Alabama

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Alabama Medicaid

Administrator

Alabama Medicaid Agency

Regional Telehealth Resource Center

Southeast Telehealth Resource Center

MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

Law Exists: No
Payment Parity: No

PROFESSIONAL REQUIREMENTS

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

Last updated 09/23/2021

Audio-Only Delivery

Medicaid: Telephonic Postpartum Visits

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Telemedicine Coverage Extension

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

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

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Tip Sheet – Guidance to Rehab Option Service Providers

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Tip Sheet – Guidance to Behavioral Health Provider

STATUS: Listed as expiring April 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Last updated 10/14/2021

Cross-State Licensing

Medical Board: Telemedicine/Telehealth Guidelines & Licensing for Physician Assistants

STATUS: Active until Oct. 31, 2021, the end of the state PHE.

Last updated 09/23/2021

Easing Prescribing Requirements

No reference found.

Last updated 09/22/2021

Miscellaneous

Medicaid: COVID-19 Emergency Expiration Date Extended to Oct. 31, 2021

Status: Expires Oct. 31, 2021.

Office of Governor: Covid-19 State of Emergency Proclamation

STATUS: Reinstated on Aug. 13, 2021, active until rescinded.

Last updated 09/22/2021

Originating Site

Medicaid: Telemedicine Origination Site Facility Fee for Outpatient Clinic Services

STATUS: Listed as expiring August 31, 2020, however extended by Medicaid until Oct. 31, 2021.

Last updated 09/24/2021

Private Payer

Department of Insurance: Insurer Response to COVID-19

STATUS: Updated 8/27/21.  Carrier-issued expiration dates vary.

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 09/23/2021

Service Expansion

Medicaid: Origination Site Facility Fee for Outpatient Clinic Services

STATUS: Listed as expiring Aug. 31, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Facility Fee

STATUS: Extended by Medicaid until Oct. 31, 2021.

Medicaid: Telemedicine for Prenatal Visits

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Temporary Physical Therapy Services

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Speech Language and Occupational Therapy Providers

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Telephonic Postpartum Visits

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Telemedicine Coverage Extension

STATUS: Listed as expiring April 16, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Tip Sheet – Guidance to Rehab Option Service Providers

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Tip Sheet – Guidance to Behavioral Health Provider

STATUS: Listed as expiring April 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Medicaid: Extension of Telemedicine Procedure Codes

STATUS: Listed as expiring May 30, 2020, however extended by Medicaid until Oct. 31, 2021.

Last updated 09/24/2021

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). July. 2021. (Accessed Sept. 2021).

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). July. 2021.  & AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Sept. 2021)

Last updated 09/24/2021

Email, Phone & Fax

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p.17). Oct. 2021. (Accessed Oct. 2021).

Telephone consultations are not covered.

SOURCE:  AL Admin. Code r. 560-X-6-.14., p. 27,. (Accessed Sept. 2021).  

Last updated 09/27/2021

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). July. 2021.  & AL Admin. Code r. 560-X-6-.14(f)(5), p. 31. (Accessed Sept. 2021)


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). July. 2021. (Accessed Sept. 2021).

Instructions are listed here for providers who wish to enroll in Medicaid to offer Applied Behavior Analysis and Positive Behavior Support (PBS). Services must be administered via an interactive audio and video telecommunications system, and observe confidentiality and technology guidelines.

SOURCE: AL Medicaid Management Information System Provider Manual,Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis)(Manual ch. 37-p. 15 and 16). July. 2021. (Accessed Sept. 2021).

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

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Sept. 2021).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.  Live video 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 and 64). July. 2021. (Accessed Sept. 2021).

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).  July. 2021. (Accessed Sept. 2021).


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). July. 2021. (Accessed Sept. 2021).

For Nursing Assessment and Care services for DMH Mental Illness, and DMH Substance Abuse the following providers are eligible:

  • Licensed Registered Nurse
  • Licensed Practical Nurse

SOURCE: AL Medicaid Management Information System Provider Manual, (ch. 105, p.64). July. 2021. (Accessed Sept. 2021).

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. 42). July. 2021. (Accessed Sept. 2021).  & AL Medicaid Management Information System Provider Manual, Physician billing(Manual Ch. 28-p. 17). July. 2021. (Accessed Sept. 2021).

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. 9).  July. 2021. (Accessed Sept. 2021).

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, (17-p.1 and 2).  July 2021. (Accessed Sept. 2021).


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, (105-13). July. 2021. (Accessed Sept. 2021).


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, (ch. 105, p.9).  July. 2021. (Accessed Sept. 2021).


FACILITY/TRANSMISSION FEE

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). July 2021. (Accessed Sept. 2021).

Last updated 09/24/2021

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), & Rehabilitative Services (105-p.15 and 16). Apr. 2021. (Accessed Sept. 2021).

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 Sept. 2021).

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

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 9).  July. 2021. (Accessed Sept. 2021).

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. 12-13).  July. 2021. (Accessed Sept. 2021).

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

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt(106, p. 27).  July. 2021. (Accessed Sept. 2021).

Last updated 09/27/2021

Out of State Providers

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. 17). Oct. 2021. (Accessed Oct. 2021).

Last updated 09/24/2021

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 Sept. 2021).

Alabama Medicaid reimburses for live video under some circumstances.  The Agency also covers an origination site fee.  For all telemedicine services, an appropriately trained staff member, or employees familiar with the patient’s treatment plan must be immediately available in-person to the patient.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (p. 28-17), April 2021. (Accessed Sept. 2021).

