Montana 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

Montana Medicaid

Montana
Medicaid Program: Montana M edicaid

Program Administrator: MT Dept. of Public Health and Human Services

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center
101 Wasatch Drive

Salt Lake City, UT 84112
(833) 747-0643
www.nrtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telemedicine means the use of interactive audio, video, or other telecommunications technology that is:
Used by a health care provider or health care facility to deliver health care services at a site other than the site where the patient is located; and

Delivered over a secure connection that complies with the requirements of HIPPA.

The term includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real time or through the use of store-and-forward technology.

The term does not include the use of audio-only telephone, e-mail, or facsimile transmissions.

Source: MT Code Sec. 33-22-138.

Telemedicine means the practice of medicine using interactive electronic communication information technology, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine typically involves the application of secure videoconferencing or store-and- forward technology, as defined in 33-22-138. The term does not mean an audio-only telephone conversation, an e-mail or instant messaging conversation, or a message sent by facsimile transmission.

Source: MT Code Sec. 37-3-102.

Telemedicine is the use of interactive audio -video equipment to link practitioners and patients located at different sites.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers (Sept. 2017). (Accessed Oct. 2017).

Healthy Montana Kids

Telemedicine is “the use of a secure interactive audio and video, or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located. Does not include audio only (phone call), e-mail, and/or facsimile transmission.”

Source: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Eff. Oct. 14, 2017), p. 11. (Accessed Oct. 2017).

Live Video Reimbursement

Private payers are required to provide coverage for services delivered through live video, equivalent to in-person coverage.

MT Medicaid reimburses for medically necessary telemedicine services to eligible members. Providers must be enrolled in Medicaid.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Eligible providers under this law include: Members should establish relationships with primary
Physicians care providers who are available on a face-to-face basis.
Registered professional nurse The originating and distant providers may not be within
Advanced practice registered nurse
the same facility or community. The same provider may
Genetic counselor certified by the American
not be the pay to for both the originating and distance
board of genetic counseling
provider.
Diabetes educator certified by the national Source: MT Dept. of Public Health and Human Svcs., Medicaid
certification board for diabetes
Dentists & Dental Hygienists (Effective Jan. 1, and Medical Assistance Programs Manual, General Information
for Providers, Sec. 5.1 (Sept. 2017).
2018) The requesting provider need not be enrolled in

Eligible facilities under this law include: Medicaid nor be present during the telemedicine consult.
Critical access hospital Source: MT Dept. of Public Health and Human Svcs., Medicaid
Hospice
and Medical Assistance Programs Manual, Physician Related
Hospital Svcs., (Sept. 2017). (Accessed Oct. 2017).
Long-term care facility Healthy Montana Kids
Mental health center Services provided by telemedicine are allowed.
Outpatient center for primary care Source: MT Children’s health Insurance Plan, Healthy Montana
Outpatient center for surgical services
Kids (HMK). Evidence of Coverage (Eff. Oct. 14, 2017), p. 29.
Source: MT Code Sec. 33-22-138. (Accessed Oct. 2017).
Telehealth services are available for Speech Therapy.

Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, Therapies Manual, p
2.6 (Aug. 2017). (Accessed Oct. 2017).

Store and Forward Reimbursement

Private payers are required to provide coverage for No reference found.

services delivered through store and forward
technology, equivalent to in-person coverage.
Eligible providers under this law include:
Physicians
Registered professional nurse
Advanced practice registered nurse
Genetic counselor certified by the American
board of genetic counseling
Diabetes educator certified by the national
certification board for diabetes
Eligible facilities under this law include:
Critical access hospital
Hospice
Hospital
Long-term care facility
Mental health center
Outpatient center for primary care

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Outpatient center for surgical services

Source: MT Code Sec. 33-22-138.

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX

No Email

No Phone
No Fax

Source: MT Code Sec. 33-22-138.

Telemedicine reimbursement does not include:

Consultation by telephone

Facsimile machine transmissions

Crisis hotlines

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Sec. 5.1 (Sept. 2017).

No reimbursement for telephone services in home.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Audiology Svcs., p 11 (Sept. 2017); Rural Health Clinics & Federally Qualified Health Center, p. 13 (Sept. 2017); Physical Therapy, Occupational Therapy and Speech Therapy, (Aug. 2017), p. 10;

Hospital Outpatient Services, (Jan. 2016), p. 11; Hospital Inpatient Services, (Jan. 2016), p. 20. (Accessed Oct. 2017).

Online Prescribing

No reference found. No reference found.

Consent

No reference found. No reference found.

Location

No reference found. Telemedicine can be provided in member’s residence;
the distance provider is responsible for the
confidentiality requirements. No originating provider
reimbursement in this case.
The originating and distant providers may not be within
the same facility or community.
Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, General Information
for Providers, Sec. 5.1 (Sept. 2017).
The place of service is considered to be the location of
the provider providing the telemedicine service.
Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, Physician Related
Svcs., p 5.13 (Nov. 2016). (Accessed Oct. 2017).
Effective Jan. 1, 2017 the new place of service code is
“02”.
Source: MT Dept. of Public Health and Human Svcs., Program
Notice. Feb. 7, 2017.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Cross-State Licensing

Montana adopted the Federation of State Medical Board Providers must be licensed in the state of Montana.
(FSMB)’s model language for an interstate medical
licensure compact. Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, General Information
Source: MT House Bill 429. for Providers, Sec. 5.1 (Sept. 2017).

Private Payers

Private payers are required to provide coverage for No reference found.
services delivered through telemedicine, equivalent to
in-person coverage.
Source: MT Code Sec. 33-22-138.

Site/Transmission Fee

No reference found. The following provider types can bill the originating site
fee:
Outpatient hospital
Critical access hospital
Federally qualified health center
Rural health center
Indian health service
Physician
Psychiatrist
Mid-levels
Dieticians
Psychologists
Licensed clinical social worker
Licensed professional counselor
Mental health center
Chemical dependency clinic
Group/clinic
Public health clinic
Family planning clinic
Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, General Information
for Providers, Sec. 5.1 (Sept. 2017).
No reimbursement for network use charges.
Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, Physician Related
Svcs., pg. 21 (Nov. 2016). (Accessed Oct. 2017).
FQHCs and RHCs can bill a telehealth originating site
code if applicable.
Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, Rural Health Clinics &
Federally Qualified Health Center, p. 5.1 (Sept. 2017). (Accessed
Oct. 2017).

Miscellaneous

Confidentially requirements apply (see manual).

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: MT Dept. of Public Health and Human Svcs., Medicaid
and Medical Assistance Programs Manual, General Information
for Providers, Sec. 5.2 (Sept. 2017).

Comments:

Professional Board Telehealth-Specific Regulations

MT Board of Speech-Language Pathology (MT Admin Rules, Sec. 24.222.9)

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