Last updated 08/02/2022
Consent Requirements
The originating site must obtain consent from the patient prior to engaging in telehealth and be documented in the medical record. If the participant is unable to provide consent, the medical record must contain in writing an explanation as to why the participant was unable to consent to services rendered via telehealth.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 1, (Accessed Aug. 2022).
Consent is required unless there is an emergency.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.05. (Accessed Aug. 2022).
Consent may be given verbally by the participant.
SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 74. Updated Jan. 2022. (Accessed Aug. 2022).
Mental Health
An individual must voluntarily consent to telemental health services, which must be documented in the individual’s medical record.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Aug. 2022).
Remote Patient Monitoring
The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease.
SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.05(A)(2). (Accessed Aug. 2022).
Last updated 08/02/2022
Definitions
Recently Passed Legislation
“Telehealth” means the delivery of medically necessary somatic, dental, or behavioral health services to a patient at an originating site by a distant site provider through the use of technology–assisted communication.
“Telehealth” includes:
- Synchronous and asynchronous interactions;
- From July 1, 2021, to June 30, 2023, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service; and
- Remote patient monitoring services.
“Telehealth” does not include the provision of health care services solely through:
- Except as provided above, an audio–only telephone conversation;
- An e–mail message; or
- A facsimile transmission.
SOURCE: MD Health General Code 15-141.2(7) Accessed Aug. 2022.
“Telehealth means the delivery of medically necessary somatic or behavioral health services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.”
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.02. (Accessed Aug. 2022).
“Telehealth services means the delivery of health care services provided through the use of interactive audio, video, or other telecommunications or electronic technology by a health care provider at a hospital to a patient at a location other than at the hospital, or to a patient at the hospital where the provider is at a location other than the hospital, which enables the patient to interact with the health care provider at the time the health care services are provided.”
SOURCE: Code of Maryland Admin. Regs. Sec. 10.37.10.07-1. (Accessed Aug. 2022).
Hospitals
“Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a physician in the practice of medicine outside the physical presence of the patient. “Telemedicine” does not include:
- An audio only telephone conversation between the physician and patient;
- An electronic mail message between a physician and a patient; or
- A facsimile transmission between a physician and a patient.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.07.01.01(B)(33). (Accessed Aug. 2022).
Last updated 08/02/2022
Email, Phone & Fax
“Telehealth” includes, from July 1, 2021, to June 30, 2023, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service.
“Telehealth” does not include the provision of health care services solely through:
- Except as provided above, an audio–only telephone conversation;
- An e–mail message; or
- A facsimile transmission.
SOURCE: MD Health General Code 15-141.2 (Accessed Aug. 2022).
To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service. Services delivered via telehealth using two-way audio-visual technology assisted communication should be billed using the “-GT” modifier. The use of audio-only telehealth services is only permitted during the Public Health State of Emergency.
SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 74. Updated Jan. 2022. (Accessed Aug. 2022).
No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
No reimbursement for telephone conversation, electronic mail message or facsimile transmission between the originating and distant site providers. There is also no reimbursement for telecommunication between providers without the participant present.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 4, Code of Maryland Admin. Regs., Sec. 10.09.49.09(B). (Accessed Aug. 2022).
Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Services
MDH Will reimburse IEP and IFSP providers for certain procedure codes via telehealth. Providers must identify telehealth services on the child’s IEP/IFSP and bill using the appropriate modifier (GT or UB). Service coordination procedures (T1023, T1023-TG, T2022, W9322, W9323, and W9324) and individual psychotherapy services (90791, 90832 and 90834) may continue with an audio-only component. See Provider Transmittal for approved Maryland Medicaid Fee-for-Service approved IEP/IFSP Telehealth Services.
SOURCE: MD Medical Assistance Program. Early Intervention and School Health Service Providers Transmittal No. 3. Sept. 23, 2021. (Accessed Aug. 2022).
Therapy Services (Physical Therapists, Occupational Therapists, Speech Therapists, Therapy Groups, EPSDT Providers, Managed Care Organizations)
MDH will reimburse providers for certain procedure codes when provided via audio-visual telehealth. MDH will not reimburse for services provided via an audio-only delivery model or for codes not included on the Provider Transmittal regarding approved therapy telehealth services when provided via any method of telehealth.
SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for Therapy Services. PT 09-22. Oct. 7, 2021. (Accessed Aug. 2022).
Last updated 08/02/2022
Live Video
POLICY
Reimbursement for telehealth is required for services appropriately delivered through telehealth regardless of the location of the patient and may not exclude from coverage a health care service solely because it is through telehealth.
SOURCE: MD Health General Code 15-141.2 (Accessed Aug. 2022).
Managed Care
MCOs shall provide coverage for medically necessary telemedicine services.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.67.06.31. (Accessed Aug. 2022).
Maryland Medicaid provides a telehealth program that employs a “hub-and-spoke” model. This model involves real-time interactive communication between the originating and distant sites via a secure, two-way audiovisual telecommunication system. The “telepresenter,” physically located at the originating site with the participant, facilitates the telehealth communication between the participant and distant site provider by arranging, moving, or operating the telehealth equipment.
SOURCE: MD Medicaid Telehealth Program. Telehealth Program Manual, p. 1. Updated April 2020. (Accessed Aug. 2022).
Mental Health
The Department shall grant approval to a telemental health provider to be eligible to receive State or federal funds for providing interactive telemental health services if the provider meets requirements of this chapter and for outpatient mental health centers; or if the telemental heath provider is an individual psychiatrist.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.03. (Accessed Aug. 2022).
ELIGIBLE SERVICES/SPECIALTIES
Covered Services – Somatic and behavioral health services: Providers must contact the participant’s Healthchoice MCO or behavioral health ASO with questions regarding prior authorization requirements for telehealth services.
SOURCE: MD Medicaid Telehealth Program. Telehealth Program Manual, p. 2. Updated April 2020. (Accessed Aug. 2022).
The Department, under the Telehealth Program, covers medically necessary services covered by the Maryland Medical Assistance Program rendered by a distant site provider that are:
- Distinct from services provided by the originating site provider;
- Able to be delivered using technology-assisted communication; and
- Clinically appropriate to be delivered via telehealth.
Services must be provided via telehealth to the same extent and standard of care as services provided in person; and as determined by the provider’s licensure or credentialing board, services performed via telehealth must be within the scope of a provider’s practice.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04. (Accessed Aug. 2022).
Services should be billed with the GT modifier.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.10. (Accessed Aug. 2022).
Mental Health Eligible Services:
- Diagnostic interview;
- Individual therapy
- Family therapy
- Group therapy, up to 8 individuals
- Outpatient evaluation and management
- Outpatient office consultation
- Initial inpatient consultation
- Emergency department services
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.09. (Accessed Aug. 2022).
Services required to be provided shall include counseling and treatment for substance use disorders and mental health conditions. The Program may not exclude from coverage a behavioral health care service provided to a Program recipient in person solely because the service may also be provided through telehealth.
The Program may undertake utilization review, including preauthorization, to determine the appropriateness of any health care service whether the service is delivered through an in–person consultation or through telehealth if the appropriateness of the health care service is determined in the same manner.
For the purpose of reimbursement and any fidelity standards established by the Department, a health care service provided through telehealth is equivalent to the same health care service when provided through an in–person consultation.
SOURCE: MD General Health Code 15-141.2(c-e, h). (Accessed Aug. 2022).
Doula Services
Prenatal and postpartum services may be delivered in the home, at the provider’s office or doctor’s office and other community-based settings. Doula services for prenatal and postpartum visits may be delivered in-person or as a telehealth service. The labor and delivery service must be provided in-person and can only be delivered at a hospital or freestanding birthing center.
The Maryland Medical Assistance Program will not cover Doula services rendered during labor and delivery as a telehealth visit.
SOURCE: MD Medicaid Doula Services Program Manual, p. 3, 5. Updated June 8, 2022. (Accessed Aug. 2022).
Effective January 1, 2022, the Program covers doula services as defined in Regulation .01 of this chapter when the services:
(1) Are medically necessary;
(2) Are rendered during a birthing parent’s prenatal period, labor and delivery, and postpartum period; and
(3) If rendered via telehealth, comply with the requirements established in COMAR 10.09.49 and any other subregulatory guidance.
