Michigan

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: Michigan Medicaid
  2. Administrator: Michigan Dept. of Health and Human Services (MDHHS)
  3. Michigan Dept. of Health and Human Services (MDHHS): Upper Midwest Telehealth Resource Center

Last updated 01/17/2022

Audio Only Delivery

Medicaid: Relaxing Face-to-Face Requirement (Update)

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Specialty Behavioral Health Supports and Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Limited Oral Evaluation via Telemedicine

STATUS: Active, time limited policy however expiration date not specified

Medicaid: Behavioral Health Telepractice; Telephone Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Reimbursement for FQHCs, RHCs, Tribal Health Centers

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid 1915(c) Waiver: Appendix K -MI Health Link Home and Community Based Services Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Health Link Home and Community Based Services Waiver

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – MI Choice

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Choice

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active until no later than six months after the expiration of the PHE

Last updated 01/17/2022

Cross State Licensing

No reference found.

Last updated 01/17/2022

Easing Prescribing Requirements

No reference found.

Last updated 01/17/2022

Miscellaneous

HB 6030: Liability Insurance

STATUS: Enacted

Last updated 01/17/2022

Originating Site

Medicaid:  General Telemedicine Policy

STATUS: Remain in effect until incorporated into the manual.

Medicaid: Telemedicine Reimbursement for FQHCs, RHCs, Tribal Health Centers

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid 1915(c) Waiver: Appendix K -MI Health Link Home and Community Based Services Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Health Link Home and Community Based Services Waiver

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – MI Choice

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Choice

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active until no later than six months after the expiration of the PHE

Last updated 01/17/2022

Private Payer

No reference found.

Last updated 01/17/2022

Provider Type

Medicaid:  General Telemedicine Policy

STATUS: Remain in effect until incorporated into Medicaid manual

Medicaid: Telemedicine Policy Changes, Physical, Occupational and Speech Therapy

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Reimbursement for FQHCs, RHCs, Tribal Health Centers

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Permanent

Medicaid 1915(c) Waiver: Appendix K – MI Choice

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K- MI Choice

STATUS: Active until six months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active until no later than six months after the expiration of the PHE

Last updated 01/17/2022

Service Expansion

Medicaid:  General Telemedicine Policy

STATUS: Active, until incorporated into manual.

Medicaid: Specialty Behavioral Health Supports and Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Limited Oral Evaluation via Telemedicine

STATUS: Active, time limited policy however expiration date not specified

Medicaid: Behavioral Health Telepractice; Telephone Services

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Policy Changes, Physical, Occupational and Speech Therapy

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Telemedicine Policy Rate Change

STATUS: Active, time limited policy however expiration date not specified

Medicaid: Telemedicine Policy Change for Audiology

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services; COVID-19 Response: Temporary Waiver of Beneficiary Signature for Home- Delivered DMEPOS

STATUS: Active, time limited policy and MDHHS will notify providers of its termination

Medicaid: Correction to Bulletin MSA 20-35, Medicaid Compliance with Interim Final Rule CMS-5531: Improving Care Planning for Medicaid Home Health Services;

STATUS: Permanent

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Habilitation Supports, Children’s Waiver Program (CWP) Waiver for Children with Serious Emotional Disturbances (SEDW)

STATUS: Active, until six months after the expiration of the PHE

Last updated 01/17/2022

Definitions

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE: MI Compiled Law Services, Section 330.1100(d)(15), (Accessed Jan. 2022).

“Telemedicine” means that term as defined in section 3476 of the insurance code: “Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.”

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) & MI Compiled Law Services Sec. 5501401k(2). (Accessed Jan. 2022).

“Telemedicine is the use of telecommunication technology to connect a patient with a health care professional in a different location. MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying  immediate medical need for services.”

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p.1785, Jan. 1, 2022 (Accessed Jan. 2022). 

Assertive Community Treatment Program (ACT)

Telepractice is the use of telecommunications and information technologies for the provision of psychiatric services to ACT consumers and is subject to the same service provisions as psychiatric services provided in-person.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 347 Jan. 1, 2022  (Accessed Jan. 2022). 

Behavioral Health Treatment Services (BHT)

Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 476 Jan. 1, 2022 (Accessed Jan. 2022).

