Alabama

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: Yes
  • Audio Only: No

PRIVATE PAYER LAW

  • Law Exists: No
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant Sites explicitly allowed for Live Video: No
  • Store-and-Forward explicitly reimbursed: No
  • Audio-Only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: Alabama Medicaid
  2. Administrator: Alabama Medicaid Agency
  3. Regional Telehealth Resource Center: Southeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 11/15/2022

Audio-Only Delivery

Medicaid: Telephonic Postpartum Visits

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Telemedicine Coverage Extension

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Authorization of Telemedicine for Prenatal Visits During COVID-19 Emergency

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Tip Sheet – Guidance to Rehab Option Service Providers

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Tip Sheet – Guidance to Behavioral Health Provider

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Last updated 11/15/2022

Cross-State Licensing

No reference found. Previous COVID waiver expired.

Last updated 11/15/2022

Easing Prescribing Requirements

No reference found.

Last updated 11/15/2022

Miscellaneous

Medicaid: COVID-19 Emergency Expiration Date Extended

STATUS: Currently set to expire Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT

Last updated 12/13/2022

Originating Site

Medicaid: Telemedicine Origination Site Facility Fee for Outpatient Clinic Services

STATUS: Listed as expiring August 31, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Last updated 11/15/2022

Private Payer

Department of Insurance: Telehealth Services Guidance to Health Insurers

STATUS: Active

Department of Insurance: Covid-19 Testing And Treatment For The Uninsured

STATUS: Active

Last updated 11/15/2022

Provider Type

Medicaid: Speech Language and Occupational Therapy Providers

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Telemedicine Coverage Extension

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Temporarily Allowing Physical Therapy Services Through Telemedicine

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Temporary Changes to allow Delivering Healthcare Professionals Reimbursement for Telephonic Postpartum Visits

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Authorization of Telemedicine for Prenatal Visits During COVID-19 Emergency

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Extension of Procedure Code Coverage For Physicians, CRNPs, PAs, FQHCs, RHCs, Optometrists, ADPH, and CRS

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Last updated 11/15/2022

Service Expansion

Medicaid: Origination Site Facility Fee for Outpatient Clinic Services

STATUS: Listed as expiring August 31, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Telemedicine for Prenatal Visits

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Temporary Physical Therapy Services

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Speech Language and Occupational Therapy Providers

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Telephonic Postpartum Visits

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Telemedicine Coverage Extension

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Tip Sheet – Guidance to Rehab Option Service Providers

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Tip Sheet – Guidance to Behavioral Health Provider

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Medicaid: Extension of Telemedicine Procedure Codes

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until the earlier of Nov. 30, 2022, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

Last updated 11/15/2022

Definition

No Reference Found

Last updated 11/15/2022

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 11/15/2022

Requirements

No Reference Found

Last updated 11/15/2022

Definitions

There is no explicit definition of “telemedicine” given in state Medicaid policy. However, the provider manual states, “Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site physician and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the physician, recipient, or a consultation between two physicians).”

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28, p.17). Oct. 2022. (Accessed Nov. 2022).

Last updated 11/15/2022

Email, Phone & Fax

Covered services does not include a telephone conversation, electronic mail message, or facsimile transmission between the physician, recipient, or a consultation between two physicians.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p.17). Oct. 2022. (Accessed Nov. 2022).

Telephone consultations are not covered.

SOURCE:  AL Admin. Code r. 560-X-6-.14., p. 27 & 31. (Accessed Nov. 2022).

Therapy Services

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2022, pg. 37-16, (Accessed Nov. 2022).

Rehabilitative Services (ASD) – DMH

Video telecommunication … does not include a telephone conversation, electronic mail message, or facsimile transmission between the treatment provider, recipient, or a consultation between two treatment providers.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-16, (Accessed Nov. 2022).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Oct. 2022, C-1, (Accessed Nov. 2022).

Last updated 11/15/2022

Live Video

POLICY

Alabama Medicaid reimburses for live video for certain services and under certain circumstances.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17). Oct 2022, (Accessed Nov. 2022).

Telemedicine: Telemedicine services are covered for limited specialties and under special circumstances. Refer to the Alabama Medicaid Provider Manual, Chapter 28 for details on coverage.

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5), p. 31. (Accessed Nov. 2022).

Therapy Services

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site and at the provider site, is sufficient to allow the provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid. Transmissions must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission information. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2022, pg. 37-16, (Accessed Nov. 2022).

Rehabilitative Services (ASD) – DMH

If any of these services are provided via video telecommunication, it must be provided in the most private available setting and must be conducted through a two-way interactive audio and video technology system that permits two-way communication between the treatment provider and the Medicaid recipient.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-16, (Accessed Nov 2022).


ELIGIBLE SERVICES/SPECIALTIES

Alabama Medicaid reimburses for the following services when billed with a GT modifier:

  • Consultations;
  • Office or other outpatient visits;
  • Individual psychotherapy;
  • Psychiatric diagnostic services;
  • Neurobehavioral status exams.

Procedure codes for Applied Behavior Analysis therapy is also covered.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (Ch. 28, p.17). Oct 2022. (Accessed Nov. 2022).

Telemedicine services are covered for limited specialties and under special circumstances.

