Montana

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Montana Healthcare Program

Administrator

Montana Dept. of Public Health and Human Services

Regional Telehealth Resource Center

Northwest Regional Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: IMLC, PTC, eNLC
Consent Requirements: No

Last updated 04/30/2021

Audio Only Delivery

Medicaid: Nursing Facility Providers

STATUS: Active

Medicaid: Coverage and Reimbursement for Telemedicine/Telehealth

STATUS: Active, until end of MT State of Emergency

Medicaid:  FAQs on Telehealth/Telemedicine

STATUS: Active

Medicaid: Non-Covered Service Agreement Change

STATUS: Active

Medicaid: Disaster Relief SPA

STATUS: Active, until the last day of the public health emergency

Office of the Governor: Directive Implementing EO 2-2021

STATUS: Active, until the last day of the public health emergency

Medicaid 1915(c) Waiver:  Appendix K – Big Sky Home and Community Based Waiver Combined

STATUS: Extended through end of PHE

Medicaid 1915(c) Waiver:  Appendix K Addendum – Big Sky Home and Community Based Waiver Combined

STATUS: Expires at the end of PHE

Medicaid: IHS/Tribal Telemedicine Questions/Answers

STATUS: Active

Last updated 04/30/2021

Cross State Licensing

Office of the Governor:  Montana State of Emergency Executive Order (2-2021)

STATUS: Active, until rescinded

Department of Labor and Industry:  COVID-19 Information for Professional and Occupational Licensees

STATUS: Active

Office of the Governor: Directive Implementing EO 2-2021

STATUS: Active, until the last day of the public health emergency

Last updated 04/30/2021

Easing Prescribing Requirements

Office of the Governor:  Montana State of Emergency Executive Order (2-2021)

STATUS: Active, until rescinded

Department of Labor and Industry:  COVID-19 Information for Professional and Occupational Licensees

STATUS: Active

Office of the Governor: Directive Implementing EO 2-2021

STATUS: Active, until the last day of the public health emergency

HB 43: Patient-Provider Relationship

STATUS: Enacted

Last updated 04/30/2021

Miscellaneous

Medicaid: Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth Guidance

STATUS: Active, until end of MT State of Emergency

Last updated 04/30/2021

Originating Site

Medicaid: Coverage and Reimbursement for Telemedicine/Telehealth

STATUS: Active, until end of MT State of Emergency

Medicaid:  FAQs on Telehealth/Telemedicine

STATUS: Active

Medicaid 1915(c) Waiver:  Appendix K – Big Sky Home and Community Based Waiver Combined

STATUS: Extended through end of PHE

Medicaid 1915(c) Waiver:  Appendix K Addendum – Big Sky Home and Community Based Waiver Combined

STATUS: Expires at the end of PHE

Medicaid: IHS/Tribal Telemedicine Questions/Answers

STATUS: Active

Last updated 04/30/2021

Private Payer

Insurance Commissioner:  Telehealth Coverage during COVID-19

STATUS: Varies based on insurer

Department of Labor and Industry:  COVID-19 Information for Professional and Occupational Licensees

STATUS: Active

Office of the Governor: Directive Implementing EO 2-2021

STATUS: Active, until the last day of the public health emergency

Last updated 04/30/2021

Provider Type

Medicaid: Dental Telemedicine Notice

STATUS: Active

Medicaid: Nursing Facility Providers

STATUS: Active

Medicaid: Coverage and Reimbursement for Telemedicine/Telehealth

STATUS: Active, until end of MT State of Emergency

Medicaid:  FAQs on Telehealth/Telemedicine

STATUS: Active

Medicaid: IHS/Tribal Telemedicine Questions/Answers

STATUS: Active

Office of the Governor: Directive Implementing EO 2-2021

STATUS: Active, until the last day of the public health emergency

Last updated 04/30/2021

Service Expansion

Medicaid: Dental Telemedicine Notice

STATUS: Active

Medicaid: Nursing Facility Providers

STATUS: Active

Medicaid: Coverage and Reimbursement for Telemedicine/Telehealth

STATUS: Active, until end of MT State of Emergency

Medicaid:  FAQs on Telehealth/Telemedicine

STATUS: Active

Medicaid: Disaster Relief SPA

STATUS: Active, until the last day of the public health emergency

Office of the Governor: Directive Implementing EO 2-2021

STATUS: Active, until the last day of the public health emergency

Medicaid 1915(c) Waiver:  Appendix K – Big Sky Home and Community Based Waiver Combined

STATUS: Extended through end of PHE

Medicaid 1915(c) Waiver:  Appendix K Addendum – Big Sky Home and Community Based Waiver Combined

STATUS: Expires at the end of PHE

Medicaid: Suspension of face-to-face requirement

STATUS: Active, until end of MT State of Emergency

Medicaid: IHS/Tribal Telemedicine Questions/Answers

STATUS: Active

 

Last updated 04/27/2021

Definitions

Telemedicine is the use of interactive audio-video equipment to link practitioners and patients located at different sites.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021). 

