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: Yes

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 11/21/2023

Definition

No Reference Found

Last updated 11/21/2023

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 11/21/2023

Requirements

No Reference Found

Last updated 11/21/2023

Definitions

Telehealth medical services means “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.

  • Digital Health is defined as “the delivery of health care services, patient education communications, or public health information via software applications, consumer devices, or other digital media.”
  • Telehealth is defined as “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.”
  • Telemedicine is defined as “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.”

The term irregular or infrequent services refers to “telehealth medical services” occurring less than 10 days in a calendar year or involving fewer than 10 patients in a calendar year.

Synchronous is defined as “the real-time exchange of medical information or provision of care between a patient and a physician via audio/visual technologies, audio-only technologies, or other means.”

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, (Accessed Nov 2023).

Last updated 11/21/2023

Email, Phone & Fax

The telemedicine visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber.

Providers meeting the telemedicine provider requirements listed above must append one of the following modifiers indicating the mode of telemedicine service delivery:

  • GT for covered telemedicine services delivered via audio and visual telecommunications.
  • FQ for covered telemedicine services delivered via audio only telecommunications.

Additional modifiers may be required. Refer to the chapter of the Provider Billing Manual that describes services provided for further information.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, pg. 4, 10 (Accessed Nov 2023).

In a Provider ALERT issued on April 26, 2023, the Alabama Medicaid Agency (Medicaid) indicated audio-only telecommunications would be reimbursed at parity with services delivered face-to-face for dates of services through September 30, 2023, and on October 1, 2023, new rates for audio-only would be established.

  Effective immediately, Medicaid will continue to reimburse services rendered via audio-only telecommunications at parity with approved services delivered face-to-face and will continue to monitor utilization.

Providers should refer to Chapter 112 – Telemedicine Services for more information. Claims not billed correctly are subject to post-payment review and recoupments.

SOURCE: AL Medicaid, Provider Alert, Reimbursement for Services Delivered via Audio-Only Telecommunications, 9/11/23, (Accessed Nov. 2023).

Telephone consultations are not covered.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p. 20). Oct. 2023. (Accessed Nov. 2023).

Telephone consultations are not authorized.

SOURCE:  AL Admin. Code r. 560-X-6-.14, (Accessed Nov. 2023).

Therapy Services

*Effective June 1, 2023, procedure codes 92507, 92508, and 92523 can be reimbursed for Audio-Only Telecommunication and only be used in lieu of the audio and video telecommunication where telemedicine is approved by Medicaid.

Providers must place the “FQ” modifier on the claim to designate that the service was rendered via audio only telecommunication method.

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. 2023, pg. 9 & 16, (Accessed Nov. 2023).

Rehabilitative Services (ASD) – DMH

Acceptable service provision that qualify as Mental Health Care Coordination includes but is not limited to: Telephone or face to face consultation with a contract provider, doctor, therapist, school teacher, school counselor and/or other professional that is working with the child external to your agency regarding the treatment needs of the child.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2023, Ch. 110, p. 9, (Accessed Nov. 2023).

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. 2023, C-1, (Accessed Nov. 2023).

Targeted Case Management

Some core elements of targeted case management can be provided through telephone.  See manual.

SOURCE:  AL Medicaid Management Information system Provider Manual, Targeted Case Management, Oct. 2023, Ch. 106, p. 7, (Accessed Nov. 2023).

Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP)

After hours 24/7 coverage requirement can be met by telephone under certain circumstances.  See manual.

SOURCE:  AL Medicaid Management Information system Provider Manual, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP), Oct. 2023, Ch. 40, p. 11-12, (Accessed Nov. 2023).

Early Intervention Services

The 6 month review can be done via telephone with the parent by the therapist or special instructor. A sign-in sheet is required as documentation for billing the 6 month review

Service may be provided in the child’s natural environment or via telephone or various videoconference mediums.

* An exception to face-to-face contacts is the 6 month review of the treatment plan. The 6 month review plan is allowable to be billed when the service plan is reviewed by telephone. It may still be done face-to-face if preferred by the parent.

SOURCE:  AL Medicaid Management Information system Provider Manual, Early Intervention Services, Oct. 2023, Ch. 108, (Accessed Nov. 2023).