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Nov. 2022).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.  Telemedicine/telehealth may also be used to deliver Nursing Assessment and Care and Rehabilitative Services when certain conditions are met.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services (ch. 105, p. 1 ). Oct. 2022. (Accessed Nov. 2022).

An appropriately trained staff or employee familiar with the recipient’s treatment plan or familiar to the recipient must be immediately available in-person to the recipient receiving a telehealth service to attend to any urgencies or emergencies that may occur during the service. “Immediately available” means the staff or employee must be either in the room or in the area outside the telehealth room in easy access for the recipient. If the recipient chooses to waive this requirement, the health care provider administering the telehealth service shall document this fact in the medical record.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA (105, p. 11).  Oct. 2022. (Accessed Nov 2022).

ABA Therapy Services

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site and at the provider site, is sufficient to allow the provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2022, pg. 37-16, (Accessed Nov. 2022).

Rehabilitative Services (ASD) – DMH

Certain codes are only approved for the use of telehealth billing.  See manual.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-15, (Accessed Nov 2022).


ELIGIBLE PROVIDERS

All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In order to participate in the telemedicine program:

  • Physicians must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service)
  • Physician must submit the telemedicine Service Agreement/Certification form
  • Physician must obtain prior consent from the recipient before services are rendered. This will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28, p.17) Oct. 2022, & Therapy Services, Oct. 2022, pg. 37-16. (Accessed Nov. 2022).

Telemedicine providers who render maternity-related services are required to sign a Non-Delivering Telemedicine DHCP Participation agreement with at least one of the Alabama Coordinated Health Networks(ACHNs) in order to receive reimbursement from Medicaid. Refer to Chapter 28 of the Provider Billing Manual to determine further requirements and procedure codes allowed for telemedicine services.

SOURCE: AL Medicaid Management Information System Provider Manual, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP) Billing, (Manual Ch. 40-p. 33). Oct. 2022) & AL Medicaid Management Information System Provider Manual, Physician billing (Manual Ch. 28-p. 17). Oct. 2022. (Accessed Nov. 2022).

Rehabilitative services that are delivered face-to-face can either be in person or via live-video telemedicine/telehealth, as approved by the Alabama Medicaid Agency.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 1).  Oct. 2022. (Accessed Nov. 2022).

The face-to-face encounter required for the ordering of home health services may be conducted using telehealth systems.

SOURCE: AL Medicaid Management Information System Provider Manual, Home Health (17-p. 2) Oct. 2022 (Accessed Nov. 2022).

The required face-to-face visit may be conducted using telehealth systems.

SOURCE: AL Medicaid Management Information System Provider Manual, Durable Medical Equipment, 14-10,  Oct. 2022. (Accessed Nov. 2022).

Therapy Services

The provider shall maintain appropriately trained staff, or employees, familiar with the recipient’s treatment plan, immediately available in-person to the recipient receiving a telemedicine service to attend to any urgencies or emergencies that may occur during the session. The provider shall implement confidentiality protocols that include, but are not limited to:

  • specifying the individuals who have access to electronic records; and
  • usage of unique passwords or identifiers for each employee or other person with access to the client records; and
  • ensuring a system to prevent unauthorized access, particularly via the Internet; and
  • ensuring a system to routinely track and permanently record access to such electronic medical information

These protocols and guidelines must be available to inspection at the telemedicine site and to the Medicaid Agency upon request.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2022, pg. 37-16, (Accessed Nov. 2022).

Rehabilitative Services (ASD) – DMH

All services (including those rendered via teleconference with a direct service or consultation recipient) must be rendered by an approved Medicaid treatment provider (operating within their scope of practice) as outlined in Section 110.1.1.

The distant site is the location of the treatment provider providing the telehealth professional services. For physicians, telemedicine can be provided within or outside of the state of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider. For all other treatment providers, treatment services can only be provided by a treatment provider located within the state of Alabama.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-16, (Accessed Nov. 2022).


ELIGIBLE SITES

For rehabilitative services, the origination site for treatment services can be delivered in any setting that is convenient for both the family and staff member, that affords an adequate therapeutic environment, and that protects the recipient’s rights to privacy and confidentiality. In order for providers to qualify for Medicaid reimbursement for telehealth services, the origination site must be located in the state of Alabama. The distant site is the location of the treatment provider providing the telehealth professional services. For physicians, telemedicine can be provided within or outside of the state of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider. For all other treatment providers, treatment services can only be provided by a treatment provider located within the state of Alabama.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services (105-9). Oct. 2022. (Accessed Nov. 2022).

Rehabilitative Services (ASD) – DMH

The origination site for treatment services can be delivered in any setting that is convenient for both the recipient/family and staff member, that affords an adequate therapeutic environment, and that protects the recipient’s rights to privacy and confidentiality. In order for providers to qualify for Medicaid reimbursement for telehealth services, the origination site must be located in the state of Alabama.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-16, (Accessed Nov. 2022).

Targeted Case Management

02 Place of Service code (telehealth – Services provided through telecommunication technology) is listed in the manual.

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Management, Ch. 106-26, Oct. 2022, (Accessed Nov. 2022).


