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
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

Medicaid: Telephonic Postpartum Visits

STATUS: Active, expires Apr. 30, 2021

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Active, expires Apr. 30, 2021

Medicaid: Telemedicine Coverage Extension

STATUS: Active, expires Apr. 30, 2021

Last updated 02/28/2021

Cross-State Licensing

Medical Board: Telemedicine/Telehealth Guidelines

STATUS: Active

Medical Board: Telemedicine during state of emergency

STATUS: Active, April 13, 2021

SB 102: Psychology Interjurisdictional Compact

STATUS: Pending

SB 82: Physical Therapy Licensure Compact

STATUS: Pending

Last updated 02/28/2021

Easing Prescribing Requirements

Medical Board: Telemedicine/Telehealth Guidelines

STATUS: Active

Medical Board: Telemedicine during state of emergency

STATUS: Expired April 13, 2021

Last updated 02/28/2021

Miscellaneous

Medicaid: COVID-19 Emergency Expiration Date Extended to April 30, 2021

STATUS: Active, expires Apr. 30, 2021

Medicaid: Extension of Telemedicine Procedure Codes

Last updated 02/10/2021

Originating Site

No reference found.

Last updated 02/28/2021

Private Payer

Department of Insurance: Insurer Response to COVID-19

STATUS: AL’s Dept. of Insurance did not issue administrative rules that required carriers in the state to cover telehealth during the PHE. Carrier-issued expiration dates vary.

Department of Insurance: Telehealth Services Guidance to Health Insurers

STATUS: Active

Last updated 02/10/2021

Provider Type

Medicaid: Speech Language and Occupational Therapy Providers

STATUS: Active, expires Apr. 30, 2021

Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Active, expires Apr. 30, 2021

Medicaid: Telemedicine Coverage Extension

STATUS: Active, expires Apr. 30, 2021

Last updated 02/28/2021

Service Expansion

Medicaid: Origination Site Facility Fee for Outpatient Clinic Services

STATUS: Active, expires Apr. 30, 2021


Medicaid: Facility Fee

STATUS: Active, expires Apr. 30, 2021


Medicaid: Telemedicine for Prenatal Visits

STATUS: Active, expires Apr. 30, 2021


Medicaid: Temporary Physical Therapy Services

STATUS: Active, expires Apr. 30, 2021


Medicaid: Speech Language and Occupational Therapy Providers

STATUS: Active, expires Apr. 30, 2021


Medicaid: Telephonic Postpartum Visits

STATUS: Active, expires Apr. 30, 2021


Medicaid: Temporary Telemedicine Extension for Optometrists

STATUS: Active, expires Apr. 30, 2021


Medicaid: Telemedicine Coverage Extension

STATUS: Active, expires Apr. 30, 2021

Last updated 02/28/2021

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 (28-17). Jan. 2021. (Accessed Feb. 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). Jan. 2021. (Accessed Feb. 2021) & AL Admin. Code r. 560-X-6-.14(f)(5).

Last updated 02/28/2021

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 (28-17). Jan. 2021. (Accessed Feb. 2021).

Telephone consultations are not authorized.

SOURCE:  AL Admin. Code r. 560-X-6-.14. March 31, 2020. (Accessed Feb. 2021).  

Last updated 02/28/2021

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


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 (28-17). Jan. 2021. (Accessed Feb. 2021).

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

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Feb. 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 (105-1, 13 & 61). Jan. 2021. (Accessed Feb. 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 (28-17). Jan. 2021. (Accessed Feb. 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, (105-61). Jan. 2021. (Accessed Feb. 2021).

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

SOURCE: AL Medicaid Management Information System Provider Manual, (105-1).  Jan. 2021. (Accessed Feb. 2021).


ELIGIBLE SITES

For rehabilitative services, the originating site must be at:

  • Physician’s office;
  • Hospital;
  • Critical Access Hospital;
  • Rural Health Clinic;
  • Federally Qualified Health Center;
  • Community mental health center (to include co-located sites with partnering agencies);
  • Public health department
  • ADMH Certified Substance Abuse Facility

SOURCE: AL Medicaid Management Information System Provider Manual, (105-12). Jan. 2021. (Accessed Feb. 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, (105-12).  Jan. 2021. (Accessed Feb. 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 (28-17). Jan. 2021. (Accessed Feb. 2021).

The Agency will not reimburse providers for origination site or transmission fees for tele-rehabilitative services.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services(105-15), Jan. 2021. (Accessed Feb. 2021).

Last updated 02/28/2021

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 (105-15). Jan. 2021. (Accessed Feb. 2021).

Last updated 02/28/2021

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 (28-17). Jan. 2021. (Accessed Feb. 2021).

Last updated 02/28/2021

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 Feb. 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), Jan. 2021. (Accessed Feb. 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 (40-38).  Jan. 2021. (Accessed Feb. 2021).

Last updated 02/28/2021

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 (40-38). Jan. 2021. (Accessed Feb. 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 (40-38). Jan. 2021. (Accessed Feb. 2021).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

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 02/28/2021

Definition

No Reference Found

Last updated 02/28/2021

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 02/28/2021

Requirements

No Reference Found

The Alabama Board of Medical Examiners holds the position that, 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, including 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(2) & (3), (Accessed Feb. 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 Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

Last updated 02/28/2021

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 Feb. 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 Feb. 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 Feb. 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 Feb. 2021).

Last updated 02/28/2021

Licensure Compact

Member of the Interstate Medical Licensing Compact.

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

Member of the enhanced Nurse Licensure Compact.

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

Last updated 02/28/2021

Miscellaneous

No Reference Found

Last updated 02/28/2021

Professional Board Standards

AL Board of Optometrists

SOURCE: AL Admin Code 630-X-13-.02. Accessed Feb. 2021.

AL Board of Nursing

SOURCE: AL Admin Code 610-X-6-.16. Accessed Feb. 2021.

AL Board of Social Work

SOURCE: AL Admin Code 850-x-2-.04. Accessed Feb. 2021.