Waiver Services

Personal Emergency Response System Services (PERS) (S5160Modifier UD – LAH) (S5160Modifier UC – ID) (S5160Modifier UD/HW – LAH) (S5160Modifier UC/HW – ID) (S5161Modifier UD – LAH) (S5161Modifier UC – ID) (S5161Modifier UD/HW – LAH) (S5161Modifier UC/HW – ID) Personal Emergency Response System (PERS) Services provides a direct telephonic or other electronic communications link between waiver recipients and health professionals to secure immediate assistance in the event of a physical, emotional or environmental emergency. PERS may also include cellular telephone service used when a conventional PERS is less cost-effective or is not feasible. PERS may include installation, monthly fee (if applicable), upkeep and maintenance of devices or systems as appropriate.

SOURCE:  AL Medicaid Management Information system Provider Manual, Waiver Services, Oct. 2023, Ch. 107, p. 39, (Accessed Nov. 2023).

Pharmacy

Prescriptions dispensed by telephone for drugs other than Schedule II drugs are acceptable without subsequent signature of the practitioner.

Over-the-counter medications require a prescription from a physician or other practitioner legally licensed by the State of Alabama to prescribe the drugs authorized under the program. Telephone prescriptions are acceptable for OTCs.

Hemophilia Management Standards of Care: A pharmacist, nurse, and/or a case representative assigned to each patient. A case representative shall maintain, at a minimum, monthly telephone contact with the patient or family/caregiver.

SOURCE:  AL Medicaid Management Information system Provider Manual, Pharmacy Services, Oct. 2023, Ch. 27, p. 5, 14, 25, (Accessed Nov. 2023).

Last updated 06/22/2023

Live Video

POLICY

This general information is related to the telehealth medical services rendered by Alabama Medicaid (Medicaid) providers. Providers are expected to comply with Alabama’s Telehealth Medical Services law (Code of Alabama, Sections 34-24-701 through 34-24-707) at all times.

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

Providers meeting the telemedicine provider requirements listed above must append one of the following modifiers indicating the mode of telemedicine service delivery:

  • GT for covered telemedicine services delivered via audio and visual telecommunications.
  • FQ for covered telemedicine services delivered via audio only telecommunications.

Additional modifiers may be required. Refer to the chapter of the Provider Billing Manual that describes services provided for further information.

Reimbursement for services provided via telemedicine, audio only and audio and video telecommunications, will be paid at parity to those services provided face-to-face. Medicaid will continue to monitor and reevaluate, if deemed necessary.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, pg. 4, 9-10 (Accessed Nov 2023).

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). (Accessed Nov. 2023).

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. 2023, pg. 16, (Accessed Nov. 2023).

Several manual chapters refer to telemedicine chapter for information.


ELIGIBLE SERVICES/SPECIALTIES

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Services must be within the provider’s scope of license.

Services must be provided to a recipient that is an established patient of the provider or practice or due 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.

A covered telemedicine service will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed, if applicable.

Specific covered services list provided in manual by provider type (page. 8-10).

Services NOT Eligible for Reimbursement for Telemedicine Services

Common examples of services via telemedicine not considered for reimbursement (not exhaustive):

  • Chart reviews
  • Electronic mail messages (between providers and recipients)
  • Facsimile transmissions (between providers and recipients)
  • Consultation between two providers
  • Internet based communications that are not HIPAA-compliant or secure
  • Services not directly provided by an enrolled provider or by office staff
  • Services not normally charged for during an office visit
  • Services not specifically listed in Provider Billing Manual chapters
  • Communication that is not secure or HIPAA-compliant (e.g., Skype, FaceTime)

Exceptions may be made to the lists for providers and services not reimbursable under this policy in the event of a public health emergency, however, separate guidance would be issued in those instances.

BMI Requirements

The BMI will be required for office visits including the telemedicine visits. The BMI is required at least once per calendar year on all claims with procedure codes 99201-99205, 99211- 99215, and 99241-99245 and EPSDT procedure codes 99382-99385 and 99392-99395. Providers should use subjective data to calculate the BMI which can include providers asking the recipient for his or her height and weight during the telemedicine visit. The BMI should be calculated, based on the information provided by the recipient, and appended to the claim for reimbursement. The BMI should also be documented in the recipient’s medical record.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, pg. 3, 6, 8-12 (Accessed Nov 2023).

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

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Nov. 2023).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.  Some services in manual specify that they can be delivered in person or via telemedicine.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA, Ch. 105,   Oct. 2023. (Accessed Nov 2023).

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. 2023, pg. 16, (Accessed Nov. 2023).