GEOGRAPHIC LIMITS

For rehabilitative services, the distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services, (105-9). Oct. 2022 & Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-16, (Accessed Nov. 2022).


FACILITY/TRANSMISSION FEE

the Alabama Medicaid Agency (Agency) will begin paying an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient.  Federally Qualified Health Centers and Rural Health Clinics should bill Q3014 independent of the encounter rate on a CMS-1500 claim form.

SOURCE: AL Medicaid Agency, Alert – Telemedicine Origination Site Facility Fee, Mar. 13, 2020, (Accessed Nov. 2022).

AL Medicaid reimburses providers for origination site fees for covered telemedicine services. The origination fee is limited to one per date of service per recipient.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28, p. 17). Oct. 2022. (Accessed Nov. 2022).

The telemedicine origination site and/or transmission fees is not reimbursable under the Rehabilitative Services program.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-19, (Accessed Nov. 2022).

Last updated 11/15/2022

Miscellaneous

All procedure codes billed for telemedicine services must be billed with modifier GT.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17), Oct. 2022, & Rehabilitative Services (105-p. 12). Oct. 2022. (Accessed Nov. 2022).

The required face-to-face visit for the initial written prescription or order for Medicaid prescriptions (including under home health services), or orders for certain medical supplies, equipment and appliances may be conducted using telehealth systems.

SOURCE: AL Admin. Code r. 560-X-6-3, p. 8  (Accessed Nov. 2022).

Billing codes for Rehabilitative Services – DMH, DHR, DYS, DCA, to be used after the covid state of emergency are listed.

In addition to modifier HE or HF, only Medicaid approved procedure codes for Telehealth billing can be billed for telemedicine services and must be billed with modifier GT (via interactive audio and video telecommunications system). The Agency will not reimburse providers for origination site or transmission fees.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 9, 12). Oct. 2022. (Accessed Nov. 2022).

Telehealth has a “place of service code” 02 for filing claims for Targeted Case Management (TCM).

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt (106, p. 26). Oct. 2022. (Accessed Nov. 2022).

The Telemedicine Services Agreement cannot be submitted electronically.

SOURCE: AL Medicaid Management Information System Provider Manual, Becoming a Medicaid Provider, 2, p. 2. Oct. 2022. (Accessed Nov. 2022).

Recipient Signatures are not required in the following instances: …

  • Treatment plan review, mental health consultation, pre-hospitalization screening, crisis intervention, family support, Assertive Community Treatment (ACT), Program for Assertive Community Treatment (PACT), and any non-face-to-face services that can be provided by telephone or telemedicine when provided by a Rehabilitation Option Provider or a physician meeting the telemedicine requirements as set forth in the Alabama Medicaid Administrative Code and the Alabama Medicaid Provider Manual. The provider must retain documentation in the medical record to show the services were rendered.

SOURCE: Alabama Admin. Code 560-X-1-.18, (Accessed Nov. 2022).

Last updated 11/15/2022

Out of State Providers

Providers (in-state and out-of-state) who meet enrollment requirements are eligible to participate in the Alabama Medicaid Program.

Providers must have an Alabama license and be enrolled as a provider with the Alabama Medicaid Agency.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (ch. 28-p. 3 & 17). Oct. 2022. (Accessed Nov. 2022).

Last updated 11/15/2022

Overview

Live video telemedicine services are covered for limited specialties and under special circumstances.  Telephone consultations are not authorized.

SOURCE: AL Admin. Code r. 560-X-6-.14.  (Accessed Nov. 2022).

Alabama Medicaid reimburses for live video under some circumstances.  The Agency also covers an origination site fee. The provider shall maintain appropriately trained staff, or employees,
familiar with the recipient’s treatment plan, immediately available in-person to the recipient receiving a telemedicine service to attend to any urgencies or emergencies that may occur during the session.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (p. 28-17), Oct. 2022. (Accessed Nov. 2022).

They make no reference to store-and-forward reimbursement, but the program has a new remote patient monitoring chapter to their manual where they outline reimbursement for the modality.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111), Oct. 2022. (Accessed Nov. 2022).

Last updated 11/15/2022

Remote Patient Monitoring

POLICY

Remote Patient Monitoring (RPM), also known as In-home Remote Patient Monitoring, is a program that allows medical providers to monitor and manage acute and chronic health conditions while the patient is home.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1), Oct. 2022. (Accessed Nov. 2022).

RPM services include, but are not limited to:

  • Initial home assessment for RPM
  • Initial setup of RPM equipment
  • Instructions and education about the use of monitoring devices
  • Instructing the patient/care giver on data entry
  • Instructing patient on optimum symptom control
  • Direct patient contact, when necessary and as indicated
  • Evaluate threshold violations
  • Monitoring and follow up
  • Diet/nutrition education
  • Needs assessing/screening
  • Making referrals for care when appropriate

RPM providers must also develop a process for addressing patient noncompliance. This process should include the expected actions of the patient and the RPM provider related to initial and on-going noncompliance issues.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3-4), Oct. 2022. (Accessed Nov. 2022).


