Maine

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: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: CC, IMLC, NLC, OT, PSY
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: MaineCare
  2. Administrator: Maine Dept. of Health and Human Services
  3. Regional Telehealth Resource Center: Northeast Regional 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 10/19/2022

Cross State Licensing

Previous COVID-19 waivers expired.

Last updated 10/19/2022

Easing Prescribing Requirements

Medicaid: MaineCare Guidance related to Telehealth and Telephone During COVID-19

STATUS: Varies, most expire at end of PHE

Last updated 10/19/2022

Private Payer

Previous COVID-19 waivers expired.

Last updated 07/27/2022

Provider Type

Medicaid: Telehealth Guidance for Home and Community Based Waiver Service Providers

STATUS: Active

Medicaid: MaineCare Guidance related to Telehealth and Telephone During COVID-19

STATUS: Varies, most expire at end of PHE

Medicaid: Adopted Rule on Telehealth and COVID-19 Public Health Emergency Services Chapter.

STATUS: Active, until repealed

Last updated 10/19/2022

Definitions

“Telehealth,” as it pertains to the delivery of health care services, means the use of information technology and includes synchronous encounters, asynchronous encounters, store and forward transfers and telemonitoring.

“Telemonitoring,” as it pertains to the delivery of health care services, means the use of information technology to remotely monitor an enrollee’s health status via electronic means, allowing the provider to track the enrollee’s health data over time. Telemonitoring may be synchronous or asynchronous.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316. (Accessed Oct. 2022).

Last updated 10/19/2022

Parity

SERVICE PARITY

Coverage for health care services provided through telehealth must be determined in a manner consistent with coverage for health care services provided through in-person consultation. If an enrollee is eligible for coverage and the delivery of the health care service through telehealth is medically appropriate, a carrier may not deny coverage for telehealth services. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided through telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to a comparable service provided through in-person consultation. A carrier may not exclude a health care service from coverage solely because such health care service is provided only through a telehealth encounter, as long as telehealth is appropriate for the provision of such health care service.

A carrier shall provide coverage for any medically necessary health care service delivered through telehealth as long as the following requirements are met:

  • The health care service is otherwise covered under an enrollee’s health plan.
  • The health care service delivered by telehealth is of comparable quality to the health care service delivered through in-person consultation.
  • Prior authorization is required for telehealth services only if prior authorization is required for the corresponding covered health care service. An in-person consultation prior to the delivery of services through telehealth is not required.
  • Coverage for telehealth services is not limited in any way on the basis of geography, location or distance for travel.
  • The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.
  • The carrier shall provide coverage for the treatment of 2 or more persons who are enrolled in the carrier’s health plan at the same time through telehealth, including counseling for substance use disorders involving opioids.
  • The carrier may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

A carrier shall provide coverage for telemonitoring if:

  • The telemonitoring is intended to collect an enrollee’s health-related data, including, but not limited to, pulse and blood pressure readings, that assist a provider in monitoring and assessing the enrollee’s medical condition;
  • The telemonitoring is medically necessary for the enrollee;
  • The enrollee is cognitively and physically capable of operating the mobile health devices or the enrollee has a caregiver willing and able to assist with the mobile health devices;  and
  • The enrollee’s residence is suitable for telemonitoring. If the residence appears unable to support telemonitoring, the telemonitoring may not be provided unless necessary adaptations are made.

Coverage for telephonic services.

A carrier may not require a provider to use specific telecommunications technology and equipment as a condition of coverage under this section as long as the provider uses telecommunications technology and equipment that comply with current industry interoperability standards and that comply with standards required under the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 and regulations promulgated under that Act.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316, (Accessed Oct. 2022).


PAYMENT PARITY

No explicit payment parity.

Last updated 10/19/2022

Requirements

A carrier offering a health plan in this State may not deny coverage on the basis that the health care service is provided through telehealth if the health care service would be covered if it were provided through in-person consultation between an enrollee and a provider and as long as the provider is acting within the scope of practice of the provider’s license and in accordance with rules adopted by the board, if any, that issued the provider’s license related to standards of practice for the delivery of a health care service through telehealth.

A carrier may not exclude a health care service from coverage solely because such health care service is provided only through a telehealth encounter, as long as telehealth is appropriate for the provision of such health care service.

Provider must be acting within the scope of practice of the provider’s license and in accordance with rules adopted by the board, if any, that issued the provider’s license related to standards of practice for the delivery of a health care service through telehealth.

A carrier shall provide coverage for any medically necessary health care service delivered through telehealth as long as the following requirements are met:

  • The health care service is otherwise covered under an enrollee’s health plan.
  • The health care service delivered by telehealth is of comparable quality to the health care service delivered through in-person consultation.
  • Prior authorization is required for telehealth services only if prior authorization is required for the corresponding covered health care service. An in-person consultation prior to the delivery of services through telehealth is not required.
  • Coverage for telehealth services is not limited in any way on the basis of geography, location or distance for travel.
  • The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.
  • The carrier shall provide coverage for the treatment of 2 or more persons who are enrolled in the carrier’s health plan at the same time through telehealth, including counseling for substance use disorders involving opioids.
  • The carrier may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

A carrier shall provide coverage for telemonitoring if:

  • The telemonitoring is intended to collect an enrollee’s health-related data, including, but not limited to, pulse and blood pressure readings, that assist a provider in monitoring and assessing the enrollee’s medical condition;
  • The telemonitoring is medically necessary for the enrollee;
  • The enrollee is cognitively and physically capable of operating the mobile health devices or the enrollee has a caregiver willing and able to assist with the mobile health devices;  and
  • The enrollee’s residence is suitable for telemonitoring. If the residence appears unable to support telemonitoring, the telemonitoring may not be provided unless necessary adaptations are made.

In order to be eligible for reimbursement under this section, a provider providing health care services through telehealth must be acting within the scope of the provider’s license. A carrier may not impose additional credentialing requirements or prior approval requirements for a provider as a condition of reimbursement for health care services provided under this section unless those credentialing requirements or prior approval requirements are the same as those imposed for a provider that does not provide health care services through telehealth.

A carrier may not require a provider to use specific telecommunications technology and equipment as a condition of coverage under this section as long as the provider uses telecommunications technology and equipment that comply with current industry interoperability standards and that comply with standards required under HIPAA.

The availability of health care services through telehealth may not be considered for the purposes of demonstrating the adequacy of a carrier’s network.

A carrier may provide coverage for health care services delivered through telehealth that is consistent with the Medicare coverage policy for interprofessional Internet consultations. If a carrier provides coverage consistent with the Medicare coverage policy for interprofessional Internet consultations, the carrier may also provide coverage for interprofessional Internet consultations that are provided by a federally qualified health center or rural health clinic.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316, (Accessed Oct. 2022).

Last updated 10/19/2022

Definitions

Telehealth services are the use of information technology by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment.  Telehealth Services may be either telephonic or interactive (combined video/audio).

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 2 (June 15, 2020). (Accessed Oct. 2022).

Telehealth as it pertains to the delivery of MaineCare services, means the use of information technology and includes, synchronous encounters, asynchronous encounters, store-and-forward transfers and telemonitoring.

SOURCE: ME Statute Sec. 22:855.3173-H(D). (Accessed Oct. 2022). 

Last updated 10/19/2022

Email, Phone & Fax

Telephonic Services:  The use of telephone communication by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment.