Nurse-Family Partnership

NFP nurse visiting services include care coordination, assessments and screenings, case management, and preventative health education and counseling. These nursing services are tailored to each woman’s needs and delivered in-person or via telehealth in the home setting, or in an alternative community setting as indicated by recipient’s need.

SOURCE: AL Medicaid Management Information System Provider Manual, Nurse Family Partnership, Ch. 41, Oct. 2023, p. 1 (Accessed Nov 2023).


ELIGIBLE PROVIDERS

Providers must submit the Telemedicine Service Agreement/Certification to Medicaid’s fiscal agent. The form is located on the Medicaid website at: www.medicaid.alabama.gov. Once the form is received, providers will be enrolled with Medicaid with a specialty type of 931 (Telemedicine Service). Providers must have the specialty type of 931 to bill for telemedicine services.

Provider Types Eligible for Reimbursement for Telemedicine Services

  • Physicians
  • Certified Registered Nurse Practitioners (CRNPs)
  • Physician Assistants
  • Rehabilitative Option Providers
  • Psychologists
  • Licensed Professional Counselors
  • Associate Licensed Counselors
  • Licensed Marriage and Family Therapist and Associates
  • Licensed Master Social Workers
  • Licensed Independent Clinical Social Workers
  • Licensed Psychological Technicians
  • Speech Therapists
  • Optometrists
  • Applied Behavior Analysts
  • Early Intervention
  • Children’s Rehabilitation Service
  • Pharmacists/Pharmacies
  • Targeted Case Management

Provider Types NOT Eligible for Telemedicine Reimbursement

  • Physical Therapists
  • Occupational Therapists
  • DME suppliers
  • Ambulance providers
  • Chiropractors
  • Home Infusion
  • Laboratory

Refer to the respective Alabama Medicaid Provider Billing Manual chapter that describes the service rendered by providers listed above for general enrollment information.

Telemedicine Provider Requirements

Providers must identify themselves to the recipient with their credentials and name at the time of service.

Providers must obtain prior written or verbal consent from the recipient before services are rendered.

Telemedicine services may only be provided as a result of a patient’s request, part of an expected follow up, or a referral from the patient’s licensed physician with whom the patient has an established patient-physician relationship.

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Services must be within the provider’s scope of license.

Services must be provided to a recipient that is an established patient of the provider or practice or due 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.

Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.

Only the provider rendering the services via telemedicine may submit for reimbursement for services.

Providers must indicate an in-state or qualifying bordering state site of practice address from which telemedicine services will be provided. This policy does not expand or grant any authority outside that authority granted to the provider by their respective licensure board or by federal or state law.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, (Accessed Nov 2023).

Telemedicine providers who render maternity related services are required to sign a DHCP agreement with one of the ACHNs to receive reimbursement from Medicaid. Refer to Chapter 112 of the Provider Billing Manual to determine further requirements and procedure codes for telemedicine services.

Beginning July 8, 2020, Medicaid will allow physicians enrolled with the specialties OB/GYN (specialty type 328) and telemedicine (specialty type 931) to be reimbursed for maternity services with a referral from either an ACHN or the referring DHCP. The NPI of the ACHN, the DHCP, or the referring DHCP’s group must be on the claim for reimbursement. Refer to section 40.43.2 (DHCP Selection Referral Number) for more detailed billing information.

Telemedicine providers who render maternity-related services are required to sign a Non-Delivering Telemedicine DHCP Participation agreement with at least one of the ACHNs in order to receive reimbursement from Medicaid. Refer to Chapter 112 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. 2023), (Accessed Nov. 2023).

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

All services rendered by a physician, physician assistant, or nurse practitioner that meet the definition above should be billed under this code including those rendered via teleconference with a direct service or consultation recipient. Please refer to the section titled Telehealth Billing Guidelines for more information.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 1 & 16).  Oct. 2023. (Accessed Nov. 2023).

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. 2023, (Accessed Nov. 2023).

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. 2023. (Accessed Nov. 2023).

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. 2023, pg. 16-17, (Accessed Nov. 2023).

For ABA therapy or PBS services listed above provided via telemedicine, enrolled providers 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:

  • Providers must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service).
  • To be enrolled with the 931 specialty, providers must submit the Telemedicine Service Agreement/Certification form which is located on the Medicaid website at: www.medicaid.alabama.gov. Electronic signatures will be acceptable for the telemedicine agreement. The agreement may be uploaded through the provider web portal along with a request to add the 931 specialty. See Chapter 2 – Becoming a Medicaid Provider for further information.
  • Providers must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2023, pg. 16, (Accessed Nov. 2023).

