Last updated 06/07/2023
Live Video
POLICY
Louisiana Medicaid only reimburses the distant site for services provided via telemedicine. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person.
The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth. NOTE: The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid beneficiaries.
Medicaid covered services provided using telemedicine must be identified on claim submissions by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the -95 modifier must be present on the claim to receive reimbursement
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165-166 (as issued 6/27/22). (Accessed Jun. 2023).
Telemedicine/telehealth is the use of an interactive audio and video telecommunications system to permit real time communication between a distant site health care practitioner and the beneficiary. There is no restriction on the originating site (i.e., where the beneficiary is located) and it can include, but is not limited to, a healthcare facility, school, or the beneficiary’s home.
Medicaid covered services provided via telehealth/telemedicine shall be identified on claim submissions by appending the Health Insurance Portability and Accountability Act (HIPAA) of 1996 compliant place of service (POS) or modifier to the appropriate procedure code, in line with current policy
SOURCE: LA Admin. Code 50: Sec. 501 & 503, p. 34 (Accessed Jun. 2023).
The MCO shall reimburse the distant site provider for services provided via telemedicine/telehealth. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person. The MCO shall require the provider to include in the enrollee’s clinical record documentation that the service was provided through the use of telemedicine/telehealth. The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid enrollees.
SOURCE: MCO Manual (revised 5/23/2023), pg. 173, (Accessed Jun. 2023).
ELIGIBLE SERVICES/SPECIALTIES
The department shall periodically review policies regarding Medicaid reimbursement for telehealth services to identify variations between permissible reimbursement under that program and reimbursement available to healthcare providers under the Medicare program.
The department may modify its administrative rules, policies, and procedures applicable to Medicaid reimbursement for telehealth services as necessary to provide for a reimbursement system that is comparable to that of the Medicare program for those services.
SOURCE: LA Statute RS 40:1255.2 (Accessed Jun. 2023).
When otherwise covered, services located in the Telemedicine appendix of the CPT manual, or its successor, may be reimbursed when provided by telemedicine/telehealth. In addition, other specified services may be reimbursed when provided by telemedicine/telehealth and these services are explicitly noted in this manual.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (as issued 6/27/22). (Accessed Jun. 2023).
In the event that the federal or state government declares an emergency or disaster, the Medicaid Program may temporarily cover services provided through the use of an interactive audio telecommunications system, without the requirement of video, if such action is deemed necessary to ensure sufficient services are available to meet beneficiaries’ needs.
SOURCE: LA Admin Code, Sec. 50:I.505, (Accessed Jun. 2023).
When otherwise covered, the MCO shall cover services located in the Telemedicine appendix of the CPT manual, or its successor, when provided by telemedicine/telehealth. In addition, the MCO shall cover other services provided by telemedicine/telehealth when indicated as covered via telemedicine/telehealth in Medicaid program policy. Physicians and other licensed practitioners must continue to adhere to all existing clinical policy for all services rendered. Providing services through telemedicine/telehealth does not remove or add any medical necessity requirements.
SOURCE: MCO Manual (revised 5/23/23, pg. 173, (Accessed Jun. 2023).
Treatment-in-place ambulance services
Claims for allowable telehealth procedure codes must be billed with procedure code G2021. The G2021 code shall be accepted, paid at $0.00, and used by the MCO to identify treatment-in-place telehealth services.
As with all telehealth claims, providers must include POS identifier “02” and modifier “95” with their claim to identify the claim as a telehealth service. Providers must follow CPT guidance relative to the definition of a new patient versus an established patient.
See valid treatment in place ambulance claim modifier list.
If an enrollee being treated-in-place has a real-time deterioration in their clinical condition necessitating immediate transport to an emergency department, as determined by the ambulance provider (i.e., EMT or paramedic), telehealth provider, or enrollee, the MCO may not reimburse for both the treatment-in-place ambulance service and the transport to the emergency department. In this situation, the MCO shall reimburse for the emergency department transport only. The MCO shall require ambulance providers to submit pre-hospital care summary reports when ambulance treatment-in-place and ambulance transportation claims are billed for the same enrollee with the same date of service.