Telemedicine for BHT Services

Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telemedicine must be obtained through real-time interaction between the individual’s physical location (patient site) and the provider’s physical location (provider site). Telemedicine services are provided to patients through hardwire or internet connection.

SOURCE: MSA Bulletin 21-20, (Sept. 1, 2021), (Accessed Jan. 2022).

Medication Therapy Management

Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telepractice must be obtained through real-time interactions between the beneficiary’s physical location (origin site) and the pharmacist provider’s physical location (distant site). Telepractice services are provided to beneficiaries through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1709 Jan. 1, 2022 (Accessed Jan. 2022). 

Speech, Language and Hearing Therapy, School- Based Services

“Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of speech, language and hearing services. Telepractice must be obtained through real-time interaction between the patient’s physical location (patient site) and the provider’s physical location (provider site).” Services are provided to patients through hardwire or internet connection.

SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1885 & 1887 Jan. 1, 2022 (Accessed Jan. 2022).

Child Therapy

Telepractice/Telehealth is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed therapy services may be prohibitive). Telepractice/Telehealth must be obtained through real-time interaction between the child’s/family’s physical location and the provider’s physical location. Telepractice/Telehealth services are provided to patients through hardwire or internet connection.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 332, Jan. 1, 2022. (Accessed Jan. 2022).

Last updated 01/18/2022

Email, Phone & Fax

Interprofessional Telephone/Internet/Electronic Health Record Consultations

Interprofessional telephone/Internet/electronic health record consultations, including e-Consults, are a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating physician (e.g., attending or primary) or practitioner requests the opinion and/or treatment advice of a Medicaid enrolled physician or practitioner with the specialty expertise to assist in the diagnosis of a condition and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consultant. The service concludes with a written report from the consultant to the treating physician/requesting provider.

The beneficiary for whom the service is requested may be either a new patient to the consulting provider or an established patient with a new problem. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology specimens, is included in the service and should not be separately reported. The written or verbal request for the consult must be documented in the beneficiary’s medical record by the treating physician/requesting provider. Providers must consult with the American Medical Association (AMA) coding guidelines to ensure appropriate reporting of these services. Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2022).

Medication Therapy Management (MTM)

The following are not eligible to be covered as MTM services:

Services provided by telephone, email or US Postal Service Mail.

SOURCE: MI Medicaid Provider Manual, p. 1707 Jan. 1, 2022 (Accessed Jan. 2022).

Last updated 01/17/2022

Live Video

POLICY

MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services.

Source: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1785. Jan. 1, 2022 (Accessed Jan. 2022). 

Assertive Community Treatment Program

All telepractice interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner/clinical nurse specialist from their respective physical location. Psychiatric services are the only ACT services that are approved to be provided in this manner.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 347-348 Jan. 1, 2022 (Accessed Jan. 2022)


ELIGIBLE SERVICES/SPECIALTIES

The following services may be provided via telemedicine:

  • ESRD-related services
  • Behavior change intervention
  • Behavioral Health and/or Substance Use Disorder Treatment
  • Education Services, Telehealth
  • Inpatient consultations
  • Nursing facility subsequent care
  • Office or other outpatient consultations
  • Office or other outpatient services
  • Psychiatric diagnostic procedures
  • Subsequent hospital care
  • Training service – Diabetes (see Diabetes Self-Management Education Training Program section in Hospital Chapter specific program requirements)

Where face-to-face visits are required (such as ESRD and nursing facility related services), the telemedicine service may be used in addition to the required face-to-face visit but cannot be used as a substitute. There must be at least one face-to-face hands-on visit (i.e., not via telemedicine) by a physician, physician’s assistant or advanced practice registered nurse per month to examine the vascular site for ESRD services. The initial visit for nursing facility services must be face-to-face.

Procedure codes and modifier information is contained in the MDHHS Telemedicine Services Database.

There is no prior authorization requirements when providing telemedicine services for fee-for-service beneficiaries.

Providers at the distant site can only bill services listed in the Telemedicine Services database.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1785-6, Jan. 1, 2022 (Accessed Jan. 2022).  