Telephonic services may be reimbursed if the following conditions are met:

  • Interactive telehealth services are unavailable; and
  • A telephonic service is medically appropriate for the underlying covered service.

Except as specified in the manual, services may not be delivered through electronic mail.

Interprofessional telephone/internet assessment are among the listed reimbursable procedure codes.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 3, 6, 10 & 16. (June 15, 2020). (Accessed Oct. 2022). 

New Medicaid Policy (Effective Upon Approval from CMS)

The Department will reimburse providers for Telephone Evaluation and Management Services provided to members. The restrictions set forth in the MaineCare Benefits Manual, Ch. I, Sec. 4.04-3 are inapplicable to Telephone Evaluation and Management Services, as these are separate and apart from the Telephonic Services set forth in Sec. 4.04-3.

Telephonic Evaluation and Management Services must be rendered by a qualified professional actively enrolled in MaineCare or contracted through an enrolled MaineCare provider.

Telephone Evaluation and Management Services are not to be billed if clinical decision-making dictates a need to see the member for an office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven (7) days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable.

The Department shall seek and anticipates receiving CMS approval for these provisions. Pending CMS approval, these provisions are effective.

Coverage also includes the virtual check-in, which can occur telephonically or through interactive services.  See manual for requirements.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 7-8. (June 15, 2020). (Accessed Oct. 2022). 

For Indian Health Services, a second-tier consultation can utilize direct email communications or telephone consultation.

SOURCE: MaineCare Benefits Manual, Indian Health Services, 10-144 Ch. II, Sec. 9, p. 5 (March 21, 2012). (Accessed Oct. 2022). 

Under Targeted Case Management, monitoring and follow-up activities may involve either face-to-face or telephone contact.

SOURCE:  MaineCare Benefits Manual, Targeted Case Management Services, 10-144 Ch. 101, Sec. 13.02, p. 6 (Mar. 20, 2014). (Accessed Oct. 2022). 

For crisis resolution services, under Behavioral health, covered services do include direct telephone contacts with both the member and the member’s parent or guardian or adult’s member’s guardian when at least one face-to-face contact is made with the member within seven (7) days prior to the first contact related to the crisis resolution service. The substance of the telephone contact(s) must be such that the member is the focus of the service, and the need for communication with the parent or guardian without the member present must be documented in the member’s record.

Also covered for Functional Family Therapy (FFT) and Multi-Systemic Therapy.

SOURCE:  MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, p. 4, 5 & 12 (Aug, 19, 2020). (Accessed Oct. 2022).

An examination following use of restraint or seclusion can be done by a telephone in consult with a registered nurse.  When a telephonic consult occurs, the physician, or nurse practitioner must examine the member in person within the following time constraints:

  • Within one (1) hour of when the registered nurse requests an examination;
  • Within one (1) hour of when information relayed is suggestive of causes leading to physical harm to the member;
  • Within one (1) hour if an examination has not yet occurred during the member’s stay; or
  • Within six (6) hours in all other circumstances.

SOURCE:  MaineCare Benefits Manual, Psychiatric Residential Treatment Facility Services, 10-44 Ch. II, Sec. 107, p. 32 (Oct. 3, 2018). (Accessed Oct. 2022).

Last updated 10/18/2022

Live Video

POLICY

If the Member is eligible for the underlying covered service to be delivered, and if delivery of the covered service via telehealth is medically appropriate, as determined by the health care provider, the member is eligible for telehealth services.

Except as provided in the manual, reimbursement will not be provided for communications between Health Care Providers when the Member is not present at the Originating (Member) Site.

Except as provided in the manual, reimbursement will not be provided for communications solely between Health Care Providers and Members when such communications would not otherwise be billable.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 3 & 9. (June 15, 2020). (Accessed Oct. 2022).

“Synchronous encounters” means a real-time interaction conducted with interactive audio or video connection between a patient and the patient’s provider or between providers regarding the patient.

SOURCE: ME Statute Sec. 22:855.3173-H, Sub. Sec. 1 (Accessed Oct. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Any medically necessary MaineCare Covered Service may be delivered via Interactive Telehealth Services, provided the following requirements are met:

  1. The Member is otherwise eligible for the Covered Service, as described in the appropriate section of the MaineCare Benefits Manual; and
  2. The Covered Service delivered by Interactive Telehealth Services is of comparable quality to what it would be were it delivered in person.

Prior authorization is required for Interactive Telehealth Services only if prior authorization is required for the underlying Covered Service. In these cases, the prior authorization is the usual prior authorization for the underlying Covered Service, rather than prior authorization of the mode of delivery. A face to face encounter prior to telehealth is not required.

There is a specific list of telehealth specific codes and reimbursement rates provided in the manual.

Coverage also includes the virtual check-in, which can occur telephonically or through interactive services.  See manual for requirements.

Non-Covered services include:

  • Medical equipment, supplies, orthotics and prosthetics
  • Personal care aide
  • Assistive technology services (for certain applicable sections, see manual)
  • Non-emergency medical transportation
  • Services that require direct physical contact with a Member by a Health Care Provider and that cannot be delegated to another Health Care Provider at the site where the Member is located are not covered
  • Any service medically inappropriate for telehealth services.

See manual for details of the exclusions.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 4-5, 7-9, 15-17. (June 15, 2020). (Accessed Oct. 2022).

Rules adopted by the department:

  • May not include any requirement that a patient have a certain number of emergency room visits or hospitalizations related to the patient’s diagnosis in the criteria for a patient’s eligibility for telemonitoring services;
  • Except as provided in paragraph E, must include qualifying criteria for a patient’s eligibility for telemonitoring services that include documentation in a patient’s medical record that the patient is at risk of hospitalization or admission to an emergency room;
  • Must provide that group therapy for behavioral health or addiction services covered by the MaineCare program may be delivered through telehealth;
  • Must include requirements for providers providing telehealth and telemonitoring services; and
  • Must allow at least some portion of case management services covered by the MaineCare program to be delivered through telehealth, without requiring qualifying criteria regarding a patient’s risk of hospitalization or admission to an emergency room.

SOURCE:  ME Revised Statute Sec. 3173,-H, (Accessed Oct. 2022)

A multitude of services are listed as being allowed either face-to-face or through telehealth in the behavioral health services manual.

SOURCE:  MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, pgs. 51-52 (Aug. 19, 2020). (Accessed Oct. 2022).

Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations

Telemedicine may be utilized as clinically appropriate, according to the standards described in Chapter I, Section 4 of the MaineCare Benefits Manual.

SOURCE: MaineCare Benefits Manual, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations, 28.08, Ch. 101, Ch. II, Sec. 28, p. 12, (9/23/19), (Accessed Oct. 2022).

Durable Medical Equipment

Face-to-Face Encounter is a mandatory encounter (including encounters through a telehealth system, (as described in Chapter I, §1.06 of this manual) and other than encounters incidental to services involved) between the member and his or her physician, physician assistant, nurse practitioner or clinical nurse specialist that takes place within the six (6) months prior to a written order for Durable Medical Equipment being given. The written order may be prescribed by the physician, physician assistant, nurse practitioner, or clinical nurse specialist who performed the face-to-face encounter.

