Missouri

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ALSP-IC, EMS, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

FQHCs

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

STATE RESOURCES

  1. Medicaid Program: HealthNet
  2. Administrator: Missouri Dept. of Social Services
  3. Regional Telehealth Resource Center: Heartland Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

COVID-19

Last updated 03/06/2023

Audio Only Delivery

Medicaid: Personal Care Program

STATUS: Telehealth service delivery no longer permitted as of Feb. 1, 2023.

Medicaid: Provider COVID-19 Tips

STATUS: Webpage archived. Likely expired

Medicaid:  COVID FAQs on Telehealth

STATUS: Likely expired due to the expiration of MO State of Emergency.

Medicaid: State Plan Amendment – Includes Telehealth

STATUS: Active, ends on the last day of the national COVID-19 PHE

Medicaid: State Plan Amendment – Disaster Relief

STATUS: Active, ends on the last day of the national COVID-19 PHE

Medicaid 1915(c) Waiver: Appendix K – AIDS Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – AIDS Waiver

STATUS: STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Adult Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Medically Fragile Adult Waiver

STATUS: STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Brain Injury Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Brain Injury Waiver

STATUS: STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Aged and Disabled Waiver Adult Day Care Waiver Independent Living Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Aged and Disabled Waiver Adult Day Care Waiver Independent Living Waiver

STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, Addendum extending current waivers no later than 6 months after the expiration of the PHE

Last updated 03/06/2023

Cross State Licensing

MO Department of Social Services: Provider Tips Telehealth Services Licensing Waiver (Jan. 11, 2022)

STATUS:  While the State of Emergency in Missouri concluded December 31, 2021, MHD must submit requests to the Centers for Medicare & Medicaid Services (CMS) to discontinue any of the flexibilities allowed during the Public Health Emergency (PHE). Therefore, the flexibilities continue temporarily until CMS approval is granted. Providers will be notified when the state is approved to discontinue the two flexibilities listed above.

Last updated 03/06/2023

Easing Consent Requirements

No Reference Found

Last updated 03/06/2023

Easing Prescribing Requirements

Previous COVID-19 waivers expired.

Last updated 03/07/2023

Miscellaneous

Medicaid: Personal Care Program Services

STATUS:  Telehealth service delivery no longer permitted as of Feb. 1, 2023.

Medicaid 1915(c) Waiver: Appendix K – AIDS Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – AIDS Waiver

STATUS: STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Adult Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Medically Fragile Adult Waiver

STATUS: STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Brain Injury Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Brain Injury Waiver

STATUS: STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Aged and Disabled Waiver Adult Day Care Waiver Independent Living Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Aged and Disabled Waiver Adult Day Care Waiver Independent Living Waiver

STATUS: Active, Addendum waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, Addendum extending current waivers no later than 6 months after the expiration of the PHE

 

Last updated 03/06/2023

Originating Site

Medicaid: Provider COVID-19 Tips

STATUS: Webpage archived. Likely expired

Medicaid 1915(c) Waiver: Appendix K – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, Addendum extending current waivers no later than 6 months after the expiration of the PHE

Last updated 03/07/2023

Private Payer

Previous COVID-19 waivers expired.

Last updated 03/06/2023

Provider Type

Medicaid: Provider COVID-19 Tips

STATUS: Webpage archived. Likely expired

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Adult Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Medically Fragile Adult Waiver

STATUS: Active, additive waiver extending current waivers no later than 6 months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, Addendum extending current waivers no later than 6 months after the expiration of the PHE

 

Last updated 03/06/2023

Service Expansion

Medicaid: Personal Care Program

STATUS: Telehealth service delivery no longer permitted as of Feb. 1, 2023.

Medicaid: Provider COVID-19 Tips

STATUS: Likely expired due to the expiration of MO State of Emergency.

Medicaid:  COVID FAQs on Telehealth

STATUS: Likely expired due to the expiration of MO State of Emergency.

Medicaid: State Plan Amendment – Includes Telehealth

STATUS: Active, ends on the last day of the national COVID-19 PHE

Medicaid: State Plan Amendment – Disaster Relief

STATUS: Active, ends on the last day of the national COVID-19 PHE

Medicaid 1915(c) Waiver: Appendix K – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, expires no later than 6 months after the expiration of the PHE (see extension below)

Medicaid 1915(c) Waiver: Appendix K Addendum – Comprehensive Waiver, Community Support Waiver, Partnership for Hope Waiver, Missouri Children with Developmental Disabilities Waiver

STATUS: Active, Addendum extending current waivers no later than 6 months after the expiration of the PHE

 

Private Payer

Last updated 03/08/2023

Definitions

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

SOURCE: MO Revised Statute Title XXIV Business and Professions, Sec. 376.1900, which references Sec. Title XII Public Health and Welfare Sec. 208.670 which references Title XII Sec. 191.1145. (Accessed Mar. 2023).

Last updated 03/08/2023

Parity

SERVICE PARITY

A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient.  A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.

SOURCE: MO Revised Statutes § 376.1900. (Accessed Mar. 2023).

PAYMENT PARITY

Missouri Consolidated Health Care Plan – Emergency Rule

Virtual visits offered through the vendor’s telehealth tool are covered at one hundred percent (100%) after deductible is met.

