Missouri 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

Missouri HealthNet

Missouri
Medicaid Program: HealthNet

Program Administrator: Missouri Dept. of Social Services

Regional Telehealth Resource Center:

Heartland Telehealth Resource Center
3901 Rainbow Blvd MS 1048

Kansas City, KS 66160
(877) 643-4872
heartlandtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

Relating to Stroke Centers

“Telemedicine-the use of medical information
exchanged from one (1) site to another via electronic
communications to improve patient’s health status. A
neurology specialist will assist the physician in the
center in rendering a diagnosis. This may involve a
patient “seeing” a specialist over a live, remote consult
or the transmission of diagnostic images and/or video
along with patient data to the specialist.”

Source: MO Code of State Regulation Title 19, 30-40.710.

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

Source: MO Revised Statute Sec. 191.1145 (2016 SB 579).

Telehealth means the use of medical information exchanged from one site to another via electronic communications to improve the health status of a patient.

Source: MO Code of State Regulation. Title 20, 2150-2.001.

“Telehealth means the use of medical information exchanged from one (1) site to another via electronic communications to improve the health status of a patient. Telehealth means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment using the transfer of medical data, audio visual, or data communications that are performed over two (2) or more locations between providers who are physically separated from the patient or from each other.”

Source: MO Code of State Regulation, Title 13, 70-3.190 (2010).

(Accessed Oct. 2017).

Telehealth Services are medical services provided through advanced telecommunications technology from one location to another. Medical information is exchanged in real-time communication from an originating site, where the participant is located, to a distant site, where the provider is located, allowing them to interact as if they are having a face-to-face, hands-on session.

A Telehealth service requires the use of a two (2)-way interactive video technology.

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 201 (Jul. 27, 2017); MO HealthNet, Physician Manual, Telehealth Services, p. 276 (May 4, 2017). (Accessed Oct. 2017).

Live Video Reimbursement

Missouri Consolidated Health Care Plan (State HealthNet will reimburse for live video for medically
employees and retirees health plan) necessary services.
Telehealth services are covered on the same basis that Eligible providers:
the service would be covered when it is delivered in
person. Physicians;
Source: MO Consolidated State Reg. 22:10-3.057. Advanced registered Nurse Practitioners,
including Nurse Practitioners with a mental

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STATE LAW/REGULATIONS MEDICAID PROGRAM

For the provision of telehealth services under MO health specialty;

HealthNet, an eligible provider includes: Psychologists.
(1) Physicians, assistant physicians, and physician
assistants; Telehealth services are limited to:
(2) Advanced practice registered nurses; Consultation made to confirm a diagnosis;
(3) Dentists, oral surgeons, and dental hygienists Evaluation and management services;
under the supervision of a currently registered A diagnosis, therapeutic or interpretive service;
and licensed dentist; Individual psychiatric or substance abuse
(4) Psychologists and provisional licensees; assessment diagnostic interview examinations;
(5) Pharmacists; or
(6) Speech, occupational, or physical therapists; Individual psychotherapy
(7) Clinical social workers;
Pharmacologic management (for RHCs)
(8) Podiatrists;

(9) Optometrists; Reimbursement to the provider at the distant site is
(10) Licensed professional counselors; and
made at the same amount as for an in-person service.
(11) Eligible health care providers under

subdivisions (1) to (10) practicing in a rural Source (eligible providers): MO HealthNet, Provider Manual,
health clinic, federally qualified health center, or Behavioral Services, Section 13, p. 205-206 (Jul. 27, 2017)
community mental health center. Source (distant site reimbursement): MO Code of State

Source: MO Revised Statute Sec. 191.1145 (2016 SB 579). Regulation, Title 13, 70-3.190 (2010).