SOURCE: MaineCare Benefits Manual, Durable Medical Equipment, 60.05, Ch. 101, Ch. II, Sec. 60, p. 4, (6/13/18), (Accessed Oct. 2022).

Children’s Residential Care Facilities (CRCFs)

The nurse may provide in-person, telehealth, and/or telephonic support outside of normal business hours as needed. The nurse must be either a psychiatric mental health nurse practitioner (APRN-PMH-NP), or a registered nurse (RN) with experience in the treatment of children with serious behavioral health conditions or requisite training to treat children with serious behavioral health conditions.

SOURCE: MaineCare Benefits Manual, Private Non-Medical Institution, 97.07, Ch. 101, Ch. II, Sec. 97, (11/1/21), (Accessed Oct. 2022).


ELIGIBLE PROVIDERS

A health care provider is an individual or entity licensed or certified under the laws of the state of Maine to provide medical, behavioral health, and related services to MaineCare Members. Health Care Providers must be enrolled as MaineCare Providers in order to be reimbursed for services.

A health care provider must also be:

  • Acting within the scope of his or her license
  • Enrolled as a MaineCare provider; and
  • Otherwise eligible to deliver the underlying Covered Service according to the requirements of the applicable section of the MaineCare Benefits Manual.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.03., p 1 & 4. (June 15, 2020). (Accessed Oct. 2022). 

Telehealth Services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the State. If approved, these facilities may serve as the provider site and bill under the encounter rate. When an FQHC or RHC serves as the Originating (Member) Site, the Originating Facility Fee is paid separately from the center or clinic all-inclusive rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 13. (June 15, 2020). (Accessed Oct. 2022).

Electronic Visit Verification (EVV) Place of Service Providers

Telehealth Personal Care Services (PCS) claims are excluded from Electronic Visit Verification (EVV) record requirements. When billing telehealth claims on the CMS 1500 Claim Form, you must use the POS code 02 or 10 and include the GT modifier, as this indicates you are providing services via telehealth and not in-person.

See the table below for affected codes. UB04 claim lines submitted with telemedicine revenue code 078x are exempt from EVV editing.

SOURCE: ME Department of Health and Human Services, Office of MaineCare Services, Electronic Visit Verification (EVV) Place of Service Reminders, Sept. 26. 2022. (Accessed Oct. 2022).


ELIGIBLE SITES

The Originating (Member) Site will usually be a Health Care Provider’s office, but it may also be the Member’s residence, provided the proper equipment is available for Telehealth Services.

When an FQHC or RHC serves as the Originating (Member) Site, the Originating Facility Fee is paid separately from the center or clinic all-inclusive rate.

The Health Care Providers at the Receiving and Originating Sites may be part of the same organization. In addition, a Health Care Provider at the Originating (Member) Site may bill MaineCare and receive payment for Telehealth Services if the service is provided by a qualified professional who is under a contractual arrangement with the Originating (Member) Site.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 2 & 13 & 14. (June 15, 2020). (Accessed Oct. 2022).

Electronic Visit Verification (EVV) Place of Service Reminders

Personal Care Services (PCS) claims are included or excluded from EVV record requirements based on the POS code and EVV service codes that are submitted on the CMS 1500 claim form.

Claims for services delivered in the following locations are not subject to EVV and do not require a verified EVV visit record:

  • POS 02: Telehealth provided other than in a patient’s home
    • Use this POS for Home Support-Remote Support: Monitor Only and Interactive services (including MaineCare policy Sections 18, 19, 20, 21, and 29).
    • Please refer to our additional telehealth billing guidance for PCS.
  • POS 10: Telehealth provided in patient’s home

SOURCE: ME Department of Health and Human Services, Office of MaineCare Services, Electronic Visit Verification (EVV) Place of Service Reminders, Sept. 26. 2022. (Accessed Oct. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

A facility fee is provided to a health care provider at the originating site.

An originating facility fee may only be billed in the event that the originating site is in a healthcare provider’s facility.

An Originating Facility Fee may not be billed for a Telephonic Service.

When an FQHC or RHC serves as the originating site, the facility fee is paid separately from the center or clinic all-inclusive rate.

The Department will not separately reimburse for any charge related to the purchase, installation, or maintenance of telehealth equipment or technology, nor any transmission fees, nor may a Member be billed for such.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 2, 9-10, 13. (June 15, 2020). (Accessed Oct. 2022).

Last updated 10/19/2022

Miscellaneous

See manual for information regarding telehealth equipment, technology, security, documentation and member choice and education requirements.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p. 9-12. (June 15, 2020). (Accessed Oct. 2022).

Beginning January 1, 2018 and annually thereafter, the department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters on the use of telehealth in the MaineCare program, including the number of providers providing telehealth and telemonitoring services, the number of patients served by telehealth and telemonitoring services and a summary of grants applied for and received related to telehealth and telemonitoring.

The Department is required to conduct educational outreach to providers and MaineCare members on telehealth and telemonitoring services.

SOURCE: ME Statute Sec. 3173-H. (Accessed Oct. 2022). 

Telepharmacy is a method of delivering prescriptions dispensed by a pharmacist to a remote site. Pharmacies using telepharmacy must follow all applicable State and Federal regulations, including use of staff qualified to deliver prescriptions through telepharmacy.

Providers may dispense prescriptions via telepharmacy when obtaining approval from the Department. Providers must assure that member counseling is available at the remote site from the dispensing provider or the provider delivering the prescription, and that only qualified staff, as defined by the Maine State Board of Pharmacy, deliver prescriptions. The Department may terminate this approval at any time by written notice.

SOURCE: MaineCare Benefits Manual, Pharmacy Services, 10-144 Ch. II, Sec. 80 p. 5 & 30. (Sept. 1, 2017), (Accessed Oct. 2022).

ME established the ME Telehealth and Telemonitoring advisory group to evaluate difficulties related to telehealth and telemonitoring services and make recommendations to the department to improve it statewide.

SOURCE: ME Statute Sec. 3173-I. (Accessed Oct. 2022).

Office of MaineCare Services

ME Medicaid has a telehealth resource page to assist providers and consumers.

SOURCE: ME Dept. of Health and Human Services, Office of MaineCare Services, Telehealth, (Accessed Oct. 2022).

Last updated 10/19/2022

Out of State Providers

Healthcare Providers must be licensed or certified in the state of Maine.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p. 1, (June 15, 2020). (Accessed Oct. 2022).

Last updated 10/19/2022

Overview

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain conditions, and remote patient monitoring for patients with certain risk factors.  Although their definition of telehealth is broad enough to include of store-and-forward, there is no mention of store-and-forward reimbursement within their policies.

Last updated 07/28/2022

Remote Patient Monitoring

POLICY

Telemonitoring Services are the use of information technology to remotely monitor a member’s health status through the use of clinical data while the member remains in the residential setting. Telemonitoring may or may not take place in real time.

SOURCE: MaineCare Benefits Manual. Ch. II. Home Health Services. Sec. 40.01, p. 5 (Aug. 11, 2019). (Accessed Oct. 2022).

“Telemonitoring,” as it pertains to the delivery of MaineCare services, means the use of information technology to remotely monitor a patient’s status via electronic means, allowing the provider to track the patient’s health data over time. Telemonitoring may be synchronous or asynchronous.

SOURCE: ME Statute Sec. 22:855.3173-H(E), (Accessed Oct. 2022).

