.
- Detection of condition changes based on the telehealth encounter that may indicate the need for a change in the plan of care.
- Implementation of a management plan through one or more of the following:
- Teaching regarding medication management as appropriate based on the telemedicine findings for that encounter.
- Teaching regarding other interventions as appropriate to both the patient and the caregiver.
- Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services.
- Coordination of care with the ordering healthcare provider regarding telehealth findings.
- Coordination and referral to other healthcare providers as needed.
- Referral for an in-person visit or the emergency room as needed.
SOURCE: LA Statute Title 40, Sec. 1227.6 (Accessed Jun. 2025).
Personal Emergency Response System (PERS)
PERS is an electronic device that enables the beneficiary to secure help in an emergency. See manual for details.
Community Choices Waiver
Telecare is a delivery of care services to beneficiaries in their home by means of telecommunications and/or computerized devices to improve outcomes and quality of life, increase independence and access to health care, and reduce health care costs. Telecare services include the following:
- Activity and Sensor Monitoring,
- Health status monitoring, and
- Medication dispensing and monitoring.
Monthly telecare services consist of:
- Delivering, furnishing, maintaining and repairing/replacing equipment on an ongoing basis. This may be done remotely as long as all routine requests are resolved within three business days;
- Monitoring of recipient-specific service activities by qualified staff;
- Training the recipient and/or the recipient’s responsible representative in the use of the equipment;
- Cleaning and storing equipment;
- Providing remote teaching and coaching as necessary to the recipient and/or caregiver(s); and
- Analyzing data, developing and documenting interventions by qualified staff based on information/data reported.
All telecare providers must make documentation collected from telecare services available to the support coordinator and OAAS upon request.
Activity and Sensor Monitoring
Activity and senor monitoring (ASM) is a computerized system that monitors the beneficiary’s inhome movement and activity for health, welfare, and safety purposes. The system is individually calibrated based on the beneficiary’s typical in-home movements and activities. The provider is responsible for monitoring electronically generated information, for responding as needed, and for equipment maintenance. At a minimum, the system shall include the following:
- Monitor the home’s points of egress;
- Detect falls;
- Detect movement or lack of movement;
- Detect whether doors are opened or closed; and
- Provide a push button emergency alert system.
See manual for more information.
Health Status Monitoring
The health status monitoring service collects health-related data to assist the health care provider in assessing the beneficiary’s health condition and in providing beneficiary education and consultation. The data is collected electronically from the beneficiary using wireless technology or a phone line and assists the healthcare provider in assessing the beneficiary’s health. Health status monitoring may be beneficial to beneficiaries with chronic medical conditions such as congestive heart failure, diabetes, or pulmonary disease in monitoring the beneficiary’s:
- Weight;
- Oxygen saturation measurements (pulse oximetry); and
- Vital signs (pulse, blood pressure, etc.).
Peripheral equipment used must be capable of interfacing with the telecare health status monitoring equipment.
Medication Dispensing and Monitoring
The medication dispensing and monitoring service assists the beneficiary by dispensing medication and monitoring medication compliance. A remote monitoring system is individually pre-programed to dispense and monitor the beneficiary’s compliance with medication therapy. The provider or family caregiver is notified when there are missed doses or non-compliance with medication therapy.
Dispensing and monitoring devices must have the ability to send text or e-mail messages to the beneficiary’s caregiver should the medication not be taken or there is a problem with the equipment.
Dispensing and monitoring systems may include a web-based component for dosage programming, monitoring, and/or communication.
Standards
Assistive Devices and Medical Supplies Provided by a Durable Medical Equipment (DME) provider that:
- Has enrolled in Medicaid as an OAAS Waivers – assistive devices provider (provider type 17);
OR
Provided by a DME provider that:
- Is enrolled to provide DME; and
- Has enrolled in Medicaid as an OAAS Waivers – assistive devices provider (provider type 17);
OR
Provided by a home health agency provider that:
- Is enrolled to provide DME; and
- Has enrolled in Medicaid as an OAAS Waivers – assistive devices provider (provider type 17);
OR
Provided by a PERS provider that:
- Has enrolled in Medicaid as a PERS provider (provider type 16); and
- Has furnished verification (copy of letter from the manufacturer written on the manufacturer’s letterhead stationary) that the provider is an authorized dealer, supplier or manufacturer of a PERS product.
OR
Provided by a support coordination agency that:
- Is certified by LDH/OAAS to provide support coordination services;
- Has signed the OAAS Performance Agreement;
- Has at least one support coordinator supervisor and one support coordinator who has passed the assessment and care planning certification training;
- Has a brochure that has been approved by OAAS;
- Has submitted a completed OAAS agency contact information form to OAAS;
- Has enrolled as a Medicaid provider of support coordination services in all regions in which it intends to provide service; and
- Is listed on the support coordination agency FOC form
Technology Supports with Remote Features:
- Mobile Emergency Response System- an on-the-go mobile medical alert system, used in and outside the home. This system will cellular/GPS technology, two-way speakers and no base station required;
- Medication Reminder System- an electronic device programmed to remind individual to take medications by a ring, automated recording or other alarm. The electronic device may dispense controlled dosages of mediation and may include a message back to the center if a medication has not been removed from the dispenser. Requires ability to self administer medication with reminder and services face-to-face once per month;
- Monitoring Device, stand alone or intergraded, include all accessories, components and electronics not otherwise classified. Monitoring Feature device may be interactive audio and video;
- Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs;
- Purchase of emergency response system; and
- Other equipment used to support someone remotely may include but not limited to: electronic motion door sensor devices, door alarms, web-cams, telephones with modifications (large buttons, flashing lights), devices affixed to wheelchair or walker to send alert when fall occurs, text-to-speech software, intercom systems, tablets with features to promote communication or smart device speakers.