They make no reference to store-and-forward reimbursement, but the program reimburses for In-Home Monitoring through the Alabama Coordinated Health Network program for diabetes and Chronic Heart failure, although it’s not considered to fall under the telemedicine program.

SOURCE: AL Medicaid Management Information System Provider Manual, Primary Care Physician (p. 38).  April 2021. (Accessed Sept. 2021).

Last updated 09/24/2021

Remote Patient Monitoring

POLICY

Alabama Medicaid will reimburse remote patient monitoring for specified conditions through the In-Home Remote Patient Monitoring Program.  The program is administered by the Alabama Coordinated Health Network (ACHN). Patients may be referred to the program by any SOURCE including a physician, ACHN Care Coordinators, patient or caregiver, the Health Department, hospitals, home health agencies or community-based organizations. Orders for In-Home Monitoring along with the specific parameters for daily monitoring must be obtained from the patient’s primary medical provider prior to evaluation and admission.

SOURCE: AL Medicaid Management Information System Provider Manual, Primary Care Physician (ch. 40.28, Pg. 32). Oct. 2021. (Accessed Oct. 2021).


CONDITIONS

Patients with the following medical conditions may register for the program:

  • Diabetes
  • Congestive Heart Failure
  • Hypertension

SOURCE: AL Medicaid Management Information System Provider Manual, Primary Care Physician (ch. 40.28, Pg. 32). Oct. 2021. (Accessed Oct. 2021).


PROVIDER LIMITATIONS

ADPH must be enrolled with provider type 05 (home health) and provider specialty 970 (disease management).

SOURCE: AL Medicaid Management Information System Provider Manual, Primary Care Physician (ch. 40.28, Pg. 32). Oct. 2021. (Accessed Oct. 2021).


OTHER RESTRICTIONS

No Reference Found

Last updated 09/24/2021

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 09/27/2021

Definition

No Reference Found

Last updated 09/27/2021

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 09/27/2021

Requirements

No Reference Found

Last updated 09/27/2021

Cross State Licensing

A special-purpose license allowing practitioners licensed in other states to practice across state lines may be issued if an applicant’s state of principle license allows for reciprocity.

SOURCE: Code of AL Sec. 34-24-502 – 507. (Accessed Sept. 2021).

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: Code of AL Ch. 870-X-7-.05, p. 58 & Code of Alabama 1975, 870-X-2-.01 (Accessed Sept. 2021)

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: Code of AL 610-X-6-.16, p. 31 ( Accessed Sept. 2021)

Last updated 09/27/2021

Definitions

Board of Medical Examiners and Medical Licensure Commission

Telemedicine, or telehealth, is the provision of medical services to a patient via telecommunication. To provide medical services to an Alabama patient via telemedicine, the physician must hold either a full license or a license to practice across state lines.

SOURCE: Alabama Board of Medical Examiners and Medical Licensure Commission. Telemedicine. (Accessed Sept. 2021).

Board of Nursing

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

SOURCE: AL Admin Code 610-X-6-.01(25), March 31, 2020. (Accessed Sept. 2021).

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 Sept 2021).

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 Sept. 2021).

Last updated 09/27/2021

Licensure Compact

Member of the Interstate Medical Licensing Compact.

SOURCE: Code of AL Sec. 34-24-520 – 543 & Interstate Medical Licensing Compact. (Accessed Sept. 2021).

Member of the enhanced Nurse Licensure Compact.

SOURCE:  Code of AL Sec. 34-21-120 – 130 & Nurse Licensure Compact. (Accessed Sept. 2021).

Member of the Emergency Services Personnel Licensure Interstate Compact

SOURCE:  Code of AL Sec. 22-18-50 & Interstate Commission for EMS Personnel Practice. (Accessed Sept. 2021).

Member of the Psychology Interjurisdictional Compact.

SOURCE: SB 102 & Psychology Interjurisdictional Compact. (Accessed Sept. 2021).

Member of the Physical Therapy Licensure Compact.

SOURCE: SB 82 & Physical Therapy Licensure Compact. (Accessed Sept. 2021).

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

SOURCE: SB 130 & Audiology and Speech-Language Pathology Interstate Compact. (Accessed Sept. 2021).

Last updated 09/27/2021

Miscellaneous

No Reference Found

Last updated 09/27/2021

Online Prescribing

The Alabama Board of Medical Examiners & Medical Licensure Commission

When prescribing medications to an individual, the prescriber, when possible, should personally examine the patient.  Prescribing medications for patients the physician has not personally examined may be suitable for certain circumstances.  These circumstances may include but not be limited to electronic encounters such as those in telemedicine

Licensees are expected to adhere to federal and state statute regarding prescribing of controlled substances.

SOURCE: AL Admin. Code. r. 540-X-9-.11, p. 17 (Accessed Sept. 2021).

The Board has no rules to prohibit the prescribing of controlled substances via telemedicine; however, the provider must comply with all requirements with regard to prescription guidelines, treating chronic pain, and utilizing risk and abuse mitigation strategies.

DEA regulations currently require a previous in-person examination before prescribing controlled substances via telemedicine, except in a declared health emergency

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, (Accessed Sept. 2021)

Board of Optometry

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 Sept. 2021).

Last updated 09/27/2021

Professional Board Standards

AL Board of Optometrists

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Sept. 2021.)

AL Board of Nursing

SOURCE: AL Admin Code 610-X-6-.16. (Accessed Sept. 2021.)

AL Board of Social Work

SOURCE: AL Admin Code 850-x-2-.04. (Accessed Sept. 2021.)

AL Board of Speech-Language Pathology and Audiology

SOURCE: AL Admin Code 870-X-7-.01-05 (Accessed Sept. 2021)