If an enrollee is offered treatment-in-place services but declines the services, ambulance providers should include procedure code G2022 on claims for ambulance transportation to an emergency department. Use of this informational procedure code is optional and does not affect the establishment of medical necessity of the service or reimbursement of the ambulance transportation claim. The G2022 code shall be accepted, paid at $0.00, and used by the MCO to identify enrollee refusal of treatment-in-place services.
The MCO shall restrict payment of treatment-in-place telehealth services to those identified on the Treatment-in-Place Telehealth Services Fee Schedule.
SOURCE: MCO Manual (revised 5/23/23), pg. 86 & LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 7/6/22), (Accessed Jun. 2023).
Behavioral Health Services
Assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services may be reimbursed when provided via telecommunication technology.
- The telecommunication system used by physicians and LMHPs must be secure, ensure member confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- The services provided are within the practitioner’s telehealth scope of practice as dictated by the respective professional licensing board and accepted standards of clinical practice;
- The member’s record includes informed consent for services provided through the use of telehealth;
- Services provided using telehealth must be identified on claims submission using by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the 95 modifier must be present on the claim to receive reimbursement;
- Assessments and evaluations conducted by an LMHP through telehealth should include synchronous, interactive, real-time electronic communication comprising both audio and visual elements unless clinically appropriate and based on member consent; and
- Providers must deliver in-person services when telehealth is not clinically appropriate or when the member requests in-person services.
LMHP’s providing assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services offered within Opioid treatment programs may be reimbursed when conducted via telecommunication technology. The LMHP is responsible for acting within the telehealth scope of practice as decided by the respective licensing board. The provider must bill the procedure code (CPT codes) with modifier “95”, as well as the correct place of service, either POS 02 (other than home) or 10 (home). Reimbursement will be at the same rate as a face-to-face service. Exclusions: Methadone admission visits conducted by the admitting physician within OTPs are not allowed via telecommunication technology.
SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 109 & 194 (As issued 5/12/23). (Accessed Jun. 2023).
Ambulance Providers – Managed Care Organizations
Physician directed treatment-in-place service is the facilitation of a telehealth visit by an ambulance provider. Each paid treatment-in-place ambulance claim must have a separate and corresponding paid treatment-in-place telehealth claim, and each paid treatment-in-place telehealth claim must have a separate and corresponding paid treatment-in-place ambulance claim or a separate and corresponding paid ambulance transportation claim. The MCO may not reimburse for both an emergency transport to a hospital and an ambulance treatment-in-place service for the same incident.
SOURCE: LA Medicaid Managed Care Organization (MCO) Manual, p. 86 (As revised 5/23/23), & LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 7/6/22), (Accessed Jun. 2023).
Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)
Telemedicine/telehealth is not a covered service, but is a service delivery method. Louisiana Medicaid encourages the use of this delivery method, when appropriate, for any and all healthcare services (i.e., not just those related to COVID-19 symptoms). Louisiana Medicaid allows for the telemedicine/telehealth mode of delivery for many common healthcare services.
All services eligible for telemedicine/telehealth may be delivered via an interactive audio/video telecommunications system.
Reimbursement for services delivered through telemedicine/telehealth is at the same level as reimbursement for in-person services.
SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Jun. 2023).
The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:
- An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
- Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
- The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.
SOURCE: LA Revised Statute, Ch. 46, Sec. 460.54, (Accessed Jun. 2023).
Mental Health Rehabilitation
Effective May 12, 2023, mental health rehabilitation services (see list of services under General Considerations) shall be provided through an in-person delivery method in accordance with federal requirements and the Medicaid Behavioral Health Services Provider Manual. Mental health rehabilitation assessments conducted by a licensed mental health professional (LMHP) may continue to be provided through telehealth using a secure telecommunications system which is compliant with HIPAA requirements; assessments conducted by an LMHP through telehealth should include synchronous, interactive, real-time electronic communication comprising both audio and visual elements, unless clinically appropriate and based on documented member consent effective May 12, 2023.
