Mississippi Medicaid Reimbursement – Telehealth
Last updated 01/13/2022
Policy applies to Private payers, MS Medicaid and employee benefit plans
“Remote patient monitoring services” means the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including:
- Monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry and other condition-specific data, such as blood glucose;
- Medication adherence monitoring; and
- Interactive video conferencing with or without digital image upload as needed.
Remote patient monitoring services aim to allow more people to remain at home or in other residential settings and to improve the quality and cost of their care, including prevention of more costly care. Remote patient monitoring services via telehealth aim to coordinate primary, acute, behavioral and long-term social service needs for high-need, high-cost patients. Specific patient criteria must be met in order for reimbursement to occur.
Remote patient monitoring services shall include reimbursement for a daily monitoring rate at a minimum of Ten Dollars ($10.00) per day each month and Sixteen Dollars ($16.00) per day when medication adherence management services are included, not to exceed thirty-one (31) days per month. These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.
A one-time telehealth installation/training fee for remote patient monitoring services will also be reimbursed at a minimum rate of Fifty Dollars ($50.00) per patient, with a maximum of two (2) installation/training fees/calendar year. These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.
To receive payment for the delivery of remote patient monitoring services via telehealth, the service must involve:
- An assessment, problem identification, and evaluation that includes:
- Assessment and monitoring of clinical data including, but not limited to, appropriate vital signs, pain levels and other biometric measures specified in the plan of care, and also includes assessment of response to previous changes in the plan of care; and
- Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care.
- Implementation of a management plan through one or more of the following:
- Teaching regarding medication management as appropriate based on the telemedicine findings for that encounter;
- Teaching regarding other interventions as appropriate to both the patient and the caregiver;
- Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services;
- Coordination of care with the ordering health care provider regarding telemedicine findings;
- Coordination and referral to other medical providers as needed; and
- Referral for an in-person visit or the emergency room as needed.
The Division of Medicaid defines remote patient monitoring as using digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for interpretation and recommendation.
The Division of Medicaid reimburses for remote patient monitoring:
- Of devices when billed with the appropriate code, and
- For disease management:
- A daily monitoring rate for days the beneficiary’s information is reviewed.
- Only one (1) unit per day is allowed, not to exceed thirty-one (31) days per month.
- An initial visit to install the equipment and train the beneficiary may be billed as a set-up visit.
- Only one set-up is allowed per episode even if monitoring parameters are added after the initial set-up and installation.
- Only one (1) daily rate will be reimbursed regardless of the number of diseases/chronic conditions being monitored.
The Division of Medicaid does not reimburse for the duplicate transmission or interpretation of remote patient monitoring data.
The Division of Medicaid does not cover remote patient monitoring for disease management as outlined in Miss. Admin. Code Part 225, Rule 2.3.B. for a beneficiary who is a resident of an institution that meets the basic definition of a hospital or long-term care facility.
Continuous Glucose Monitoring
A continuous glucose monitoring service is reimbursed when when medically necessary, prior authorized by the UM/QIO, Division of Medicaid or designee, ordered by the physician who is actively managing the beneficiary’s diabetes and the beneficiary meets specific criteria. See admin code.
The Division of Medicaid covers remote patient monitoring, for disease management when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), Division of Medicaid or designee, ordered by a physician, physician assistant, or nurse practitioner for a beneficiary who meets the following criteria:
- Has been diagnosed with one (1) or more of the following chronic conditions which include, but are not limited to, diabetes, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD), heart disease, mental health, and sickle cell;
- Is capable of using the remote patient monitoring equipment and transmitting the necessary data or has a willing and able person to assist in completing electronic transmission of data.
The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner which includes, but not limited to:
- Implantable pacemakers,
- Cardiac monitors,
- Loop recorders,
- External mobile cardiovascular telemetry, and
- Continuous glucose monitors.
To qualify for RPM services, patients must meet all of the following criteria:
- Be diagnosed in the last 18 months with one or more chronic condition, which include, but are not limited to, sickle cell, mental health, asthma, diabetes, and heart disease; and
- The patient’s healthcare provider recommends disease management services via remote patient monitoring.
The entity that will provide the remote monitoring must be a Mississippi-based entity and have certain protocols (see statute).
Remote patient monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines. Must be ordered by a physician, physician assistant or nurse practitioner.
A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.
A remote patient monitoring prior authorization request form may be required for approval of telemonitoring services. If prior authorization is required, the law lists certain requirements for the form.
The telemonitoring equipment must:
- Be capable of monitoring any data parameters in the plan of care; and
- Be a FDA Class II hospital-grade medical device.
The telemedicine equipment and network used for remote patient monitoring services should meet the following requirements:
- Comply with applicable standards of the United States Food and Drug Administration;
- Telehealth equipment be maintained in good repair and free from safety hazards;
- Telehealth equipment be new or sanitized before installation in the patient’s home setting;
- Accommodate non-English language options; and
- Have 24/7 technical and clinical support services available for the patient user.
Providers of remote patient monitoring services must have protocols in place to address all of the following:
- A mechanism for monitoring, tracking and responding to changes in a beneficiary’s clinical condition, and
- A process for notifying the prescribing physician of significant changes in the beneficiary’s clinical signs and symptoms.
See admin code for list of requirements for prior authorization form.
Remote patient monitoring services must be provided in the beneficiary’s private residence.