Last updated 01/05/2023
Consent Requirements
A patient may provide verbal, electronic or written consent for telehealth and telemonitoring services under this section.
SOURCE: ME Statute Sec. 22:855.3173-H, Sub. Sec. 6, (Accessed Jan. 2023).
Recently Passed Legislation
No later than January 1, 2023, the Department of Health and Human Services shall amend its rules in 14-193 C.M.R. Chapter 6, Licensing of Mental Health Facilities, and 14-118 C.M.R. Chapter 5, Regulations for Licensing and Certifying of Substance Abuse Treatment Programs, to allow a facility licensed under the Maine Revised Statutes, Title 5, section 20005, subsection 6, paragraph B or Title 34-B, section 1203-A to obtain consent through verbal, electronic or written means from a person during a public
health emergency in accordance with Title 22, section 51. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
SOURCE: ME Revised Statutes Annotated, Title 22, Ch. 1, Subchapter 2. §51 as enacted by L.D. 1758 (2022 Session). (Accessed Jan. 2023).
Prior to the provision of any Telehealth Service, the Health Care Provider shall document that it has provided the educational information to the Member or authorized representative and obtain the Member’s written informed consent to the receipt of Telehealth Services and/or to Store-and-Forward Telehealth Services, Remote Consultation, Virtual Check-In, or Telephone Evaluation and Management. A copy of the signed informed consent shall be retained in the Member’s medical record and provided to the Member or the Member’s legally-authorized representative upon request.
This information should be in a format and manner that the Member is able to understand and include the following:
- Description of the telehealth services and what to expect;
- Explanation that the use of telehealth for this service is voluntary and that the member is able to refuse the telehealth visit at any time without affecting the right to future care or treatment or loss or withdrawal of MaineCare benefit;
- Explanation that MaineCare will pay for transportation to a distant appointment if needed;
- Explanation that the Member will have access to all information resulting from the telehealth service provided by law;
- The dissemination, storage or retention of an identifiable Member image or other information shall comply with federal and state laws and regulations requiring confidentiality.
- Informed of all parties who will be present at the receiving and originating site and have the right to exclude anyone from either site; and
- Member has the right to object to videotaping or other recording of a telehealth 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.
SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 6 & 10-11. (June 15, 2020). (Accessed Jan. 2023).
Member’s record must document consent for Assistive Technology-Remote Monitoring.
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 Jan. 2023).
Prior to the provision of telemonitoring services, the Health Care Provider shall document that it has provided the member with choice and educational information obtained the member’s written informed consent to the receipt of telemonitoring services. The Health Care Provider shall retain a copy of the signed informed consent in the member’s medical record and provide a copy to the member or the member’s legally authorized representative upon request.
SOURCE: Mainecare Benefits Manual. Ch. 11. Home Health Services. Sec. 40.08. p. 24. (Aug 11, 2019). (Accessed Jan. 2023).
Last updated 01/05/2023
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 Jan. 2023).
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 Jan. 2023).
Last updated 01/05/2023
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Multi-Systemic Therapy.
SOURCE: MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, p. 4, 12 (Nov. 2022). (Accessed Jan. 2023).
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 Jan. 2023).
Last updated 01/04/2023
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 Jan. 2023).
“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 Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Any medically necessary MaineCare Covered Service may be delivered via Interactive Telehealth Services, provided the following requirements are met:
- The Member is otherwise eligible for the Covered Service, as described in the appropriate section of the MaineCare Benefits Manual; and
- 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 Jan. 2023).
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 Jan. 2023)
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, (Nov. 9, 2022). (Accessed Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
Last updated 01/05/2023
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
Last updated 01/05/2023
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 Jan. 2023).
Last updated 01/05/2023
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 01/05/2023
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 Jan. 2023).
“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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
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 Jan. 2023).
Last updated 01/05/2023
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 Jan. 2023).
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 Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
MaineCare will provide reimbursement for two types of store-and-forward:
- 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.
- 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 Jan. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found