Last updated 01/17/2023
Consent Requirements
No Reference Found
Last updated 01/17/2023
Definitions
“Telehealth” means healthcare services, including behavioral health services, provided by a healthcare provider, as defined in this Section, to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer technology, or synchronous interaction between a provider at a distant site and a patient at an originating site, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient, and transfer of medical data. The term “telehealth” shall not include any of the following:
- Electronic mail messages and text messages that are not compliant with applicable requirements of the Health Insurance Portability and Accountability Act of 1996, as amended, 42 U.S.C. 1320d et seq.
- Facsimile transmissions
SOURCE: LA Revised Statutes 40:1223.3, (Accessed Jan.. 2023).
“Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or other licensed practitioner and a beneficiary are not in the same location. The telecommunications system shall include, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the beneficiary at the originating site and the physician or other licensed practitioner at the distant site. The telecommunications system must be secure, ensure patient confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act.”
SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (As revised 9/3/20), & MCO Manual (revised 1/12/23), pg. 171-172, (Accessed Jan. 2023).
Telecare is a delivery of care services to recipients in their home by means of telecommunications and/or computerized devices to improve outcomes and quality of life, increase independence and access to health care, and reduce health care costs. Telecare services include:
- Activity and sensor monitoring;
- Health status monitoring; and
- Medication dispensing and monitoring.
SOURCE: LA Dept. of Health and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 25-26 (As revised on Oct. 14 2021). (Accessed Jan. 2023).
Last updated 01/17/2023
Email, Phone & Fax
Hospices may report some social worker calls as a visit. Hospices may not report any other types of phone calls.
SOURCE: LA Medicaid, Chapter 24: Hospice, Sec. 24.9, Medicaid Svcs. Manual, p. 62, (As issued on Feb. 7, 2022), (Accessed Nov. 2022).
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 Nov. 2022).
Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)
- All services eligible for telemedicine/telehealth may be delivered via an interactive audio/video telecommunications system;
- A secure, HIPAA-compliant platform is preferred, if available. However, for the duration of the COVID-19 event, if a HIPAA-compliant system is not immediately available at the time it is needed, providers may use everyday communications technologies such as cellular phones with widely available audio/video communication platforms;
- Providers should follow guidance from the Office for Civil Rights at the Department of Health and Human Services for software deemed appropriate for use during this event;
- For the duration of the COVID-19 event, in cases where an interactive audio/video system is not immediately available at the time it is needed, an interactive audio-only system (e.g., telephone) without the requirement of video may be employed, unless noted otherwise;
- For use of an audio-only system, the same standard of care must be met, and the need and rationale for employing an audio-only system must be documented in the clinical record; and
- Please note, some telemedicine/telehealth services require delivery through an audio/video system due to the clinical nature of these services. Where applicable, this requirement is noted explicitly.
SOURCE: LA Dept. of Health and Hospitals, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Jan. 2023).
Supports Waiver
Covered services include face-to-face support off the job site by provider staff that is necessary for the beneficiary to maintain gainful employment. Examples of this kind of contact include, but are not limited to communications with the beneficiary by telephone, e-mail or fax that is necessary
for the beneficiary to maintain gainful employment.
SOURCE: LA Dept. of Health and Hospitals, Support Services, Ch. 43.4, (As issued on Sept. 10, 2021), (Accessed Jan. 2023).
Last updated 01/17/2023
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 and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165-166 (Sept. 3, 2020). (Accessed Jan. 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 Jan. 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 1/12/2023), pg. 172, (Accessed Jan. 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 Jan. 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 and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (Sept. 3, 2020). (Accessed Jan. 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 Jan. 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 1/12/23), pg. 172, (Accessed Jan. 2023).
Behavioral Health Services
Assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services may be reimbursed when provided via telecommunication technology. The LMHP is responsible for acting within the telehealth scope of practice as decided by their 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.
SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 108-109 (As issued on Feb. 25, 2022). (Accessed Jan. 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. 85 (As revised 1/12.23), (Accessed Jan. 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 and Hospitals, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Jan. 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.
ELIGIBLE PROVIDERS
The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services.
SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on Sept. 3, 2020). (Accessed Jan. 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 Jan. 2023).
FQHC manual refers to provider manual for billing instructions for telemedicine services.
SOURCE: LA Dept. of Health and Hospitals, 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 Jan. 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 and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (As revised 9/3/20), & MCO Manual (revised 1/12/23), pg. 172, (Accessed Jan. 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 Jan. 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 Jan. 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 Jan. 2023).
FACILITY/TRANSMISSION FEE
Louisiana Medicaid only reimburses the distant site provider.
SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on Sept. 3, 2020). (Accessed Jan. 2023).
Last updated 01/17/2023
Miscellaneous
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 Statute Sec. 46:460.54. (Accessed Jan. 2023).
The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth.
SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 165, (As issued on Sept. 3, 2020), (Accessed Jan. 2023).
Last updated 01/17/2023
Out of State Providers
No Reference Found
Last updated 01/17/2023
Overview
Live video telemedicine is covered for distant site providers enrolled in Louisiana Medicaid. There is no reimbursement for the originating site. Activity and sensor monitoring, health status monitoring and medication dispensing and monitoring are forms of remote patient monitoring that are covered by Louisiana Medicaid. There is no reference to store-and-forward.
Last updated 11/08/2022
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 and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-25 (as issued on Oct. 14, 2021). (Accessed Jan. 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 and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 74 and 84 (As replaced on July 16, 2021). (Accessed Jan. 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 and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 35 (as replaced on Oct. 14, 2021). (Accessed Jan. 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
SOURCE: LA Dept. of Health and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 84 (As replaced on July 16, 2021). (Accessed Jan. 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 and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 35 & 32 (As replaced on Oct. 14, 2021). (Accessed Jan. 2023).
Last updated 01/17/2023
Store and Forward
POLICY
Louisiana Medicaid will not provide reimbursement for store-and-forward based upon the definition of “telemedicine/telehealth” which describes telemedicine as including “audio and video equipment permitting two-way, real time interactive communication” therefore excluding store-and-forward.
SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on Sept. 3, 2020). (Accessed Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