B. The Program shall cover up to:
(1) Eight prenatal or postpartum visits; and
(2) One labor and delivery service.
SOURCE: Code of Maryland Admin Regs. 10.09.39.04 (Accessed Aug. 2022).
Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Services
MDH Will reimburse IEP and IFSP providers for certain procedure codes via telehealth. Providers must identify telehealth services on the child’s IEP/IFSP and bill using the appropriate modifier (GT or UB). Service coordination procedures (T1023, T1023-TG, T2022, W9322, W9323, and W9324) and individual psychotherapy services (90791, 90832 and 90834) may continue with an audio-only component. In addition to IEP/IFSP services, MDH will continue to reimburse Autism Waiver service coordination when provided via telehealth. See Provider Transmittal for approved Maryland Medicaid Fee-for-Service approved IEP/IFSP Telehealth Services.
SOURCE: MD Medical Assistance Program. Early Intervention and School Health Service Providers Transmittal No. 3. Sept. 23, 2021. (Accessed Aug. 2022).
Therapy Services (Physical Therapists, Occupational Therapists, Speech Therapists, Therapy Groups, EPSDT Providers, Managed Care Organizations)
MDH will reimburse providers for certain procedure codes when provided via audio-visual telehealth. Services must be identified and billed using the GT modifier to indicate a telehealth delivery model. MDH will not reimburse for services provided via an audio-only delivery model or for codes not included on the Provider Transmittal regarding approved therapy telehealth services when provided via any method of telehealth.
SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for Therapy Services. PT 09-22. Oct. 7, 2021. (Accessed Aug. 2022).
Applied Behavior Analysis (ABA) Services
Maryland Medicaid reimburses for certain procedure codes via audio-visual telehealth for ABA providers. ABA providers may continue to render up to 100% of supervision services (97155) via telehealth. When billing for services that are rendered via two-way HIPAA compliant audio-visual telehealth, providers must bill using the GT modifier and Place of Service 11 to indicate a telehealth delivery model.
SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for ABA Services. PT 11-22. Oct. 26 2021. (Accessed Aug. 2022).
ELIGIBLE PROVIDERS
“Health care provider” means:
- A person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program;
- A mental health and substance use disorder program licensed in accordance with § 7.5–401 of this article;
- A person licensed under Title 7, Subtitle 9 of this article to provide services to an individual with developmental disability or a recipient of individual support services; or
- A provider as defined under § 16–201.4 of this article to provide services to an individual receiving long–term care services.
SOURCE: MD General Health Code 15-141.2(a)(4). (Accessed Aug. 2022).
The Program shall reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth. This subsection does not require the Program to reimburse a health care provider for a health care service delivered in person or through telehealth that is:
- Not a covered health care service under the Program; or
- Delivered by an out–of–network provider unless the health care service is a self–referred service authorized under the Program.
From July 1, 2021, to June 30, 2023, both inclusive, when appropriately provided through telehealth, the Program shall provide reimbursement on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:
- Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
- Any room and board fees.
The Department may specify in regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this section. If the Department specifies by regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this subsection, the regulations shall include all types of health care providers that appropriately provide telehealth services.
The Program or a managed care organization that participates in the Program may not impose as a condition of reimbursement of a covered health care service delivered through telehealth that the health care service be provided by a third–party vendor designated by the Program.
The Department may adopt regulations to carry out this section. The Department shall obtain any federal authority necessary to implement the requirements of this section, including applying to the Centers for Medicare and Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan. This section may not be construed to supersede the authority of the Health Services Cost Review Commission to set the appropriate rates for hospitals, including setting the hospital facility fee for hospital–provided telehealth.
SOURCE: MD General Health Code 15-141.2(g-l). (Accessed Aug. 2022).
Effective October 7, 2019, all distant site providers enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice. Providers should consult their licensing board prior to rendering services via telehealth.
Telehealth providers must be enrolled in the Maryland Medical Assistance Program before rendering services via telehealth.
Only providers who are HIPAA compliant and meet Technical Requirements may bill for services rendered via telehealth.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual, p. 1-3. Updated April 2020. MD Medical Assistance Program. Professional Services Provider Manual, p. 74. Updated Jan. 2022. (Accessed Aug. 2022).