SOURCE:  MO Consolidated State Reg. 22:10-2.053 & 22:10-3.055, (Accessed Mar. 2023).

The following services are not subject to deductible, coinsurance, or copayment requirements and will be paid at one hundred percent (100%) when provided by a network provider: …

  • Virtual visits offered through the vendor’s telehealth tool.

SOURCE:  MO Consolidated State Reg. 22:10-3.058, 3.059, 2.047, (Accessed Mar. 2023).

Last updated 03/08/2023

Requirements

Health carriers shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.

A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient.

A health carrier shall not be required to reimburse a telehealth provider or a consulting provider for site origination fees or costs for the provision of telehealth services; however, subject to correct coding, a health carrier shall reimburse a health care provider for the diagnosis, consultation, or treatment of an insured or enrollee when the health care service is delivered through telehealth on the same basis that the health carrier covers the service when it is delivered in-person.

A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.

SOURCE: MO Revised Statutes § 376.1900. (Accessed Mar. 2023). 

Missouri Consolidated Health Care Plan (State employees and retirees health plan)

Telehealth services are covered for the diagnosis, consultation, or treatment of a member on the same basis that the service would be covered when it is delivered in person.

SOURCE: MO Consolidated State Reg. 22:10-3.057. pg. 23, April 30, 2022, (Accessed Mar. 2023).

Telehealth site origination fees or costs for the provision of telehealth services are not covered.

SOURCE: MO State Regulation Title 22, Sec. 10-3.061, & 2.061 (Accessed Mar. 2023).

Medicaid

Last updated 03/08/2023

Consent Requirements

Prior to the provision of telemedicine [or telehealth as its referred to in rural health clinic manual] services in a school, the parent or guardian of the child shall provide authorization for the provision of such service.  Such authorization shall include the ability for the parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.

SOURCE: MO Revised Statute. XII Public Health and Welfare. Ch. 208, Sec. 208.677;  MO HealthNet, Rural Health Clinic, 13.14.A p. 166 (Feb. 6, 2023); MO HealthNet, Physician Manual, Telehealth Services, 13.26.A p. 286-287 (Feb. 3, 2023) & MO HealthNet, Provider Manual, Behavioral Health Services, 13.22.A p. 210 (Feb. 6, 2023). (Accessed Mar. 2023).

Last updated 03/07/2023

Definitions

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

SOURCE: MO Revised Statute Title XII Public Health and Welfare Sec. 208.670 which references Title XII Sec. 191.1145. (Accessed Mar. 2023).

Telemedicine Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.

SOURCE: MO HealthNet, Physician Manual, 13.14 p. 165 (Feb 3, 2023), MO Code of State Regulations 13 CSR 70-3.330(B)(5) (Feb. 28, 2023), MO HealthNet, Provider Manual, Rural Health Clinics, Section 13.14 p. 165 (Feb. 6, 2023) & MO HealthNet, Provider Manual, Behavioral Services, Section 13.22, p. 210 (Feb. 6, 2023).(Accessed Mar. 2023).

Department of Health and Senior Services – Comprehensive Emergency Medical Services Systems

Telemedicine–the use of medical information exchanged from one (1) site to another via electronic communications to improve patient’s health status. A neurology specialist will assist the physician in the center in rendering a diagnosis. This may involve a patient “seeing” a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to the specialist.

SOURCE: MO Code of State Regulation, Title 19, Sec. 30-40.710, (Accessed Mar. 2023).

Mental Health

Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

SOURCE: MO 13 CSR 70-3.330, MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Mar. 2023)

Last updated 03/08/2023

Email, Phone & Fax

MHD also allowed the use of telephone for telehealth services, and allowed quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number. MHD did not require additional CMS flexibility for these options, and they will continue. However, this allowance may no longer be allowed.

SOURCE:  MO Medicaid Provider Tips, Telehealth services, Jan. 11, 2022, (Accessed Mar. 2023).

Mental Health

Audio-only is real-time, interactive voice-only discussion between an individual and the service provider.

The CR Modifier will be ending on June 30, 2022, regardless of the PHE declaration end date.

Starting July 1, 2022, Audio-Only services shall utilize the FQ Modifier.

The GT modifier will continue to be utilized for Telemedicine, with the exception of CSTAR programs that have transitioned to American Society of Addiction Medicine (ASAM), as this billing structure no longer utilizes modifiers.

Starting July 1, 2022, CSTAR programs that have transitioned to ASAM, will use the 02 Place of Service, instead of the GT modifier.

See bulletin for audio-only service guidance.

SOURCE:  MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Mar. 2023).

Last updated 03/07/2023

Live Video

POLICY

Services provided through telemedicine [or telehealth, as referred to in Rural Health Clinics manual] must meet the standard of care that would otherwise be expected should such services be provided in person. Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.

SOURCE: MO HealthNet, Physician Manual, 13.69A p. 286 (Feb. 3, 2023), Provider Manual, Rural Health Clinics, Section 13,14 p. 166 (Feb. 6, 2023) & MO HealthNet, Provider Manual, Behavioral Services, Section 13.22, p. 210 (Feb. 6, 2023). (Accessed Mar. 2023).

The department of social services shall reimburse providers for services provided through telehealth if such providers can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person.  Reimbursement for telehealth services shall be made in the same way as reimbursement for in-person contact; however, consideration shall also be made for reimbursement to the originating site.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Mar. 2023).