Healthy Montana Kids

Telemedicine is “the use of a secure interactive audio and video, or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located.  Does not include audio only (phone call), e-mail, and/or facsimile transmission.”

SOURCE: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov., 2017), p. 11. (Accessed Apr. 2021).

Last updated 04/27/2021

Live Video

POLICY

MT Medicaid reimburses for medically necessary telemedicine services to eligible members.  Providers must be enrolled as Montana Healthcare Programs providers and be licensed in the state of Montana.

Telemedicine should not be selected when face-to-face services are medically necessary. Members should establish relationships with primary care providers who are available on a face-to-face basis.

The originating and distant providers may not be within the same facility or community. The same provider may not be the “pay to” for both the originating and distance provider.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Healthy Montana Kids

Services provided by telemedicine are allowed for non-surgical medical services and behavioral health outpatient services.

SOURCE: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov. 2017), p. 24 & 30. (Accessed Feb. 2021). 

Telehealth services are available for Physical, Occupational and Speech Therapy when ordered by a physician or mid-level practitioner. The order is valid for 180 days. All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable so long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth.

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services program (EPSDT) covers all medically necessary services for children age 20 and under. Therapy services for children are not restricted to a specific number of hours or units as long as the therapy services are restorative, not maintenance. All other applicable requirements apply.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Therapies Manual, Covered Services (Mar. 2020). (Accessed Apr. 2021). 

School-Based Services

Telehealth services are allowed for Physical Therapy, Occupational Therapy and Speech Therapy. All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable so long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance PRograms Manual, School-Based Services Manual (Mar. 2020). (Accessed Apr. 2021).

The availability of services through telemedicine in no way alters the scope of practice of any health care provider; or authorizes the delivery of health care services in a setting or manner not otherwise authorized by law.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Feb. 2020). (Accessed Apr. 2021).

Home Health Services

A face to face encounter may occur through telehealth.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Senior and Long Term Care Division, Community Services Bureau, Home Health Policy Manual. Apr. 1, 2019. pg. 1, (Accessed Apr. 2021).

Durable Medical Equipment

Face-to-face assessments of the patient by the prescriber can be performed using telemedicine.

SOURCE:  MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) Manual (Dec. 2020). (Accessed Apr. 2021).


ELIGIBLE PROVIDERS

Providers must be enrolled as Montana Healthcare Programs providers and be licensed in the State of Montana in order to:

  • Treat a Montana Healthcare Programs member; and
  • Submit claims for payment to Montana Healthcare Programs

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Feb. 2020). (Accessed Apr. 2021).


ELIGIBLE SITES

Telemedicine can be provided in a member’s residence; the distance provider is responsible for the confidentiality requirements. See Facility/Transmission fee section for list of eligible originating sites for facility fee.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).


GEOGRAPHIC LIMITS

The originating and distant providers may not be within the same facility or community. The same provider may not be the pay to for both the originating and distance provider.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr 2021).


FACILITY/TRANSMISSION FEE

The following provider types can bill the originating site fee:

  • Outpatient hospital
  • Critical access hospital*
  • Federally qualified health center*
  • Rural health center*
  • Indian health service*
  • Physician
  • Psychiatrist
  • Mid-levels
  • Dieticians
  • Psychologists
  • Licensed clinical social worker
  • Licensed professional counselor
  • Mental health center
  • Chemical dependency clinic
  • Group/clinic
  • Public health clinic
  • Family planning clinic

*Reimbursement for Q3014 is a set fee and is paid outside of both the cost to charge ratio and the all-inclusive rate.

Originating site providers must include a specific diagnosis code to indicate why a member is being seen by a distance provider and this code must be requested from the distance site prior to billing for the telemedicine appointment.

