Last updated 02/28/2021
Definitions
Telemedicine means, as it relates to the delivery of health care services, the use of interactive audio, video, or other telecommunications or electronic technology:
- By a health care provider to deliver a health care service that is within the scope of practice of the health care provider at a site other than the site at which the patient is located; and
- That enables the patient to see and interact with the health care provider at the time the health care service is provided to the patient.
Telemedicine does not include an audio-only conversation between a health care provider and a patient; an electronic mail message between a health care provider and a patient; or a facsimile transmission between a healthcare provider and a patient.
SOURCE: MD Health General Code 15-105.2. (Accessed Feb. 2021).
“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 Feb. 2021).
Last updated 02/28/2021
Live Video
POLICY
Reimbursement for telehealth is required for services appropriately delivered through telehealth and may not exclude from coverage a health care service solely because it is through telehealth.
SOURCE: Insurance Code 15-139 (Accessed Feb. 2021).
To the extent authorized by federal law or regulation, the provisions of § 15–139(c) through (f) (see reference above) of the Insurance Article relating to coverage of and reimbursement for health care services delivered through telemedicine shall apply to the Program and managed care organizations in the same manner they apply to carriers.
The Department may require providers to submit a registration form to include information required for the processing of telehealth claims.
SOURCE: MD General Health Code Sec. 15-105.2 (Accessed Feb. 2021).
Managed Care
MCOs shall provide coverage for medically necessary telemedicine services.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.67.06.31. (Accessed Feb. 2021).
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 Feb. 2021).
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 Feb. 2021).
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 Feb. 2021).
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 providers 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 Feb. 2021).
Services should be billed with the GT modifier.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.10. (Accessed Feb. 2021).
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 Feb. 2021).
Subject to the limitations of the State budget, the medical assistance program shall provide mental health services appropriately delivered through telehealth to a patient in the patient’s home setting.
SOURCE: MD General Health Code Sec.15.103 (HB 1208 & SB 502 – 2020 Session). (Accessed Feb. 2021).
Effective Immediately, expires June 30, 2025:
On or before Dec. 1, 2020, the Department shall apply to the Centers for Medicare and Medicaid Services for an amendment to any of the state’s 1115 waivers necessary to implement a pilot program to provide services to program recipients regardless of the program recipient’s location at the time telehealth services are provided. Chronic condition case management services will be available through the pilot. The Department shall collect outcomes data on recipients of telehealth services under the pilot program to evaluate the effectiveness of the pilot program and submit a report to the Department on or before Dec. 1, 2020 and every 6 months after that.
SOURCE: MD General Health Code Sec.15.141.2 (HB 1208 & 502-2020 Session), (Accessed Feb. 2021).
ELIGIBLE PROVIDERS
Expires in three years at the end of September 30, 2021
The Department may specify by regulation the types of health care providers eligible to receive reimbursement for health care services. If the Department specifies by regulation the types of health care providers eligible to receive reimbursement, the types of health care providers shall include:
- Primary care providers; and
- Psychiatrists, and psychiatric nurse practitioners who are providing assertive community treatment or mobile treatment services to program recipients located in a home or community-based setting.
The health services provided by a psychiatrist or a psychiatric nurse practitioner must be equivalent to the same health care service when provided through in-person consultation.
* Effective Sept. 30, 2021, psychiatrists and nurse practitioners are removed from the eligible health care provider list above.
SOURCE: MD General Health Code Sec. 15-105.2(b)(4)(ii) (Accessed Feb. 2021).
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. (Accessed Feb. 2021).
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. (Accessed Feb. 2021).
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 Feb. 2021).
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 Feb. 2021).
ELIGIBLE SITES
Eligible originating sites:
- 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 Feb. 2021).
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.
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.
SOURCE: MD Medicaid Telehealth Program FAQs. p. 1-2, Updated April 2020 & School-based Health Center Provider Manual, p. 23, Revised Sept. 14, 2020. (Accessed Feb. 2021).
Subject to the limitations of the State budget, the medical assistance program shall provide mental health services appropriately delivered through telehealth to a patient in the patient’s home setting.
SOURCE: MD General Health Code Sec.15.103 (HB 1208 & SB 502 – 2020 Session), (Accessed Feb. 2021).
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.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Feb. 2021).
GEOGRAPHIC LIMITS
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 Feb. 2021).
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. (Accessed Feb. 2021).
FACILITY/TRANSMISSION FEE
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 Feb. 2021).
Last updated 02/28/2021
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 & 502 (2020 Session). (Accessed Feb. 2021).
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 (Accessed Feb. 2021).
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 Feb. 2021).
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 Feb. 2021).
Last updated 02/28/2021
Remote Patient Monitoring
POLICY
The department may provide reimbursement for services delivered through remote patient monitoring technology.
SOURCE: Health General Code 15-105.2. (Accessed Feb. 2021).
MD Medicaid reimburses for remote patient monitoring for certain chronic conditions. Preauthorization requirements apply.
SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed Feb. 2021).
No reimbursement for home health monitoring services under telehealth manual.
SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 3, (Accessed Feb. 2021).
CONDITIONS
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 connect 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. (Accessed Feb. 2021).
PROVIDER LIMITATIONS
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 Feb. 2021).
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. (Accessed Feb. 2021).