CONDITIONS

Remote Patient Monitoring (RPM) services are available to Medicaid eligible persons with a need for daily monitoring and with a diagnosis of one or more of the following conditions:

  • Diabetes
  • Gestational Diabetes (effective 10/1/2022)
  • Hypertension
  • Congestive Heart Failure
  • Pediatric Asthma (effective 10/1/2022)

An order from the recipient’s primary care physician (PCP) is required prior to the start of rendering RPM service. Orders for RPM, along with the specific parameters for daily monitoring, must be obtained from the patient’s PCP prior to evaluation and admission. The order must be documented in the medical record. Orders must be signed and dated by the ordering practitioner and must be obtained annually. Referrals for RPM may be accepted from any source, including physicians, ACHN Care Coordinators, patient or caregiver, the Health Department, hospitals, home health agencies, or community-based organizations.

A practitioner must obtain patient consent before furnishing or billing RPM services (see informed consent section for details).

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3), Oct. 2022. (Accessed Nov. 2022).


PROVIDER LIMITATIONS

Services rendered by non-physician practitioners, i.e., physician assistants, certified registered nurse practitioner, etc., must adhere to applicable guidelines, policies and procedures. Refer to Administrative Code chapters 6: Physicians and 49: Certified Register Nurse Practitioner (CRNP) for additional information.

A provider who contracts with Medicaid as an RPM provider is added to the Medicaid system with the National Provider Identifiers provided to the Agency at the time application is made. Appropriate provider specialty codes are assigned to enable the provider to submit requests and receive reimbursements for RPM related claims.

Any provider that can and is willing to pay the Alabama State Share may enroll as an RPM provider. A Memorandum of Understand (MOU) must be executed between the Medicaid Agency and the RPM provider. The MOU will outline the financial and
medical responsibilities for the Medicaid Agency and the RPM provider.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1-2), Oct. 2022. (Accessed Nov. 2022).


OTHER RESTRICTIONS

Requirements for RPM include but not limited to:

  • Ability to provide services statewide.
  • Meet appropriate clinical staffing requirements.
  • Provides and allows the recipients to keep user friendly, interactive audio and video technology monitoring equipment.
  •  Accepts electronic submissions of referrals.
  • Provides an in-home initial assessment.
  • Transmits recipient data automatically in real time (a Medicare requirement).
  • Reviews, intervenes and reports on the data promptly.
  • Provides 24-hour-a-day, 7-day-a-week (24/7) access to physicians or other qualified health care professionals or clinical staff, to address urgent needs of recipients.
  • Develops, monitors and updates a patient-centered care plan
  • Ongoing, compliance monitoring.
  • Program graduation, when appropriate.

Federal requirements mandate providers re-validate periodically with the Alabama Medicaid program. Providers will receive a notification when it is time to re-validate. Failure to re-validate and provide appropriate documentation to complete the enrollment process will result in an end-date being placed on the provider file. A new enrollment application must be submitted once a provider file has been closed due to failure to timely re-validate.

Medicaid will not separately reimburse for any direct care services, such as wound care, rendered by RPM providers. RPM services are restricted to the medical diagnosis outlined in section 111.2.

See manual for documentation and evaluation report requirements.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 2-4), Oct. 2022. (Accessed Nov. 2022).

Last updated 11/15/2022

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/15/2022

Cross State Licensing

Physicians who engage in the provision of telehealth medical services to any individual in this state must possess a full and active license to practice medicine or osteopathy issued by the Medical Licensure Commission.

Notwithstanding the section above, a physician who engages in the provision of telehealth medical services to any individual in this state is not required to possess a license issued by the Medical Licensure Commission, if either of the following apply:

  • The services are provided on an irregular or infrequent basis. The term “irregular or infrequent” refers to telehealth medical services occurring less than 10 days in a calendar year or involving fewer than 10 patients in a calendar year.
  • The services are provided in consultation, as further provided by Section 34-24-74, with a physician licensed to practice medicine or osteopathy in this state.

Nothing in this article shall be construed to apply to or to restrict the provision of health-related services via telehealth by a health care provider other than a physician, provided that those health-related services are within the scope of practice of the health care professional licensed in Alabama.

SOURCE: AL Code Sec. 34-24-702 & Senate Bill 272 (2022 Session), (Accessed Nov. 2022).

Alabama Board of Medical Examiners and Medical Licensure Commission – Telemedicine

Physicians who engage in the provision of telehealth medical services to any individual in Alabama must possess a full and active license to practice medicine in Alabama.  The provision of telehealth medical services is deemed to occur at the patient’s physical location within Alabama at the time telehealth medical services are provided.  Telehealth services that do not require an Alabama license:

  • The physician is licensed in another state or D.C.; and services are irregular or infrequent (less than ten days/calendar year or ten patients/a calendar year); or
  • Services are provided in consultation with an Alabama licensed physician, limited to ten days in a calendar year, or necessary medical care is provided to a patient being transported into Alabama.
  • Practitioners should consult an attorney with questions about when a license is required.

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Nov. 2022)

Speech-Language Pathology and Audiology

Providers must hold a license in the State of Alabama unless there is a qualifying exemption as noted in Code of Alabama 1975, Section 34-28A-3; 870-X-2-.01 and shall be in compliance with the statutory and regulatory requirements of the patient site.

SOURCE: AL Admin Code Ch. 870-X-7-.05 (Nov. 2022).