LDH is seeking continued CMS approval of telehealth Community Psychiatric Support and Treatment (CPST) services. The telehealth facilitation of CPST services will technically end as of May 12, 2023, as the telehealth allowance was temporary due to the COVID-19 pandemic. To maintain continued telehealth CPST services, LDH has revised its State Plan Amendment (SPA), adding telehealth as an allowable mode of delivery for CPST. In the SPA submission, LDH has requested an effective date of May 1, 2023, with the hopes of providing uninterrupted
telehealth CPST services to Louisiana residents. LDH expects CMS approval by mid-to-late June 2023.
See notice for telemedicine/telehealth guidelines.
SOURCE: LA Department of Health Informational Bulletin 20-4, Revised May 12, 2023, (Accessed Jun. 2023).
Outpatient Substance Use Disorder Treatment Services
The Biden Administration announced the public health emergency is set to expire on May 11, 2023. Beginning May 12, 2023, the requirements in the Medicaid Behavioral Health Services Provider Manual will resume. As stated in the Manual currently posted for public comment, licensed mental health professionals (LMHP) may provide assessments, evaluations, individual psychotherapy, family psychotherapy and medication management within an intensive outpatient or outpatient substance use treatment setting, through telemedicine/telehealth; assessments and evaluations conducted by an LMHP through telehealth should include synchronous, interactive, real-time electronic communication comprising both audio and visual elements, unless clinically appropriate and based on documented member consent effective May 12, 2023. NOTE: Methadone admission visits conducted by the admitting physician within Opioid Treatment Programs are not allowed via telehealth.
Provider responsibilities when providing services delivered through telehealth include:
- The provider shall deliver telehealth services in accordance with all state and federal laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any HIPAA related directives from the Office for Civil Rights at the Department of Health and Human Services.
- The provider shall deliver telehealth services in accordance with rules set forth by their respective professional licensing board and accepted standards of clinical practice.
- The provider shall maintain documentation for the services delivered through the use of telehealth and document the specific telehealth modality used.
- The provider shall use the appropriate procedure code, modifiers, and place of service codes.
Psychological testing and group therapy provided by an LMHP shall be delivered through an in-person service delivery method effective May 12, 2023, unless otherwise allowed per the Manual or subsequent LDH-issued notice.
Effective May 12, 2023, only LMHPs and psychiatrists may continue to conduct substance use disorder screenings and assessments via telemedicine/telehealth.
Effective May 12, 2023, OP-SUD treatment groups must be provided through an in-person service delivery method.
SOURCE: LA Department of Health Informational Bulletin 20-7, Revised March 16, 2023, (Accessed Jun. 2023).
Licensed Mental Health Practitioners
Beginning May 12, 2023, the requirements in the Medicaid Behavioral Health Services Provider Manual will resume.
Assessments and evaluations conducted by an LMHP through telehealth should include synchronous, interactive, real-time electronic communication comprising both audio and visual elements, unless clinically appropriate and based on documented member consent effective May 12, 2023.
Provider responsibilities when providing services delivered through telehealth include:
- The provider shall deliver telehealth services in accordance with all state and federal laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any HIPAA related directives from the Office for Civil Rights at the Department of Health and Human Services.
- The provider shall deliver telehealth services in accordance with rules set forth by their respective professional licensing board and accepted standards of clinical practice.
- The provider shall maintain documentation for the services delivered through the use of telehealth and document the specific telehealth modality used.
- The provider shall use the appropriate procedure code, modifiers, and place of service codes.
Psychological testing and group therapy provided by an LMHP shall be delivered through an in-person service delivery method effective May 12, 2023, unless otherwise allowed per the Manual or subsequent LDH-issued notice.
Telehealth/telemedicine may be used to facilitate certain services, when clinically appropriate. Telemedicine/telehealth does not exempt providers from any of the service requirements or record keeping as set forth in the Medicaid Behavioral Health Services Provider Manual.
Services must be medically necessary.
LDH has approved utilizing telemedicine/telehealth for conducting assessments conducted by licensed mental health practitioners.