Reimbursement to the health care provider delivering the telemedicine service at the distant site shall be made at the same amount as the current fee schedule for an in person service

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(5), (Accessed Mar. 2023). 

ELIGIBLE SERVICES/SPECIALTIES

Services provided through telemedicine must meet the standard of care that would otherwise be expected should such services be provided in person. Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate CPT code for the service along with place of service 02 (telehealth/telemedicine). Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

When a participant is located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02.

SOURCE: MO HealthNet, Physician Manual,13-69A p. 286-287 (Feb. 3, 2023) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210-211 (Feb. 6, 2023). (Accessed Mar. 2023).

Services provided through telehealth must meet the standard of care that would otherwise be expected should such services be provided in person.

Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.

SOURCE: MO HealthNet, Physician Manual, 13-69A p. 286 (Feb. 3, 2023), MO HealthNet, Provider Manual, Behavioral Services, Section 13,22.A p. 210 (Feb. 6, 2023). & MO HealthNet, Provider Manual, Rural Health Clinics, Section 13.14.A, p. 165-166 (Feb. 6, 2023), (Accessed Mar. 2023).

There is not a separate telemedicine fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.

SOURCE:  MO Medicaid Provider Tips, Telemedicine, July 18, 2022, (Accessed Mar. 2023).

Behavioral Health Services

Telemedicine is subject to the same precertification requirements. Claims submitted for behavioral health telemedicine services without a required precertification will be denied.

SOURCE: MO HealthNet Provider Tips (Nov. 22, 2022). (Accessed Mar. 2023).

Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program

Communication with a collateral contact may be made face to face, by phone, or by telehealth platforms. See manual for code list.

Medication services may be provided via telehealth. See manual for code list.

SOURCE: MO HealthNet, CSTAR Manual, 13.14(K)(1), 13.14(K)(5) pgs. 201 &202 & 13.14(L)(4) p. 203 (Sept. 8, 2022). (Accessed Mar. 2023).

Community Psych Rehab Program

Several services are covered if delivered via telehealth. See manual for specific services.

SOURCE: MO HealthNet, Community Psych Rehab Program Manual,  (Nov. 7, 2022), (Accessed Mar. 2023).

Home Health

The face-to-face encounter may occur through telehealth, as allowed by State law.

SOURCE: MO HealthNet, Home Health Manual, p. 170. (Feb. 4, 2023), (Accessed Mar. 2023).

Teledentistry

MO HealthNet covers teledentistry services. MO HealthNet allows any licensed dental provider, enrolled with MO HealthNet, to provide teledentistry services if the services are within the scope of practice for which the dental provider is licensed. Teledentistry services must be performed with the same standard of care as an in-person, face-to-face service.

Teledentistry services must be billed by the distant site facility (physical location of the dentist or clinic providing the dental service to an eligible Medicaid participant through teledentistry). Dentists must bill either D9995 or D9996 and the CDT code(s) for services provided. Reimbursement to dental providers delivering the service at the distant site is equal to the current fee schedule amount for the service provided. There is not a separate teledentistry fee schedule.

The originating site (physical location of the participant) is where diagnostic data is collected in order to communicate to the dentist for diagnosis or where a dental service is performed. The originating site cannot bill MHD for CDT codes D9995 or D9996. The originating site can bill procedure code Q3014 on the CMS-1500 Claim Form to receive reimbursement for use of the facility where teledentistry services were rendered.

The distant site service must be billed on the American Dental Association (ADA) Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth.

SOURCE: MO HealthNet, Dental Manual, pgs. 179 & 260. (Feb. 6, 2023). (Accessed Mar. 2023).

Opioid Treatment Programs

Services may be provided via telehealth to enhance accessibility for individuals served.

SOURCE: MO Code of State Regulation, Title 9, Sec. 30-3.132(3), (Accessed Mar. 2023).

A telemedicine service shall be covered only if it is medically necessary.

A telemedicine service must be performed with the same standard of care as an in-person, face-to-face service. If the same standard of care cannot be met, a telemedicine service shall not be provided.

School Services. Prior to the provision of telemedicine services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for a parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(3), (4)(D), (Accessed Mar. 2023). 

Health Assessment and Coordination Services (DD Waiver)

Health Assessment and Coordination (HAC) services are consultative telemedicine services designed for individuals with I/DD receiving HCBS Waiver services. The services are intended to coordinate care with local emergency departments, urgent cares, and primary care physicians to enable real time support, consultation, and coordination on health issues. HAC services assist individuals, families, and support providers in understanding the health symptoms with which individuals present in order to identify the most appropriate next steps. Services are available 24 hours a day, 7 days a week and include immediate evaluations, video-assisted examinations, treatment plans, and discussion and coordination with individuals and/or caregivers.

SOURCE: MO HealthNet, DD Waiver, p. 60 (Dec. 20, 2022).  (Accessed Mar. 2023).

ELIGIBLE PROVIDERS

Any licensed health care provider shall be authorized to provide telemedicine [or telehealth, as referred to in Rural Health Clinic manual] services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. To be reimbursed for telehealth/telemedicine services health care providers treating patients in this state, utilizing telehealth/telemedicine, must be fully licensed to practice in this state and be enrolled as a MO HealthNet/ MHD provider prior to rendering services.

