Alabama 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

Alabama Medicaid

Alabama

Medicaid Program: Alabama Medicaid

Program Administrator: Alabama Medicaid Agency

Regional Telehealth Resource Center: Southeast Telehealth Resource Center www.setrc.us

Alabama

Medicaid Program: Alabama Medicaid

Program Administrator: Alabama Medicaid Agency

Regional Telehealth Resource Center: Southeast Telehealth Resource Center www.setrc.us

 

 

Alabama 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
          IMLC, NLC  

Alabama Detailed Policy

Medicaid Telehealth Reimbursement Summary Alabama Medicaid reimburses for live video under some circumstances. The Agency will not reimburse providers for origination site or transmission fees. For all telemedicine services, an appropriately trained staff member or employee familiar with the patient’s treatment plan must be immediately available in-person to the patient.

 

Source: AL Medicaid Management Information System Provider Manual, (p. 28-17), January 2020, AL Admin. Code r. 560-X-6-.14, (Accessed Feb. 2020).

They make no reference to store-and-forward reimbursement, but the program reimburses for

In-Home Monitoring through the Alabama Coordinated Health Network program for diabetes and Chronic Heart failure, although it’s not considered to fall under the telemedicine program.

Source: AL Medicaid Management Information System Provider Manual, (40-33), January 2020 (Accessed Feb. 2020).

Definitions There is no explicit definition of “telemedicine” given in state Medicaid policy. However, the provider manual states, “Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site physician and the origination site where the recipient is located (this does not include a tele- phone conversation, electronic mail message, or facsimile transmission between the physi- cian, recipient, or a consultation between two physicians).”

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020. (Accessed Feb. 2020).

Live Video Policy Alabama Medicaid reimburses for live video for certain services.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020 & AL Admin. Code r. 560-X-6-

.14(f)(5), (Accessed Feb. 2020).

Medicaid Telehealth Reimbursement Live Video Eligible Services / Specialties Alabama Medicaid reimburses for the following services when billed with a GT modifier:

 

•          Consultations;

•          Office or other outpatient visits;

•          Individual psychotherapy;

•          Psychiatric diagnostic services;

•          Neurobehavioral status exams.

However, for some specialties, special conditions or circumstances must be present for reim- bursement to occur.

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020. (Accessed Jan. 2020). & AL Admin. Code r. 560-X-6-.14.

Live video telehealth may also be used to deliver Nursing Assessment and Care and Rehabilita- tive Services when certain conditions are met.

Source: AL Medicaid Management Information System Provider Manual, (105-13 & 62), January 2020, (Accessed Feb. 2020).

Eligible Providers All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In order to participate in the telemedicine program:

 

•                     Physicians must be enrolled with Alabama Medicaid with a specialty type of 931 (Tele- medicine Service).

•                     Physician must submit the telemedicine Service Agreement/Certification form.

•                     Physician must obtain prior consent from the recipient before services are rendered. This will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

Source: AL Medicaid Management Information System Provider Manual, (28-17) January 2020, (Accessed Feb. 2020).

For Nursing Assessment and Care services for DMH Mental Illness, and DMH Substance Abuse the following providers are eligible:

•                     Licensed Registered Nurse

•                     Licensed Practical Nurse

•                     Certified Nursing Assistant

•                     MAC Worker (operating within their scope of practice)

Source: AL Medicaid Management Information System Provider Manual, (105-62), January 2020 (Accessed Feb. 2020).

Rehabilitative services that are delivered face-to-face can either be in person or via telemedi-

cine/telehealth, as approved by the Alabama Medicaid Agency.

Source: AL Medicaid Management Information System Provider Manual, (105-1), January, 2020 (Accessed Feb. 2020).

Eligible Sites For rehabilitative services, the originating site must be at:

 

•                     Physician’s office;

•                     Hospital;

•                     Critical Access Hospital;

•                     Rural Health Clinic;

•                     Federally Qualified Health Center;

•                     Community mental health center (to include co-located sites with partnering agencies);

•                     Public health department.

Source: AL Medicaid Management Information System Provider Manual, (105-13), January 2020. (Accessed Feb. 2020).

Medicaid Telehealth Reimbursement Live Video Geographic Limits For rehabilitative services, the distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.

 

Source: AL Medicaid Management Information System Provider Manual, (105-13), January 2020 (Accessed Feb. 2020).

Facility/Transmission Fee No reimbursement for originating site or transmission fees.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17 & 105-15), January 2020 (Accessed Feb. 2020).

Store-and-Forward Policy No reference found.
Eligible Services/Specialties No reference found.
Geographic Limits No reference found.
Transmission Fee No reference found.
Medicaid Telehealth Reimbursement Remote Patient Monitoring Policy Alabama Medicaid will reimburse remote patient monitoring for specified conditions through the In-Home Remote Patient Monitoring Program. The program is administered by the Alabama Coordinated Health Network (ACHN). Patients may be referred to the program by any source including a physician, ACHN Care Coordinators, patient or caregiver, the Health Department, hospitals, home health agencies or community-based organizations. Orders for In-Home Monitoring along with the specific parameters for daily monitoring must be obtained from the patient’s primary medical provider prior to evaluation and admission.