Distant Site Providers may render services via telehealth within the provider’s scope of practice.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.06(D). (Accessed Aug. 2022).
Mental Health
Eligible Providers:
- Outpatient mental health centers
- Telemental health providers who are individual psychiatrists.
Telemental health providers may be private practice, part of a hospital, academic, health or mental health care system. Public Mental Health System (PMHS) approved community-based providers or individual practitioners may engage in agreements with TMH providers for services. Fee-for-service reimbursement shall be at an enhanced rate, as stipulated by the Department, provided all applicable provisions of this chapter are met and funds are available.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.03 & Sec. 10.21.30.04. (Accessed Aug. 2022).
An approved distant telemental health location shall be within the State.
SOURCE: Code of Maryland Admin. Regs., Sec. 10.21.30.05(D). (Accessed Aug. 2022).
ELIGIBLE SITES
The Program shall provide health care services appropriately delivered through telehealth to Program recipients regardless of the location of the Program recipient at the time telehealth services are provided and allow a distant site provider to provide health care services to a Program recipient from any location at which the health care services may be appropriately delivered through telehealth.
SOURCE: MD General Health Code 15-141.2(b). (Accessed Aug. 2022).
Eligible originating sites may be:
- College or university student health or counseling office
- Community-based substance use disorder provider
- Deaf or hard of hearing participant’s home or any other secure location approved by the participant and provider
- Elementary, middle, high or technical school with a supported nursing, counseling or medical office
- Local health department
- FQHC
- Hospital, including emergency department
- Nursing facility
- Private office of a physician, physician assistant, psychiatric nurse practitioner, nurse practitioner, or nurse midwife
- Opioid treatment program
- Outpatient mental health center
- Renal dialysis center; or
- Residential crisis services site
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual, p. 2. Updated April 2020. & Code of Maryland Admin. Regs. Sec. 10.09.49.06. (Accessed Aug. 2022).
Schools are permitted to act as originating sites under Medicaid telehealth Program regulations. All distant site providers enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice. Providers should consult their licensing board prior to rendering services via telehealth.
A school may still serve as the originating site for a telehealth interaction if the service is performed outside of an SBHC with an FQHC or local health department sponsor.
SOURCE: MD Medicaid Telehealth Program FAQs. p. 1-2, Updated April 2020. (Accessed Aug. 2022).
Mental Health
Eligible Originating Sites:
- County government offices appropriate for private clinical evaluation services;
- Critical Access Hospital;
- Federally Qualified Health Center;
- Hospital;
- Outpatient mental health center;
- Physician’s office;
- Rural Health Clinic;
- Elementary, middle, high, or technical school with a supported nursing, counseling or medical office; or
- College or university student health or counseling office.
Distant Site Location Eligibility – An approved distant TMH location shall be within the State.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Aug. 2022).
Providers should use the place of service code that would be appropriate as if it were a non-telehealth claim. The distant site should use the location of the doctor. If a distant site provider is rendering services at an off-site office, use place of service office (11). Place of Service Code 02 (Telehealth) is not recognized for Maryland Medicaid participants except for use on Medicare crossover claims to specify services rendered through a telecommunication system for dual eligible participants. Allowable place of service codes should remain unchanged for Medicaid-only claims.
The Program recognizes specific modifiers for certain services rendered via telehealth delivery models; providers may bill using -GT and -UB. Providers should submit claims in the same manner as for in-person services and include the “-GT” modifier to identify that services were rendered via two-way audio-visual telehealth. To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service. Billing with these modifiers will not affect Medicaid reimbursement rates. The use of audio-only telehealth services is only permitted during the Public Health State of Emergency.
SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 24-25, 74. Updated Jan. 2022. (Accessed Aug. 2022).
Distant site providers may use secure space/areas in the provider’s home to engage in telehealth. Telehealth providers must meet the minimum requirements for privacy as well as the minimum requirements for technology.
Other permitted places of service from where to deliver services via telehealth include: school, office, inpatient hospital, outpatient hospital, emergency room, nursing facility, independent clinic, Federally Qualified Health Center (FQHC), community mental health center, non-residential substance abuse treatment facility, end-stage renal disease treatment facility, public health clinic.
