Michigan 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 2019: http://cchpca.org

Michigan Medicaid

Michigan
Medicaid Program: Michigan Medicaid

Program Administrator: Michigan Dept. of Community Health

Regional Telehealth Resource Center:

Upper Midwest Telehealth Resource Center
2901 Ohio Boulevard, Ste. 110

Terre Haute, IN 47803
(855) 283-3734 ext. 232
www.umtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the use of an electronic media to “Telemedicine is the use of telecommunication
link patients with health care professionals in different technology to connect a patient with a health care
locations. To be considered telemedicine, the health professional in a different location.”
care professional must be able to examine the patient
via a real-time, interactive audio or video, or both, Source: MI Dept. of Community Health, Medicaid Provider
telecommunications system, and the patient must be Manual, p. 1622 (Oct. 1, 2017).
able to interact with the off-site health care professional Speech-Language and Audiology Services;
at the time the services are provided.”
Behavioral Health Therapy; Medication Therapy

Source: MI Compiled Law Svcs. Sec. 500.3476 (2012). Management

“Telepractice is the use of telecommunications and

information technologies for the exchange of encrypted
patient data for the provision of speech-language and
audiology services. Telepractice must be obtained
through real-time interaction between the patient’s
physical location (patient site) and the provider’s
physical location (provider site).”
Source: MI Dept. of Community Health, Medicaid Provider
Manual, p. 1720 (Oct. 1, 2017).

Live Video Reimbursement

Michigan law states that “contracts shall not require Michigan Medicaid reimburses for the following services
face-to-face contact between a health care professional categories via live video:
and a patient for services appropriately provided through
telemedicine”, which includes live video. Inpatient Consults;
Source: MI Compiled Law Services Sec. 500.3476 (2012). Office or other outpatient consults
Office or other outpatient services
(See “Private Payers” section). Psychiatric diagnostic procedures
Subsequent hospital care

Training services, diabetes
End stage renal disease (ESRD) related
services. However, there must be at least one
in-person visit per month, by a physician, nurse
practitioner, or physician’s assistant, to examine
the vascular site for ESRD services.
Behavior change intervention, individual
Behavior health and/or substance use disorder
treatment
Education service, telehealth

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Nursing facility subsequent care

The initial visit for nursing facility services must be face-

to-face.

Where face-to-face visits are required, telemedicine

services may be used in addition to the required face-to-
face visit, but cannot be used as a substitute.

Physicians and practitioners are eligible to be

distant site providers. Providers at the distant
site can only bill services listed in the
telemedicine services database.

Source: Dept. of Community Health, Medicaid Provider Manual, p.

1622 (Oct. 1, 2017).

Telepractice for BHT Services

Telepractice services must be prior authorized.

Providers may arrange telepractice services for
the purpose of teaching parents/guardians to
provide individualized interventions to their child
and to engage in behavioral health clinical
observation and direction. Qualified providers
include:

Board certified behavior analysts

Board certified assistant behavior analysts

Licensed psychologists

Limited licensed psychologists

Qualified behavioral health professionals

Occupational, physical and speech therapists are not

included in this policy.

A facilitator trained in telepractice technology must be

physically present with the patient.

Source: Dept. of Community Health, Medicaid Provider Manual, p.

461 (Apr. 1, 2017).

Medication Therapy Management (MTM)

In the event that the beneficiary is unable to physically
access a face-to-face care setting, an eligible
pharmacist may provide MTM services via telepractice.
Services must be provided through hardwire or internet
connection.

Source: MI Medical Services Administration Bulletin 17-09.

Updates to Provider Manual. 2/24/17. (Accessed Oct. 2017).

Speech-Language and Audiology Services

MI Medicaid will reimburse for speech language and
audiology services provided through their school based
program.

The patient site may be located within the school, at the

patient’s home or any other established site deemed

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STATE LAW/REGULATIONS MEDICAID PROGRAM

appropriate by the provider.
Source: MI Dept. of Community Health, Medicaid Provider
Manual, p. 1720 (Oct. 1, 2017).