 

Source: AL Medicaid Management Information System Provider Manual, (40-33), January 2020, (Accessed Feb. 2020).

Conditions Patients with the following medical conditions may register for the program:

 

•          Diabetes

•          Congestive Heart Failure

Source: AL Medicaid Management Information System Provider Manual, (40-33), January 2020. (Accessed Feb. 2020).

Provider Limitations No reference found.
Other Restrictions No reference found.
Email / Phone / Fax No reimbursement for email.

 

No reimbursement for telephone. No reimbursement for FAX.

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020, (Accessed Feb. 2020).

Consent Physician must obtain prior consent from the recipient before services are rendered, this will count as

 

part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020, (Accessed Feb. 2020).

For rehabilitative services, informed consent is required with specific requirements to be included in

the consent. See manual for details.

Source: AL Medicaid Management Information System Provider Manual, (105-15), January 2020, (Accessed Feb. 2020).

Medicaid Telehealth Reimbursement Out of State Providers Providers must have an Alabama license.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020, (Accessed Feb. 2020).

Miscellaneous All procedure codes billed for telemedicine services must be billed with modifier GT.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), January 2020, (Accessed Feb. 2020).

Private Payer Laws Definitions No reference found.
Requirements No reference found.
Parity Service Parity No reference found.
Payment Parity No reference found.
Professional Regulation / Health & Safety Definitions Board of Nursing

 

Telehealth Nursing: The practice of distance nursing care using telecommunications technology.

Source: AL Admin Code 610-X-6-.01(25), (Accessed Feb. 2020).

Board of Optometry

Telemedicine: As used in these regulations, a health service that is delivered by a licensed optometrist acting within the scope of his or her license and that requires the use of telecommunications technology other than telephone or facsimile. Telecommunications technology as used herein shall include, but not be limited to:

•          Compressed digital interactive video, audio, or data transmission;

•          Clinical data transmission using computer imaging by way of still image capture and store and forward;

•          Other technology that facilitates access to health care services or optometric specialty ser- vices.

Source: AL Admin Code 630-X-13-.01(7). (Accessed Feb. 2020).

Board of Social Work

Telehealth is a mode of providing social work services through interactive audio, video or electronic communication occurring between a licensed social worker and the client, including any electronic communication for evaluation, assessment, treatment, and management of confidential information and case records in a secure platform.

Source: AL Admin Code 850-x-2-.01(7). (Accessed Feb. 2020).

Consent Board of Social Work

 

Consent must be obtained and documented from the client upon initiation of telehealth services.

Source: AL Admin Code 850-x-2-.04(2)(a). (Accessed Feb. 2020).

Online Prescribing The Alabama Board of Medical Examiners holds the position that, when prescribing medications to an individual, the prescriber, when possible, should personally examine the patient. Prescribing medica- tions for patients the physician has not personally examined may be suitable for certain circumstances, including telemedicine.

 

Licensees are expected to adhere to federal and state statute regarding prescribing of controlled sub- stances.

Source: AL Admin. Code. r. 540-X-9-.11(2) & (3), (Accessed Feb. 2020).

Board of Optometry

A distant site provider who provides telemedicine services to a patient that is not present at an estab- lished treatment site shall ensure that a proper provider-patient relationship is established, which shall include at least the following:

•          Having had at least one face-to-face meeting, either in person, or at an established treatment site via telecommunications;

•          Confirming the identity of the person requesting treatment by establishing that the person

requesting the treatment is in fact whom he or she claims to be.

Evaluation, treatment, and consultation recommendations made via telemedicine, including, but not limited to the issuance of prescriptions, shall be held to the same standards of practice as those in tradi- tional in-person clinical settings. Distant site providers shall obtain an adequate and complete medical history for the patient before providing treatment and shall document the medical history in the patient record.

Source: AL Admin Code 630-X-13-.02. (Accessed Feb. 2020).

Professional Regulation / Health & Safety Cross-State Licensing A special purpose license allowing practitioners licensed in other states to practice across state lines may be issued.

 

Source: Code of AL Sec. 34-24-502 – 507. (Accessed Feb. 2020).

Member of the interstate medical licensing compact.

Source: Code of AL Sec. 34-24-520 – 543. (Accessed Feb. 2020).

Member of the enhanced nurse’s licensure compact.

Source: Code of AL Sec. 34-21-120 – 130. (Accessed Feb. 2020).

Miscellaneous Professional Board Telehealth-Specific Regulations

 

•          AL Board of Optometrists (Source: AL Admin Code 630-X-13-.02). (Accessed Feb. 2020).

•          AL Board of Nursing (Source: AL Admin Code 610-X-6-.16). (Accessed Feb. 2020).

•          AL Board of Social Work (Source: AL Admin Code 850-x-2-.04). (Accessed Feb. 2020).

 

 

 

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