ME Medicaid provides coverage for telemonitoring services (which may or may not take place in real time) under certain circumstances.

Covered telemonitoring services include:

  • Evaluation of the Member to determine if Telemonitoring Services are medically necessary for the Member. The Home Health Agency must assure that a Health Care Provider’s order or note, demonstrating the necessity of Telemonitoring Services, is included in the Member’s Plan of Care.
  • Evaluation of the Member to assure that the Member is cognitively and physically capable of operating the Telemonitoring equipment or assurance that the Member has a caregiver willing and able to assist with the equipment;
  • Evaluation of the Member’s residence to determine suitability for Telemonitoring Services. If the residence appears unable to support Telemonitoring Services, the Home Health Agency may not implement Telemonitoring Services in the Member’s residence unless necessary adaptations are made. Adaptations are not reimbursable by MaineCare;
  • Education and training of the Member and/or caregiver on the use, maintenance and safety of the Telemonitoring equipment, the cost of which is included in the monthly flat rate paid by MaineCare to the Home Health Agency;
  • Remote monitoring and tracking of the Member’s health data by a registered nurse, nurse practitioner, physician’s assistant or physician, and response with appropriate clinical interventions. The Home Health Agency and Health Care Provider utilizing the data shall maintain a written protocol that indicates the manner in which data shall be shared in the event of emergencies or other medical complications;
  • At least monthly Telephonic Services with the Member;
  • Maintenance of equipment, the cost of which is included in the monthly flat rate paid by MaineCare to the Home Health Agency.
  • Removal/disconnection of equipment from the Member’s home when Telemonitoring Services are no longer necessary or authorized

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.04. p. 6-7. (June 15, 2020). (Accessed Oct. 2022).

Home and Community Benefits for the Elderly and for Adults with Disabilities

Assistive Technology-Remote Monitoring means real time remote support monitoring of the member with electronic devices to assist them to remain safely in their homes. Remote monitoring services may include a range of technological options including in-home computers, sensors, and video camera linked to a provider that enables 24/7 monitoring and/or contact as necessary.

SOURCE: MaineCare Benefits Manual, Home and Community Benefits for the Elderly and for Adults with Disabilities, 10-144 Ch. II, Sec. 19.04-2, p. 23 (May 2, 2021). (Accessed Oct. 2022).


CONDITIONS

In order to be eligible for telemonitoring a member must:

  • Be eligible for home health services;
  • Have a current diagnosis of a health condition requiring monitoring of clinical data at a minimum of five times per week, for at least one week;
  • Have documentation in the patient’s medical record that the patient is at risk of hospitalization or admission to an emergency room OR have continuously received Telemonitoring Services during the past calendar year and have a continuing need for such services, as documented by an annual note from a health care provider;
  • Have telemonitoring services included in the Member’s plan of care. A notation from a Health Care Provider, dated prior to the beginning of service delivery, must be included in the Member’s Plan of Care. If Telemonitoring Services begin prior to the date recorded in the Provider’s note, services delivered shall not be reimbursed;
  • Reside in a setting suitable to support telemonitoring equipment; and
  • Have the physical and cognitive capacity to effectively utilize the telemonitoring equipment or have a caregiver willing and able to assist with the equipment.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.02. p.3-4 (June 15, 2020). & MaineCare Benefits Manual. Ch. II. Home Health Services. Sec. 40.05. p. 10-11. (Aug. 11, 2019). (Accessed Oct. 2022).

Home and Community Benefits for the Elderly and for Adults with Disabilities Final approval must be obtained from the Department, Office of Aging and Disability Services upon a recommendation by the ASA or SCA. In making such a recommendation the ASA or the SCA must consider and document the following information:

  • Number of hospitalizations in the past year;
  • Use of emergency room in the past year;
  • History of falls in the last six months resulting from injury;
  • Member lives alone or is home alone for significant periods of time;
  • Service access challenges and reasons for those challenges;
  • History of behavior indicating that a member’s cognitive abilities put them at a significant risk of wandering; and
  • Other relevant information.

SOURCE: MaineCare Benefits Manual, Home and Community Benefits for the Elderly and for Adults with Disabilities, 10-144 Ch. II, Sec. 19.04-2, p. 23 (May 2, 2021). (Accessed Oct. 2022).


PROVIDER LIMITATIONS

Telemonitoring only reimbursed when provided by a certified Home Health Agency.  See regulations for specific requirements of Home Health Agencies utilizing telemonitoring services.

SOURCE:  MaineCare Benefits Manual. Ch. II. Home Health Services. Sec. 40.05. p. 16. (Aug. 11, 2019). (Accessed Oct. 2022). 

In order to be reimbursed for services, Health Care providers:

  • Must be enrolled as MaineCare providers in order to be reimbursed for services;
  • Be a certified Home Health Agency pursuant to the MaineCare Benefits Manual Ch. II Section 40 (“Home Health Services”);
  • The Provider ordering the service must be a Provider with prescribing privileges (physician, nurse practitioner or physician’s assistant);
  • Must document that they have had a face-to-face encounter with the member before a physician may certify eligibility for services under the home health benefit. This may be accomplished through interactive telehealth services, but not by telephone or e-mail.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p.1 & 4 (June 15, 2020). (Accessed Oct. 2022).


OTHER RESTRICTIONS

Telemonitoring services are intended to collect a member’s health-related data, such as pulse and blood pressure readings, that assist healthcare providers in monitoring and assessing the member’s medical conditions.

A note, dated prior to the beginning of service delivery, and demonstrating the necessity of home telemonitoring services, must be included in the member’s file. In the event that services begin prior to the date recorded on the provider’s note, services delivered in that month will not be covered.

SOURCE:  Mainecare Benefits Manual. Ch. II. Home Health Services. Sec. 40.05. p. 16. (Aug. 11, 2019). (Accessed Oct. 2022). 

Services shall not be duplicate of any other services.  See regulation for examples of duplication.

SOURCE:  Mainecare Benefits Manual. Ch. II. Home Health Services. Sec. 40.06.p. 17-18.  (Aug. 11, 2019). (Accessed Oct. 2022). 

See regulation for list of non-covered services.

SOURCE:  Mainecare Benefits Manual. Ch. II. Home Health Services. Sec. 40.07. p. 18-19. (Aug. 11, 2019). (Accessed Oct. 2022).

Department required to adopt regulations that comply with the following:

  • May not include any requirement that a patient have a certain number of ER visits or hospitalizations related to the patient’s diagnosis in the criteria for a patient’s eligibility for telemonitoring services;
  • Except as provided in the last bullet point (see below), must include qualifying criteria for a patient’s eligibility of telemonitoring services that include documentation in a patient’s medical record that the patient is at risk of hospitalization or admission to an ER
  • Must provide that group therapy for behavioral health or addiction services covered by the MaineCare program may be delivered through telehealth;
  • Must include requirements for providers providing telehealth and telemonitoring services; and
  • Must allow at least some portion of case management services covered by the MaineCare program to be delivered through telehealth, without requiring qualifying criteria regarding a patient’s risk of hospitalization or admission to an emergency room.

SOURCE: ME Statute Sec. 3173-H, (Accessed Oct. 2022).

A health care provider must document that a face-to-face encounter with the member occurred before they are eligible for a home health benefit.  This can occur through interactive telehealth services, but not by telephone or e-mail.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.03. p. 4. (June 15, 2020). (Accessed Oct. 2022). 