SOURCE: MD Medicaid Telehealth Program FAQs. p. 1, Updated April 2020. (Accessed Aug. 2022).
GEOGRAPHIC LIMITS
The Program may not distinguish between Program recipients in rural or urban locations in providing coverage under the Program for health care services delivered through telehealth.
SOURCE: MD General Health Code 15-141.2(f). (Accessed Aug. 2022).
The Telehealth Program serves Medicaid participants regardless of geographic location within Maryland.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. p. 1, Updated April 2020. (Accessed Aug. 2022).
Mental Health
To be eligible a beneficiary must reside in one of the designated rural geographic areas or whose situation makes person-to-person psychiatric services unavailable.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05(A)(3). (Accessed Aug. 2022).
FACILITY/TRANSMISSION FEE
The Department may not reimburse distant site providers for a facility fee.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.09(G). (Accessed Aug. 2022).
Hospital Billing Instructions
Facility charges related to the use of telemedicine services. This revenue code is payable for dates of service 10/1/13 forward.
SOURCE: Maryland Dept. of Health Medical Assistance, UB04 Hospital Billing Instructions, 4/23/2020, p. 93 (Accessed Aug. 2022).
From July 1, 2021, to June 30, 2023, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:
- Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
- Any room and board fees.
The Department may adopt regulations to carry out this section.
SOURCE: MD Health General Code 15-141.2 (g)(3), (h). (Accessed Aug. 2022)
Last updated 08/02/2022
Miscellaneous
Expires June 30, 2025:
The Maryland Department of Health shall study whether, under the Maryland Medical Assistance Program, substance use disorder services may be appropriately provided through telehealth to a patient in the patient’s home setting. On or before December 1, 2021, the Maryland Department of Health shall submit a report to the General Assembly that includes findings and recommendations.
SOURCE: HB 1208/SB 502 (2020 Session). (Accessed Aug. 2022).
Technology requirements for providers:
- A camera that has the ability to manually, or under remote control, provider multiple views of a patient with the capability of altering the resolution, focus, and zoom requirements according to the consultation;
- Have display monitor size sufficient to support diagnostic needs used in the service via telehealth;
- Bandwidth speed and image resolution sufficient to provide quality video to meet a minimum of 15 frames per second, or higher, as industry standards change;
- Unless engaging in a telehealth communication with a participant who is deaf or hard of hearing, audio equipment that ensures clear communication and includes echo cancellation;
- Creates audio transmission with less than 300 millisecond delay;
- Secure and HIPAA compliant telehealth communication;
A dedicated connection that provides bandwidth only for telehealth communications is preferable for services delivered via telehealth.
All tech staff must be trained in telehealth technology use and HIPAA compliance.
Provider manual outlines various telehealth provider scenarios.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 3 & 7-8, MD Medicaid Telehealth Program FAQ, Updated April 2020, p. 2-4 (HIPAA). (Accessed Aug. 2022).
Providers of health care services delivered through telehealth must use video and audio transmission with less than a 300 millisecond delay. Other minimum technology requirements apply.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.07. (Accessed Aug. 2022).
Providers may not store at originating or distant site video images or audio portion of telemedicine services for future use.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.08. (Accessed Aug. 2022).
Recently Passed Legislation – Effective October 1, 2021
Legislation adds additional requirements to the annual report on behavioral health services for children and young adults, including adding the number and percentage of those that used a public behavioral health service provided through telehealth.
SOURCE: MD Health General Code 7.5-209. As amended by HB 1243/SB 520 (2021 Session). (Accessed Aug. 2022).
Recently Passed Legislation
The Maryland Health Services Cost Review Commission, the Maryland Department of Health, and the Maryland Insurance Administration, shall submit a report to the Senate Finance Committee and the House Health and Government Operations Committee on the impact of providing telehealth services. The Maryland Health Care Commission shall consider both audio–only and audio–visual technologies for purposes of reporting on the impact of providing telehealth services as required by this section.