Provider-Based RHCs and RHCs Independent

When not physically present, the physician must be available at all times through direct telecommunication for consultation, assistance with medical emergencies or patient referral.

SOURCE:  AL Medicaid Management Information System Provider Manual, Provider-Based RHCs, Oct. 2023, Ch. 32, pg. 2, & AL Medicaid Management Information System Provider Manual, RHCs Independent, Oct. 2023, Ch. 36, pg. 2, (Accessed Nov. 2023).

Certified Registered Nurse Practitioner and Physician Assistant

CRNPs are assigned a provider type of 09 (Nurse Practitioner). Valid specialties for CRNPs include the following: …

  • Telemedicine Service (931)

SOURCE: AL Medicaid Management Information System Provider Manual, Certified Registered Nurse Practitioner and Physician Assistant, Ch. 21 Oct. 2023, pg. 2, (Accessed Nov. 2023).

Eye Care Services

Opticians are assigned a provider type of 19. Optometrists are assigned a provider type of 18. Valid specialties for Eye Care providers include the following: …

  • Telemedicine (931) Ophthalmologist and Optometrist

SOURCE: AL Medicaid Management Information System Provider Manual, Eye Care Services, Ch. 15, Oct. 2023, pg. 2, (Accessed Nov. 2023).


ELIGIBLE SITES

The following are required for the origination site where the patient is located:

  • The site provider shall ensure that the telecommunication technology and equipment used at the origination site is HIPAA compliant and is sufficient to allow the appropriate evaluation, diagnosis, and/or treatment of the patient.
  • The site provider shall implement protocols that ensure the same confidentiality of the telemedicine visit as for in-person visits.
  • Regardless of the location of the recipient, it is the provider’s responsibility to ensure the telemedicine visit meets all required HIPAA rules and regulations regarding telemedicine visits.

The following sites are recognized by Medicaid as origination sites:

  • Physician and practitioner offices
  • Hospitals
  • Rural Health Clinics (RHCs)
  • Federally Qualified Health Centers (FQHCs)
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
  • Skilled Nursing Facilities (SNFs)
  • Community Mental Health Centers (CMHCs)
  • Renal Dialysis Facilities
  • Mobile Stroke Units
  • Alabama Department of Public Health

Telemedicine services can be rendered to a recipient in their home. However, a recipient’s home should not be considered an origination site entitled to receive an origination site fee.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, pg. 5, (Accessed Nov 2023).

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. 2023, (Accessed Nov. 2023).


GEOGRAPHIC LIMITS

No reference found.


FACILITY/TRANSMISSION FEE

Effective April 1, 2020, Medicaid pays an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient and may be billed by all of the providers listed above under Origination Sites.

No origination site facility fee will be paid for an origination site not listed above.  See manual for billing instructions.

Note: If a Medicaid-enrolled provider performs another medically necessary service(s), the provider may bill for the covered service(s) in addition to providing his/her facility as an origination site and be eligible for reimbursement for the origination site facility fee and the other medically necessary service(s).  A recipient’s home should not be considered an origination site entitled to receive an origination site fee.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, pg. 11, (Accessed Nov 2023).

Last updated 11/21/2023

Miscellaneous

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

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.

The provider shall implement confidentiality protocols that include, but are not limited to:

  • specifying the individuals who have access to electronic records;
  • usage of unique passwords or identifiers for each employee or other person with access to the client records;
  • 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 for inspection at the telemedicine site and to Medicaid upon request.

Documentation Requirements

Providers shall document in the medical record detailed information of the telemedicine visits including, but not limited to:

  • Identification of the patient.
  • Identification of parent or legal guardian attending the telemedicine visit if recipient is under the age of medical consent.
  • Physical location of the patient, including the city and state.
  • The medical record documentation must accurately reflect the services rendered and the level of medical decision making to substantiate the procedure code billed.
  • The same “in” and “out” documentation is required for telemedicine as is required for current services with incremental timeframes provided in person.
  • Identification of the provider including credentials.
  • Patient’s consent for the use of telemedicine delivery of health care services. This consent must be documented in the recipient’s medical record.
  • Condition for which the care is being provided.
  • Medical necessity and appropriateness of services billed.
  • Follow up care needed.
  • Other relevant details of the visit, to include BMI recording, when applicable.