Effective May 12, 2023, psychological testing may only be performed through an in-person service delivery method.
Effective May 12, 2023, group psychotherapy shall be provided via an in-person delivery method.
SOURCE: LA Department of Health Informational Bulletin 20-6, Revised March 16, 2023, (Accessed Jun. 2023).
For services rendered in the natural environment (home and community). “Community”: environment where children of same age with no disabilities or special needs participate such as childcare centers, agencies, libraries, and other community settings. Services can be provided via “teletherapy” specific POS/modifier combinations.
POS/modifier combination must be one of these two choices:
- POS 12 (Home) and Procedure Modifier U8; or
- POS 99 (Other Place of Service) and Procedure Modifier U8.
- POS 02 (Teletherapy) and Procedure Modifiers 95 and U8.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, EPSDT Health and IDEA, Part C- Early Steps, Section 47.5.1, p. 21 (As issued on 2/27/23), (Accessed Jun. 2023).
Applied Behavior Analysis (ABA)
Louisiana Medicaid will reimburse the use of telehealth, when appropriate, for rendering certain ABA services for the care of new or established patients or to support the caregivers of new or established patients.
An established patient is defined as one who already has an approved and a prior authorized treatment plan. An existing prior authorization does not need an addendum to be eligible for telehealth delivery. However, new patients still require approval and prior authorization for services, and subsequent new assessments and behavior treatment plans can be performed remotely via telehealth only if the same standard of care can be met. Previously approved prior authorizations can be amended to increase units of care and/or to reflect re-assessment goals. The codes listed below can be performed via telehealth; however, requirements for reimbursement are otherwise unchanged from Section 4.5 – Reimbursement of this manual chapter. See manual for codes.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Applied Behavior Analysis Section 4.1, p. 11-12 (As issued on 5/22/23). (Accessed Jun. 2023).
ELIGIBLE PROVIDERS
Distant site means the site at which the physician or other licensed practitioner is located at the time the services are provided.
The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid beneficiaries.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22) & Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 108 & 193 (As issued 5/12/23). (Accessed Jun. 2023).
Rural health clinics (RHC) and federally qualified health clinics (FQHC): Reimbursement for these services will be at the all-inclusive prospective payment rate on file for the date of service (DOS).
SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Jun. 2023).
FQHC manual refers to provider manual for billing instructions for telemedicine services.
SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pg. 33, (As issued on Jun. 30, 2022) & Rural Health Clinic Manual, Chapter 40, Sec. 40.4, pg. 33 (As issued on Jun. 30, 2022). (Accessed Jun. 2023).
Distant Site: The distant site refers to where the provider is located. The preferred location of a distant site provider is in a healthcare facility. However, if there is disruption to a healthcare facility or a risk to the personal health and safety of a provider, there is no formal limitation as to where the distant site provider can be located, as long as the same standard of care can be met.
SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Jun. 2023).
Treatment-in-place ambulance services
Valid rendering providers are licensed physicians, advanced practice registered nurses, and physician assistants.
SOURCE: MCO Manual (revised 5/23/23), pg. 87, & LA Dept. of Health and Hospitals, Medical Transportation, Sec. 10.8, (As issued on 7/6/22), (Accessed Jun. 2023).
Outpatient Substance Use Disorder Treatment Services
LDH is issuing approval to utilize telemedicine/telehealth for conducting substance use disorder screenings and assessments until May 11, 2023. Effective May 12, 2023, only LMHPs and psychiatrists may continue to conduct substance use disorder screenings and assessments via telemedicine/telehealth.
SOURCE: LA Department of Health Informational Bulletin 20-7, Revised March 16, 2023, (Accessed Jun. 2023).
Licensed Mental Health Practitioners
Fully licensed mental health practitioners include:
- Psychiatrists;
- Medical Psychologists;
- Licensed Psychologists;
- Licensed Clinical Social Workers (LCSW);
- Licensed Professional Counselors (LPC);
- Licensed Marriage and Family Therapists (LMFT);
- Licensed Addiction Counselors (LAC); and
- Advanced Practice Registered Nurses (APRN) with a psychiatric specialization.
