Mississippi State Telehealth Laws and Reimbursement Policies

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Connected Health Policy 2019: http://cchpca.org

Mississippi Medicaid

Mississippi
Medicaid Program: Mississippi Medicaid

Program Administrator: Mississippi Division of Medicaid

Regional Telehealth Resource Center:

South Central Telehealth Resource Center
4301 W. Markham St. #519

Little Rock, AR 72205
(855) 664-3450
learntelehealth.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine is the practice of medicine using The Division of Medicaid defines telemedicine as a

electronic communication, information technology or method which uses electronic information and
other means between a physician in one location and a communication equipment to supply and support health
patient in another location with or without an intervening care when remoteness disconnects patients and links
health care provider. This definition does not include the primary care physicians, specialists, providers, and
practice of medicine through postal or courier services.” beneficiaries which includes, but is not limited to,
telehealth services, remote patient monitoring services,
Source: Code of MS Rules 50-013-2635 & Title 20, Part 2. teleradiology services, store-and-forward and
Telemedicine means the delivery of health care services continuous glucose monitoring services.
such as diagnosis, consultation, or treatment through The Division of Medicaid defines telehealth services as
the use of interactive audio, video or other electronic
the delivery of health care by an enrolled Medicaid
media. Telemedicine must be “real-time” consultation,
provider, through a real-time communication method, to
and it does not include the use of audio-only telephone,
a beneficiary who is located at a different site. The
e-mail or facsimile.
interaction must be live, interactive, and audiovisual.

Source: MS Code Sec. 83-9-351. Source: Code of MS Rules 23-225, Rule. 1.1 (Accessed Oct. 2017).

Telehealth service is defined as the practice of health
care delivery by a provider to a beneficiary who is under
the care of a provider at a different geographical
location.
Source: State of Mississippi. State Plan Under Title XIX of the
Social Security Act. Medical Assistance Program. Attachment
3.1-A. 3/31/15. (Accessed Oct. 2017).

Live Video Reimbursement

Mississippi Medicaid and private payers are required to Medicaid covers medically necessary health services
provide coverage for live video consultations. via telehealth when coverage is provided in person and
Source: MS Code Sec. 83-9-351. is live, interactive and audiovisual.

(also see Medicaid column) Source: State of Mississippi. State Plan Under Title XIX of the
Social Security Act. Medical Assistance Program. Attachment
3.1A. 3/31/15. (Accessed Oct. 2017).
There is live video reimbursement for Medicaid mental
health medication evaluation and management.
Source: Code of MS Rules 23-206, Rule. 1.9, pg. 28.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Any enrolled Medicaid provider may provide telehealth
services at the originating site. The following enrolled
Medicaid providers may provide telehealth services at
the distant site:
Physicians,
Physician assistants,
Nurse practitioners,
Psychologists, and
Licensed Clinical Social Workers (LCSW)
Licensed Professional Counselors (LPCs).
Source: Code of MS Rules 23-225, Rule. 1.2(C). (2016).
Real time telehealth may be used for the following
monitoring services:
Assessing the need for psychotropic
medication,
Prescribing medication, and
Regular periodic monitoring of the medications
prescribed for therapeutic effect and medical
safety.
Medication evaluation
Medication management
Source: Section 43-13-117 (16) of the Mississippi Code of 1972,
as amended; Section 43-13-121 of the Mississippi Code of 1972,
as amended.

Store and Forward Reimbursement

Private payers, MS Medicaid and employee benefit Telehealth services must be live, interactive and
plans are required to provide coverage at the same level audiovisual.
as in-person consultation for store-and-forward
telemedicine services. Source: State of Mississippi. State Plan Under Title XIX of the
Social Security Act. Medical Assistance Program. Attachment
A health insurance or employee benefit plan can limit 3.1-A. 3/31/15. (Accessed Oct. 2017).

coverage to health care providers in a telemedicine There is reimbursement for tele-radiology services,
network approved by the plan.
however there is no reference to reimbursing for other

Patients receiving medical care through store and specialties.

forward must be notified of their right to receive Source: Mississippi Division of Medicaid. Radiology Services
interactive communication with the distant site provider. Provider Reference Guide, pg. 4-5. March 2013. (Accessed Oct.
Telemedicine networks unable to offer this will not be 2017).
reimbursed for store and forward telemedicine services. MS Medicaid is required to cover store and forward

Source: MS Code Sec. 83-9-353. services to the same level as in-person services.

