Alaska State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2020: http://cchpca.org

Alaska Medicaid

Alaska

Medicaid Program: Alaska Medicaid

Program Administrator: Alaska Dept. of Health and Social Services, Division of Public Assistance

Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center www.nrtrc.org

 

 

Alaska Policy At-a-Glance

MEDICAID REIMBURSEMENT PRIVATE PAYER LAW PROFESSIONAL REQUIREMENTS
LIVE VIDEO STORE-AND-FORWARD REMOTE PATIENT MONITORING LAW EXISTS PAYMENT PARITY LICENSING COMPACT CONSENT REQUIREMENT

Alaska Detailed Policy

Medicaid Telehealth Reimbursement

Summary

Alaska reimburses for Live Video, Store & Forward & Remote Patient Monitoring, although some restrictions apply.

Definitions

“Alaska Medicaid will pay for telemedicine services delivered in the following manner:

•          Interactive method: Provider and patient interact in ‘real-time’ using video/camera and/or

dedicated audio conference equipment.

•          Store-and-forward method: The provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.

•          Self-monitoring method: The patient is monitored in his or her home via a telemedicine application, with the provider indirectly involved from another location.”

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician Services (5/13) (Accessed Feb. 2020).

The department will pay a provider for a telemedicine application if the provider provided the medi-

cal services through one of the following methods of delivery in the specified manner:

•          Live or interactive: the service must be provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis; medical services provided by a telephone that is not a part of a dedicated audio conference system or by a facsimile machine are not eligible for payment under this paragraph.

•          Store-and-forward: the service must be provided through the transference of digital imag- es, sounds, or previously recorded video from one location to another to allow a consult- ing provider to obtain information, analyze it, and report back to the referring provider.

•          Self-monitoring or testing: the services must be provided by a telemedicine application based in the recipient’s home, with the provider only indirectly involved in the provision of the service.

Source: AK Admin. Code, Title 7, 12.449 & Sec. 110.639. (Accessed Feb. 2020).

Medicaid Telehealth Reimbursement

Definitions

“Telemedicine means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data through audio, video, or data communications that

are performed over two or more locations between providers who are physically separated from the recipient or from each other.”

Source: AK Admin. Code, Title 7, 12.449 & Sec. 110.639. (Accessed Feb. 2020).

Live Video

Policy

Alaska’s Medicaid program will reimburse for services “provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis.”

Source: AK Admin. Code, Title 7, 110.625(a)(1) (Accessed Feb. 2020).

Alaska Medicaid will pay for a covered medical service furnished through telemedicine applica- tion if the service is:

•          Covered under traditional, non-telemedicine methods;

•          Provided by a treating, consulting, presenting or referring provider;

•          Appropriate for provision via telemedicine.

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician Services (5/13), (Accessed Feb. 2020).

The department will pay for telemedicine applications provided by a treating, consulting, presenting, or referring provider for a medical service covered by Medicaid and provided within the scope of the provider’s license. A presenting provider is only eligible to receive Medicaid payment for a live or interactive telemedicine application.

Source: AK Admin. Code, Title 7, 110.630. (Accessed Feb. 2020).

The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients. For the provider to receive payment, the provider’s use of telemedicine applications must comply with the stan- dards for services delivered under the Medicaid program and for the medical services provided by the type of provider, including provisions that affect the efficiency, economy and quality of service; and coverage limitations.

Source: Alaska Admin Code. Title 7, Sec. 110.620. (Accessed Feb. 2020).

Eligible Services / Specialties

Medically necessary office consultations provided via telemedicine may be covered only when used as a second opinion and the provider is of a different specialty than the requesting provid- er. Documentation requirements apply.

Source: Alaska Medicaid Policy Clarification: Office Consultations via Telemedicine Applications. March 30, 2017. (Accessed Feb. 2020).

Eligible services:

•          Initial or one follow-up office visit;

•          Consultation made to confirm diagnosis;

•          A diagnostic, therapeutic or interpretive service;

•          Psychiatric or substance abuse assessments;

•          Psychotherapy; or

•          Pharmacological management services on an individual recipient basis.

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); & Physician Services (5/13)(Accessed Feb. 2020).

Family psychotherapy may be provided through telemedicine, with or without recipient involve- ment, if the services could not be provided in person and the clinician documents the reason for providing the service telephonically in the recipient’s treatment notes for each session.

Source: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Community Behavioral Health Clinic Services; Mental Health Physician Clinic (1/2/19) (Accessed Feb. 2020).

Medicaid Telehealth Reimbursement

Live Video

Eligible Services / Specialties

Dental services do not require the use of the telemedicine modifier.