Source (psychiatrists): MO HealthNet, Community Psychiatric
Rehabilitation Program Manual, Sec. 13, pg. 233-235 (May 4,
2017). (Accessed Oct. 2017).
Source: MO HealthNet, Physician Manual, Telehealth Services, p.
276 (May 4, 2017). (Accessed Oct. 2017).
Source (Pharmacologic management): MO HealthNet, Rural
Health Clinic, p. 161 (May 3, 207). (Accessed Oct. 2017).
RHCs must bill with their non-RHC provider number
when they are either the distant or originating site.
Source: MO HealthNet, Rural Health Clinic, p. 161 (May 3, 2017).
(Accessed Oct. 2017).
Comprehensive Substance Treatment and
Rehabilitation (CSTAR):

Medication services may be provided via telehealth.
Source: MO HealthNet, Provider Manual, CSTAR, Section 13, p.
196 (May 4, 2017). (Accessed Oct. 2017).
Anesthesiologist monitoring telemetry in the operating
room is a noncovered service.
Source: MO HealthNet, Physician Manual, p. 202 (May 4, 2017).
(Accessed Oct. 2017).

Store and Forward Reimbursement

Reimbursement for the use of asynchronous store-and-forward technology in the practice of telehealth in the MO HealthNet program shall be allowed for orthopedics, dermatology, ophthalmology and optometry, in cases of diabetic retinopathy, burn and wound care, dental services which require a diagnosis, and maternal-fetal medicine ultrasounds. Payment cannot exceed the

HealthNet will not reimburse for store and forward.

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 201 (Jul. 27, 2017); MO HealthNet, Physician Manual, Telehealth Services, p. 276 (May 4, 2017). (Accessed Oct. 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

payment for a face-to-face consultation of the same

level.

The department of social services, in consultation with

the departments of mental health, health and senior
services, shall promulgate rules governing the use of
asynchronous store-and-forward technology in the
practice of telehealth in the MO HealthNet program.
Such rules shall include, but not be limited to:
(1) Appropriate standards for the use of asynchronous store-and-forward technology in the practice of telehealth;
(2) Certification of agencies offering asynchronous store-and-forward technology in the practice of telehealth;

(3) Timelines for completion and communication of a consulting provider’s consultation or opinion, or if the consulting provider is unable to render an opinion, timelines for communicating a request for additional information or that the consulting provider declines to render an opinion;

(4) Length of time digital files of such asynchronous store-and-forward services are to be maintained;

(5) Security and privacy of such digital files;

(6) Participant consent for asynchronous store-and-forward services; and
(7) Payment for services by providers; except that, consulting providers who decline to render an opinion shall not receive payment under this section unless and until an opinion is rendered.

Source: MO Revised Statute Sec. 208.670-671 (2016 SB 579).

Remote Patient Monitoring Reimbursement

Subject to appropriations, the Department is required to establish a statewide program that permits reimbursement for home telemonitoring services under MO HealthNet.

Eligible conditions:

Pregnancy

Diabetes

Heart disease

Cancer

Chronic obstructive pulmonary disease

Hypertension

Congestive heart failure

Mental illness or serious emotional disturbance

Asthma

Myocardial infarction; or

Stroke

The beneficiary must also exhibit two or more the

Personal Emergency Response Systems (an electronic device that is programmed to signal a response center once the help button is activated) is available for patients at high risk of being institutionalized.

Source: MO HealthNet, Provider Manual, Developmental Disabilities Waiver Manual, Section 13, p. 23 (Jul. 15, 2016). (Accessed Oct. 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

following risk factors:

Two or more hospitalizations in the prior twelve-
month period;
Frequent or recurrent emergency department
admissions;
A documented history of poor adherence to
ordered medication regimens;
A documented history of falls in the prior six-
month period;
Limited or absent informal support systems;
Living alone or being home alone for extended
periods of time;
A documented history of care access
challenges; or
A documented history of consistently missed
appointments with health care providers
The program must ensure the home health agency or
hospital shares telemonitoring clinical information with
participant’s physician.
If the department finds the program is not cost effective,
they may discontinue the program and stop providing
reimbursement for telemonitoring services.
The department may promulgate rules to implement this
section.
Source: MO Revised Statute Sec. 208.686 (2016 SB 579).
http://www.senate.mo.gov/16info/pdf-bill/tat/SB579.pdf