Store and Forward Reimbursement

No reimbursement based upon definition of “telemedicine” which describes telemedicine as occurring in “real time.

Source: MI Compiled Law Svcs. Sec. 500.3476 (2012).

Telecommunication systems using store and forward technology are not included in MI Medicaid’s telemedicine policy.

Source: Dept. of Community Health, Medicaid Provider Manual, p.
1622 (Apr. 1, 2017).

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX Restrictions

No reference found. No reference found.

Online Prescribing

Providers must have an existing physician-patient No reference found.
relationship.
Source: MI Compiled Laws Sec. 333.17751 (2012).
A health professional providing telehealth service to a
patient may prescribe the patient a drug if both the
following are met:
The health professional is a prescriber who is
acting within the scope of his or her practice;
and
If the health professional is prescribing a
controlled substance, the health professional
must meet the requirements of this act
applicable to that health professional for
prescribing a controlled substance.
The health professional must also provide a referral for
health care services that are geographically accessible
to the patient, if medically necessary. They also must
make himself or herself (or a delegated health
professional) available for follow-up care or refer the
patient to another health professional for follow-up care.
Source: MI Compiled Laws, Sec. 16285.

Consent

No reference found. No reference found.

Location

No reference found. Eligible originating sites:

County mental health clinics or publicly funded
mental health facilities;
Federally Qualified Health Centers;

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Hospitals (inpatient, outpatient, or Critical
Access Hospitals);
Physician or other providers’ offices, including
medical clinics;
Hospital-based or CAH-based Renal Dialysis
Centers;
Rural Health Clinics;
Skilled nursing facilities;
Tribal Health Centers
Source: MI Dept. of Community Health, Medicaid Provider
Manual, p. 1623 (Oct. 1, 2017).
Prepaid Inpatient Health Plans/Community Mental
Health (PIHP/CMH) can be either originating or distant
sites.
Source: MI Dept. of Community Health, Medicaid Provider
Manual, p. 330 (Oct. 1, 2017).
Speech-Language and Audiology Services

The patient site may be located within the school, at the
patient’s home or any other established site deemed
appropriate by the provider for reimbursement in their
school based program.
Source: MI Dept. of Community Health, Medicaid Provider
Manual, p. 1720 (Oct. 1, 2017).
Behavioral Health Therapy
Eligible patient site:
Center
Clinic
Patient’s home
Any other established site deemed appropriate
by the provider
Room must be free of distractions. A trained facilitator
must be present at the patient site.
Source: Dept. of Community Health, Medicaid Provider Manual, p.
461 (Oct. 1, 2017).

Cross-State Licensing

No reference found. Telemedicine services must be provided by a health
care professional who is licensed, registered or
otherwise authorized to engage in his or her health care
profession in the state where the patient is located.
Source: Dept. of Community Health, Medicaid Provider Manual, p.
490 (Oct. 1, 2017).
Behavioral Health Therapy
Must be fully licensed in MI.
Source: Dept. of Community Health, Medicaid Provider Manual, p.
461 (Oct. 1, 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Private Payers

Contracts shall not require face-to-face contact between No reference found.
a health care professional and a patient for services
appropriately provided through telemedicine, as
determined by the insurer. Telemedicine services shall
be provided by a health care professional who is
licensed, registered, or otherwise authorized to engage
in his or her health care profession in the state where
the patient is located. Telemedicine services are subject
to all terms and conditions of the contract.
Source: MI Compiled Law Services Sec. 500.3476 (2012).

Site/Transmission Fee

No reference found. Originating site may bill for a facility fee.
Source: Dept. of Community Health, Medicaid Provider Manual, p.
262 (Oct. 1, 2017).

Miscellaneous

The Department required to study the use of No reimbursement for remote access for surgical
telemedicine to perform competency examinations by procedures, and use of robotics.
forensic psychiatrists. Source: Dept. of Community Health, Medicaid Provider Manual, p.

Source: SB 270 (2017). 1622 (Oct. 1, 2017).

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