Source: AK Dept. of Health and Social Svcs. Dental Services. Tribal Services Manual (1/3/17). (Accessed Feb. 2020).

No reimbursement for:

•          Direct entry midwife

•          Durable medical equipment (DME)

•          End-stage renal disease

•          Home and community-based waiver

•          Personal care assistant

•          Pharmacy

•          Private duty nursing

•          Transportation and accommodation

•          Vision (includes visual care, dispensing, or optician services)

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician Services (5/13), & AK Admin. Code, Title 7, 110.635. (Accessed Feb. 2020).

Eligible Providers

Providers fall into three categories:

•          Referring Provider: Evaluates a patient, determines the need for a consultation, and arranges services of a consulting provider for the purpose of diagnosis and treat- ment.

•          Presenting Provider: Introduces a patient to the consulting provider during an interac- tive telemedicine session (may assist in the telemedicine consultation).

•          Consulting Provider: Evaluates the patient and/or medical data/images using tele- medicine mode of delivery upon recommendation of the referring provider.

Source: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology Services (6/12); Autism Services (6/12); Chiropractic Services (6/12); Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); Durable Medical Equipment (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Prosthetics & Orthotics (6/12); Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behav- ioral Rehabilitation Services (6/12); Therapies (6/12); Vision (6/12) & Alaska Admin Code Title 7, Sec. 110.639. (Accessed Feb. 2020).

Office consultations performed by a provider of the same specialty within the same organiza- tion are not covered.

Source: Alaska Medicaid Policy Clarification: office Consultations via Telemedicine Applications. March 30, 2017. (Accessed Feb. 2020).

Eligible Sites

No reference found.

Geographic Limits

No reference found.

Medicaid Telehealth Reimbursement

Live Video

Facility/Transmission Fee

The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

Source: AK Admin. Code, Title 7, 110.635(b). (Accessed Feb. 2020).

Community Behavioral Health Services

The department will pay a community behavioral health services provider or a mental health physician clinic for facilitation of a telemedicine session if the facilitating provider:

•          Provides the telemedicine communication equipment;

•          Establishes the electronic connection used by the treating provider and the recipient; and

•          Remains available during the telemedicine session to reestablish the electronic con- nection if that connection fails before the intended end of the telemedicine session.

Source: AK Admin. Code, Title 7, 135.290. (Accessed Feb. 2020).

Store-and-Forward

Policy

Alaska Medicaid will reimburse for store-and-forward telehealth, which is defined as the “pro- vider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.”

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Be- havioral Health Services (1/2/19); Mental Health Physician Clinic (1/2/2019); Physician Services (5/13), (Accessed Feb. 2020).

The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients. For the

provider to receive payment, the provider’s use of telemedicine applications must comply with the standards for services delivered under the Medicaid program and for the medical services provided by the type of provider, including provisions that affect the efficiency, economy and quality of service; and coverage limitations. Store-and-forward services must be provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider.

Source: Alaska Admin Code. Title 7, Sec. 110.620 & 625. (Accessed Feb. 2020).

Eligible Services/Specialties

A consulting provider may send data he/she has received during a store-and-forward telemed- icine consultation to another consulting provider (with equal or greater scope of practice as determined by his/her occupational license or level of expertise within their field of specialty).

Source: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology Services (6/12); Autism Services (6/12); Chiropractic Services (6/12); Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); Durable Medical Equipment (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Prosthetics & Orthotics (6/12); Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behav- ioral Rehabilitation Services (6/12);; Therapies (6/12); Vision (6/12). (Accessed Feb. 2020).

Eligible services:

•          Initial or one follow-up office visit;

•          Consultation made to confirm diagnosis;

•          A diagnostic, therapeutic or interpretive service;

•          Psychiatric or substance abuse assessments;

•          Psychotherapy; or

•          Pharmacological management services on an individual recipient basis.

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); & Physician Services (5/13) (Accessed Feb. 2020).

Medicaid Telehealth Reimbursement

Store-and-Forward

Geographic Limits

No reference found.

Transmission Fee

The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

Source: AK Admin. Code, Title 7, 110.635(b). (Accessed Feb. 2020).

Remote Patient Monitoring

Policy

Alaska Medicaid will reimburse for services delivered through self-monitoring, where the patient is monitored in their home via a telemedicine application, with the provider indirectly involved from another location.

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician Services (5/13), (Accessed Feb. 2020).

To be eligible for payment under self-monitoring or testing, “the services must be provided by a telemedicine application based in the recipient’s home, with the provider only indirectly involved in the provision of the service.”

Source: AK Admin. Code, Title 7, 110.625(a). (Accessed Feb. 2020).

Conditions

No reference found.

Provider Limitations

No reference found.

