Remote Patient Monitoring
POLICY
Subject to appropriations, the department shall establish a statewide program that permits reimbursement under the MO HealthNet program for home telemonitoring services.
“Home telemonitoring service” shall mean a health care service that requires scheduled remote monitoring of data related to a participant’s health and transmission of the data to a health call center accredited by the Utilization Review Accreditation Commission (URAC).
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Apr. 2026).
CONDITIONS
The program shall: Provide that home telemonitoring services are available only to persons who: Are diagnosed with one or more of the following conditions:
- Pregnancy
- Diabetes
- Heart disease
- Cancer
- Chronic obstructive pulmonary disease
- Hypertension
- Congestive heart failure
- Mental illness or serious emotional disturbance
- Asthma
- Myocardial infarction; or
- Stroke
The beneficiary must also exhibit two or more the following risk factors:
- Two or more hospitalizations in the prior twelve-month period;
- Frequent or recurrent emergency department admissions;
- A documented history of poor adherence to ordered medication regimens;
- A documented history of falls in the prior six-month period;
- Limited or absent informal support systems;
- Living alone or being home alone for extended periods of time;
- A documented history of care access challenges; or
- A documented history of consistently missed appointments with health care providers
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Apr. 2026).
The Assistive Technology service is available in all four of the Developmental Disabilities Waiver.
Electronic support systems using on demand video and/or web-cameras, or other technology is only available on an individual, case-by-case basis when an individual requests the service and the planning team agrees it is appropriate and meets the health and safety needs of the individual. Video and/or web-cameras shall not record audio or video feed of an individual. When video equipment is utilized, the data system shall track all utilization of the equipment including who activated it, when it was activated, how long it was active, and why it was activated. When cameras are utilized, they may not be placed in or provide view of private spaces such as bedrooms and bathrooms. See manual for more details.
Effective August 29, 2024, MO HealthNet will expand coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without a prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently OR if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim.
As a reminder, any MO HealthNet participant who currently utilizes insulin can also obtain a CGM without a prior authorization.
PROVIDER LIMITATIONS
Provider must ensure that clinical information gathered by a home health agency or hospital while providing home telemonitoring services is shared with the participant’s physician.
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Apr. 2026)
OTHER RESTRICTIONS
Provider must ensure that the program does not duplicate any disease management program services provided by MO HealthNet.
If, after implementation, the department determines that the program established under this section is not cost effective, the department may discontinue the program and stop providing reimbursement under the MO HealthNet program for home telemonitoring services.
The department shall promulgate rules and regulations to implement the provisions of this section.
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Apr 2026).
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