SOURCE: MO HealthNet, Physician Manual, 13.69B p. 287 (Feb. 3, 2023), Provider Manual, Rural Health Clinics, Section 13,14.B p. 166 (Feb. 6, 2023) & MO HealthNet, Provider Manual, Behavioral Services, Section 13,22.B p. 211 (Feb. 6, 2023). (Accessed Mar. 2023).

MO HealthNet covers Telehealth services. MO HealthNet allows any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.

SOURCE:  MO Medicaid Provider Tips, Telehealth services, Jan. 11, 2022, (Accessed Mar. 2023).

Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate CPT® code for the service along with place of service 02 (telemedicine). When a participant is located in a residential or inpatient place of service (14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02. Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

SOURCE: MO HealthNet, Physician Manual, 13..69 C p. 287 (Feb. 3, 2023) & MO HealthNet, Provider Manual, Behavioral Services, Section 13,22.C p. 211 (Feb. 6, 2023). (Accessed Mar. 2023).

RHCs must bill with their non-RHC provider number when they are the originating site to receive the facility fee. RHCs may bill with either their non-RHC provider number or their RHC provider number when they are the distant site.  The provider will use the appropriate procedure code for the service along with place of service 02 (Telehealth). Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. To be reimbursed for telehealth services health care providers treating patients in this state, utilizing telehealth, must be fully licensed to practice in this state and be enrolled as a MHD provider prior to rendering services.

SOURCE: MO HealthNet, Rural Health Clinic,  13.14.B & 13.14.C(1) & (2) p. 166 (Feb. 6, 2023). (Accessed Mar. 2023).

Anesthesiologist monitoring telemetry in the operating room is a non-covered service.

SOURCE: MO HealthNet, Physician Manual, p. 209 (Feb 3, 2023). (Accessed Mar. 2023).

Health care professional shall mean a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law.

Health care provider or provider shall mean a health care professional or a health care facility.

Any licensed/enrolled health care professional shall be authorized to provide telemedicine services if such services to MHD participants are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. This shall not prohibit a health care entity from reimbursing nonclinical staff for services otherwise allowed by law. This includes applied behavior analysis services rendered by a registered behavior technician under the supervision of a licensed behavior analyst or licensed psychologist or any individual provider delivering services within a Department of Mental Health (DMH) licensed, contracted, and/or certified organization.

A health care provider utilizing telemedicine at either a distant site or an originating site shall be enrolled as a MO HealthNet provider pursuant to 13 CSR 65-2.020 and be fully licensed for practice in the state of Missouri. A health care provider utilizing telemedicine must do so in a manner that is consistent with the provisions of all laws governing the practice of the provider’s profession and shall be held to the same standard of care as a provider employing in-person behavioral health or medical health care.

For purposes of the provision of telemedicine services in the MO HealthNet Program, the provider-patient relationship may be established by the following:

  • An in-person encounter through a medical interview and physical examination;
  • Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the patient’s care; or
  • A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(1)(B)(6-7), (2)(A) & (C), (Accessed Mar. 2023). 

ELIGIBLE SITES

When a participant is located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02.

SOURCE: MO HealthNet, Physician Manual, 13-69C p. 287 (Feb. 3, 2023) & MO HealthNet, Provider Manual, Behavioral Services, Section 13,22.C p. 211 (Feb. 6, 2023). (Accessed Mar. 2023).

The department shall not restrict the originating site through rule or payment so long as the provider can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Mar. 2023). 

No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient’s medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in-person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

SOURCE: MO Revised Statute Sec. 191.1145(6). (Accessed Mar. 2023).  

RHCs must bill with their non-RHC provider number to receive reimbursement for a facility fee for the Telehealth services when operating as the originating site.

As the distant site, RHCs may bill with either their non-RHC provider number or their RHC provider number. The provider will use the appropriate procedure code for the service along with place of service 02 (Telehealth).

Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

SOURCE: MO HealthNet, Rural Health Clinic, p. 166 (Feb. 6, 2023). (Accessed Mar. 2023). 

Originating site shall mean a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.

School Services. Prior to the provision of telemedicine services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for a parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(1)(B)(3) &(4)(D), (Accessed Mar 20223). 

GEOGRAPHIC LIMITS

Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Mar. 2023).

FACILITY/TRANSMISSION FEE

The originating site is only eligible to receive a facility fee for the telemedicine service. Claims should be submitted with HCPCS code Q3014 (telemedicine originating site facility fee). Procedure code Q3014 is used by the originating site to receive reimbursement for the use of the facility while telehealth services are being rendered.

SOURCE: MO HealthNet, Physician Manual, 13.69(C) p. 287 (Feb. 3, 2023); & MO HealthNet, Provider Manual, Behavioral Services, Section 13,22.C p. 211 (Feb. 6, 2023). (Accessed Mar. 2023).

RHCs must bill with their non-RHC provider number to receive reimbursement for a facility fee for the Telehealth services when operating as the originating site. Claims must be submitted with HCPCS code Q3014 (Telehealth originating site facility fee).

SOURCE: Provider Manual, Rural Health Clinics, Section 13,14.C(1) p. 166 (Feb. 6, 2023). (Accessed Mar. 2023).