Speech-Language and Audiology Services

Speech, language and hearing services may be reimbursed. Requires an annual referral from a physician. In addition to the use of the appropriate billing code, billers use the “GT modifier to identify services provided by telepractice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1885, Jan. 1, 2022 (Accessed Jan. 2022). 

Assertive Community Treatment Program

The telepractice modifier, 95, must be used in conjunction with ACT encounter reporting code H0039 when telepractice is used.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 347 Jan. 1, 2022 (Accessed Jan. 2022). 

Telepractice for BHT Services

Telepractice services must be prior authorized.  Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection. It is the expectation that providers, facilitators, and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients, and services provided via telepractice are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. Qualified providers of behavioral health services are able to arrange telepractice services for the purposes of teaching the parents/guardians to provide individualized interventions to their child and to engage in behavioral health clinical observation and direction (i.e. increase oversight of the provision of services to the beneficiary to support the outcomes of the behavioral plan of care developed by the primary supervising BHT provider).

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 476 Jan. 1, 2022 (Accessed Jan. 2022). 

Telemedicine/Telepractice for BHT Services

Refer to the Behavioral Health Telemedicine reporting requirements database for appropriate or allowed telemedicine services that may be covered by Medicaid. Certain qualifications and conditions will also need to be met. Us GT modifier in addition to appropriate procedure code.

It is the expectation that providers, facilitators, and staff involved in telemedicine are trained in the use of equipment and software prior to servicing patients and services provided via telemedicine are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. The provider of the telemedicine service is only able to monitor one child/family at a time.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 476, 1887-1889 Jan. 1, 2022 (Accessed Jan. 2022).

Child Therapy

A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. Telepractice/Telehealth is approved for Individual Therapy or Family Therapy using approved children’s evidence-based practices (i.e., Trauma Focused Cognitive Behavioral Therapy, Parent Management Training-Oregon, Parenting Through Change) and utilizes the GT modifier when reporting the service.  Qualified providers of children’s evidence-based practices have completed their training in the model, its implementation via telehealth, and are able to provide the practice with fidelity.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 332, Jan. 1, 2022 (Accessed Jan. 2022). 

Psychiatric Collaborative Care Model (CoCM) Services

Provider care management services provided by a Behavioral Health Care Manager can be provided in a non-face-to-face interaction. Weekly consults with the psychiatric consultant may also be non-face-to-face. Non-face-to-face weekly to monthly follow-up by the behavioral health care manager that must include monthly screening with validated rating scale, monitoring of goals and/or medication, and may include recommended evidence-based therapies.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1780 Jan. 1, 2022  (Accessed Jan. 2022).

Medication Therapy Management (MTM)

In the event that the beneficiary is unable to physically access a face-to-face setting, an eligible pharmacist may provide MTM services via telepractice.  The arrangements for telepractice will be made by the pharmacist. The administration of telepractice services are subject to the same provision of services that are provided to a beneficiary in person.  For services provided through telepractice each procedure code must include the modifier GT (professional claims).

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1709 Jan. 1, 2022  (Accessed Jan. 2022.


ELIGIBLE PROVIDERS

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2018, Jan. 1, 2022 (Accessed Jan. 2022). 

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telemedicine services (as described in the Telemedicine Services subsection) may bill, and receive payment for, the service when it is delivered via a telecommunication system. In order to be reimbursed for services, distant site providers must be enrolled in Michigan Medicaid.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 1786-7, Jan. 1, 2022 (Accessed Jan. 2022). 

Telepractice for BHT Services

Qualified providers include:

  • Board certified behavior analysts
  • Board certified assistant behavior analysts
  • Licensed psychologists
  • Limited licensed psychologists
  • Qualified behavioral health professionals

Occupational, physical and speech therapists are not included in this policy.

A facilitator trained in telepractice technology must be physically present with the patient during the entire telepractice session.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 476-477 Jan. 1, 2022 (Accessed Jan. 2022). 

