Maine State Telehealth Laws and Reimbursement Policies

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MaineCare

Maine
Medicaid Program: MaineCare

Medicaid Program Administrator: Maine Dept. of Health and Human Services

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center
11 Parkwood Drive

Augusta, ME 04330
(800) 379-2021
www.netrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine, as it pertains to the delivery of health care services, means the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. ‘Telemedicine’ does not include the use of audio-only telephone, facsimile machine or e-mail.”

Source: ME Revised Statutes Annotated. Title 24, Sec. 4316 (2012).

Telehealth is the use of information technology by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment. Telehealth Services may be either telephonic or interactive (combined video/audio).

Source: Code of ME Rules 10-144-101, Ch. 1, Sec. 4.

“Telemedicine” means the practice of medicine or the rendering of health care services using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes asynchronous store-and- forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telemedicine shall not include the provision of medical services only through an audio-only telephone, e-mail, instant messaging, facsimile transmission, or U.S. mail or other parcel service, or any combination thereof.

Source: ME Regulation Sec. 02-373-6 & 02-383-6.

Recently Passed Legislation (Now Effective)

Telehealth as it pertains to the delivery of health care services, means the use of interactive real- time visual and audio or other electronic media for the purpose of

Telehealth is the use of information technology by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment. Telehealth Services may be either telephonic or interactive (combined video/audio).

Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Apr. 16, 2016). (Accessed Oct. 2017).

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consultation and education concerning and diagnosis,

treatment, care management and self-management of a
patient’s physical and mental health and includes real-
time interaction between the patient and the telehealth
provider, synchronous encounters, asynchronous
encounters, store and forward transfers and remote
patient monitoring. “Telehealth” includes telephonic
services when interactive telehealth services are
unavailable or when a telephonic service is medically

appropriate for the underlying covered service.

Source: ME Statute Sec. 3173-H.

Live Video Reimbursement

Maine law requires coverage for services provided through telemedicine, which includes live video.

Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).

ME Medicaid covers telehealth when it is medically appropriate (see Medicaid Column for details).

Source: Code of ME Rules 10-144-101, Ch. 1, Sec. 4.

(See Medicaid column & “Private Payers” section)

If the Member is eligible for the underlying covered service and providing it via telehealth is medically appropriate, the Member is eligible for telehealth services.

There is a specific list of codes provided in the manual.

Non-Covered services include:

Medical equipment

Personal care aide

Pharmacy services

Assistive technology services

Non-emergency medical transportation

Ambulance services

Services that require physical contact

Any service medically inappropriate for telehealth services.

See manual for full list of exclusions.

No reimbursement for communication between health care providers.

Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Accessed Oct. 2017).

Store and Forward Reimbursement

ME Medicaid provides coverage for telemonitoring services (which may or may not take place in real time) under certain circumstances (See Medicaid column).

Source: Code of ME Rules 10-144-101, Ch. 1, Sec. 4. http://www.maine.gov/sos/cec/rules/10/144/ch101/c1s004.docx

Provider manual indicates coverage of “telehealth services” which is inclusive of store- and-forward, however the manual only discusses interactive telehealth, and remote patient monitoring in detail. Additionally, the manual only discusses the use of the GT modifier (live interactive video), and does not mention the GQ modifier (asynchronous).

Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Accessed Oct. 2017).

Remote Patient Monitoring Reimbursement

ME Medicaid provides coverage for telemonitoring (see Medicaid column for details).

In order to be eligible for telemonitoring a member must:

Be eligible for home health services;

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: Code of ME Rules 10-144-101, Ch. 1, Sec. 4. Have a diagnosis of a health condition requiring
monitoring of clinical data at a minimum of five
Recently Passed Legislation (Now Effective) times per week, for at least one week;
Have had two or more hospitalizations or