Hospitals

Costs and charges for the telehealth originating site fee reimbursed on a fee schedule shall be excluded when calculating the outpatient cost-to-charge ratios used to determine outpatient percentage rates starting with the calculation of the outpatient percentage rate for the SFY after the telehealth originating site fee is moved to a fee schedule.

SOURCE: MO Revised Statute Title 13, Sec. 70-15.160, (Accessed Mar. 2023).

The originating site is eligible to receive an originating site/facility fee.

Reimbursement of the originating site fee will be made according to the MO HealthNet Fee Schedule.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(5), (Accessed Mar. 2023). 

The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.

SOURCE:  MO Medicaid Provider Tips, Telemedicine, July 18, 2022, (Accessed Mar. 2023).

Last updated 03/08/2023

Miscellaneous

No later than July 1, 2022, there shall be established within the department a statewide telehealth network for forensic examinations of victims of sexual offenses in order to provide access to sexual assault nurse examiners (SANE) or other similarly trained appropriate medical providers.  A statewide coordinator for the telehealth network shall be selected by the director of the department of health and senior services and shall have oversight responsibilities and provide support for the training programs offered by the network, as well as the implementation and operation of the network.  The statewide coordinator shall regularly consult with Missouri-based stakeholders and clinicians actively engaged in the collection of forensic evidence regarding the training programs offered by the network, as well as the implementation and operation of the network.

SOURCE: MO Revised Statute Ch. 192.2520 (Accessed Mar. 2023).

For purposes of the provision of telemedicine services in the MO HealthNet Program, the provider-patient relationship may be established by the following:

  • An in-person encounter through a medical interview and physical examination;
  • Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the patient’s care; or
  • A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

In order to establish a provider-patient relationship through telemedicine—

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
  • Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

See regulation for special documentation and confidentiality and data integrity requirements.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(D) & (E), (Accessed Mar. 2023). 

Special documentation requirements apply.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13.22.E, p. 211 (Feb. 6, 2023); MO HealthNet, Physician Manual, Telehealth Services, p. 287 (Feb. 3, 2023) & MO HealthNet, Rural Health Clinic, p. 166 (Feb. 6, 2023). (Accessed Mar. 2023).

Precertification and Utilization Review

All services are subject to utilization review for medical necessity and program compliance. Reviews can be performed before services are furnished, before payment is made, or after payment is made.

Certain procedures or services can require precertification from the MO HealthNet Division or its authorized agents. Services for which a precertification was obtained remain subject to utilization review at any point in the payment process. A service provided through Telemedicine is subject to the same precertification and utilization review requirements which exist for the service when not provided through Telemedicine.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 211 (Feb. 6, 2023), (Accessed Mar. 2023).

School-based Therapy Services

Place of service school (03) must be used for services provided in a school or on school grounds. If a school district is providing telehealth services on school grounds, the GT modifier must be used.

SOURCE: MO HealthNet, Therapy Manual, p. 174 (Jan. 1, 2023). (Accessed Mar. 2023).

Last updated 03/08/2023

Out of State Providers

Payment cannot be made to any financial institutions, telemedicine providers, pharmacies, or other entities outside of the US, and US territories.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, 2.1.E, p. 58 (Feb. 6, 2023); MO HealthNet, Physician Manual, Telehealth Services, 2.1.E p. 66 (Feb. 3. 2023) & MO HealthNet, Rural Health Clinic, 2.1.E p. 56 (Feb. 6, 2023). (Accessed Mar. 2023). (Language also appears in ALL Medicaid manuals).

In order to treat participants in this state through the use of telemedicine, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards. In addition, psychologists licensed in a Psychology Interjurisdictional Compact (PSYPACT) state may render telemedicine services under the Authority to Practice Interjurisdictional Telepsychology, according to the requirements in the PSYPACT.

A health care provider utilizing telemedicine at either a distant site or an originating site shall be enrolled as a MO HealthNet provider pursuant to 13 CSR 65-2.020 and be fully licensed for practice in the state of Missouri. A health care provider utilizing telemedicine must do so in a manner that is consistent with the provisions of all laws governing the practice of the provider’s profession and shall be held to the same standard of care as a provider employing in-person behavioral health or medical health care.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(2)(B) & (C), (Accessed Mar. 2023). 

Last updated 03/08/2023

Overview

Missouri Medicaid will reimburse for services delivered via live video.  They will also reimburse for some tele-dentistry asynchronous services and remote patient monitoring for specific conditions.

 

Last updated 03/08/2023

Remote Patient Monitoring

POLICY

Subject to appropriations, the department shall establish a statewide program that permits reimbursement under the MO HealthNet program for home telemonitoring services.

“Home telemonitoring service” shall mean a health care service that requires scheduled remote monitoring of data related to a participant’s health and transmission of the data to a health call center accredited by the Utilization Review Accreditation Commission (URAC).

SOURCE: MO Revised Statute Sec. 208.686. (Accessed Mar. 2023).