The originating site provider may also, as appropriate, bill for clinical services provided on-site the same day that a telemedicine originating site service is provided. The originating site may not bill for assisting the distant site provider with an examination, including for any services that would be normally included in a face-to-face visit.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).

No reimbursement for infrastructure or network use charges.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Billing Procedures (Sep. 2017). (Accessed Apr. 2021).

FQHCs and RHCs can bill a telehealth originating site code if applicable.

SOURCE: MT Dept. of Public Health and Human Svcs, Medicaid and Medical Assistance Programs Manual, Rural Health Clinics & Federally Qualified Health Center, Billing Procedures (Jan, 2020). (Accessed Apr 2021).

Last updated 04/27/2021

Miscellaneous

Effective January 1, 2017, providers must also use the telehealth place of service of 02 for claims. By coding with the GT modifier and the 02 place of service, the provider is certifying that the service was a face-to-face visit provided via interactive audio-video telemedicine.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).

If a rendering provider’s number is required on the claim for a face-to-face visit, it is required on a telemedicine claim.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).

Confidentially requirements apply (see manual).

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).

Last updated 02/28/2021

Out of State Providers

Providers must be licensed in the state of Montana.

Any out of state distance providers must be licensed in the State of Montana and enrolled in Montana Healthcare Programs in order to provide telemedicine services to Montana Healthcare Programs members. Providers must contact the Montana Department of Labor and Industry to find out details on licensing requirements for their applicable professional licensure.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).

Last updated 04/27/2021

Overview

Montana Medicaid reimburses for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring based on the definition for telemedicine.

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 04/27/2021

Store and Forward

POLICY

There is no reimbursement for store-and-forward based on the definition for telemedicine restricting the service to interactive audio-video.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 04/27/2021

Definitions

Telemedicine means the use of interactive audio, video, or other telecommunications technology that is:

  • Used by a health care provider or health care facility to deliver health care services at a site other than the site where the patient is located; and
  • Delivered over a secure connection that complies with the requirements of HIPPA.
  • The term includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real-time or through the use of store-and-forward technology.
  • The term does not include the use of audio-only telephone, e-mail, or facsimile transmissions.

SOURCE: MT Code Annotated Sec. 33-22-138(6)(d). (Accessed Apr. 2021).

New Legislation (Effective Jan. 1, 2022)

Telehealth” means the use of audio, video, or other telecommunications technology or media, including audio-only communication, that is:

  • Used by a health care provider or health care facility to deliver health care services; and
  • delivered over a secure connection that complies with state and federal privacy laws.

The term does not include delivery of health care services by means of facsimile machines or electronic messaging alone. The use of facsimile and electronic message is not precluded if used in conjunction with other audio, video, or telecommunications technology or media.

For physicians providing written certification of a debilitating medical condition pursuant to 50-46-310, the term does not include audio-only communication unless the physician has previously established a physician-patient relationship through an
in-person encounter.”

SOURCE: House Bill 43 (2021 Session), (Accessed Apr. 2021).

Last updated 04/27/2021

Parity

SERVICE PARITY

Private payers are required to provide coverage for services delivered through telemedicine [term changes to ‘telehealth’ Jan. 1, 2022] if the services are otherwise covered by the policy, certificate, contract, or agreement.

Coverage must be equivalent to the coverage for services that are provided in-person by a health care provider or health care facility.

SOURCE: MT Code Sec. 33-22-138 & HB 43 (2021 Session). (Accessed Apr. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 04/27/2021

Requirements

Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telemedicine [term changes to ‘telehealth’ Jan. 1, 2022] if services are otherwise covered by the policy, certificate, contract, or agreement.

Coverage under this section must be equivalent to the coverage for services that are provided in person by a health care provider or health care facility.

Eligible providers under the parity law include:

  • Physicians
  • Physician Assistants
  • Podiatrists
  • Pharmacists
  • Optometrists
  • Physical Therapists
  • Occupational Therapists
  • Speech-language Pathologists and Audiologists
  • Psychologists
  • Social Workers
  • Licensed Professional Counselors
  • Nutritionists
  • Addiction Counselors
  • Registered professional nurse
  • Naturopathic physician (Effective Jan. 1, 2022)
  • Advanced practice registered nurse
  • Genetic counselor certified by the American board of genetic counseling
  • Diabetes educator certified by the national certification board for diabetes
  • Dentists & Dental Hygienists

Eligible facilities under this law include:

  • Critical access hospital
  • Hospice
  • Hospital
  • Long-term care facility
  • Mental health center
  • Outpatient center for primary care
  • Outpatient center for surgical services

A health insurer is not:

  • Required to provide coverage for services that are not medically necessary, subject to the terms and conditions of the policy
  • Permitted to require a health care provider to be physically present with the patient at the site where the patient is located unless the distant site provider determines that the presence of a health care provider is necessary.