Until and no later than June 30, 2023, while the Maryland Health Care Commission completes the study and submits the report for consideration by the General Assembly for the adoption of comprehensive telehealth policies by the State:
- The Maryland Medical Assistance Program is to continue to reimburse health care providers for covered health care services provided through audio–only and audio–visual technology in accordance with the requirements of Section 1 of this Act, and all applicable executive orders and waivers issued in accordance with Chapters 13 and 14 of the Acts of the General Assembly of 2020
- Insurers, nonprofit health service plans, and health maintenance organizations that are subject to § 15–139 of the Insurance Article as enacted by Section 1 of this Act continue to reimburse health care providers for covered health care services provided through audio–only and audio–visual technology in accordance with the requirements of Section 1 of this Act and all applicable accommodations made by the insurers, nonprofit health service plans, and health maintenance organizations during the Declaration of State of Emergency and Existence of Catastrophic Health Emergency – COVID–19 issued on March 5, 2020, and its renewals
The Maryland Health Care Commission should use the data collected from utilization and coverage of telehealth to complete the report.
The State is to use the report required to establish comprehensive telehealth policies for implementation after the Declaration of State of Emergency and Existence of Catastrophic Health Emergency – COVID–19 issued on March 5, 2020, and its renewals expire.
SOURCE: HB 123/SB 3 (2021 Session). (Accessed Aug. 2022)
Last updated 08/02/2022
Out of State Providers
If you are rendering services via telehealth with a participant located in Maryland, then you are considered to be practicing in Maryland; therefore, you must be licensed in Maryland and are subject to your professional board’s licensure requirements.
It is your responsibility to ensure that you meet the Board licensure requirements. This includes consulting with the professional board in the state where the patient physically is located as well as where the provider is physically located. Failure to comply with licensure requirements involving services delivered via telehealth will likely have implications beyond Maryland Medicaid’s telehealth purview.
SOURCE: MD Medicaid Telehealth Program FAQs. p. 2, Updated April 2020. (Accessed Aug. 2022).
“Health care provider” means a person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program.
SOURCE: MD Health General Code Sec. 15-141.2(a)(4)(i). (Accessed Aug. 2022).
Last updated 08/02/2022
Overview
Maryland Medicaid covers live video telehealth conducted by specific providers and in specific originating sites. Recently passed legislation requires expanded coverage of asynchronous and remote patient monitoring modalities. Until June 30, 2023, the legislation also requires coverage of audio-only and telehealth reimbursement parity.
Last updated 08/02/2022
Remote Patient Monitoring
POLICY
Recently Passed Legislation
Remote patient monitoring services means the use of synchronous or asynchronous digital technologies that collect or monitor medical, patient–reported, and other forms of health care data for Program recipients at an originating site and electronically transmit that data to a distant site provider to enable the distant site provider to assess, diagnose, consult, treat, educate, provide care management, suggest self–management, or make recommendations regarding the Program recipient’s health care.
SOURCE: MD Health General Code 15-141.2. (Accessed Aug. 2022).
“Remote patient monitoring” means digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment, recommendations, and interventions.
SOURCE: Code of Maryland Admin. Regs., Sec. 10.09.96.02(B)(13). (Accessed Aug. 2022).
Existing MD Medicaid guidance and regulation limits reimbursement for remote patient monitoring to certain chronic conditions. Preauthorization requirements also apply.
SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed Aug. 2022).
No reimbursement for home health monitoring services is included under telehealth manual.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 3, (Accessed Aug. 2022).
The Department may not reimburse for home health monitoring services.
SOURCE: Code of Maryland Admin. Regs., Sec. 10.09.49.09(H). (Accessed Aug. 2022).
CONDITIONS
Recently Passed Legislation
Telehealth definition includes remote patient monitoring. The Program is required to reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth regardless of patient and provider location.
From July 1, 2021, to June 30, 2023, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:
- Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
- Any room and board fees.
The Department may adopt regulations to carry out this section.
SOURCE: MD Health General Code 15-141.2 (a-b, h).. (Accessed Aug. 2022).