Department required to adopt regulations that comply
emergency room visits related to their diagnosis
with the following:
in the past calendar year or have continuously
May not include any requirement that a patient
received telemonitoring services during the past
have a certain number of ER visits or
calendar year and have a continued need;
hospitalizations related to the patient’s diagnosis
Have telemonitoring services included in the
in the criteria for a patient’s eligibility for
Member’s plan of care;
telemonitoring services;
Reside in a setting suitable to support
Must include qualifying criteria for a patient’s
telemonitoring equipment; and
eligibility of telemonitoring services that include
Have the physical and cognitive capacity to
documentation in a patient’s medical record that
effectively utilize the telemonitoring equipment
the patient is at risk of hospitalization or
or have a caregiver willing and able to assist
admission to an ER
with the equipment.
Must provide that group therapy for behavioral

health or addiction services covered by the A physician must document that a face-to-face
MaineCare program may be delivered through
encounter with the member occurred before they are
telehealth; and
eligible for a home health benefit. This can occur
Must include requirements for individual providers
through interactive telehealth services, but not by
and the facility or organization in which the
telephone or e-mail.
provider works for providing telehealth and

telemonitoring services. Covered telemonitoring services include:

Source: ME Statute Sec. 3173-H. Evaluation of the member to determine if
telemonitoring services are medically

ME established the ME Telehealth and Telemonitoring necessary;
advisory group to evaluate difficulties related to Evaluation of Member to ensure cognitively and
telehealth and telemonitoring services and make physically capable of operating equipment;
recommendations to the department to improve it Evaluation of residence;
statewide. Education and training;
Remote monitoring and tracking of data by a
Source: ME Statute Sec. 3173-I. RN, NP, PA or physician and response with
appropriate clinical interventions;
Monthly telephonic services;
Maintenance of equipment; and
Removal/disconnection of equipment
Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101,
Ch. 1, Sec. 4. (Accessed Oct. 2017).
RPM is covered under Home and Community Benefits
for the Elderly and for Adults with Disabilities. Services
may include a range of technological options including
in-home computers, sensors and video camera linked to
a provider that enables 24/7 monitoring.
Final approval must be obtained from the Department,
Office of Aging and Disability Services while
considering:
Number of hospitalizations in the past year;
Use of emergency room in the past year;
History of falls in the last six months resulting
from injury;
Member lives alone or is home alone for

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STATE LAW/REGULATIONS MEDICAID PROGRAM

significant periods of time;

Service access challenges and reasons for
those challenges;
History of behavior indicating that a member’s
cognitive abilities put them at a significant risk of
wandering; and
Other relevant information.
Use of remote monitoring requires sufficient Back Up
Plans and the SCA will be responsible for ensuring that
the member has at least two adequate back-up plans
prior to making a referral for this service.
Source: MaineCare Benefits Manual, Home and Community
Benefits for the Elderly and for Adults with Disabilities, 10-144
Ch. II, Sec. 19, p. 16 (Jun. 1, 2017). (Accessed Oct. 2017).

Email/Phone/FAX

“Telehealth” includes telephonic services when interactive telehealth services are unavailable or when a telephonic service is medically appropriate for the underlying covered service.

Source: ME Statute Sec. 3173-H.

No reimbursement for email.

No reimbursement for telephone.
No reimbursement for FAX.

Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).

No reimbursement for email.

No reimbursement for telephone.
No reimbursement for FAX.

Source: Code of ME Rules. 10-144-101 (2012).

For Indian Health Services, a second tier consultation can utilize direct email communications or telephone consultation.

Source: MaineCare Benefits Manual, Indian Health Services, 10-144 Ch. II, p. 5 (March 21, 2012). (Accessed Oct. 2017).

Telephonic services may be reimbursed if the following conditions are met:

Interactive telehealth services are unavailable; and

A telephonic service is medically appropriate for the underlying condition.

Services may not be delivered through electronic mail.

Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Accessed Oct. 2017).

Telephone is also covered for:

Targeted Case Management Services for purposes of monitoring and follow up activities can take place over the telephone.

The Home and Community Benefits for the Elderly and for Adults with Disabilities for purposes of monitoring.

Behavioral Health Services for purposes of crisis resolution services.

Source: MaineCare Benefits Manual, Targeted Case Management Services, 10-144 Ch. 101, Sec. 13, p. 6 (Mar. 20, 2014). (Accessed Oct. 2017).

Source: MaineCare Benefits Manual, Behavioral Health Services,

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10-44 Ch. II, Sec. 65, p. 10 (Nov. 26, 2016). (Accessed Oct. 2017).