A licensed speech-language pathologist or audiologist, who resides in another state and who is not licensed by the Board, may perform speech-language pathology or audiology services in this state provided:

  1. The person is licensed under the laws of another state that has established licensure requirements at least equivalent to those established by the State of Alabama, or who holds a Certificate of Clinical Competence in speech-language pathology or audiology from the American Speech-Language-Hearing Association, or its equivalent; and
  2. Services are performed for no more than 30 days in any calendar year; and
  3. Services are performed in cooperation with a speech-language pathologist or audiologist licensed by the Board.

Any practitioner who does not meet the exemptions stated above must hold an Alabama license. This shall be required for all individuals providing services for consumers in Alabama via in-office practice as well as telepractice or any other electronic means.

See code for additional details.

SOURCE: AL Admin Code, 870-X-2-.01 (Accessed Nov. 2022)

Nursing

The licensed nurse must hold an active Alabama license or multistate license issued by a party state other than Alabama, as defined in Chapter 4 of these rules, in order to practice telenursing in the State of Alabama. The licensed nurse shall adhere to the existing Alabama Nurse Practice Act and Alabama Administrative Code.

SOURCE: AL Admin Code 610-X-6-.16, p. 31 ( Accessed Nov. 2022)

Hospitals

Hospitals may provide telemedicine services to their patients if these medical services are provided pursuant to a written contract. If these services are provided by contract with another hospital that hospital shall be a Medicare-participating hospital and assure the physicians providing the telemedicine services are privileged to offer the services in the second hospital and are licensed in Alabama. If these services are provided by a distant-site telemedicine entity other than a Medicare-participating hospital, the physicians must be appropriately credentialed to provide these services and must be licensed in Alabama.

SOURCE: AL Admin Code 420-5-7-.09 p. 32 (Accessed Nov. 2022)

Optometry

An optometrist who is licensed by another state to practice optometry, but who is not licensed in the state of Alabama pursuant to §§ 34-22-20 or 34-22-21, who utilizes telemedicine to provide optometric services in the state of Alabama from a distant site outside of the state of Alabama during a state of emergency is not subject to the requirements of this article. For the purposes of this section 13.08(1), a state of emergency means a natural or man-made disaster for which the Governor of the State of Alabama has declared or proclaimed a state of emergency or where the President of the United States has declared a disaster in accordance with the Disaster Relief and Emergency Assistance Act of 1988 as amended. For the exemption contained in this section to apply, the patient receiving telemedicine services from the distant site must be located within the geographical boundaries established in the governor’s declaration of a state of emergency or the president’s disaster declaration.

A provider who is contacted in an emergency shall not be subject to the notice and security provisions of this article. The provisions of this section 13.08(2) shall not apply to any non-emergency optometric services provided to the patient as a continuation of treatment initiated in the emergency or for a different condition or issue which arises later. For the purposes of this section 13.08(2), an emergency shall have the meaning and definition set out in section 13.01(2) above.

SOURCE: AL Admin Code 630-X-13-.08, (Accessed Nov. 2022).

A licensed optometrist, who is not licensed in Alabama pursuant to Section 34-22-20 or Section 34-22-21, who utilizes telemedicine across state lines in an emergency, as defined by the board, is not subject to the requirements of this article.

A provider that is contacted in an emergency is not subject to the notice and security provisions of this article, but is subject to those provisions should any nonemergency care continue with the patient.

SOURCE: AL Code Sec. 34-22-85, (Accessed Nov. 2022).

Last updated 11/15/2022

Definitions

Telehealth. The use of electronic and telecommunications technologies, including devices used for digital health, asynchronous and synchronous communications, or other methods, to support a range of medical care and public health services.

Telehealth medical service. Digital health, telehealth, telemedicine, and the applicable technologies and devices used in the delivery of telehealth. The term does not include incidental communications between a patient and a physician.

Telemedicine. A form of telehealth referring to the provision of medical services by a physician at a distant site to a patient at an originating site via asynchronous or synchronous communications, or other devices that may adequately facilitate and support the appropriate delivery of care. The term includes digital health, but does not include incidental communications between a patient and a physician.

SOURCE: AL Code Sec. 34-24-701 & Senate Bill 272 (2022 Session), (Accessed Nov. 2022).

Board of Nursing

Telehealth Nursing: The practice of distance nursing care using telecommunications technology.

SOURCE: AL Admin Code 610-X-6-.01(26), p. 4, (Accessed Nov. 2022).

Optometrists

Telemedicine. — A health service that is delivered by a licensed optometrist acting within the scope of his or her license and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including all of the following:

  • Compressed digital interactive video, audio, or data transmission.
  • Clinical data transmission using computer imaging by way of still image capture and store and forward.
  • Other technology that facilitates access to health care services or optometric specialty expertise.

SOURCE: Code of Alabama, Sec. 34-22-81, (Accessed Nov. 2022).

Board of Optometry

Telemedicine: As used in these regulations, a health service that is delivered by a licensed optometrist acting within the scope of his or her license and that requires the use of telecommunications technology other than telephone or facsimile. Telecommunications technology as used herein shall include, but not be limited to:

  • Compressed digital interactive video, audio, or data transmission;
  • Clinical data transmission using computer imaging by way of still image capture and store and forward;
  • Other technology that facilitates access to health care services or optometric specialty services.