Email/Phone/FAX

No reference found. No reimbursement for email.
No reimbursement for phone.
No reimbursement for fax.
No reimbursement for a consultation between
healthcare providers.
No reimbursement for services provided via videophone.
Source: MO HealthNet, Physician Manual, Telehealth Services, p.
276 (May 4, 2017). (Accessed Oct. 2017).

Online Prescribing

Prescribing or dispensing drugs without sufficient No reference found.
examination is prohibited.
Source: MO Revised Statutes § 334.100 (2012).
The physician-patient relationship may be established
by a telemedicine encounter, if the standard of care
does not require an in-person encounter, and in
accordance with evidence-based standards of practice
and telemedicine practice guidelines that address the
clinical and technological aspects of telemedicine.
In order to establish a physician-patient relationship

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

through telemedicine:
(1) The technology utilized shall be sufficient to
establish an informed diagnosis as though the
medical interview and physical examination has
been performed in person; and
(2) Prior to providing treatment, including issuing
prescriptions, a physician who uses
telemedicine shall interview the patient, collect
or review relevant medical history, and perform
an examination sufficient for the diagnosis and
treatment of the patient. A questionnaire
completed by the patient, whether via the
internet or telephone, does not constitute an
acceptable medical interview and examination
for the provision of treatment by telehealth.
Source: MO Revised Statute Sec. 191.1145 (2016 SB
579). http://www.senate.mo.gov/16info/pdf-bill/tat/SB579.pdf

No health care provider shall prescribe any drug,
controlled substance or other treatment to a patient
based solely on an evaluation over the telephone unless
there is a previously established and ongoing physician-
patient relationship.
No health care provider shall prescribe based solely on
an internet request or questionnaire.
Source: MO Revised Statute Sec. 334.108 (2016 SB 579).

Consent

Services related to pregnancy Providers must obtain written patient consent before

Telehealth providers are required to obtain patient delivery of telehealth services.
consent. Source: MO Code of State Regulation, Title 13, 70-3.190 (2010),

Source: MO Revised Statutes § 376.1900.1 MO HealthNet, Provider Manual, Behavioral Services, Section 13,
p. 202 (Jul. 27, 2017); MO HealthNet, Physician Manual, Telehealth
Collaborative Care Arrangement Services, p. 278 (May 4, 2017) & MO HealthNet, Rural Health
Clinic, p. 161 (May 3, 2017), (Accessed Oct. 2017).
Telehealth providers are required to obtain patient

consent and document consent in patient’s record.
Source: MO Code of State Regulation. Title 20, 2150-2.240.
Telehealth providers using asynchronous store-and-
forward technology shall be required to obtain
participant consent before asynchronous store-and-
forward services are initiated and to ensure
confidentiality of medical information.
Source: MO Revised Statute Sec. 208.671 (2016 SB 579).
If an originating site is a school, a parent or guardian
must give permission for telehealth services.
Advanced Practice Registered Nurses who provides
nursing services under a collaborative practice
arrangement must obtain informed consent.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: MO Code of State Rules Sec. 20, 2150-5.100 & MO

Revised Statute Sec. 335.175.