Telemedicine for Behavioral Health Services

Behavioral health services may be provided by:

  • Licensed physician or psychiatrist;
  • LIcensed psychologist;
  • Limited licensed master’s level psychologist under the supervision of a licensed psychologist;
  • MDE-credentialed master’s level school psychologist;
  • Licensed master’s level marriage and family therapist;
  • Board-certified behavior analyst (BCBA);
  • Board-certified assistant behavior analyst (BCaBA) under the supervision of a BCBA;
  • Licensed master’s level professional counselor;
  • LImited licensed master’s level professional counselor under the supervision of a licensed master’s level professional counselor;
  • Licensed master’s level social worker;
  • Licensed master’s level school social worker;
  • LImited licensed master’s level social worker under the supervision of a licensed master’s level social worker; and
  • Temporary limited licensed psychologist under the supervision of a fully licensed psychologist.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1887-1888, Jan. 1, 2022 (Accessed Jan. 2022).

Medication Therapy Management (MTM)

In the event that the beneficiary is unable to physically access a face-to-face care setting, an eligible pharmacist may provide MTM services via telepractice.  Services must be provided through hardwire or internet connection.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1709,  Jan. , 2022 (Accessed Jan. 2022).

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites. Practitioners must meet the provider qualifications for the covered service provided via telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 338, Jan. 1, 2022 (Accessed Jan. 2022).

Speech-Language and Audiology Services

Eligible providers:

  • A fully licensed speech-language pathologist
  • Licensed Audiologist in Michigan
  • Speech language pathologist and/or audiology candidate under the direction of a qualified SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed SLP or licensed audiologist.
  • A limited licensed speech language pathologist under the direction of a fully licensed SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed supervising SLP or licensed audiologist.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1885, Jan. 1, 2022 (Accessed Jan. 2022).  

Federally Qualified Health Centers, Hospital, Nursing Facility, Rural Health Centers, Tribal Health Centers

An FQHC, hospital, nursing facility,  RHC or tribal health centers can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 728, 958, 1428, 1848 & 2022 Jan. 1, 2022 (Accessed Jan. 2022). 

Dual Eligibles – FQHC’s, IHCs, and RHCs Distant Site Telehealth Services: The Michigan Department of Health and Human Services (MDHHS) will allow Federally Qualified Health Centers, Indian Health Centers, and Rural Health Clinics a one-time exception to temporarily waive timely filing for distant site telehealth services for dual-eligible beneficiaries. The one-time exception will only apply to dates of service from January 1, 2020 – June 30, 2020. The deadline to resubmit impacted G2025 claims, and encounters is March 18, 2022, to waive timely filing for distant site telehealth services for dual-eligible beneficiaries. Once the deadline has passed to resubmit, clinics will no longer receive an exception to waive timely filing for G2025. The deadline pertains to Medicaid fee-for-service (FFS) and Medicaid Health Plan (MHP) claims.

Clinics resubmitting G2025 services will be required to adjust FFS claims and include a claim note on the adjusted claim. The claim note should read, “Clinic telehealth distant site service from January 1, 2020, to June 30, 2020.” If the claim note does not contain this language, it will not be considered for payment. The MHP impacted encounter claims will need to be corrected as well. Please work with the health plans to adjust impacted encounter claims for the dates of service listed above.

SOURCE: MI Dept of Health and Human Services, Medicaid, Attention FQHCs, IHCs, RHCS (Jan. 11, 2022). (Accessed Jan. 2022).

Child Therapy

A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. It is the expectation that providers involved in telepractice/telehealth are trained in the use of equipment and software prior to servicing children/families.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 332, Jan. 1, 2022 (Accessed Jan. 2022).

School-Based Services and Caring 4 Students Providers

Telepractice specifically applies to the SBS and C4S programs.  See Medicaid manual for requirements.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-15, School Based Services, p 1888-1889. Jan. 1, 2022 (Accessed Jan. 2022).


ELIGIBLE SITES

Beginning October 1, 2020, telemedicine services are covered under the medical assistance program and Healthy Michigan program if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider.

SOURCE: MI Compiled Laws Sec. 400.105h. (Accessed Jan. 2022).

Tribal 638 Facilities

Tribal FQHCs are eligible to receive all-inclusive rate (AIR) reimbursement for clinic services provided outside of the four walls of the facility, including telemedicine and services provided by contracted employees.