SOURCE: AL Admin Code 630-X-13-.01(7). (Accessed Nov. 2022).

Board of Social Work

Telehealth is a mode of providing social work services through interactive audio, video or electronic communication occurring between a licensed social worker and the client, including any electronic communication for evaluation, assessment, treatment, and management of confidential information and case records in a secure platform.

SOURCE: AL Admin Code 850-x-2-.01(7). (Accessed Nov. 2022).

Last updated 11/15/2022

Licensure Compact

Member of the Interstate Medical Licensing Compact.

SOURCE: Interstate Medical Licensing Compact. (Accessed Nov. 2022).

Member of the Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact. (Accessed Nov. 2022).

Member of the Emergency Services Personnel Licensure Interstate Compact

SOURCE:  Interstate Commission for EMS Personnel Practice. (Accessed Nov. 2022).

Member of the Psychology Interjurisdictional Compact.

SOURCE: Psychology Interjurisdictional Compact. (Accessed Nov. 2022).

Member of the Physical Therapy Licensure Compact.

SOURCE: Physical Therapy Licensure Compact. (Accessed Nov. 2022).

Member of the Audiology and Speech-Language Pathology Interstate Compact.

SOURCE:  Audiology and Speech-Language Pathology Interstate Compact. (Accessed Nov. 2022).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Nov. 2022). 

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Nov. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 11/15/2022

Miscellaneous

See statute for privacy and medical record requirements.

The Board of Medical Examiners, the Medical Licensure Commission, and its officers, agents, representatives, employees, and directors thereof, shall be considered to be acting pursuant to clearly expressed state policy as established in this act and under the active supervision of the state. The boards, agencies, and individuals in this section shall not be subject to state or federal antitrust laws while acting in the manner provided in this section.

SOURCE: AL Code Sec. 34-24-707 & Senate Bill 272 (2022 Session), (Accessed Nov. 2022).

Alabama has a rural health plan that encourages use of telemedicine and telehealth.  See plan for details.

SOURCE: Alabama Admin. Code 410-2-2-.04, (Accessed Nov. 2022).

Last updated 11/15/2022

Online Prescribing

Telehealth medical services may only be provided following the patient’s initiation of a physician-patient relationship, or pursuant to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition. The physician-patient relationship may be formed without a prior in-person examination.

Prior to providing any telehealth medical service, the physician, to the extent possible, shall do all of the following:

  • Verify the identity of the patient.
  • Require the patient to identify his or her physical location, including the city and state.
  • Disclose to the patient the identity and credentials of the physician and any other applicable personnel.
  • Obtain the patient’s consent for the use of telehealth as an acceptable mode of delivering health care services, including, but not limited to, consent for the mode of communication used and its limitations. Acknowledgment of consent shall be documented in the patient’s medical record.

If a physician or practice group provides telehealth medical services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall do either of the following:

  • See the patient in person within a reasonable amount of time, which shall not exceed 12 months.
  • Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months.

The provision of telehealth medical services that includes video communication to a patient at an originating site with the in-person assistance of a person licensed by the Board of Medical Examiners or by the Board of Nursing pursuant to Chapter 21 of Title 34 of the Code of Alabama 1975, shall constitute an in-person visit for the purposes of this subsection.

This section does not apply to the provision of telehealth medical services provided by a physician in active consultation with another physician who is providing in-person care to a patient.

This section shall not apply to the provision of mental health services as defined in Section 22-50-1.

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance to a patient as a result of a telehealth medical service if the prescriber is authorized to prescribe the drug, supplies, or substance under applicable state and federal laws. To be valid, a prescription must be issued for a legitimate medical purpose by a prescriber acting in the usual course of his or her professional practice.

A prescription for a controlled substance may only be issued as a result of telehealth medical services if each of the following apply:

  • The telehealth visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber responsible for the prescription.
  • The prescriber has had at least one in-person encounter with the patient within the preceding 12 months.
  • The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

This subsection shall not apply in an in-patient setting.

A physician shall be exempt from the requirements of subsection (b) and may issue a prescription for a controlled substance to a patient if the prescription is for the treatment of a patient’s medical emergency, as further defined by rule by the Board of Medical Examiners and the Medical Licensure Commission.

SOURCE: AL Code Sec. 34-24-703 & 704 & Senate Bill 272 (2022 Session), (Accessed Nov. 2022).

The Alabama Board of Medical Examiners & Medical Licensure Commission

It is the position of the Board that, when prescribing medications to an individual, the prescriber, when possible, should personally examined the patient. Before prescribing a medication, a physician should make an informed medical judgment based on appropriate medical history, the circumstances of the situation and on his or her training and experience. This process must be documented appropriately.

Prescribing medications for a patient whom the physician has not personally examined may be suitable under certain circumstances. These circumstances may include but not be limited to electronic encounters such as those in telemedicine; admission orders for a patient newly admitted to a health care facility; prescribing for a patient of another physician for whom the prescribing physician is taking call; or continuing medication on a short-term basis for a new patient prior to the patient’s first appointment.