Prior authorization is not required for services to be delivered via telemedicine, though prior authorization may be required for the individual procedure codes billed. Refer to the Provider Billing Manual chapter that describes the service provided for prior authorization requirements.

Refer to Appendix A and the respective Alabama Medicaid Provider Billing Manual chapter that describes the service provided for information about Early and Periodic Screening, Diagnostic, and Testing (EPSDT) referrals.

See manual for instructions regarding cost sharing and completing the claim form.

Prescribing Medications

In accordance with Alabama’s Telemedicine Law, an enrolled provider may prescribe a legend drug, medical supplies, or a controlled substance via telemedicine if the prescriber is authorized to do so under state and federal law. However, a prescription for a controlled substance may only be issued via telemedicine if:

  • The telemedicine 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: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, (Accessed Nov 2023).

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

  • 02: Telehealth – Services provided through telecommunication technology
  • See manual for others.

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt (106, p. 26). Oct. 2023. (Accessed Jun. 2023).

The Telemedicine Services Agreement cannot be submitted electronically.

SOURCE: AL Medicaid Management Information System Provider Manual, Becoming a Medicaid Provider, Ch. 2, p. 2. Oct. 2023. (Accessed Nov. 2023).

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. 2023).

Last updated 11/21/2023

Out of State Providers

Telemedicine services may only be provided as a result of a patient’s request, part of an expected follow up, or a referral from the patient’s licensed physician with whom the patient has an established patient-physician relationship.

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Providers must indicate an in-state or qualifying bordering state site of practice address from which telemedicine services will be provided.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, pg. 3-4 (Accessed Nov 2023).

Last updated 11/21/2023

Overview

AL Medicaid reimburses live video for a specific set of services and specific provider types.  See manual for full lists.  Although asynchronous is included in the definition of telehealth and telemedicine, the telemedicine policy makes no further mention of the modality.

Remote patient monitoring is reimbursed for certain conditions and providers and when the service meets certain requirements. An entire chapter of the Medicaid manual is dedicated to remote patient monitoring instructions.

Audio-only is reimbursed currently the same as face-to-face with FQ modifier.

Last updated 11/21/2023

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. The goal of the program is to decrease exacerbation episodes, emergent care visits, hospital admissions, and medical costs and increase self-management of the disease/chronic condition.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1), Oct. 2023. (Accessed Nov. 2023).

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. Noncompliance and the specified actions must be documented in the patient’s chart.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3-4), Oct. 2023. (Accessed Nov. 2023).


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. 2023. (Accessed Nov. 2023).


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. 2023. (Accessed Nov. 2023).


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. 2023. (Accessed Nov. 2023).

Last updated 11/21/2023

Store and Forward

POLICY

Asynchronous is included in definition of telemedicine and telehealth but no further mention of it is made in telemedicine policy.

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

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, (Accessed Nov 2023).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/21/2023

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 (Accessed Nov. 2023).

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 may 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. 2023)

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 Ala. 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. 2023).

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. 2023).

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. 2023)

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. 2023)

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. 2023).

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. 2023).

Last updated 11/21/2023

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, (Accessed Nov. 2023).

Board of Nursing

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

SOURCE: AL Admin Code 610-X-6-.01(26), (Accessed Nov. 2023).

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. 2023).

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. 2023).

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. 2023).

Last updated 11/21/2023

Licensure Compact

Member of the Interstate Medical Licensing Compact.

SOURCE: Interstate Medical Licensing Compact. (Accessed Nov. 2023).

Member of the Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact. (Accessed Nov. 2023).

Member of the Emergency Services Personnel Licensure Interstate Compact

SOURCE:  Interstate Commission for EMS Personnel Practice. (Accessed Nov. 2023).

Member of the Psychology Interjurisdictional Compact.

SOURCE: Psychology Interjurisdictional Compact. (Accessed Nov. 2023).

Member of the Physical Therapy Licensure Compact.

SOURCE: Physical Therapy Licensure Compact. (Accessed Nov. 2023).

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

SOURCE:  Audiology and Speech-Language Pathology Interstate Compact. (Accessed Nov. 2023).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Nov. 2023). 

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Nov. 2023).

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

Last updated 11/21/2023

Miscellaneous

This article, and the rules adopted by the Board of Medical Examiners and the Medical Licensure Commission, shall apply only to the provision of telehealth medical services by physicians to individuals located in this state.

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 article 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 (Accessed Nov. 2023).

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 Jun. 2023).