Source: MS Code Sec. 83-9-353. (Accessed Oct. 2017).

Remote Patient Monitoring Reimbursement

Private payers, MS Medicaid and employee benefit MS Medicaid is required to cover remote patient

plans are required to provide coverage for remote monitoring services. (see State law/regulation column)
patient monitoring services for Mississippi-based
telehealth programs affiliated with a Mississippi health Source: MS Code Sec. 83-9-353. (Accessed Oct. 2017).
care facility. The Division of Medicaid covers remote patient

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STATE LAW/REGULATIONS MEDICAID PROGRAM

A onetime telehealth installation/training fee is also monitoring of devices when medically necessary,
reimbursed. ordered by a physician, physician assistant or nurse
A health insurance or employee benefit plan can limit practitioner which includes, but not limited to:

coverage to health care providers in a telemedicine Implantable pacemakers,
network approved by the plan. Defibrillators,
To qualify for reimbursement patients must meet all of Cardiac monitors,
Loop recorders, and
the following criteria: External mobile cardiovascular telemetry.
Be diagnosed in the last 18 months with one
or more chronic condition, as defined by CMS. The Division of Medicaid covers remote patient
Have a recent history of costly services; and monitoring, for disease management when medically
The patient’s healthcare provider recommends necessary, prior authorized by the Utilization
disease management services via remote Management/Quality Improvement Organization
patient monitoring. (UM/QIO), Division of Medicaid or designee, ordered by
Remote patient monitoring prior authorization request a physician, physician assistant, or nurse practitioner for
a beneficiary who meets the following criteria:
form must be submitted to request telemonitoring
services. Has been diagnosed with one (1) or more of the
The law lists specific technology requirements. following chronic conditions of diabetes,
congestive heart failure (CHF), or chronic
Source: MS Code Sec. 83-9-353. obstructive pulmonary disease (COPD);
Has had two (2) or more hospitalizations in the
previous twelve (12) months for one (1) of the
chronic conditions listed above;
Hospitalizations for two (2) different chronic
conditions cannot be combined to satisfy the
two (2) or more hospitalizations requirement;
and
Is capable of using the remote patient
monitoring equipment and transmitting the
necessary data or has a willing and able person
to assist in completing electronic transmission
of data.
Remote patient monitoring services must be provided in
the beneficiary’s private residence.
Source: Code of MS Rules 23-225, Rule. 2.3. (Accessed Oct.
2017).
The Division of Medicaid reimburses for remote patient
monitoring:
Of devices when billed with the appropriate
code, and
For disease management:
A daily monitoring rate for days the
beneficiary’s information is reviewed.
Only one (1) unit per day is allowed, not to
exceed thirty-one (31) days per month.
An initial visit to install the equipment and
train the beneficiary may be billed as a set-up
visit. Only one set-up is allowed per episode
even if monitoring parameters are added after
the initial set-up and installation.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Only one (1) daily rate will be reimbursed

regardless of the number of diseases/chronic
conditions being monitored.
Source: Code of MS Rules 23-225, Rule. 2.5. (Accessed Oct.
2017).

Email/Phone/FAX

No Email No reimbursement for email.
No Phone No reimbursement for telephone.
No Fax No reimbursement for facsimile.
Source: MS Code Sec. 83-9-351. Source: Code of MS Rules 23-225, Rule. 1.4(C). (Accessed Oct.
2017).
Not considered telehealth:
Telephone conversations;
Chart reviews;
Electronic mail messages;
Facsimile transmission;
Internet services for online medical evaluations; or
The installation or maintenance of any
telecommunication devices or systems.
Source: State of Mississippi. State Plan Under Title XIX of the
Social Security Act. Medical Assistance Program. Attachment
3.1-A. 3/31/15. (Accessed Oct. 2017).
Home and Community-Based Services & Hospice
Services

MS Medicaid does not cover telephone consults.
Source: Mississippi Medicaid Provider Reference Guide, Home
and Community-Based Services, Mar. 2013, pg. 1; Hospice
Services, May 2016, pg. 4. (Accessed. Oct. 2017).