Home and Community Benefits for the Elderly and for Adults with Disabilities

Use of remote monitoring requires sufficient Back Up Plans and the SCA will be responsible for ensuring that the member has at least two adequate back-up plans prior to making a referral for this service.

SOURCE: MaineCare Benefits Manual, Home and Community Benefits for the Elderly and for Adults with Disabilities, 10-144 Ch. II, Sec. 19, p. 23 (May 2, 2021). (Accessed Oct. 2022).

Telemonitoring Services

Only the Health Care Provider at the Receiving (Provider) Site will be reimbursed for Telemonitoring Services.

No Originating Facility Fee will be paid for Telemonitoring Services.

Only a Home Health Agency may receive reimbursement for Telemonitoring Services.

Telemonitoring Services shall be billed using code S9110, which provides for a flat monthly fee for services, which is inclusive of all Telemonitoring Services, including but not limited to:

  • Equipment installation;
  • Training the Member on the equipment’s use and care;
  • Monitoring of data;
  • Consultations with the primary care physician; and
  • Equipment removal when the Telemonitoring Service is no longer medically necessary.

Except as described in this policy, no additional reimbursement beyond the flat fee is available for Telemonitoring Services.

MaineCare will not reimburse separately for Telemonitoring equipment purchase, installation, or maintenance.

In the event that in person visits are required, these visits must be billed separately from the Telemonitoring Service in accordance with Chapters II and III, Section 40 (“Home Health Services”) of the MBM.

In the event an interpreter is required, the Home Health Agency may bill for interpreter services in accordance with another billable service and the requirements of Ch. I, Section 1 of the MBM.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p.14, (June 15, 2020). (Accessed Oct. 2022).

Last updated 10/19/2022

Store and Forward

POLICY

“Store and forward transfers” means transmission of a patient’s recorded health history through a secure electronic system to a health professional.

“Asynchronous encounters” means the interaction or consultation between an enrollee and the enrollee’s provider or between providers regarding the enrollee through a system with the ability to store digital information, including, but not limited to, still images, video, audio and text files, and other relevant data in one location and subsequently transmit such information for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient or the health professionals.

SOURCE: ME Statute Sec. 22:855.3173-H, Sub. Sec. 1 (Accessed Oct. 2022).

New Medicaid Policy (Effective Upon Approval from CMS)

Store-and-Forward (asynchronous) Telehealth is only permitted for Established Patients and involves the transmission of recorded clinical information (including, but not limited to radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a Health Care Provider. All health information must be transmitted via secured email. In order for the Health Care Provider to be reimbursed for a covered service delivered via Store-and-Forward Telehealth, a Member must not be present.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. Pg. 5, (June 15, 2020) (Accessed Oct. 2022).


ELIGIBLE SERVICES/SPECIALTIES

MaineCare will provide reimbursement for two types of store-and-forward:

  1. Virtual Transfer of Health Information:  The Health Care Provider uses the information to evaluate a Member’s condition or render a covered MaineCare service separate from services delivered via Interactive Telehealth. The Health Care Provider uses a desktop computer or a mobile device, such as a smartphone to gather and send the information. Information is transmitted by electronic mail, uploaded to a secure website, or a private network. Only the Health Care Provider who receives and reviews the recorded clinical information is eligible for reimbursement.
  2. Remote Consultation Between and Treating Provider and Specialist:  Interprofessional telecommunications assessment and management service provided by a Specialist. A primary care referral is required for a Member to seek Specialist care. The interaction includes discussion (via telephone or internet) of a written report by the Specialist to assess the Member’s Electronic Health Record and/or diagnoses/treatment.  Duration of this service is a minimum of five minutes to no greater than thirty minutes. The Treating Provider must document that they have informed the Member as to results and conclusions following the Remote Consultation.

Written or verbal Member consent for each Remote Consultation must be documented in the Member’s medical record. Billing for interprofessional services is limited to those practitioners who can independently bill Medicaid for evaluation and management services.

Remote Consultation may be utilized as often as medically necessary, per the terms of these rules.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. Pg. 5-6, (June 15, 2020). (Accessed Oct. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 10/19/2022

Cross State Licensing

A physician not licensed to practice medicine in this State may provide consultative services through interstate telehealth to a patient located in this State if the physician is registered in accordance with subsection 3 (see statute for registration requirements). A physician intending to provide consultative services in this State through interstate telehealth shall provide any information requested by the board and complete information on:

  • All states and jurisdictions in which the physician is currently licensed
  • All states and jurisdictions in which the physician was previously licensed; and
  • All negative licensing actions taken previously against the physician in any state or jurisdiction.

Includes a fee of $500.

A physician registered to provide interstate telehealth services under this section shall immediately notify the board of restrictions placed on the physician’s license to practice medicine in any state or jurisdiction.

In registering to provide interstate telehealth services to residents of this State under this section, a physician agrees to be subject to the laws and judicial system of this State and board rules with respect to providing medical services to residents of this State.

The board shall obtain confirmation of licensure from all states and jurisdictions in which a physician applying for registration has ever been licensed prior to registering the physician pursuant to subsection 3. The board shall request notification from a state or jurisdiction if future adverse action is taken against the physician’s license in that state or jurisdiction.

SOURCE:  Maine Revised Statutes Annotated, Title 32, Sec. 3300-D (Accessed Oct. 2022).

The Board may issue an interstate telemedicine consultation registration to an applicant who:

  • Submits an administratively complete application on forms approved by the Board;
  • Pays the appropriate licensure application fee;
  • Demonstrates that the applicant is a physician and is fully licensed without restriction to practice medicine in the state from which the physician provides telemedicine services;
  • Meets the examination requirement;
  • Has not had a license to practice medicine revoked or restricted in any state or jurisdiction; and
  • Has no cause existing that may be considered grounds for disciplinary action or denial of licensure as provided by law.

A physician registered for the interstate telemedicine consultation shall not:

  • Open an office in this State;
  • Meet with patients in this State;
  • Receive calls in this State from patients; and
  • Shall provide only consultative services as requested by a physician, advanced practice registered nurse or physician assistant licensed in this State who retains ultimate authority over the diagnosis, care and treatment of the patient.

SOURCE: ME Regulation Sec. 02-373 Ch. 1, (Accessed Oct. 2022).

Recently Passed Legislation 

Notwithstanding any other provision of law granting authority to a board or commission, the Director of the Office of Professional and Occupational Regulation has the following superseding powers, duties and functions:

  • To exercise discretionary authority, after consultation with the appropriate licensing board, commission or personnel administering a regulatory function of the office, to review and determine on a case-by-case basis examination and licensing eligibility for applications for licensure submitted by individuals who identify themselves as veterans with military service, experience and training.
  • To exercise discretionary authority, after consultation with the appropriate licensing board, commission or personnel administering a regulatory function of the office, to waive, on a case-by-case basis, documentation requirements for licensure submitted by applicants for licensure educated in or with relevant experience or licensure in other jurisdictions, including other states, United States territories, foreign nations and foreign administrative divisions, as long as the waiver does not reduce the requisite standards of proficiency for the licensed profession or occupation. The Director of the Office of Professional and Occupational Regulation may adopt rules to implement this paragraph. Rules adopted pursuant to this paragraph are routine technical rules pursuant to Title 5, chapter 375, subchapter 2-A.
  • To adopt rules defining, as appropriate for licensing purposes, the term “jurisdiction” to mean a state, a United States territory, a foreign nation or a foreign administrative division that issues a license or credential. Rules adopted pursuant to this paragraph are routine technical rules pursuant to Title 5, chapter 375, subchapter 2-A.