SOURCE: MI Medical Services Administration Bulletin MSA 20-60, Sept. 1, 2020 (Accessed Jan. 2022)

Eligible originating sites:

  • County mental health clinics or publicly funded mental health facilities;
  • Federally Qualified Health Centers;
  • Hospitals (inpatient, outpatient, or Critical Access Hospitals);
  • Physician or other providers’ offices, including medical clinics;
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
  • Rural Health Clinics;
  • Skilled nursing facilities;
  • Tribal Health Centers

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1786. Jan. 1, 2022 (Accessed Jan. 2022). 

Speech-Language and Audiology Services, Behavioral Health Therapy, School-Based Services & Caring 4 Students Provider

The patient site may be located:

  • Within the school (for speech-language and audiology services & School-Based and Caring 4 Students Provider);
  • The Center (Behavioral Health Therapy);
  • Home;
  • Any other established site deemed appropriate by the provider.

The room must be free from distractions so as not to interfere with the telepractice session.  A facilitator must be trained in the use of the telepractice technology and physically present at the patient site during the entire telepractice session to assist the patient at the direction of the SLP or audiologist.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 477 (BHT), 1885 (SLP & Audiology), 1887 (BHT), 1888 (School-Based/Caring 4 Kids Providers) Jan. 1, 2022 (Accessed Jan. 2022). 

Federally Qualified Health Centers, Hospital, Nursing Facility, Rural Health Centers, Tribal Health Centers

An FQHC, hospital, nursing facility,  RHC or tribal health centers can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 728, 958, 1428, 1848 & 2022 Jan. 1, 2022 (Accessed Jan. 2022). 


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Originating site may bill for a facility fee. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 263, Jan. 1, 2022 (Accessed Jan. 2022).

Last updated 01/18/2022

Miscellaneous

No reimbursement for remote access for surgical procedures, and use of robotics.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1785, Jan. 1, 2022  (Accessed Jan. 2022).

Last updated 01/18/2022

Out of State Providers

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1786, Jan. 1, 2022 (Accessed Jan. 2022).  

Assertive Community Treatment Programs (ACT)

The physician (MD or DO) must possess a valid license to practice medicine in Michigan, a Michigan Controlled Substance License, and a Drug Enforcement Administration (DEA) registration.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 347, Jan. 1, 2022 (Accessed Jan. 2022).

Behavioral Health Therapy

Providers of telepractice services must be currently certified by the Behavior Analyst Certification Board (BACB), be a QBHP, be fully licensed in MI as a fully licensed psychologist, or be a practitioner who holds a limited license and is under the direction of a licensed psychologist.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 476, Jan. 1, 2022 (Accessed Jan. 2022).

Last updated 01/17/2022

Overview

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals, for patients located at certain originating sites for specific services.  A new bulletin effective Aug. 1, 2021 Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional telephone/internet/electronic health record consultations and remote patient monitoring services under certain circumstances. Michigan Medicaid uses the terms “telemedicine” and “telepractice”.

Last updated 01/18/2022

Remote Patient Monitoring

POLICY

“Remote patient monitoring means digital technology to collect medical and other forms of health data from an individual in 1 location and electronically transmit that information via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure system to a health care provider in a different location for assessment and recommendations.”

The Department of Health and Human Services must provide coverage for remote patient monitoring services through the medical assistance program and Healthy Michigan program.

SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Jan. 2022).

Remote Patient Monitoring (RPM) is a covered service under Michigan Compiled Law (MCL) 400.105g. RPM means using digital technology to collect medical and other forms of health data from an individual in one location and electronically transmit that information via a secure, HIPAA-compliant system to a health care provider in a different location for assessment and recommendations. RPM is covered for both acute and chronic conditions.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2022).


CONDITIONS

RPM devices include (1) non-invasive remote monitoring devices that measure or detect common physiological parameters, and (2) non-invasive monitoring devices that wirelessly transmit the beneficiary’s medical information to their health care provider or other monitoring entity. The device must be reliable and valid, and the beneficiary must be trained or sufficiently knowledgeable in the proper use/wearing of the device to ensure appropriate recording of medical information. Medical information may include, but is not limited to, blood pressure and heart rate and rhythm monitoring.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2022).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

All RPM devices, including mobile medical applications, must meet the U.S. Food & Drug Administration (FDA) definition of a medical device. Personal tablets, computers, cell phones, software intended for administrative support or support of healthy lifestyles/general wellness, and electronic health records are not medical devices or durable medical equipment and are not covered as part of RPM services.

