Missouri

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: No

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

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

STATE RESOURCES

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

COVID-19

Last updated 01/10/2022

Audio Only Delivery

Medicaid: Provider COVID-19 Tips

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

Medicaid:  COVID FAQs on Telehealth

STATUS: Unclear if 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 01/10/2022

Cross State Licensing

Previous COVID-19 waivers expired.

Last updated 01/10/2022

Easing Consent Requirements

No Reference Found

Last updated 01/10/2022

Easing Prescribing Requirements

Previous COVID-19 waivers expired.

Last updated 01/10/2022

Miscellaneous

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 01/10/2022

Originating Site

Medicaid: Provider COVID-19 Tips

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

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 01/10/2022

Private Payer

Previous COVID-19 waivers expired.

Last updated 01/10/2022

Provider Type

Medicaid: Provider COVID-19 Tips

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

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 01/10/2022

Service Expansion

Medicaid: Provider COVID-19 Tips

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

Medicaid:  COVID FAQs on Telehealth

STATUS: Unclear if 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

 

Medicaid

Last updated 01/11/2022

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, p. 166 (Nov. 25, 2020); MO HealthNet, Physician Manual, Telehealth Services, p. 286-87 (Oct. 13 2021) & MO HealthNet, Provider Manual, Behavioral Health Services, p. 211 (Sept. 9, 2021). (Accessed Jan. 2022).

Last updated 01/10/2022

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 Jan. 2022).

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,13-69 p. 286 (Oct. 13, 2021), (Accessed Jan. 2022).

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, Provider Manual, Rural Health Clinics, Section 13, p. 165 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13.22, p. 211 (Sept. 9, 2021). (Accessed Jan. 2022).

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 Jan. 2022).

Last updated 01/11/2022

Email, Phone & Fax

No Reference Found

Last updated 01/11/2022

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 (Oct. 13, 2021), Provider Manual, Rural Health Clinics, Section 13, p. 165 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 211 (Sept. 9, 2021). (Accessed Jan. 2022).

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 Jan. 2022).

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. 287 (Oct. 13, 2021) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).

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 Statute Annotated, Title 12, Sec. 208.677 & MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 166 (Nov. 25, 2020), (Accessed Jan. 2022).

Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program

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

SOURCE: MO HealthNet, CSTAR Manual, 13.14(K)(4) p. 201 (Sept. 6, 2019, (Accessed Jan. 2022).

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, p. 239. (Sept. 6, 2019), (Accessed Jan. 2022).

Home Health

The telehealth may be used in the “face-to-face” requirement of an encounter.

SOURCE: MO HealthNet, Home Health Manual, p. 170. (Nov. 20, 2021), (Accessed Jan. 2022).

Dentistry

Some teledentistry is covered. See manual for codes.

SOURCE: MO HealthNet, Dental Manual, p. 260. (Nov. 1, 2021). (Accessed Jan. 2022).

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, (Accessed Jan. 2022).

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 (Oct. 13, 2021), Provider Manual, Rural Health Clinics, Section 13, p. 165-166 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).

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, 13.69A p. 287 (Oct. 13, 2021) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).

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, p. 166 (Nov. 25, 2020). (Accessed Jan. 2022).

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

SOURCE: MO HealthNet, Physician Manual, p. 208 (Oct 13, 2021). (Accessed Jan. 2022).

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,13-69A p. 287 (Oct. 13, 2021) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).

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 Jan. 2022). 

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 Jan. 2022).  

RHCs must bill with their non-RHC provider number (or when the distant site, the RHC provider number can also be used) when they are the originating site to receive the facility fee.

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. 165 (Nov. 25, 2020). (Accessed Jan. 2022). 

The originating site is where the MO HealthNet participant receiving the telehealth service is physically located.  The originating site and distant site can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility.

SOURCE: MO Department of Social Services. Provider Bulletin. Vol. 40, No. 47. Feb. 2, 2018. (Accessed Jan. 2022).

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 Jan. 2022).

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, 13.69A p. 287 (Oct. 13, 2021); & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).

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, p. 166 (Nov. 25, 2020). (Accessed Jan. 2022).

FQHCs and RHCs are eligible for an originating site facility fee. Special billing instructions apply to FQHC providers.

SOURCE: MO Department of Social Services. Provider Bulletin. Vol 41, No. 44. Mar. 5, 2019. (Accessed Jan. 2022).

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 Jan. 2022).

Last updated 01/11/2022

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.

SOURCE: MO Revised Statute Ch. 192.2520 (Accessed Aug. 2021).

Special documentation requirements apply.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021); MO HealthNet, Physician Manual, Telehealth Services, p. 287 (Oct. 13, 2021) & MO HealthNet, Rural Health Clinic, p. 166 (Nov. 24, 2020). (Accessed Jan. 2022).

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. 212 (Sept. 9, 2021), (Accessed Jan. 2022).

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 (Oct. 12, 2021). (Accessed Jan. 2022).

Last updated 01/11/2022

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, Section 13, p. 58 (Sept. 9, 2021); MO HealthNet, Physician Manual, Telehealth Services, p. 66 (Oct. 13, 2021) & MO HealthNet, Rural Health Clinic, p. 56 (Nov. 25, 2020). (Accessed Jan. 2022). (Language also appears in ALL Medicaid manuals).

Last updated 01/11/2022

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 01/11/2022

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 Jan. 2022).

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 Jan. 2022).

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 (Mar. 1, 2021). (Accessed Jan. 2022).

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 Jan. 2022)

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 Jan. 2022).

Last updated 01/11/2022

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 Jan. 2022).

ELIGIBLE SERVICES/SPECIALTIES

Dentistry

Dentist review via teledentistry is covered. See manual for codes.

SOURCE: MO HealthNet, Dental Manual, p. 260. (Nov. 1, 2021). (Accessed Jan. 2022).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Private Payer

Last updated 01/11/2022

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 Jan. 2022).

Last updated 01/11/2022

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 Jan. 2022).

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 (expires June 29, 2022), (Accessed Jan. 2022).

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

Last updated 01/11/2022

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 Jan. 2022). 

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, 2021, (Accessed Jan. 2022).

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 Jan. 2022).

Professional Requirements

Last updated 01/11/2022

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(3(H) (Accessed Jan. 2022)

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 Jan. 2022).

Last updated 01/11/2022

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 Jan. 2022).

Last updated 01/11/2022

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 Jan. 2022).

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 Jan. 2022).

Last updated 01/11/2022

Licensure Compacts

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Website.  (Accessed Jan. 2022).

Member of Physical Therapy Compact.

SOURCE: PT Compact Map.  (Accessed Jan. 2022).

Member of Nurses Licensure Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status.  NCSBN.  (Accessed Jan. 2022). 

Member of The Interstate Commission for EMS Personnel Practice.

SOURCE: The Interstate Commission for EMS Personnel Practice. (Accessed Jan. 2022).

Member of Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact & MO Statute Sec. 324.087 (Accessed Jan. 2022).

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

Last updated 01/11/2022

Miscellaneous

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 Jan. 2022).

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 Jan. 2022).

Last updated 01/11/2022

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.

SOURCE: MO Revised Statutes § 334.100(4)(h). (Accessed Jan. 2022).

A telemedicine encounter can establish a physician-patient relationship 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 Jan. 2022).

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

  1. 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;
  2. Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
  3. If appropriate, following up with the patient to assess the therapeutic outcome;
  4. 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
  5. 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 Jan. 2022).

Last updated 01/11/2022

Professional Boards Standards

No Reference Found