Licensees are expected to adhere to all federal and state statutes regarding the prescribing of controlled substances and all Alabama Board of Medical Examiners’ Rules regarding the prescribing of controlled substances.

SOURCE: AL Admin. Code. r. 540-X-9-.11, p. 23 (Accessed Nov. 2022).

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance via telehealth if the prescriber is authorized to do so under state and federal law.

A prescription for a controlled substance may only be issued via telehealth if:

  • The telehealth visit includes synchronous audio or audio-visual communication using HIPAA-compliant equipment with the prescriber;
  • The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
  • The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Nov. 2022)

Board of Optometry

The provision of optometric diagnosis, treatment, or other services to a patient through telemedicine at an established treatment site may be used for all patient visits, including initial evaluations to establish an optometrist-patient relationship between a provider and a patient.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which shall include at least the following:

  • Having had at least one face-to-face meeting, either in person, or at an established treatment site via telecommunications;
  • Confirming the identity of the person requesting treatment by establishing that the person requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made via telemedicine, including, but not limited to the issuance of prescriptions, shall be held to the same standards of practice as those in traditional in-person clinical settings.  Distant site providers shall obtain an adequate and complete medical history for the patient before providing treatment and shall document the medical history in the patient record.

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Nov. 2022).

Telemedicine services provided at an established treatment site may be used for all patient visits, including initial evaluations to establish a proper doctor-patient relationship between a provider and a patient.

  • A provider shall be reasonably available onsite at the established medical site to assist with the provision of care.
  • A provider may delegate tasks and activities at an established treatment site to an assistant who is properly trained and supervised or directed.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which at a minimum includes all of the following:

  • Having had at least one face-to-face meeting at an established treatment site before engaging in telemedicine services. A face-to-face meeting is not required for new conditions relating to an existing patient, unless the provider deems that such a meeting is necessary to provide adequate care.
  • Establishing that the person requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made in a telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: Code of Alabama Sec. 34-22-83, (Accessed Nov. 2022).

Last updated 11/15/2022

Professional Board Standards

AL Board of Optometrists

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Nov. 2022).

AL Board of Nursing

SOURCE: AL Admin Code 610-X-6-.16, (Accessed Nov. 2022).

AL Board of Social Work

SOURCE: AL Admin Code 850-x-2-.04. (Accessed Nov. 2022)

AL Board of Speech-Language Pathology and Audiology

SOURCE: AL Admin Code 870-X-7-.01-05 (Accessed Nov. 2022).

Alabama Board of Medical Examiners and Medical Licensure Commission – Telemedicine

A physician has the same duty to exercise reasonable care, diligence, and skill whether providing services in-person or via telehealth.  See webpage for details.

If a physician or practice group provides telehealth services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall either:

  • See the patient in person within a reasonable amount of time, which shall not exceed 12 months; or
  • Appropriately refer the patient to a physician who can provide the in-person care within a reasonable amount of time, which shall not exceed 12 months.

The provision of telehealth services that includes video communication to a patient at an originating site with the in-person assistance of a licensed physician, physician assistant, certified registered nurse practitioner, certified nurse midwife, or other person licensed by the Alabama Board of Nursing shall constitute an in-person visit for this purpose.

This requirement does not apply to the provision of mental health services as defined in state law (Ala. Code § 22-50-1).

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Nov. 2022)

A physician providing telehealth medical services shall owe to the patient the same duty to exercise reasonable care, diligence, and skill as would be applicable if the service or procedure were provided in person. Telehealth medical services shall be governed by the Medical Liability Act of 1987, codified in Sections 6-5-540 through 6-5-552, and shall be subject to the exclusive jurisdiction and venue of the circuit courts of the State of Alabama, regardless of the citizenship of the parties.

See statute for list of requirements for physicians practicing telemedicine.

The Board of Medical Examiners and the Medical Licensure Commission may adopt rules regulating the provision of telehealth medical services by physicians in this state, even if the rules displace competition.

Rules adopted by the Board of Medical Examiners and the Medical Licensure Commission shall promote quality care, prevent fraud, waste, and abuse, and ensure that physicians provide adequate supervision of health professionals who aid in providing telehealth medical services.

Other than as set forth in this article, the authority of the Board of Medical Examiners and the Medical Licensure Commission to regulate physicians providing telehealth medical services shall be the same as the authority of the Board of Medical Examiners and the Medical Licensure Commission to regulate physicians providing services in person.

SOURCE: AL Code Sec. 34-24-703 & 705 & Senate Bill 272 (2022 Session), (Accessed Nov. 2022).

Optometry

Written policies and procedures shall be maintained when using electronic mail for provider-patient communications. A provider who uses telemedicine in his or her practice shall adopt protocols to prevent fraud and abuse through the use of telemedicine.  See code for requirements.

SOURCE: Sec. 34-22-82 & 83, (Accessed Nov. 2022).

Last updated 11/15/2022

Definition of Visit

Encounters are face-to-face contacts between a patient and a health professional for medically necessary services.