Remote Technology Service Delivery: covers monthly response center/remote support monitoring fee and tech upkeep (no internet cost coverage)
Remote Technology Consultation: evaluation of tech support needs for an individual, including functional evaluation of technology available to address the person’s assess needs and support person to achieve outcomes identified in the POC.
CONDITIONS
Remote patient monitoring services provided through telehealth may be used by patients who meet the requirements of this Section and are capable and willing to use home telehealth and can maintain performance of needed tasks, or have the availability of informal caregivers to help with remote patient monitoring through telehealth.
To qualify for participation in remote patient monitoring services, a patient shall meet any two of the following criteria:
- Be diagnosed with one or more chronic conditions, as defined by the Centers for Medicare and Medicaid Services, which include but are not limited to sickle cell disease, mental illness, asthma, diabetes, cancer, and heart disease.
- Have a recent history of costly service use due to one or more chronic conditions as evidenced by two or more hospitalizations, including emergency room visits, in the last twelve months.
- Have a recommendation from the patient’s healthcare provider for disease management services through remote patient monitoring
SOURCE: LA Statute Title 40, Sec. 1227.5 (Accessed Jun. 2025).
Health status monitoring:
Health status monitoring may be beneficial to beneficiaries with chronic medical conditions such as congestive heart failure, diabetes, or pulmonary disease in monitoring the beneficiary’s:
- Weight;
- Oxygen saturation measurements (pulse oximetry); and
- Vital signs (pulse, blood pressure, etc.).
Services must be based on a verified need of the beneficiary and the service must have a direct or remedial benefit with specific goals and outcomes.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 29 (as issued on 1/13/25). (Accessed Jun. 2025).
PROVIDER LIMITATIONS
Assistive devices and providers that provide telecare services under ADMS, must meet the following system requirements:
- Be UL listed/certified or have 501(k) clearance;
- Be web-based;
- Be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- Have beneficiary specific reporting capabilities for tracking and trending;
- Have a professional call center for technical support based in the United States; and
- Have on-going provision of web-based data collection for each beneficiary, as appropriate. This includes response to beneficiary self-testing, manufacturer’s specific testing, self-auditing, and quality control.
OTHER RESTRICTIONS
In any reimbursement claim for the remote monitoring services provided, the appropriate procedure code as established by the Louisiana Department of Health for the covered healthcare service shall be included with the appropriate modifier indicating telehealth services were used.
Nothing in this Section shall prohibit any health benefit plan offered by a health insurer, managed care organization, or other health payor from establishing its own policy and payment structure for in lieu of service agreements with providers.
SOURCE: LA Statute Title 40, Sec. 1227.8 (Accessed Jun. 2025).
Any telehealth equipment and network used for remote patient monitoring services shall meet all of the following requirements:
- Compliance with applicable standards of the United States Food and Drug Administration.
- Maintenance of telehealth equipment in good repair and free from safety hazards.
- Installation of only new or sanitized equipment in the patient’s home setting.
- Availability of technical and clinical support services for the patient user.
SOURCE: LA Statute Title 40, Sec. 1227.7 (Accessed Jun. 2025).
Where applicable, beneficiaries must use Medicaid state plan services, Medicare, or other available payers first. The beneficiary’s preference for a certain brand or supplier is not grounds for declining another payer in order to access waiver services.
Limitations
- Services must be based on a verified need of the beneficiary and the service must have a direct or remedial benefit with specific goals and outcomes.
- The benefit must be determined by an independent assessment on any item that costs over $500 and on all communication devices, mobility devices, and environmental controls.
- Independent assessments must be performed by individuals who have no fiduciary relationship with the manufacturer, supplier, or vendor of the item.
- All items must reduce reliance on other Medicaid State Plan or waiver services.
- All items must meet applicable standards of manufacture, design, and installation.
- The items must be on the POC developed by the support coordinator and are subject to approval by OAAS Regional office or its designee.
- A beneficiary will not be able to simultaneously receive telecare activity and sensor monitoring services and traditional PERS services.
Reimbursement for Telecare services includes a one-time installation fee that covers the cost of equipment installation and removal. A monthly maintenance fee includes a face-to-face visit by a qualified professional should the collected data warrant a visit. Should the beneficiary require additional visits during the month, those visits must be conducted by a nurse, authorized by the support coordinator, and provided under Nursing Service. If the data indicates a potential emergency, the provider may dispatch a qualified professional without consultation for approval with the support coordinator; however, the support coordinator must be contacted by the next business day to request retroactive approval.
Billing for PERS or Telecare services involves an installation fee and a monthly maintenance fee. Only one claim for each month is allowed. Claims for the monthly maintenance fee may be span-dated at the discretion of the provider. Partial months shall not be billed.
If a beneficiary who receives PERS or Telecare service moves to a different location or changes providers, reimbursement for a second installment is permissible.
Assistive devices/equipment and/or medical supplies (up to $500) are reimbursed in the amount authorized in the POC or POC revision. The PA is released upon completion and submission of the Assistive Devices and Medical Supplies form and the approved POC or POC revision by the support coordinator.
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