Remote Patient Monitoring
POLICY
Telemonitoring Services are the use of information technology to remotely monitor a member’s health status through the use of clinical data while the member remains in the residential setting. Telemonitoring may or may not take place in real time.
“Telemonitoring,” as it pertains to the delivery of MaineCare services, means the use of information technology to remotely monitor a patient’s health status via electronic means, allowing the provider to track the patient’s health data over time. Telemonitoring may be synchronous or asynchronous.
SOURCE: ME Statute Sec. 22:855.3173-H(E), (Accessed Feb. 2025).
Telemonitoring Services: The use of information technology to remotely monitor a Member’s health status via electronic means, allowing the provider to track the enrollee’s health data over time. Telemonitoring may be synchronous or asynchronous.
Telemonitoring Services are intended to collect a Member’s health related data, such as pulse and blood pressure readings, that assist Health Care Providers in monitoring and assessing the Member’s medical conditions. The following activities qualify as Telemonitoring Services:
- Evaluation of the Member to determine if Telemonitoring Services are medically necessary for the Member. Prior to conducting an evaluation, the Home Health Agency must assure that a Health Care Provider’s order
or note demonstrating the necessity of Telemonitoring Services, is included in the Member’s Plan of Care. - Evaluation of the Member to assure that the Member is cognitively and physically capable of operating the Telemonitoring equipment or assurance that the Member has a caregiver willing and able to assist with the equipment;
- Evaluation of the Member’s residence to determine suitability for Telemonitoring Services. If the residence appears unable to support Telemonitoring Services, the Home Health Agency may not implement Telemonitoring Services in the Member’s residence unless necessary adaptations are made. Adaptations are not reimbursable by MaineCare;
- Education and training of the Member and/or caregiver on the use, maintenance and safety of the Telemonitoring equipment, the cost of which is included in the monthly flat rate paid by MaineCare to the Home Health Agency;
- Remote monitoring and tracking of the Member’s health data by a registered nurse, nurse practitioner, physician’s assistant, or physician, and response with appropriate clinical interventions. The Home Health Agency and Health Care Provider utilizing the data shall maintain a written protocol that indicates the manner in which data shall be shared in the event of emergencies or other medical complications;
- At least monthly Interactive Telehealth Services or Telephonic Services with the Member;
- Maintenance of equipment, the cost of which is included in the monthly flat rate paid by MaineCare to the Home Health Agency; and
- Removal/disconnection of equipment from the Member’s home when Telemonitoring Services are no longer necessary or authorized.
SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Nov. 6, 2023). Adopted 10-144 C.M.R. Chapter 101, Chapter I, Section 4, Telehealth Services. (Nov. 6, 2023). (Accessed Feb. 2025).
Home and Community Benefits for the Elderly and for Adults with Disabilities
Assistive Technology-Remote Monitoring means real time remote support monitoring of the member with electronic devices to assist them to remain safely in their homes. Remote monitoring services may include a range of technological options including in-home computers, sensors, and video camera linked to a provider that enables 24/7 monitoring and/or contact as necessary.
CONDITIONS
In order to be eligible for telemonitoring a member must:
- Be eligible for home health services;
- Have a current diagnosis of a health condition requiring monitoring of clinical data at a minimum of five times per week, for at least one week;
- Have documentation in the patient’s medical record that the patient is at risk of hospitalization or admission to an emergency room OR have continuously received Telemonitoring Services during the past calendar year and have a continuing need for such services, as documented by an annual note from a health care provider;
- Have telemonitoring services included in the Member’s plan of care. A notation from a Health Care Provider, dated prior to the beginning of service delivery, must be included in the Member’s Plan of Care. MaineCare shall not
reimburse for Telemonitoring Services if they began prior to the date recorded in the Provider’s note. - Reside in a setting suitable to support telemonitoring equipment; and
- Have the physical and cognitive capacity to effectively utilize the telemonitoring equipment or have a caregiver willing and able to assist with the equipment.
- Have telemonitoring services included in the member’s plan of care. A notation from a Health Care Provider, dated prior to the beginning of service delivery, must be included in the member’s plan of care. If telemonitoring Services begin prior to the date recorded in the provider’s note, services shall not be reimbursed. [last bullet only in Home Health Services Manual].
SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.02-2. p.3 (Nov. 6, 2023). Adoption 10-144 C.M.R. Chapter 101, Chapter I, Section 4, Telehealth Services (Nov 6, 2023) & MaineCare Benefits Manual. Ch. II. Home Health Services. Sec. 40.05. p. 10-11. (Aug. 11, 2019). (Accessed Feb. 2025).
Home and Community Benefits for the Elderly and for Adults with Disabilities Final approval must be obtained from the Department, Office of Aging and Disability Services upon a recommendation by the ASA or SCA. In making such a recommendation the ASA or the SCA must consider and document the following information:
- Number of hospitalizations in the past year;
- Use of emergency room in the past year;
- History of falls in the last six months resulting from injury;
- Member lives alone or is home alone for significant periods of time;
- Service access challenges and reasons for those challenges;
- History of behavior indicating that a member’s cognitive abilities put them at a significant risk of wandering; and
- Other relevant information.
PROVIDER LIMITATIONS
Telemonitoring will be reimbursed only when provided by a certified Home Health Agency. See regulations for specific requirements of Home Health Agencies utilizing telemonitoring services.
In order to be eligible for reimbursement for Telemonitoring Services, a Health Care Provider must be a certified Home Health Agency pursuant to the MBM Chapter II, Section 40, Home Health Services. Compliance with all applicable requirements listed in Chapter II, Section 40, Home Health Services, is required.
The Health Care Provider ordering the service must be a Health Care Provider with prescribing privileges (physician, nurse practitioner or physician’s assistant).
Health Care Providers must document that they have had a face-to-face encounter with the Member before a physician may certify eligibility for services under the home health benefit. This may be accomplished through interactive telehealth services, but not by telephone or e-mail.
OTHER RESTRICTIONS
Telemonitoring services are intended to collect a member’s health-related data, such as pulse and blood pressure readings, that assist healthcare providers in monitoring and assessing the member’s medical conditions.
A note, dated prior to the beginning of service delivery, and demonstrating the necessity of home telemonitoring services, must be included in the member’s file. In the event that services begin prior to the date recorded on the provider’s note, services delivered in that month will not be covered.
Telemonitoring services must be included in the member’s plan of care. See page 16-17 for responsibilities of home health agencies utilizing telemonitoring.
Services shall not be duplicate of any other services. See regulation for examples of duplication.
See home health manual for list of non-covered services.
Department required to adopt regulations that comply with the following:
- May not include any requirement that a patient have a certain number of ER visits or hospitalizations related to the patient’s diagnosis in the criteria for a patient’s eligibility for telemonitoring services;
- Except as provided in the last bullet point (see below), must include qualifying criteria for a patient’s eligibility of telemonitoring services that include documentation in a patient’s medical record that the patient is at risk of hospitalization or admission to an ER
- Must provide that group therapy for behavioral health or addiction services covered by the MaineCare program may be delivered through telehealth;
- Must include requirements for providers providing telehealth and telemonitoring services; and
- Must allow at least some portion of case management services covered by the MaineCare program to be delivered through telehealth, without requiring qualifying criteria regarding a patient’s risk of hospitalization or admission to an emergency room.
SOURCE: ME Statute Sec. 3173-H, (Accessed Oct. 2024).
Home and Community Benefits for the Elderly and for Adults with Disabilities
Use of remote monitoring requires sufficient Back Up Plans and the SCA will be responsible for ensuring that the member has at least two adequate back-up plans prior to making a referral for this service.
Telemonitoring Services
Only the Health Care Provider at the Receiving (Provider) Site will be reimbursed for Telemonitoring Services.
No Originating Facility Fee will be paid for Telemonitoring Services.
Only a Home Health Agency may receive reimbursement for Telemonitoring Services.
Telemonitoring Services shall be billed using code S9110, which provides for a flat monthly fee for services, which is inclusive of all Telemonitoring Services, including, but not limited to:
- Equipment installation;
- Training the Member on the equipment’s use and care;
- Monitoring of data;
- Consultations with the primary care physician; and
- Equipment removal when the Telemonitoring Service is no longer medically necessary.
Except as described in this policy, no additional reimbursement beyond the flat fee is available for Telemonitoring Services.
MaineCare will not reimburse separately for Telemonitoring equipment purchase, installation, or maintenance.
If in-person visits are required, these visits must be billed separately from the Telemonitoring Service in accordance with Chapters II and III, Section 40, Home Health Services, of the MBM.
If an interpreter is required, the Home Health Agency may bill for interpreter services in accordance with another billable service and the requirements of Chapter I, Section 1, of the MBM.
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