CONDITIONS

Eligible conditions:

  • Pregnancy
  • Diabetes
  • Heart disease
  • Cancer
  • Chronic obstructive pulmonary disease
  • Hypertension
  • Congestive heart failure
  • Mental illness or serious emotional disturbance
  • Asthma
  • Myocardial infarction; or
  • Stroke

The beneficiary must also exhibit two or more the following risk factors:

  • Two or more hospitalizations in the prior twelve-month period;
  • Frequent or recurrent emergency department admissions;
  • A documented history of poor adherence to ordered medication regimens;
  • A documented history of falls in the prior six-month period;
  • Limited or absent informal support systems;
  • Living alone or being home alone for extended periods of time;
  • A documented history of care access challenges; or
  • A documented history of consistently missed appointments with health care providers

SOURCE: MO Revised Statute Sec. 208.686. (Accessed Mar. 2023).

Personal Emergency Response Systems is available under the Developmental Disabilities Waiver.  This service may also include electronic support systems using video, web-cameras, or other technology. However, use of such systems may be subject to due process review. Assistive technology shall not include household appliances or items that are intended for purely diversional or recreational purposes. Assistive technology should be evidenced based, and shall not be experimental.  Electronic support systems using video, web-cameras, or other technology is only available on an individual, case-by-case basis when an individual requests the service and the planning team agrees it is appropriate and meets the health and safety needs of the individual.  See manual for more details.

SOURCE: MO HealthNet, Provider Manual, Developmental Disabilities Waiver Manual, Section 13, p. 30-31 (Dec. 20, 2022). (Accessed Mar. 2023).

Home Health – Preventive Care

MO HealthNet home health does not allow coverage for preventive care. Preventive care includes these services:

  • Ongoing observation of a client’s condition without the provision of treatment or the adjustment of the plan/orders.
  • Repetitive nutrition and medication instruction.
  • Encouragement to increase physical activity.
  • Monitoring to ensure compliance with a treatment regimen.

The above mentioned services are considered preventive because they are meant to help a patient avoid complications or setbacks. Regardless, they do not constitute the provision of therapeutic services and are not MO HealthNet covered services.

SOURCE: MO HealthNet Provider Manual: Home Health 13.22.E, p. 207 (Feb. 4, 2023).  (Accessed Mar. 2023).

PROVIDER LIMITATIONS

The program must ensure the home health agency or hospital shares telemonitoring clinical information with participant’s physician.

SOURCE: MO Revised Statute Sec. 208.686. (Accessed Mar. 2023)

OTHER RESTRICTIONS

If, after implementation, the department determines that the program established under this section is not cost effective, the department may discontinue the program and stop providing reimbursement under the MO HealthNet program for home telemonitoring services.  The department shall promulgate rules and regulations to implement the provisions of this section.

SOURCE: MO Revised Statute Sec. 208.686. (Accessed Mar. 2023).

Last updated 03/08/2023

Store and Forward

POLICY

Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate had the service been provided in-person.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Mar. 2023).

The telemedicine program shall be administered by the MO HealthNet Division (MHD). This rule is established pursuant to the authority granted to the Missouri Department of Social Services, MO HealthNet Division, to promulgate rules governing the practice of telemedicine in the MO HealthNet Program and to provide services under established, approved MO HealthNet benefits.

Asynchronous store-and-forward shall mean the transfer of a participant’s clinically important digital samples, such as still images, videos, audio, text files, and relevant data from an originating site through the use of a camera or similar recording device that stores digital samples that are forwarded via telecommunication to a distant site for consultation by a consulting provider without requiring the simultaneous presence of the participant and the participant’s treating provider.

  • Asynchronous store-and-forward technology shall mean cameras or other recording devices that store images which may be forwarded via telecommunication devices at a later time.
  • Asynchronous store-and-forward transfer shall mean the collection of a participant’s relevant health information and the subsequent transmission of that information from an originating site to a provider at a distant site without the participant being present.

Distant site shall mean a telemedicine site where the health care provider providing the telemedicine service is physically located.

Originating site shall mean a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.

Licensed health care provider-patient relationship shall mean that a health care provider licensed under Chapter 334, RSMo, and/or other providers utilizing telemedicine, shall ensure that a properly established provider-patient relationship exists with the participant who receives telemedicine services.

Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

Health care professional shall mean a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law.

Health care provider or provider shall mean a health care professional or a health care facility.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(1), (Accessed Mar. 2023). 

ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

MO HealthNet covers teledentistry services. MO HealthNet allows any licensed dental provider, enrolled with MO HealthNet, to provide teledentistry services if the services are within the scope of practice for which the dental provider is licensed. Teledentistry services must be performed with the same standard of care as an in-person, face-to-face service.

Teledentistry services must be billed by the distant site facility (physical location of the dentist or clinic providing the dental service to an eligible Medicaid participant through teledentistry). Dentists must bill either D9995 or D9996 and the CDT code(s) for services provided. Reimbursement to dental providers delivering the service at the distant site is equal to the current fee schedule amount for the service provided. There is not a separate teledentistry fee schedule.

The originating site (physical location of the participant) is where diagnostic data is collected in order to communicate to the dentist for diagnosis or where a dental service is performed. The originating site cannot bill MHD for CDT codes D9995 or D9996. The originating site can bill procedure code Q3014 on the CMS-1500 Claim Form to receive reimbursement for use of the facility where teledentistry services were rendered.

The distant site service must be billed on the American Dental Association (ADA) Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth. See manual for codes.

SOURCE: MO HealthNet, Dental Manual, p. 180 & 262 (Feb. 6, 2023). (Accessed Mar. 2023).