Last updated 11/21/2023

Online Prescribing

Practitioners’ Responsibilities

A physician has the same duty to exercise reasonable care, diligence, and skill whether providing services in-person or via telehealth, including when appropriate, to:

  • Establish a diagnosis.
  • Disclose the diagnosis and evidence for it.
  • Discuss the risks and benefits of treatment options.
  • Provide a visit summary to the patient and information how to obtain appropriate follow-up and emergency care if needed.
  • A physician-patient relationship must be established either at the initiation of the patient or referral by the patient’s established physician.

Before providing telehealth medical services, the physician must:

  • Verify the patient’s identity;
  • Require the patient to identify his or her physical location, including city and state;
  • Disclose the identity and credentials of the physician and any other personnel; and
  • Obtain the patient’s consent for the use of telehealth and document it in the patient’s medical record.

In-Person Visit Requirement

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).

Prescribing via Telemedicine

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.
  • The in-person encounter may be satisfied by the in-person assistance of personnel licensed by the Board of Medical Examiners or Board of Nursing at the originating site when the prescriber is evaluating the patient from a distant site using video communication.

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Nov. 2023).

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, (Accessed Nov. 2023).

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 examine 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, continuing medication on a short-term basis for a new patient prior to the patient’s first appointment, or prescribing for the sexual partner(s) of a patient in accordance with an Expedited Partner Therapy (EPT) and/or Patient Delivered Partner Therapy (PDPT) protocol for the prevention of transmission and spread of sexually transmitted diseases.

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, (Accessed Nov. 2023).

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. 2023).

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. 2023).

Last updated 11/21/2023

Professional Board Standards

AL Board of Optometrists

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Nov. 2023).

AL Board of Nursing

SOURCE: AL Admin Code 610-X-6-.16, (Accessed Nov. 2023).

AL Board of Social Work

SOURCE: AL Admin Code 850-x-2-.04. (Accessed Nov. 2023).

AL Board of Speech-Language Pathology and Audiology

SOURCE: AL Admin Code 870-X-7-.05 (Accessed Nov. 2023).

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. 2023).

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 & 706, (Accessed Nov. 2023).

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. 2023).

Last updated 11/21/2023

Definition of Visit

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

Encounters are classified as 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 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. 2023, p. 7, (Accessed Nov. 2023).

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. 2023).

Last updated 11/21/2023

Eligible Distant Site

Not included on distant site provider list in Medicaid Telemedicine Policy.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, (Accessed Nov 2023).

Last updated 11/21/2023

Eligible Originating Sites

The following sites are recognized by Medicaid as origination sites: …

  • Federally Qualified Health Centers (FQHCs)

Telemedicine services can be rendered to a recipient in their home. However, a recipient’s home should not be considered an origination site entitled to receive an origination site fee.

FQHCs can bill Q3014 (independent of the encounter rate)

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, p. 5 & 11 (Accessed Nov 2023).

Last updated 11/21/2023

Facility Fee

Effective April 1, 2020, Medicaid pays an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient and may be billed by all of the providers listed above under Origination Sites (Section 112.2).

No origination site facility fee will be paid for an origination site not listed above. To receive the origination site facility fee, the following must be included on a CMS-1500 or UB-04 claim:

  • FQHCs: Q3014 (independent of the encounter rate)

Note: If a Medicaid-enrolled provider performs another medically necessary service(s), the provider may bill for the covered service(s) in addition to providing his/her facility as an origination site and be eligible for reimbursement for the origination site facility fee and the other medically necessary service(s).

A recipient’s home should not be considered an origination site entitled to receive an origination site fee

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2023, p. 11 (Accessed Nov 2023).

Last updated 11/21/2023

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. 2023, p. 3, 4 & 11 (Accessed Nov. 2023).

Last updated 11/21/2023

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

Asynchronous is included in definition of telemedicine and telehealth but no further mention of it is made in telemedicine policy.

There is no reference found for store-and-forward 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

Audio-only is reimbursed in AL Medicaid, per the AL Telemedicine policy with modifier FQ, however no explicit mention is made to whether or not FQHCs specifically can be reimbursed for the modality. See: AL Medicaid Email, Phone and Fax

Last updated 11/21/2023

Patient-Provider Relationship

No reference found.

Last updated 11/21/2023

PPS Rate

No reference found.

Last updated 11/21/2023

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. 2023, p. 7 & 8, (Accessed Nov. 2023).

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. 2023).