Reimbursement for the device used for remote monitoring, and programming of the device, is generally included in the reimbursement of RPM services and not separately reimbursable. For items or devices separately reimbursed to a medical supplier, such as personal use continuous glucose monitoring systems (CGMs), refer to the Medical Supplier chapter of the MDHHS Medicaid Provider Manual.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2022).

Last updated 01/18/2022

Store and Forward

POLICY

Telecommunication systems using store-and-forward technology are not included in MI Medicaid’s telemedicine policy.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1785, Jan. 1, 2022 (Accessed Jan. 2022).

Asynchronous telemedicine services include the transmission of a beneficiary’s medical or other personally identifiable information through a secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant, electronic communications system to a provider, often a specialist, at a distant site without the beneficiary present. Such communications, including store and forward services, interprofessional telephone/Internet/electronic health record consultations, and RPM services, involve contact between two parties (beneficiary to provider or provider to provider) in a way that does not require real-time interaction.

Photographs visualized by a telecommunications system must be specific to the beneficiary’s physical and/or behavioral health condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.

In accordance with Section 16284 of Public Act No. 359 of 2016, telemedicine services, including asynchronous telemedicine, must be provided only with direct or indirect beneficiary consent and this consent must be properly documented in the beneficiary’s medical record in accordance with applicable standards of practice.

Interprofessional telephone/Internet/electronic health record consultations, including e-Consults, are a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating physician (e.g., attending or primary) or practitioner requests the opinion and/or treatment advice of a Medicaid enrolled physician or practitioner with the specialty expertise to assist in the diagnosis of a condition and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consultant. The service concludes with a written report from the consultant to the treating physician/requesting provider.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2022)


ELIGIBLE SERVICES/SPECIALTIES

Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.  Asynchronous telemedicine services must be performed under the general or direct supervision of a Medicaid-enrolled physician or practitioner who has an active role in the management of the beneficiary’s physical and/or behavioral health. The analysis and interpretation of the beneficiary’s data must contribute to the development and/or monitoring of the beneficiary’s treatment plan.

Asynchronous telemedicine services generally may not be separately reported on the same day the beneficiary presents for an evaluation and management (E/M) or other related service to the same provider. These services are typically considered part of the E/M or other related service and are not separately reimbursed. Activities performed in the facility setting under the general or direct supervision of the provider are bundled with the facility services on the UB-04 claim form and cannot be reported on the CMS 1500 claim form or billed under the provider’s National Provider Identifier (NPI).

Store and forward services are asynchronous electronic transmissions of physical and/or behavioral health information from the beneficiary to a Medicaid-enrolled physician or practitioner at the distant site when video or face-to-face contact is not necessary. Information transmitted to the provider is analyzed and used in the diagnosis, development, or maintenance of an individualized treatment plan. Information may include, but is not limited to, digital images, documents, video clips, still images, x-rays, magnetic resonance images (MRIs), electrocardiograms (EKGs) and electroencephalograms (EEGs), and audio clips.

Store and forward services include interpretation and follow-up with the beneficiary. Services must not originate from or result in a related E/M service.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2022)


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 01/19/2022

Definitions

“Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a HIPPA compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.”

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) (Accessed Jan. 2022).

Last updated 01/19/2022

Parity

SERVICE PARITY

Insurers and health care corporations must cover services appropriately provided through telemedicine, as determined by the insurer or health care corporation.

SOURCE: MI Compiled Law Services Sec. 500.3476 & Sec. 550.1401k. (Accessed Jan. 2022).


PAYMENT PARITY

No explicit payment parity.

Last updated 01/19/2022

Requirements

An insurer that delivers, issues for delivery, or renews in this state a health insurance policy or a group or nongroup health care corporation certificate shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health care corporation. Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the health insurance policy agreed upon between the policy holder and the insurer or the certificate agreed upon between the certificate holder and the health care corproation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

SOURCE: MI Compiled Law Services Sec. 500.3476(1) & Sec. 550.1401k(1). (Accessed Jan. 2022).