Online Prescribing

Prior to providing treatment, including issuing Tele-pharmacy is allowed.
prescriptions, electronically or otherwise, a licensee who
uses telemedicine in providing health care shall Tele-pharmacy is a method of delivering prescriptions
interview the patient to collect the relevant medical dispensed by a pharmacist to a remote site. Pharmacies
history and perform a physical examination, when using tele-pharmacy must follow all applicable State and
medically necessary, sufficient for the diagnosis and Federal regulations, including use of staff qualified to
treatment of the patient. An internet questionnaire that is deliver prescriptions through tele-pharmacy.
a static set of questions provided to the patient, to which Providers may dispense prescriptions via tele-
the patient responds with a static set of answers, in
contrast to an adaptive interactive and responsive online pharmacy; pre-authorization is required.
interview, does not constitute an acceptable medical
interview and physical examination for the provision of Source: MaineCare Benefits Manual, Ch. 2, Pharmacy Services,
treatment, including issuance of prescriptions, 10-144 Chapter 101, p. 5 & 33 (Nov. 29, 2015) (accessed Oct.
electronically or otherwise, by the licensee. 2017).

A valid physician-patient relationship may be established
between a licensee who uses telemedicine in providing
health care and a patient who receives telemedicine
services through consultation with another licensee or
through telemedicine if the standard of care does not
require an in-person encounter and in accordance with
evidence-based standards for practice and telemedicine
practice guidelines that address the clinical and
technological aspects of telemedicine.
Source: ME Regulation Sec. 02-373-6 & 02-383-6.

Consent

No reference found. Providers must deliver written educational information to
patients at their visit.
This information should be written at a sixth-grade
comprehension level, and include the following:
Description of the telehealth equipment and
what to expect;
Explanation that the use of telehealth for this
service is voluntary;
Explanation that the member is able to stop the
telehealth visit at any time and request a face-
to-face service;
Explanation that MaineCare will pay for
transportation to a distant appointment if
needed;
Explanation that the Member will have access to
all information resulting from the telehealth
service provided by law;
HIPAA compliance information regarding the
telehealth encounter;
Informed of all parties who will be present at the
receiving and originating site and have the right
to exclude anyone from either site; and

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Member has the right to object to videotaping or
other recording of consult.
Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101,
Ch. 1, Sec. 4. (Accessed Oct. 2017).
Member’s record must document consent for RPM.
Source: MaineCare Benefits Manual, Home and Community
Benefits for the Elderly and for Adults with Disabilities, 10-144
Ch. II, Sec. 19, p. 16 (Mar. 15, 2016). (Accessed Oct. 2017).

Location

No reference found. No reference found.

Cross-State Licensing

Adopted the Interstate Medical Licensure Compact. No reference found.
Source: ME Code, Ch. 145, Sec. 18507-24. (SP 467-2017).
A physician can practice medicine in Maine through
interstate telemedicine if they are licensed in the state
they are providing telemedicine from, their license is in
good standing, the physician does not open an office,
and the physician annually registers with the board and
pays a fee.
Source: 32 MSRA Sec. 3300-D.

Private Payers

Requires coverage of telemedicine services, subject to No reference found.
contract terms and conditions.
Coverage must be provided in a manner that is
consistent with coverage for in-person consultation.
Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).

Site/Transmission Fee

No reference found. A facility fee is provided to a health care provider at the

originating site.
When an FQHC or RHC serves as the originating site,
the facility fee is paid separately from the center or clinic
all-inclusive rate.
Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101,
Ch. 1, Sec. 4. (Apr. 16, 2016). (Accessed Oct. 2017).

Miscellaneous

The Department is required to report on the utilization of telehealth and telemonitoring services within the MaineCare program annually beginning in 2018.

The Department is required to conduct educational outreach to providers and MaineCare members on

MaineCare will pay for transportation to a distant appointment if needed.

Source: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Apr. 16, 2016). (Accessed Oct. 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

telehealth and telemonitoring.

Source: ME Statute Sec. 3173-H.

Professional regulation with telehealth specific standards

Board of Licensure in Medicine (Source: ME Regulation Sec. 02-373-6)

Board of Osteopathic Licensure (Source: ME Regulation 02-383-6)

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