SOURCE: LA Department of Health Informational Bulletin 20-6, Revised March 16, 2023, (Accessed Jun. 2023).
Applied Behavior Analysis (ABA)
Telehealth services must be based on ABA methodology and rendered or directed by a registered line technician (RLT), licensed behavior analyst (LBA), or certified assistant behavior analyst (CaBA). The caregivers/patients and RLT/LBA/CaBA must be linked through an interactive audio/visual telecommunications system.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Applied Behavior Analysis Section 4.1, p. 12 (As issued on 5/22/23). (Accessed Jun. 2023).
ELIGIBLE SITES
Originating site means the location of the Medicaid beneficiary at the time the services are provided. There is no restriction on the originating site and it can include, but is not limited to, a healthcare facility, school, or the beneficiary’s home.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (As issued 6/27/22), & MCO Manual (revised 5/23/23), pg. 173, & Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 108 & 193 (As issued 5/12/23). (Accessed Jun. 2023).
The Centers for Medicare and Medicaid Services (CMS) added a new place of service (POS) for telehealth services provided in the patient’s home effective for dates of service on and after January 1, 2022. Providers are required to use the appropriate POS, either 02 (other than home) or 10 (home) with modifier 95 for the billing of telemedicine/telehealth services based on the beneficiary’s location at the time of service.
SOURCE: LA Dept. of Health, Informational Bulletin 19-11. (May 18, 2022). (Accessed Jun. 2023).
Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.
SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Jun. 2023).
Originating Site: The originating site refers to where the patient is located. There is currently no formal limitation on the originating site and this can include, but is not limited to, the patient’s home.
SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Jun. 2023).
GEOGRAPHIC LIMITS
A BHS provider that is not a licensed mental health professional or a provisionally licensed mental health professional acting within his/her scope of practice may not provide telehealth services outside of its geographic service area.
SOURCE: LA Admin Code 48:I Sec. 5605, (Accessed Jun. 2023).
FACILITY/TRANSMISSION FEE
Louisiana Medicaid only reimburses the distant site provider.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22). (Accessed Jun. 2023).
Last updated 06/07/2023
Remote Patient Monitoring
POLICY
Under the Community Choices Waiver, Louisiana Medicaid will reimburse for telecare, including:
- Activity and Sensor Monitoring,
- Health status monitoring, and
- Medication dispensing and monitoring.
Monthly telecare services consist of:
- Delivering, furnishing, maintaining and repairing/replacing equipment on an ongoing basis. This may be done remotely as long as all routine requests are resolved within three business days;
- Monitoring of recipient-specific service activities by qualified staff;
- Training the recipient and/or the recipient’s responsible representative in the use of the equipment;
- Cleaning and storing equipment;
- Providing remote teaching and coaching as necessary to the recipient and/or caregiver(s); and
- Analyzing data, developing and documenting interventions by qualified staff based on information/data reported.
Personal Emergency Response System (PERS) is also reimbursed under Community Choices Waiver, which sends alerts when emergency services are needed by the recipient.
Activity and Sensor Monitoring
This service is a computerized system that monitors the recipient’s in-home movement and activity for health, welfare and safety purposes. At a minimum the system must:
- Monitor the home’s points of egress;
- Detect falls;
- Detect movement or lack of movement;
- Detect whether doors are opened or closed; and
- Provide a push button emergency alert system.
Some systems also monitor the home’s temperature.
Health Status Monitoring
This service collects health-related data to assist the health care provider in assessing the recipient’s health condition and in providing recipient education and consultation. Could be beneficial for patient with chronic conditions for monitoring weight, oxygen saturation measurements and vital signs.
Medication Dispensing and Monitoring
A remote monitoring system that is individually pre-programmed to dispense and monitor the recipient’s compliance with medication therapy. The provider or caregiver is notified when there are missed doses or non-compliance with medication therapy.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-25 (as issued on 4/13/22). (Accessed Jun. 2023).