The office, board or commission may:

  • Exercise discretionary authority to grant provisional licenses to applicants for licensure educated in or with relevant experience or licensure in other jurisdictions, including other states, United States territories, foreign nations and foreign administrative divisions. For purposes of this subparagraph, “provisional license” means a license issued for a defined period of time and with the requirement that the licensee meet certain established conditions in order to maintain the provisional license or to gain full licensure. The office, board or commission may adopt rules to implement this subparagraph. Rules adopted pursuant to this subparagraph are routine technical rules pursuant to Title 5, chapter 375, subchapter 2-A.

See statute for additional details.

SOURCE: ME Revised Statutes, Title 10, Part 9, Ch. 901, 8003,  (Accessed Oct. 2022).

Licensure by Endorsement

The Office of Professional and Occupational Regulation, referred to in this section as “the office,” including the licensing boards and commissions within the office, shall establish a process to issue a license by endorsement to an applicant who presents proof of licensure by another jurisdiction of the United States as long as the other jurisdiction maintains substantially equivalent license requirements for the licensed profession or occupation and as long as:

  • Good standing. The applicant is in good standing in all jurisdictions in which the applicant holds or has held a license. For purposes of this subsection, “good standing” means that the applicant does not have a complaint, allegation or investigation pending, does not have a license that is suspended or subject to practice restrictions and has never surrendered a license or had a license revoked;
  • No cause for denial. No cause for denial of a license exists under section 8003, subsection 5-A, paragraph A or under any other law; and
  • Fee. The applicant pays the fee, if any, pursuant to section 8003, subsection 2-A, paragraph D.

The office, or a licensing board or commission within the office, may require an applicant to pass a jurisprudence examination if such an examination is required to be passed for licensure pursuant to law or rule of the office, licensing board or commission.

The office, including the licensing boards and commissions within the office, shall adopt rules to implement this section. Rules adopted pursuant to this paragraph are routine technical rules pursuant to Title 5, chapter 375, subchapter 2-A.

SOURCE: ME Revised Statutes, Title 10, Part 9, Ch. 901, 8003-H,  (Accessed Oct. 2022).Maine License required

Board of Licensure in Medicine, State Board of Nursing, & Board of Osteopathic Licensure

Maine License Required

Physicians, physician assistants and advanced practice registered nurses who use telehealth in the examination, diagnosis, consultation or treatment of a patient located in Maine shall hold an active Maine license or shall hold an active registration in Maine to provide interstate consultative telemedicine services.

Licensed practical nurses and registered professional nurses who use telehealth to provide nursing care services to a patient located in Maine shall hold an active Maine nursing license or an active multistate license in a nurse compact state.

SOURCE: ME Regulation Sec. 02-373 Ch. 11, 02-380 Ch. 11, 02-383 Ch. 11. (Accessed Oct. 2022). 

Recently Adopted Rule 

Teledentistry 

An individual who delivers teledentistry services to a patient in Maine must hold a current and valid license issued by the Board and/or be authorized to provide care pursuant to the delegation provisions of 32 M.R.S. §18371(3) and authorized to provide care pursuant the supervision provisions of 32 M.R.S. §18377(2).

An individual providing teledentistry services to a patient physically located in any other jurisdiction is responsible for ensuring compliance with all laws and rules of that jurisdiction prior to providing services to a patient located in that jurisdiction.

SOURCE: ME Regulation Sec. 02-313 Ch. 15,  (Accessed Oct. 2022).

Last updated 10/19/2022

Definitions

Board of Licensure in Medicine, State Board of Nursing & Board of Osteopathic Licensure

Telehealth means the provision of health care services using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a clinician in one location and a patient in another location with or without an intervening health care provider. Telehealth includes asynchronous store-and-forward technologies, telemonitoring, and real-time interactive services, including teleradiology and telepathology. When necessary and appropriate under the circumstances and if in compliance with the applicable standard of care, telehealth includes the use of audio-only technology. Telehealth shall not include the provision of health care services between a licensee in one location and a patient in another location with or without an intervening health care provider only through e-mail, instant messaging, facsimile transmission, or U.S. mail or other parcel service, or any combination thereof.

SOURCE:  Joint Rule Regarding office-based treatment of opioid use disorder Sec. 02-373-12, 02-380-12, 02-383-12. (Accessed Jul. 2022).

“Telehealth services” means health care services delivered through the use of information technology and includes synchronous encounters, asynchronous encounters, store and forward transfers and telemonitoring.

SOURCE: ME Revised Statute Title 32, Sec. 69, Sec. 566, Sec. 1533, Sec. 2266, Sec. 2276-A, Sec. 2447, Sec. 2600-AA, Sec. 3120, Sec. 3300-AA, Sec. 3661, Sec. 3850-E, Sec. 4879, Sec. 6231, Sec. 7071, Sec. 9714, Sec. 9863, Sec. 9916, Sec. 12611, Sec. 13848, Sec. 13868, Sec. 14363, Sec. 17401, (Accessed Oct. 2022).

“Teledentistry,” as it pertains to the delivery of oral health care services, means the use of interactive, real-time visual, audio or other electronic media for the purposes of education, assessment, examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by individuals licensed under this chapter and includes synchronous encounters, asynchronous encounters, remote patient monitoring and mobile oral health care in accordance with practice guidelines specified in rules adopted by the board.

SOURCE: ME Revised Statute Title 32, Sec. 18302, (Accessed Oct. 2022).

Recently Adopted Rule 

Board of Licensure in Medicine, State Board of Nursing, & Board of Osteopathic Licensure

“Telehealth” means the provision of health care services using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telehealth includes asynchronous store-and-forward technologies, telemonitoring, and real-time interactive services, including teleradiology and telepathology. When necessary and appropriate under the circumstances and if in compliance with the applicable standard of care, telehealth includes the use of audio-only technology. Telehealth shall not include the provision of health care services only through e-mail, instant messaging, facsimile transmission, or U.S. mail or other parcel service, or any combination thereof between a licensee in one location and a patient in another location with or without an intervening health care provider.

SOURCE: ME Regulation Sec. 02-373 Ch. 11, 02-380 Ch. 11, 02-383 Ch. 11. (Accessed Oct. 2022).

Recently Adopted Rule 

“Teledentistry services” means oral health care services delivered through the use of interactive, real-time visual, audio or other electronic media for the purposes of education, assessment, examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by licensees and includes a synchronous encounter, an asynchronous encounter, a store and forward transfer and remote patient monitoring and mobile oral health care in accordance with this chapter.

SOURCE: ME Regulation Sec. 02-313 Ch. 15,  (Accessed Oct. 2022).

Last updated 10/19/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (SP 467-2017). (Accessed Oct. 2022).

Member of Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact.  Current NLC States and Status. NCSBN.  (Accessed Oct. 2022).

Member of the Occupational Therapy Licensure Compact

SOURCE: Occupational Therapy Licensure Compact. (Accessed Oct. 2022).