SOURCE: MT Code Sec. 33-22-138. (Accessed Apr. 2021).

Newly Passed Legislation (Effective Jan. 1, 2022)

A policy, certificate, contract, or agreement may not:

  • impose restrictions involving:
    • the site at which the patient is physically located and receiving health care services by means of telehealth; or
    • the site at which the health care provider is physically located and providing the services by means of telehealth; or
  • distinguish between telehealth services provided to patients in rural locations and telehealth services provided to patients in urban locations.

Nothing in this section may be construed to require:

  • A health issuer to provide coverage for services that are not medically necessary, subject to the terms and conditions of the policy;
  • Provide coverage of an otherwise noncovered benefit;
  • A health care provider to be physically present with the patient at the site where the patient is located unless the distant site provider determines that the presence of a health care provider is necessary; or
  • Except as provided in 50-46-310 or as provided in Title 37 and related administrative rules, a patient to have a previously established patient-provider relationship with a specific health care provider in order to receive health care services by means of telehealth.

The commissioner may adopt rules necessary to implement the provisions of this section.

SOURCE: MT Code Sec. 33-22-138 & HB 43 (2021 Session). (Accessed Apr. 2021).

Last updated 04/27/2021

Cross State Licensing

No Reference Found.

Last updated 04/27/2021

Definitions

Telemedicine means the practice of medicine using interactive electronic communication, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider.  Telemedicine typically involves the application of secure videoconferencing or store-and-forward technology, as defined in 33-22-138.  The term does not mean an audio-only telephone conversation, an e-mail or instant messaging conversation, or a message sent by facsimile transmission.

SOURCE: MT Code Sec. 37-3-102(14). (Accessed Apr. 2021).

New Legislation (Effective Jan. 1, 2021)

Telemedicine means the practice of medicine using interactive electronic communications, information technology, audio-only conversations, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes the application of secure videoconferencing or store-and-forward technology.

The term does not mean an e-mail or instant messaging conversation or a message sent by facsimile transmission.

For physicians providing written certification of a debilitating medical condition pursuant to 50-46-310, the term does not include audio-only communication unless the physician has previously established a physician-patient relationship through an in-person encounter.

SOURCE: House Bill 43 (2021 Session).

Last updated 04/27/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. Interstate Medical Licensure Compact. (Accessed Apr. 2021).

Member of the enhanced Nurse Licensure Compact.

SOURCE: Current NLC States and Status. Nurse Licensure Compact. (Accessed Apr. 2021). 

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Apr. 2021).

 

Last updated 04/27/2021

Miscellaneous

No Reference Found

Last updated 04/27/2021

Online Prescribing

A physician-patient relationship may be established for purposes of telemedicine:

  • by an in-person medical interview and physical examination when the standard of care requires an in-person encounter;
  • by consultation with another licensee or health care provider who has a documented relationship with the patient and who agrees to participate in, or supervise, the patient’s care; or
  • through telemedicine if the standard of care does not require an in-person encounter.

The licensee using telemedicine in patient care may prescribe Schedule II drugs to a patient only after first establishing a physician-patient relationship through an in-person encounter which includes a medical interview and physician examination.

The licensee using telemedicine in patient care shall:

  • make available to the patient verification of the licensee’s identity and credentials;
  • verify the identity of the patient;
  • establish a physician-patient relationship prior to initiating care;
  • obtain a medical history sufficient for diagnosis and treatment in keeping with the applicable standard of care prior to providing treatment, issuing prescriptions, or delegating the patient’s medical services to other health care providers;
  • delegate the patient’s medical care only to appropriate health care providers (see regulation)
  • securely maintain and make timely available medical and billing records to patient or patient’s representative and to other health care providers.

SOURCE: Montana State Board of Medical Examiners. Administrative Rules of MT. Rule 24.156.813 Practice Requirements for Physicians Using Telemedicine. (Accessed Apr. 2021).

Last updated 04/27/2021

Professional Boards Standards

MT Board of Speech-Language Pathology

SOURCE: MT Admin Rules, Sec. 24.222.9 (Accessed Apr. 2021).