Standards
Assistive Devices and Medical Supplies Provided by a Durable Medical Equipment (DME) provider that:
- Is enrolled to provide DME; and
- Has enrolled in Medicaid as an Assistive Devices and Medical Supplies CCW provider (Provider Type 17);
OR
Provided by a home health agency provider that:
- Is licensed to provide home health services;
- Is Medicare certified; and
- Has enrolled in Medicaid as an OAAS – Community Choices Waiver assistive devices provider (Provider Type 17).
For personal emergency response systems (PERS), these services are provided by a provider that:
- Is enrolled in Medicaid as a PERS provider; and
- Has furnished verification (copy of letter from the manufacturer written on the manufacturer’s letterhead stationary) that the provider is an authorized dealer, supplier or manufacturer of a PERS product.
The PERS provider must install and support PERS equipment in compliance with all of the applicable federal, state, parish and local laws and regulations, as well as meet manufacturer’s specifications, response requirements, maintenance records, and recipient education.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 74 and 84 (As issued 4/13/22). (Accessed Jun. 2023).
Technology Supports with Remote Features:
- Mobile Emergency Response System- an on-the-go mobile medical alert system, used in and outside the home. This system will cellular/GPS technology, two-way speakers and no base station required;
- Medication Reminder System- an electronic device programmed to remind individual to take medications by a ring, automated recording or other alarm. The electronic device may dispense controlled dosages of mediation and may include a message back to the center if a medication
has not been removed from the dispenser. Requires ability to self-administer medication with reminder; and
Other equipment used to support someone remotely may include but not limited to: electronic motion door sensor devices, door alarms, web-cams, telephones with modifications (large buttons, flashing lights), devices affixed to wheelchair or walker to send alert when fall occurs, text-to-speech software, intercom systems, tablets with features to promote communication or smart device speakers.
Remote Technology Service Delivery: covers monthly response center/remote support monitoring fee and tech upkeep (no internet cost coverage)
Remote Technology Consultation: evaluation of tech support needs for an individual, including functional evaluation of technology available to address the person’s assess needs and support person to achieve outcomes identified in the POC.
SOURCE: LA Dept. of Health, Residential Options Waiver, Section 38.1, p. 46-47 (As issued 3/27/23). (Accessed Jun. 2023).
CONDITIONS
Health status monitoring:
May be beneficial to individuals with congestive heart failure, diabetes or pulmonary disease.
Services must be based on a verified need of the beneficiary and the service must have a direct or remedial benefit with specific goals and outcomes.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 35 (as issued on 4/13/22). (Accessed Jun. 2023).
PROVIDER LIMITATIONS
Telecare providers must meet the following requirements:
- Be UL listed/certified or have 501(k) clearance;
- Be web-based;
- Be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- Have beneficiary specific reporting capabilities for tracking and trending;
- Have a professional call center for technical support based in the United States; and
- Have on-going provision of web-based data collection for each beneficiary, as appropriate. This includes response to beneficiary self-testing, manufacturer’s specific testing, self-auditing, and quality control.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 84 (As issued 4/13/22). (Accessed Jun. 2023).
OTHER RESTRICTIONS
Limitations
- Services must be based on verified need and have a direct or remedial benefit with specific goals and outcomes.
- Benefit must be determined by an independent assessment on any item that costs over $500 and on all communication devices, mobility devices, and environmental controls.
- Independent assessments must be performed by individuals who have no fiduciary relationship with the manufacturer, supplier, or vendor of the item.
- All items must reduce reliance on other Medicaid State Plan or waiver services
- All items must meet applicable standards of manufacture, design and installation
- The items must be on the Plan of Care developed by the support coordinator and are subject to approval by OAAS Regional Office or its designee.
- A beneficiary will not be able to simultaneously receive telecare activity and sensor monitoring services and traditional PERS services.
Where applicable, beneficiaries must use Medicaid state plan services, Medicare, or other available payers first. The beneficiary’s preference for a certain brand or supplier is not grounds for declining another payer in order to access waiver services.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 35 & 32 (As issued on 4/13/22). (Accessed Jun. 2023).