Billable encounters are visits for face-to-face contact between a patient and a health professional in order to receive medically necessary services such as lab services, x-ray services (including ultrasound and EKG), dental services, medical services, EPSDT services, family planning services, and prenatal services. Billable encounters are forwarded to Medicaid’s fiscal agent for payment through the proper filing of claims forms. Billable services must be designated by procedure codes from the Physicians Current Procedure Terminology (CPT) or by special procedure codes designated by Medicaid for its own use. Non-billable encounters are visits for face-to-face contact between a patient and health professional for services other than those listed above (i.e., visits to social worker, LPN). Such services include, but are not limited to, weight check only or blood pressure check only. Non-billable encounters cannot be forwarded to Medicaid’s fiscal agent for payment.

SOURCE: AL Medicaid, Ch. 15 Alabama FQHC Manual, Oct. 2022, p. 16-5, (Accessed Nov. 2022).

Encounters are face-to-face contacts between a patient and a health professional for the provision of medically necessary services.

  • Ancillary Encounter – Face-to-face contact between a patient and a health professional for lab or x-ray services only.
  • Dental Encounter – Face-to-face contact between a patient and a health professional for the provision of dental services.
  • Medical Encounter – Face-to-face contact between a patient and a health professional for the provision of medical services (i.e., physician, physician assistant, nurse practitioner).
  • EPSDT, Family Planning, or Prenatal Encounter – Face-to-face contact to receive services within the parameters of the program guidelines.

 SOURCE: Ala. Admin. Code r. 560-X-56-.03, (Accessed Nov. 2022).

Last updated 11/15/2022

Eligible Distant Site

No reference found.

Last updated 11/15/2022

Eligible Originating Sites

Based on their ability to collect the origination site fee, FQHCs are eligible originating site.

SOURCE: AL Medicaid Alert, Origination Site Facility Fee, Mar. 13 ,2020, (Accessed Nov. 2022).

Last updated 11/15/2022

Facility Fee

FQHCs should bill Q3014 independent of the encounter rate on a CMS-1500 claim form.

SOURCE: AL Medicaid Alert, Origination Site Facility Fee, Mar. 13 ,2020, (Accessed Nov. 2022).

Last updated 11/15/2022

Home Eligible

Home Health services are excluded as an FQHC service because home health services are available on a state wide basis.

The following place of service codes apply when filing claims for FQHCs:

  • (12) Home

SOURCE: AL Medicaid, Ch. 15 Alabama FQHC Manual, Oct. 2022, p. 16-5, (Accessed Nov. 2022).

Last updated 11/15/2022

Modalities Allowed

Live Video

FQHC manual instructs providers to reference Physician manual. Physician manual outlines reimbursement for live video telemedicine.  See:  AL Medicaid Live Video


Store and Forward

There is no reference found for store-and-forward in Medicaid generally or for FQHCs.  See: AL Medicaid Store-and-Forward.


Remote Patient Monitoring

There is no reference found for RPM in Medicaid for FQHCs specifically.  See: AL Medicaid Remote Patient Monitoring


Audio-Only

Telephone consultations and conversations are explicitly excluded from coverage in the physician manual and admin code. See: AL Medicaid Email, Phone and Fax

Last updated 11/15/2022

Patient-Provider Relationship

No reference found.

Last updated 11/15/2022

PPS Rate

No reference found.

Last updated 11/15/2022

Same Day Encounters

A patient may have one physical health encounter and one behavioral health (psychologist or clinical social worker) encounter on the same day. If the patient later suffers an illness or injury requiring additional diagnosis or treatment on the same date of service, a separate encounter may be billed. Dental services are limited to one dental encounter per date of service. A patient can have one dental encounter in addition to one physical health and/or behavioral health encounter on the same day.

Prior Authorization: FQHC procedure codes generally do not require prior authorization. Any service warranted outside of these codes must have prior authorization. Refer to Chapter 4, Obtaining Prior Authorization, for general guidelines.

SOURCE: AL Medicaid, Ch. 15 Alabama FQHC Manual, Oct. 2022, p. 16-5, (Accessed Nov. 2022).

Encounters are face-to-face contacts between a patient and a health professional for the provision of medically necessary services. Contacts with more than one health professional and multiple contacts with the same health professional, that take place on the same day and at a single location, constitute a single encounter unless the patient, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment. This does not apply to dental service; however, dental services are limited to one dental encounter per date of service. Therefore, a patient can have one dental encounter and one other encounter on the same day. Services incident to an encounter are inclusive.

Encounters are classified as either billable or non-billable. Billable encounters are visits for face-to-face contact between a patient and a health professional in order to receive medically necessary services such as lab services, x-ray services (including ultrasound and EKG), dental services, medical services, EPSDT services, family planning services, and prenatal services. Billable encounters are forwarded to the Fiscal Agent for payment through the proper filing of claims forms. Non-billable encounters are visits for face-to-face contact between a patient and health professional for services other than those listed above (i.e., visits to social worker, LPN). Such services include, but are not limited to, administering injections only, blood pressure checked only, and TB skin testing. Non-billable encounters can not be forwarded to the Fiscal Agent for payment. The costs of the non-billable encounters will be included in the allowable costs; however, the non-billable encounter will not be counted as an encounter on the cost report.

SOURCE: Ala. Admin. Code r. 560-X-56-.06  (Accessed Nov. 2022).