Other Restrictions

No reference found.

Medicaid Telehealth Reimbursement

Email / Phone / Fax

No reimbursement for telephone when not part of a dedicated audio conference system. No reimbursement for FAX.

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician Services (5/13), & AK Admin Code, Title 7, 110.625 & 635 (Accessed Feb. 2020).

Consent

No reference found.

Out of State Providers

No reference found.

Miscellaneous

Documentation requirements for telemedicine consultations include:

•          Statement that the service was provided using telemedicine

•          The address location of the patient

•          The address location of the provider

•          The method of telemedicine used

•          The names of all persons participating in the telemedicine service and their role in the en- counter

•          The inquiry from the requesting provider

•          The consulting provider’s report back to the requesting provider (see policy for more details).

Source: Alaska Medicaid Policy Clarification: Office Consultations via Telemedicine Applications. March 30, 2017. (Accessed Feb. 2020).

Payment to the presenting provider is limited to the rate established for brief evaluation and manage- ment of an established patient.

Receiving providers will be reimbursed in the same manner as reimbursement is made for the same service provided through traditional modes of delivery, not to exceed 100 percent of the rate estab- lished in state law.

Source: AK Admin Code, Title 7, 145.270. (Accessed Feb. 2020).

Private Payer Laws

Definitions

No reference found.

Requirements

Mental Health

A health care insurer that offers, issues for delivery, or renews in the state a health care insurance plan in the group or individual market that provides mental health benefits shall provide coverage for men- tal health benefits provided through telehealth by a health care provider licensed in this state and may not require that prior in-person contact between a health care provider and a patient before payment is made for covered services.

Source: AK Statute, Sec. 21.42.422 (Accessed Feb. 2020).

Parity

Service Parity

Limited to mental health.

Source: AK Statute, Sec. 21.42.422 (Accessed Feb. 2020).

Payment Parity

None.

Professional Regulation/Health & Safety

Definitions

Speech-Language Pathology

Telemedicine services means the delivery of health care services using the transfer of medical data through audio, visual, or data communications that are performed over two or more locations by a provider who is physically separated from the recipient of the health care services.

Source: AK Statute, Sec. 44.33.381(c) & AK Admin. Code, Title 12, Sec. 07.090(4) (Accessed Feb. 2020).

Consent

Speech-Language Pathology

Providers who provides telemedicine services must document the efforts to obtain the client’s con- sent to send all records to a client’s primary care provider. The consent must be obtained in writing and be signed by the client or client’s legal guardian.

Source: AK Admin. Code, Title 12, Sec. 07.030 (Accessed. Feb. 2020).

Professional Regulation/Health & Safety

Online Prescribing

The guiding principles for telemedicine practice in the American Medical Association (AMA), Report 7 of the Council on Medical Service (A-14), Coverage of and Payment for Telemedicine, dated 2014, and the Federation of State Medical Boards (FSMB), Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, dated April 2014, are adopted by reference as the standards of practice when providing treatment, rendering a diagnosis, prescribing, dispensing, or administering a prescription or controlled substance without first conducting an in-person physical examination.

Source: AK Admin. Code, Title 12, Sec. 40.943 (Accessed Feb. 2020).

A physician is not subject to disciplinary sanctions for rendering a diagnosis, treatment or prescribing a prescription drug (except a controlled substance) without a physical examination if the physician

or another health care provider or physician in the physician’s group practice is available for follow up care and the physician requests that the person consent to sending a copy of all records of the encounter to the person’s primary care provider.

If the above requirements are met, a physician may also prescribe a controlled substance or botulinum toxin when an appropriate licensed health care provider is present with the patient to assist the physi- cian with examination, diagnosis and treatment.

Source: AK Statute, Sec. 08.64.364. (Accessed Feb. 2020).

Physicians are prohibited from prescribing medications based solely on a patient-supplied history received by telephone, FAX, or electronic format.

Source: AK Admin. Code, Title 12, Sec. 40.967(27). (Accessed Feb. 2020).

Cross-State Licensing

No reference found.

Miscellaneous

The Department of Commerce, Community and Economic Development has adopted regulations for establishing and maintaining a registry of businesses performing telemedicine in the state.

See business registry regulations for more details.

Source: AK Admin Code. Sec. 600 (Accessed Feb. 2020) & AK Dept. of Commerce, Community, and Economic Development, Occupation- al Licensing Centralized Regulations, Article 5. Dec 2019. (Accessed Feb. 2020).

Professional Board Telehealth-Specific Regulations

•          Medical Board (Source: AK Admin. Code, Title 12, Sec. 40.943).

•          Speech-Language Pathology (Source: AK Admin. Code, Title 12, Sec. 07.020).

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