Existing guidance states Medicaid recipients diagnosed with one of the following conditions qualify:
- Chronic Obstructive Pulmonary Disease
- Congestive Heart Failure
- Diabetes (Type 1 or 2)
The participant must be enrolled in Medicaid, consent to RPM, have an internet connection and capability to use monitoring tools and have one of the following scenarios within the most recent 12-month period:
- Two hospital admissions with the same qualifying medical condition as the primary diagnosis
- Two emergency room department visits with the same qualifying medical condition as the primary diagnosis
- One hospital admission and one emergency department visit with the same qualifying medical condition as the primary diagnosis.
SOURCE: MD Home Health Transmittal No. 64. Jan. 10, 2018. MD General Provider Transmittal No. 85. Feb. 12, 2018, MD Remote Patient Monitoring Transmittal No. 1, Jan 10, 2018. (Accessed Aug. 2022).
An MCO shall provide its enrollees medically necessary remote patient monitoring services as described in COMAR 10.09.96.
SOURCE: Code of Maryland Admin Regs., Sec. 10.67.06.26-5. (Accessed Aug. 2022).
PROVIDER LIMITATIONS
Recently Passed Legislation
The Department may specify in regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients via telehealth. If the Department specifies by regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this subsection, the regulations shall include all types of health care providers that appropriately provide telehealth services.
The Program is not required to reimburse a health care provider for a health care service delivered in person or through telehealth that is:
- Not a covered health care service under the Program; or
- Delivered by an out–of–network provider unless the health care service is a self–referred service authorized under the Program.
SOURCE: MD General Health Code 15-141.2(g-h). (Accessed Aug. 2022).
Eligible Providers:
- Home Health Agencies
- Hospitals
- Clinics
- Federally Qualified Health Centers
- Managed Care Organizations
- Health Professionals (Physicians, Nurses, Physician Assistants)
SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed Aug. 2022).
Remote patient monitoring is not a substitute for delivery of care. Provider shall see patients in person periodically for follow-up care. To provide remote patient monitoring, the provider shall be enrolled with an active status as a Maryland Medical Assistance Program provider on the date the service is rendered and be a:
- Physician;
- Physician assistant;
- Certified nurse practitioner; or
- Home health agency when remote patient monitoring services are prescribed by a physician; and
- Meet the requirements for participation in the Medical Assistance Program as set forth in COMAR 10.09.36.03.
Medical Record Documentation. A remote patient monitoring provider shall:
- Maintain documentation using either electronic or paper medical records;
- Retain remote patient monitoring records according to the provisions of Health-General Article, §4-403, Annotated Code of Maryland;
- Submit the preauthorization on a form developed by the Department; and
- Include the participant’s consent to participate in remote patient monitoring.
SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.04. (Accessed Aug. 2022).
OTHER RESTRICTIONS
Preauthorization required.
The RPM reimbursement rate is an all-inclusive rate of $125 per 30 days of monitoring which covers equipment installation, participant education for using the equipment, and daily monitoring of the information transmitted for abnormal data measurements.
Reimbursement does not include RPM equipment, upgrades to RPM equipment or internet service for participants.
SOURCE: MD Home Health Transmittal No. 64. Jan. 10, 2018., Code of Maryland Admin Regs, Sec. 10.09.96.06. (Accessed Aug. 2022).
Last updated 08/02/2022
Store and Forward
POLICY
Recently Passed Legislation
Telehealth definition includes both synchronous and asynchronous interactions. The Program is required to reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth regardless of patient and provider location.
From July 1, 2021, to June 30, 2023, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person.
The Department may adopt regulations to carry out this section.
SOURCE: MD Health General Code 15-141.2 (a-b, g, j). Accessed Aug. 2022.
According to the Maryland Medicaid Telehealth Provider Manual, store and forward technology means the transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site. As of the last update, the manual states that store-and-forward is only covered for dermatology, ophthalmology and radiology under Physician services of COMAR 10.09.02.07.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. p. 4, Updated April 2020. (Accessed Aug. 2022).
ELIGIBLE SERVICES/SPECIALTIES
MD regulations state store and forward technology does not meet the Maryland Medical Assistance Program’s definition of telehealth. However, dermatology, ophthalmology and radiology are excluded from definition of store-and-forward and they do reimburse for these services according to COMAR 10.09.02.07.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.09. (Accessed Aug. 2022).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