Location

A telehealth eligible originating site for MO HealthNet is one of the following:

(1) An office of a physician or health care provider;
(2) A hospital;
(3) A critical access hospital;
(4) A rural health clinic;
(5) A federally qualified health center;
(6) A long-term care facility licensed under chapter 198;
(7) A dialysis center;

(8) A Missouri state habilitation center or regional office;
(9) A community mental health center;
(10)A Missouri state mental health facility;
(11)A Missouri state facility;
(12)A Missouri residential treatment facility licensed by and under contract with the children’s division. Facilities shall have multiple campuses and have the ability to adhere to technology requirements. Only Missouri licensed psychiatrists, licensed psychologists, or provisionally licensed psychologists, and advanced practice registered nurses who are MO HealthNet providers shall be consulting providers at these locations;

(13)A comprehensive substance treatment and rehabilitation (CSTAR) program;
(14)A school;
(15) The MO HealthNet recipient’s home;
(16)A clinical designated area in a pharmacy; or
(17)A child assessment center as described in section 210.001.

Source: MO Revised Statute Sec. 191.1145 (2016 SB 579).

Originating sites must be one of the following:

Physician or other health care provider office; Hospital;

Critical Access Hospital;

Rural Health Clinic;

Federally Qualified Health Center;

Missouri state habilitation center or regional office;

Community mental health center;

Missouri state mental health facility;

Missouri state facility;

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 202 (Jul. 27, 2017). (Accessed Oct. 2017).

Source: MO HealthNet, Physician Manual, Telehealth Services, p.
276 (May 4, 2017). (Accessed Oct. 2017).

RHCs may act as a distant site provider but must bill with their non-RHC provider number, the originating site must be an RHC or FQHC.

Source: MO HealthNet, Rural Health Clinic, p. 161 (May 3, 2017).
(Accessed Oct. 2017).

Cross-State Licensing

Health care providers must be fully licensed to practice in Missouri by their respective professional boards.

Exception for the following:

Informational consultation performed by licensed out of state providers, outside the context of a contractual relationship and on an irregular or frequent basis without the expectation or exchange of direct or indirect compensation;

Furnishing health care services by a health care provider licensed and located in another state in case of an emergency or disaster, provided that

Payment cannot be made to entities outside of the US, and US territories.

Source: MO HealthNet, Physician Manual, Telehealth Services, p.

276 (May 4, 2017). (Accessed Oct. 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

no charge is made for the medical assistance;
Episodic consultation by a provider licensed and
located in another state who provides such
consultation services on request to a physician
in Missouri.
Source: MO Revised Statute Sec. 191.1145 (2016 SB 579).

Private Payers

Payers are required to provide coverage for services No reference found.
through telehealth, if the same service could have been
provided through face to face diagnosis, consultation or
treatment.
Source: MO Revised Statutes § 376.1900.1

Site/Transmission Fee

Services related to pregnancy Originating sites are eligible to receive a facility fee;
Payers are not required to reimburse telehealth distant sites are not eligible. The cost of an optional
providers for site origination fees or costs for the telepresenter is included in the facility fee.
provision of telehealth. Source: MO Code of State Regulations, Title 13, 70 3.190 (May 31,

Source: MO Revised Statutes § 376.1900.1 2011), MO HealthNet, Provider Manual, Behavioral Services,
Missouri Consolidated Health Care Plan (State Section 13, p. 202 (Jul. 27, 2017). (Accessed Oct. 2017).
Source: MO HealthNet, Physician Manual, Telehealth Services, p.
employees and retirees health plan)
277 (May 4, 2017). (Accessed Oct. 2017).
Telehealth site origination fees or costs for the provision
of telehealth services are not covered.
Source: MO Consolidated State Reg. 22:10-3.060.

Miscellaneous

The legislation establishes the “Telehealth Services Advisory Committee” to advise the department of social services and propose rules regarding the coverage of telehealth services in MO HealthNet program utilizing store-and-forward technology.

Source: MO Revised Statute Sec. 208.673 (2016 SB 579).

Special documentation requirements apply.

A telehealth service must be performed on a private dedicated telecommunications line approved through the Missouri Telehealth Network (MTN).

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 202 (Jul. 27, 2017) & Physician Services, Section 13, p. 278 (May 4, 2017) & MO HealthNet, Rural Health Clinic, p. 161 (May 3, 2017). (Accessed Oct. 2017).

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