Member of the Interstate Psychology Compact

SOURCE: Pyspact Compact Map. (Accessed Oct. 2022).

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Oct. 2022).

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

Last updated 10/19/2022

Miscellaneous

See Joint Rule on office-based treatment of opioid use disorder for telehealth practice requirements under the Board of Medicine, Nursing and osteopathic licensure.

SOURCE: Joint Rule Regarding office-based treatment of opioid use disorder Sec. 02-373-12, 02-380-12, 02-383-12. (Accessed Oct. 2022).

Municipal Gigabit Broadband Network Access Fund

The fund is established to address the need in the State for access to broadband infrastructure that will enhance the State’s competitiveness in national and international economies.  Except as described in subsection 3-A, to the extent funds are available, the fund must be used to provide grants to municipalities to support public-private partnerships to support a municipal gigabit fiber-optic broadband network in their regions with the following goals:

  • Provide high-speed broadband access to attract, create and grow the State’s economy and market the products and services of businesses in the State in national and international markets with symmetric connectivity and address challenges in geography;
  • Provide expanded health care services by facilitating access to telehealth, as defined in Title 24‐A, section 4316, subsection 1, and state and local services for senior citizens and persons with disabilities;
  • Expand educational opportunities for students across the State through virtual and distance learning;
  • Facilitate broader access for the public to services provided by municipal and county governments, including, but not limited to, law enforcement entities, the judicial system and child, youth and family social services; and
  • Provide expanded residential services to support employment opportunities.

In order to facilitate the achievement of the goals and policies of this section, the authority shall establish and regularly update, after opportunity for public comment and taking into consideration relevant federal policies, definitions of “gigabit fiber-optic broadband network” and “broadband infrastructure.”

Purpose of the fund; grant match funding

In addition to grants provided in accordance with subsection 3, the fund may be used to provide grant match funding to municipal entities applying for project grants from other sources that require applicants to provide matching funds. To the extent that funds are available, grant match funding may be awarded for a project under this subsection only if the authority finds the project is consistent with the purposes stated in subsection 3. A municipal entity selected for grant match funding under this subsection must provide services to any unserved community anchor institution in the project area to which the municipal entity is extending services that provides or will provide open access to the Internet for the public. For purposes of this subsection, “municipal entity” means a municipality or a group of municipalities working together to support a gigabit fiber-optic broadband network project. The authority shall, by rule, define an applicant’s “project area” and “unserved community anchor institution” for the purposes of this subsection. The authority may also adopt other rules to administer grant match funding awards under this subsection.

SOURCE: ME Revised Statutes Title 35-A, Part 7, Ch. 93, Sec. 9211. (Accessed Oct. 2022).

Last updated 10/19/2022

Online Prescribing

Insurers may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316 (Accessed Oct. 2022).

Recently Adopted Rule 

Board of Licensure in Medicine, State Board of Nursing, & Board of Osteopathic Licensure

A licensee who uses telehealth in providing health care shall establish a valid licensee-patient relationship with the person who receives telehealth services. The licensee-patient relationship begins when:

  • The person with a health-related matter seeks assistance from the licensee;
  • The licensee agrees to undertake examination, diagnosis, nursing assessment, consultation or treatment of the person; and
  • The person agrees to receive health care services from the licensee whether or not there has been an in-person encounter between the licensee and the person.

A valid licensee-patient relationship may be established between a licensee who uses telehealth in providing health care and a patient who receives telehealth services through any of the following circumstances:

  • Consultation with another licensee. Through consultation with another licensee (or other health care provider) who has an established relationship with the patient upon agreement to participate in, or supervise, the patient’s care; or
  • Telehealth encounter. Through telehealth, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telehealth practice guidelines that address the clinical and technological aspects of telehealth.

Medical History and Physical Examination

Generally a physician, physician assistant, and advanced practice registered nurse shall perform an in-person clinical interview and physical examination for each patient. However, the clinical interview and physical examination may not be in-person if the technology utilized in a telehealth encounter is sufficient to establish an informed diagnosis as though the clinical interview and clinician examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telehealth in providing health care shall interview the patient to collect the relevant medical history and perform a pertinent physical examination as defined by the standard of care for the purpose of the visit, when clinically necessary, sufficient for the diagnosis and treatment of the patient. An internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive interactive and responsive online interview, does not constitute an acceptable clinical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by the licensee.

Prescribing Based Solely on an Internet Request, Internet Questionnaire or a Telephonic Interview Prohibited

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e. static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid licensee-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in Section 3, subsection 20, subparagraph A(3) of this rule.

Telehealth technologies, where prescribing may be contemplated, must implement measures to uphold patient safety in the absence of traditional physical examination. Such measures should guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical evaluation and resulting prescription is required. Measures to assure informed, accurate and error prevention prescribing practices (e.g. integration with e-Prescription systems) are encouraged. All applicable law shall be complied with.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the licensee. The licensee prescribing via telehealth must ensure that the clinical evaluation, indication, appropriateness, and safety consideration for the resulting prescription are appropriately documented and meet the applicable standard of care. Consequently, prescriptions via telehealth carry the same accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, licensees may exercise their judgment and prescribe medications as part of telehealth encounters.

Circumstances Where the Standard of Care May Not Require A Licensee to Personally Interview or Conduct a Nursing Assessment or Physical Examination of a Patient

Under the following circumstances, whether or not such circumstances involve the use of telehealth in providing health care, a licensee may treat a patient who has not been personally interviewed, examined, assessed and diagnosed by the licensee:

  • Situations in which the licensee prescribed medications on a short-term basis for a new patient and has scheduled an appointment to personally examine the patient;
  • For institutional settings, including writing initial admission orders for a newly hospitalized patient;
  • Call situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
  • Cross-coverage situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
  • Situations in which the patient has been examined in person by an advanced practice registered nurse or a physician assistant or other licensed practitioner with whom the licensee has a supervisory or collaborative relationship;
  • Emergency situations in which the life or health of the patient is in imminent danger;
  • Emergency situations that constitute an immediate threat to the public health including, but not limited to, empiric treatment or prophylaxis to prevent or control an infectious disease outbreak;
  • Situations in which the licensee has diagnosed a sexually transmitted disease in a patient and the licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention;
  • Situations where the patients are in a licensed or certified long term care facility, nursing facility, residential care facility, intermediate care facility, assisted living facility or hospice setting and doing so is within the practice standards for that setting; and
  • Circumstances in which a patient’s treating clinician determines that a radiology or pathology consultation is warranted

SOURCE: ME Regulation Sec. 02-373 Ch. 11, 02-380 Ch. 11, 02-383 Ch. 11. (Accessed Oct. 2022).

Recently Adopted Rule 

Teledentistry

Prior to establishing a patient relationship as defined by Board Rules, Chapter 1(I)(N) and prior to providing teledentistry services, a dentist, denturist, or a dental hygienist (when the dental hygienist is providing services as an independent practice dental hygienist, public health dental hygienist, dental therapist, or and provisional dental therapist) must take reasonable steps to verify the patient’s physical location.