Last updated 01/27/2022

Cross State Licensing

In limited circumstances, MI Public Health Code states that certain individuals are not required to have a license for practice of a health profession in MI, including the following:
  • A student who is in a health profession training program, that has been approved by the appropriate board, while performing the duties assigned in the course of training.
  • An individual who is practicing a health profession in the discharge of official duties while in the military service of the United States, the United States Public Health Service, the United States Department of Agriculture, or the United States Department of Veterans Affairs. The institution in which the individual practices shall report the name and address of the individual to the appropriate board within 30 days after the date of employment.
  •  An individual who by education, training, or experience substantially meets the requirements of this article for licensure while rendering medical care in a time of disaster or to an ill or injured individual at the scene of an emergency.
  • If the director of the department of health and human services determines that control of an epidemic is necessary to protect the public health under section 2253, an individual who is authorized to practice a health profession in another state, who would otherwise meet the requirements of this article for licensure, while rendering medical care during an epidemic-related staffing shortage to meet health professional staffing needs. As used in this subdivision, “epidemic-related staffing shortage” means a shortage of individuals who are licensed under this article during the epidemic. Epidemic-staffing shortage does not include a staffing shortage caused by a labor dispute as that term is defined in section 2 of 1939 PA 176, MCL 423.2.
  • An individual who provides nonmedical nursing or similar services in the care of the ill or suffering or an individual who in good faith ministers to the ill or suffering by spiritual means alone, through prayer, in the exercise of a religious freedom, and who does not hold himself or herself out to be a health professional.
  • An individual who resides in another state or country and is authorized to practice a health profession in that state or country who, in an exceptional circumstance, is called in for consultation or treatment by a health professional in this state.
  • An individual who resides in another state or country and is authorized to practice a health profession in that state or country, when attending meetings or conducting lectures, seminars, or demonstrations under the auspices of professional associations or training institutions in this state, if the individual does not maintain an office or designate a place to meet patients or receive calls in this state.
  • An individual who is authorized in another country to practice a health profession and who is employed by the United States Public Health Service or the government of another country for the exclusive use of members of its merchant marine and members of its consular and diplomatic corps, while caring for those members in the performance of his or her official duties.
  • An individual who resides adjacent to the land border between this state and an adjoining state and is authorized under the laws of that state to practice a health profession and whose practice may extend into this state, but who does not maintain an office or designate a place to meet patients or receive calls in this state.
  • An individual who is authorized to practice a health profession in another state and who is appointed by the United States Olympic Committee to provide health services exclusively to team personnel and athletes registered to train and compete at a training site in this state approved by the United States Olympic Committee or at an event conducted under the sanction of the United States Olympic Committee. An exemption granted under this subdivision applies to the individual while he or she is performing the duties assigned in the course of the sanctioned training program or event and for the time period specified by the United States Olympic Committee.
  • An individual who is currently authorized to practice a health profession in another state and is providing health services for an athletic team, if certain criteria are met.

SOURCE: MI Public Health Code 333.16171. License for practice of health profession; exemptions. Accessed Jan. 2022.

Last updated 01/19/2022

Definitions

“Telehealth” means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, “telemedicine” means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE:  MI Compiled Laws Sec. 333.16283(c),  MI Insurance Code 500.3476. MI Compiled Laws Sec. 330.1100d(15), & (Accessed Jan. 2022).

Last updated 01/21/2022

Licensure Compacts

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact, Compact Map. (Accessed Jan. 2022).

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

Last updated 01/21/2022

Miscellaneous

A health care provider or health care facility that provides health care services (including telehealth) in support of this state’s response to the COVID-19 pandemic is not liable for an injury, including death, sustained by an individual by reason of those services, regardless of how, under what circumstances, or by what cause those injuries are sustained, unless it is established that the provision of the services constituted willful misconduct, gross negligence, intentional and willful criminal misconduct, or intentional infliction of harm by the health care provider or health care facility.

SOURCE: MI Compiled Law Section 691.1473 (Definitions) & Section 691.1475 (Accessed Jan. 2022).

In a manner consistent with this part and in addition to the provisions set forth in this part, a disciplinary subcommittee may place restrictions or conditions on a health professional’s ability to provide a telehealth service if the disciplinary subcommittee finds that the health professional has violated section 16284 or 16285.