Health care service shall mean a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease, including but not limited to the provision of drugs or durable medical equipment.

A telemedicine service shall be covered only if it is medically necessary.

A telemedicine service must be performed with the same standard of care as an in-person, face-to-face service. If the same standard of care cannot be met, a telemedicine service shall not be provided.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(B)(8) & (3), (Accessed Mar. 2023). 

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 03/08/2023

Consent Requirements

Collaborative Practice Arrangement with Nurses & Assistant Physician Collaborative Practice Agreements

Telehealth providers shall obtain patient’s or the patient’s guardian’s consent before telehealth services are initiated and shall document the patient’s or the patient’s guardian’s consent in the patient’s file or chart. All telehealth activities must comply with the requirements of the Health Insurance Portability and Accountability Act of 1996, as amended and all other applicable state and federal laws and regulations.

SOURCE: MO Code of State Regulation. Title 20, 2150-2.240 & Sec. 20, 2150-5.100. (Accessed Mar. 2023)

Nurses

Telehealth providers shall be required to obtain patient consent before telehealth services are initiated and ensure confidentiality of medical information.

SOURCE: MO Revised Statute Title XXII Occupations and Professions Ch. 335.175. (Accessed Mar. 2023).

Last updated 03/08/2023

Cross State Licensing

In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards.

Does not apply to:

  • Informal consultation performed by a health care provider licensed in another state, outside of the context of a contractual relationship, and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;
  • Furnishing of health care services by a health care provider licensed and located in another state in case of an emergency or disaster; provided that, no charge is made for the medical assistance; or
  • Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state.

SOURCE: MO Revised Statute Ch. 191 Sec. 191.1145. (Accessed Mar. 2023).

Last updated 03/08/2023

Definitions

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

SOURCE: MO Revised Statute Sec. 191.1145. (Accessed Mar. 2023).

Licensing of Physicians and Surgeons

Telehealth means the use of medical information exchanged from one site to another via electronic communications to improve the health status of a patient.

SOURCE: MO Code of State Regulation. Title 20, 2150-2.001. (Accessed Mar. 2023).

Last updated 03/08/2023

Licensure Compacts

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Website.  (Accessed Mar. 2023).

Member of Physical Therapy Compact.

SOURCE: PT Compact Map.  (Accessed Mar. 2023).

Member of Nurses Licensure Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status.  NCSBN.  (Accessed Mar. 2023). 

Member of The Interstate Commission for EMS Personnel Practice.

SOURCE: The Interstate Commission for EMS Personnel Practice. (Accessed Mar. 2023).

Member of Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact (Accessed Mar. 2023).

Member of the Audiology and Speech-language Pathology Interstate Compact.

SOURCE: ASPL Compact. Compact Map. (Accessed Mar. 2023).

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

Last updated 03/08/2023

Miscellaneous

Teledental Pilot

Pursuant to the provisions of section 332.325, RSMo, the board is collaborating with the Office of Dental Health (ODH) within the Missouri Department of Health and Senior Services (DHSS) to create a pilot project designed to examine new methods of extending dental care to residents in assisted living facilities, intermediate care facilities, residential care facilities, skilled nursing facilities, and homebound special needs patients.

In order to allow a dentist to supervise a dental assistant, certified dental assistant, or expanded functions dental assistant using telehealth technology. A supervising dentist may delegate to an expanded functions dental assistant any expanded function duties that dental assistant has a board issued permit for:

  • allow a licensed dental hygienist to administer local anesthetic under the supervision of a dentist using telehealth technology.
  • temporary restorations or caries arresting fluoride under the supervision of a dentist using telehealth technology subsequent to an examination and diagnosis by the supervising dentist.
  • allow a licensed dental hygienist to provide scaling and polishing, root planning, and nonsurgical periodontal procedures prior to the supervising dentist performing an examination pursuant to standing orders written by the supervising dentist.

The provisions of this rule shall only apply to dental healthcare workers providing services pursuant to a pilot project created through a collaboration between ODH and the board and shall expire on August 28, 2026, in accordance with section 332.325, RSMo.

SOURCE: Emergency Rules 20 CSR 2110-2.133.  (Accessed Mar. 2023).

Utilization of telehealth by nurses

No later than January 1, 2014, there is hereby established within the state board of registration for the healing arts and the state board of nursing the “Utilization of Telehealth by Nurses”. An advanced practice registered nurse (APRN) providing nursing services under a collaborative practice arrangement under section 334.104 may provide such services outside the geographic proximity requirements of section 334.104 if the collaborating physician and advanced practice registered nurse utilize telehealth in the care of the patient and if the services are provided in a rural area of need.

The boards shall jointly promulgate rules governing the practice of telehealth under this section. Such rules shall address, but not be limited to, appropriate standards for the use of telehealth.

Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.

SOURCE: MO Annotated Statute, Title 22, Sec. 335.175, (Accessed Mar. 2023).

No later than July 1, 2022, there shall be established within the department a statewide telehealth network for forensic examinations of victims of sexual offenses in order to provide access to sexual assault nurse examiners (SANE) or other similarly trained appropriate medical providers. A statewide coordinator for the telehealth network shall be selected by the director of the department of health and senior services and shall have oversight responsibilities and provide support for the training programs offered by the network, as well as the implementation and operation of the network. The statewide coordinator shall regularly consult with Missouri-based stakeholders and clinicians actively engaged in the collection of forensic evidence regarding the training programs offered by the network, as well as the implementation and operation of the network.  See statute for further details.