Practice Requirements Specific to Prescribing Medications

  • The validity when prescribing medication to a patient as a result of a teledentistry service is determined by the same standards that would apply when prescribing medication to a patient in an in-person setting.
  • This section does not limit the professional judgment, discretion or decision-making authority when prescribing medication to a patient. It is the expectation that the standard of care is met with demonstrated professional practice standards and judgment, consistent with all applicable statutes and rules when prescribing medication as a result of a teledentistry service.
  • Prescribing medication must be for a legitimate dental purpose as part of an established patient relationship and must meet all other applicable laws and rules governing prescribing practices, including the use of controlled substances.

SOURCE: ME Regulation Sec. 02-313 Ch. 15,  (Accessed Oct. 2022).

Last updated 10/19/2022

Professional Boards Standards

Board of Licensure in Medicine

SOURCE: ME Regulation Sec. 02-373-11 (Accessed Oct. 2022). 

Board of Osteopathic Licensure

SOURCE: ME Regulation 02-383-11 (Accessed Oct. 2022).

Office Based Treatment of Opioid Use Disorder

SOURCE: ME Regulation, 02, Ch. 12, Section 6, (Accessed Oct. 2022).

State Board of Nursing

SOURCE: ME Regulation, 02-380-11. (Accessed Oct. 2022).

Board of Dental Practice

SOURCE: ME Regulation, 02-313-15. (Accessed Oct. 2022).

Legislation for multiple professions requires boards to adopt rules governing telehealth services by persons licensed under the profession.  The rules must establish standards of practice and appropriate restrictions for the various type and forms of telehealth services.  See statute for additional requirements.

SOURCE: ME Revised Statute Title 32, Ch. 2 Sec. 69, Ch. 9 Sec. 566, Ch. 22 Sec. 1533, Ch. 31 Sec. 2266, Ch. 32 Sec. 2276A, Ch. 34-A Sec. 2447, Sec. 2448, Ch. 36 Sec. 2600-AA, Ch. 45-A Sec. 3120, Ch. 48 Sec. 3300-AA, Ch. 51 Sec. 3661, Ch. 56 Sec. 3850-E, Ch. 71-A Sec. 4879, Ch. 81 Sec. 6231, Ch. 83 Sec. 7071, Ch. 97 Sec. 9714, Ch. 103 Sec. 9863, Ch. 104 Sec. 9916, Ch. 113-B Sec. 12611, Ch. 117 Sec. 13848, Ch. 119 Sec. 13868, Ch. 127 Sec. 14363, Ch. 137 Sec. 17401, (Accessed Oct. 2022).

Teledentistry 

An individual licensed under this chapter may provide oral health care services and procedures authorized under this chapter or by rule using teledentistry. The board shall adopt by rule guidelines and practice standards for the use of teledentistry, including, but not limited to, practice requirements for protecting patient rights and protocols for referrals, quality and safety, informed consent, patient evaluation, treatment parameters, patient records, prescribing, supervision and compliance with data exchange standards for the security and confidentiality of patient information.

SOURCE: ME Revised Statute Title 32, Sec. 18394, (Accessed Oct. 2022).

Last updated 10/18/2022

Definition of Visit

FQHC unit of service is a visit that includes a facetoface contact with one or more of the center’s core or ambulatory professional and other qualified staff and, where appropriate, receipt of supplies, treatments, and laboratory services.

SOURCE: MaineCare Benefits Manual, Federally Qualified Health Centers, 10-144 Ch. 101, Sec. 31, pg. 2. (Accessed Oct. 2022).

Last updated 10/18/2022

Eligible Distant Site

If approved, FQHCs may serve as the provider site and bill under the encounter rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 13. (June 15, 2020). (Accessed Oct. 2022).

Also see: ME Medicaid Live Video Eligible Providers

Last updated 10/18/2022

Eligible Originating Site

When an FQHC or RHC serves as the Originating (Member) Site, the Originating Facility Fee is paid separately from the center or clinic all-inclusive rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 13. (June 15, 2020). (Accessed Oct. 2022).

Also see: ME Medicaid Live Video Eligible Sites

Last updated 10/18/2022

Facility Fee

When an FQHC or RHC serves as the Originating (Member) Site, the Originating Facility Fee is paid separately from the center or clinic all-inclusive rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 13 (June 15, 2020). (Accessed Oct. 2022).

Also see: ME Medicaid Live Video Facility/Transmission Fee

Last updated 10/18/2022

Home Eligible

Off-site delivery of services furnished by health center staff are reimbursable when they are provided away from the center and when it is documented in the member’s chart that it is the most clinically appropriate setting for the provision of services. Examples of off-site service locations include: a nursing facility, an emergency room, an inpatient hospital, or a member’s home.

Visiting nurse services will be reimbursed when:

  • a registered nurse or licensed practical nurse provides the services to a member who is homebound;
  • the services are provided in accordance with a written plan of treatment;
  • the member’s record documents that the member would not otherwise receive these services;
  • the services are provided in an area for which the Secretary of the US Department of Health and Human Services has determined there is a shortage of home health agencies; and
  • the health center that provides in-home services by a registered or licensed practical nurse is licensed by the State of Maine as a home health service provider.

SOURCE: MaineCare Benefits Manual, Federally Qualified Health Centers, 31.04-4, 10-144 Ch. 101, Sec. 31, pg. 5. (Accessed Oct. 2022).

Last updated 10/18/2022

Modalities Allowed

Live Video

FQHCs are paid both as a provider site and originating site fee, if approved.

See: ME Medicaid Live Video


Store and Forward

Although ME Medicaid reimburses for two types of store-and-forward, FQHCs are not explicitly mentioned leaving it unclear if they would be eligible for such services.

See: ME Medicaid Store-and-Forward


Remote Patient Monitoring

Although ME Medicaid reimburses for telemonitoring in some situations, FQHCs are not explicitly mentioned leaving it unclear if they would be eligible for such services.

See: ME Medicaid Remote Patient Monitoring


Audio-Only

Although ME Medicaid reimburses for telephonic services in some situations, FQHCs are not explicitly mentioned leaving it unclear if they would be eligible for such services. 

See: ME Medicaid Email, Phone and Fax

Last updated 10/18/2022

Patient-Provider Relationship

An initial assessment, which must include a direct encounter with the member, and his/her family if appropriate, shall be performed and included in the member’s FQHC record. The assessment must include the member’s medical and social history and must include the member’s diagnosis and the professional who made the diagnosis and that person’s credentials.

SOURCE: MaineCare Benefits Manual, Federally Qualified Health Centers, 10-144 Ch. 101, Sec. 31, pg. 7. (Accessed Oct. 2022).

Last updated 10/18/2022

PPS Rate

Telehealth Services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the State. If approved, these facilities may serve as the provider site and bill under the encounter rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 13. (June 15, 2020). (Accessed Oct. 2022).

Last updated 10/18/2022

Same Day Encounters

Reimbursement is generally limited to one core service visit, and/or one ambulatory service visit per day. Reimbursement for a second core visit is also covered if the member has both an encounter with a physician, physician assistant, advanced nurse practitioner or visiting nurse, and in addition to that encounter, is seen on the same day by a licensed clinical psychologist, clinical social worker, clinical professional counselor or a clinical nurse specialist licensed as an advanced practice clinical nurse specialist. An additional visit of any other kind will only be reimbursed for unforeseen circumstances as documented in the member’s record. The goal remains to treat the whole individual during one visit.

SOURCE: MaineCare Benefits Manual, Federally Qualified Health Centers, 10-144 Ch. 101, Sec. 31, pg. 9. (Accessed Oct. 2022).