SOURCE: MI Compiled Law Section 333.16284 (Accessed Jan. 2022).

Last updated 01/18/2022

Online Prescribing

Providers must have an existing physician-patient or dentist-patient relationship.  See statute for additional requirements.

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a).  (Accessed Jan. 2022).

Schedule 2 to 5 controlled substances cannot be prescribed unless the prescribing is in a bona fide prescriber-patient relationship with the patient.  If a licensed prescriber prescribes a controlled substance under this subsection, the prescriber shall provide follow-up care to the patient to monitor the efficacy of the use of the controlled substance as a treatment of the patient’s medical condition. If the licensed prescriber is unable to provide follow-up care, he or she shall refer the patient to the patient’s primary care provider for follow-up care or, if the patient does not have a primary care provider, he or she shall refer the patient to another licensed prescriber who is geographically accessible to the patient for follow-up care.

SOURCE:  MI Compiled Laws Sec. 333.7303a. (Accessed Jan. 2022). 

A health professional providing telehealth service to a patient may prescribe the patient a drug if both the following are met:

  • The health professional is a prescriber who is acting within the scope of his or her practice; and
  • If the health professional is prescribing a controlled substance, the health professional must meet the requirements of this act applicable to that health professional for prescribing a controlled substance.

If the health professional considers it medically necessary, he or she shall provide the patient with a referral for other health care services that are geographically accessible to the patient, including, but not limited to, emergency services. After providing a telehealth service, the health professional, or a health professional who is acting under the delegation of the delegating health professional, shall make himself or herself available to provide follow-up health care services to the patient or refer the patient to another health professional for follow-up health care services.

SOURCE:  MI Compiled Laws, Sec. 333.16285. (Accessed Jan. 2022).

Genetic Counseling, Optometry, Medicine, Podiatric Medicine & Surgery

A licensee providing a telehealth service may prescribe a drug if the licensee is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285, and if he or she does both of the following:

If medically necessary, refers the patient to a provider that is geographically accessible to the patient.

Makes himself or herself available to provide follow-up care services to the patient, or to refer the patient to another provider, for follow-up care.

A licensee providing any telehealth service shall do both of the following:

  • Act within the scope of his or her practice.
  • Exercise the same standard of care applicable to a traditional, in-person health care service.

SOURCE: MI Administrative Code 338.2455. MI Administrative Code 338.306, MI Administrative Code 338.2407, & MI Administrative Code 338.814, (Accessed Jan. 2022).

Last updated 01/21/2022

Professional Boards Standards

Podiatric Medicine and Surgery

SOURCE: MI Admin. Code Sec. 338.8145. (Accessed Jan. 2022).

Social Work

SOURCE: MI Admin Code 338.2930, (Accessed Jan. 2022).

Acupuncture

SOURCE: MI Admin Code 338.13003, (Accessed Jan. 2022).

Massage Therapy

SOURCE: MI Admin Code 338.702, (Accessed Jan. 2022).

Veterinary Medicine

SOURCE: MI Admin Code 338.4901a, (Accessed Jan. 2022).

Genetic Counseling

SOURCE: MI Admin Code 338.2455, (Accessed Jan. 2022).

Athletic Trainers

SOURCE: MI Admin Code 338.1301, (Accessed Jan. 2022).

Osteopathic Medicine and Surgery

SOURCE: MI Admin Code 338.114, (Accessed Jan. 2022).

Optometry

SOURCE: MI Admin Code 338.306, (Accessed Jan. 2022).

Medicine

SOURCE: MI Admin Code 338.2407, (Accessed Jan. 2022).

Psychology

SOURCE: MI Admin Code 338.2526, (Accessed Jan. 2022).

Respiratory Care

SOURCE: MI Admin Code 338.2201b, (Accessed Jan. 2022).

Behavior Analyst

SOURCE: MI Admin Code 338.1832, (Accessed Jan. 2022).

Acupuncture

SOURCE: MI Admin Code 338.13003, (Accessed Jan. 2022).

Marriage and Family Therapy

SOURCE: MI Admin Code 338.7204, (Accessed Jan. 2022).