SOURCE: MO Annotated Statute, Title 12, Sec. 192.2520, & 197.135, (Accessed Mar. 2023).

Last updated 03/08/2023

Online Prescribing

Prescribing or dispensing drugs without sufficient examination is prohibited including failing to establish a valid physician-patient relationship pursuant to section 334.108. See statute for additional information.

SOURCE: MO Revised Statutes § 334.100(4)(h). (Accessed Mar. 2023).

A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

  • In order to establish a physician-patient relationship through telemedicine:
    • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in person; and
    • Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.

SOURCE: MO Revised Statute Ch. 191 Sec. 191.1146. (Accessed Mar. 2023).

In addition, in order to prescribe, the relationship includes:

  • Obtaining a reliable medical history and performing a physical examination of the patient, adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contraindications to the treatment recommended or provided;
  • Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
  • If appropriate, following up with the patient to assess the therapeutic outcome;
  • Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to the patient’s other health care professionals; and
  • Maintaining the electronic prescription information as part of the patient’s medical record.

The requirements of subsection 1 (see above) may be satisfied by the prescribing physician’s designee when treatment is provided in:

  • A hospital;
  • A hospice program;
  • Home health services provided by a home health agency;
  • Accordance with a collaborative practice agreement;
  • Conjunction with a physician assistant licensed;
  • Conjunction with an assistant physician;
  • Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications; or
  • On-call or cross-coverage situations.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician’s on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

SOURCE: MO Revised Statute Sec. 334.108. (Accessed Mar. 2023).

 “Remote dispensing site pharmacy”, any location in this state where the practice of pharmacy occurs and that is licensed as a pharmacy to dispense prescription drugs and is staffed by one or more qualified pharmacy technicians, as defined by the board, or intern pharmacists, whose activities are supervised by a pharmacist at a supervising pharmacy through a continuous real-time audio and video link.  “Remote dispensing site pharmacy” does not include the office of a dispensing prescriber or an automated device.

A remote dispensing site pharmacy shall be located at least ten miles from an existing retail pharmacy unless:

  • The remote dispensing site pharmacy is part of a community mental health center, federally qualified health center, rural health clinic, or outpatient clinic setting; or
  • An applicant of a proposed remote dispensing site pharmacy demonstrates to the board how the proposed remote dispensing site pharmacy will promote public health.

SOURCE: MO Revised Statutes Sec. 338.215, (Accessed Mar. 2023).

HealthNet Medicaid Program

In order to establish a provider-patient relationship through telemedicine—

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
  • Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Mar. 2023). 

Mental Health – Division of Behavioral Health Community Treatment Program

For purposes of the provision of all services via telemedicine and audio-only, the provider-patient relationship may be established by the following:

  • An in-person encounter through a medical interview and physical examination; or
  • Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the individual’s care; or
  • A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

In order to establish a provider-patient relationship via telemedicine and/or audio-only for all services:

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
  • Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

In-Person Requirements Post Federal Declaration of Public Health Emergency (PHE)

  • Individuals who have only received telemedicine and/or audio-only services must receive an in person service within 6 months of their last service. After the initial 6-month in-person visit, all individuals must be seen in person, at minimum, once every 12 months.
  • All new individuals being served via telemedicine and/or audio-only require an in-person service within 6 months of beginning services and then every 12 months following.

SOURCE:  MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Mar. 2023).

Last updated 03/08/2023

Professional Boards Standards

No Reference Found

Federally Qualified Health Center (FQHC)

Last updated 03/08/2023

Definition of Visit

No reference found

Last updated 03/08/2023

Eligible Distant Site

MO Medicaid allows all licensed health care providers to provide telemedicine, however FQHCs are not listed explicitly as eligible distant site.

See:  MO Medicaid Live Video Distant Site

Last updated 03/08/2023

Eligible Originating Site

There are no restrictions on originating site.

See: MO Medicaid Live Video Eligible Sites.

Last updated 03/08/2023

Facility Fee

No reference found explicit to FQHCs.  Procedure code Q3014 is reimbursed, as referenced in the Physician manual.

See: MO Medicaid Live Video Facility/Transmission Fee

Last updated 03/08/2023

Home Eligible

No reference found

Last updated 03/08/2023

Modalities Allowed

Live Video

According to statute, there is no restrictions on distant sites, and live video is covered.

See:  MO Medicaid Live Video.

Store and Forward

While store and forward is reimbursed, CCHP has not found an explicit reference to whether FQHCs are qualified for reimbursement in Medicaid manuals.

See:  MO Medicaid Store and Forward.

Remote Patient Monitoring

CCHP has not found an explicit reference in Medicaid manuals.

See: MO Medicaid Remote Patient Monitoring.

Audio-Only

While audio-only is reimbursed in some circumstances, CCHP has not found an explicit reference to whether or not FQHCs are reimbursed in Medicaid manuals.

See:  MO Medicaid Email, Phone and Fax.

Last updated 03/08/2023

Patient-Provider Relationship

No reference found

Last updated 03/08/2023

PPS Rate

No reference found

Last updated 03/08/2023

Same Day Encounters

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