Online Prescribing

A prescription for a controlled substance based solely on a consumer’s completion of an online medical questionnaire is not a valid prescription.

Source: MS Code Annotated Sec. 41-29-137 (2012).

A health care practitioner may prescribe medication after an appropriate examination through the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.

Source: MS Code Sec. 83-9-351.

To establish the physician patient relationship through telemedicine, it must include:
Verify the identity of the person;

Conduct an appropriate history and physical examination (which can be conducted via telemedicine);

An e-prescribed, telephoned or faxed prescription from the prescriber may be accepted when it is not in conflict with federal and state laws and regulations.

Source: MS. Code Ann.23-214, Rule 1.7 & Mississippi Medicaid Provider Reference Guide, Pharmacy Services, Jul. 2014, pg. 29. (Accessed Oct. 2017).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Establish a diagnosis through the use of

acceptable medical practice;

Discuss with the patient the diagnosis, risks and

benefits of various treatment options to obtain
informed consent;

Insuring the availability of appropriate follow up

care; and
Maintaining a complete medical record available

to patient and other treating health care
providers.

Source: MS Code Sec. 73-25-34. Rule 5.4.

Consent

The physician should obtain the patient’s informed No reference found.
consent before providing care.
Source: Code of MS Rules 50-013-2635 & 73-25-34. Rule 5.3.

Location

No reference found. Medicaid allows any provider to provide telehealth

services at the originating site, however a telepresenter
must be present.
Source: MS Admin Code Title 23, Part 225, Rule 1.2.
An originating site fee is covered in the following
originating sites:
Office of a physician or practitioner;
Outpatient Hospital (including a Critical Access
Hospital (CAH));
Rural Health Clinic (RHC);
Federally Qualified Health Center (FQHC);
Community Mental Health/Private Mental Health
Centers;
Therapeutic Group Homes;
Indian Health Service Clinic; or
School-based clinic.
Source: State of Mississippi. State Plan Under Title XIX of the
Social Security Act. Medical Assistance Program. Attachment
3.1-A. 3/31/15. (Accessed Oct. 2017) & MS Admin Code Title 23,
Part 225, Rule 1.2.

Cross-State Licensing

Physicians practicing telemedicine must have a No reference found.
Mississippi medical license.

However, a valid Mississippi license is not required

where the evaluation, treatment and/or medicine given
by a physician outside of Mississippi is requested by a
physician duly licensed to practice medicine in
Mississippi, and the physician who has requested such
evaluation, treatment and/or medical opinion has
already established a doctor/patient relationship with the

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

patient to be evaluated and/or treated.

In order to practice telemedicine a valid “physician

patient relationship” must be established. The elements
of this valid relationship are:

1. verify that the person requesting the medical treatment is in fact who they claim to be;

2. conducting an appropriate examination of the patient that meets the applicable standard of care;
3. establishing a diagnosis through the use of accepted medical practices, i.e., a patient history, mental status exam, physical exam and appropriate diagnostic and laboratory testing;
4. discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent;

5. insuring the availability of appropriate follow-up care; and
6. Maintaining a complete medical record available to patient and other treating health care providers.

Source: Code of MS Rules 50-013-2635 & Title 20, Part 2.

Mississippi adopted the Federation of State Medical

Board (FSMB)’s model language for an interstate
medical licensure compact.

Source: MS Code Sec. 73-25-101. (2016).

Private Payers

Health insurance plans must provide coverage for No reference found.
telemedicine services to the same extent as in-person
consultations.
Source: MS Code Sec. 83-9-351.
Health insurance plans are also required to provide
coverage for store-and-forward and remote patient
monitoring services, in accordance with certain
requirements (see above store and forward & remote
patient monitoring sections).
Source: MS Source: MS Code Sec. 83-9-353.

Site/Transmission Fee

The originating site is eligible to receive a facility fee.

Source: MS Code Sec. 83-9-351

Source: MS Code Sec. 83-9-353.

RHCs acting as the originating site may receive an additional fee per completed transmission.

The Division of Medicaid reimburses the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission.

The following enrolled Medicaid providers are eligible to receive the originating site facility fee for telehealth

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: MS Code Sec. 23-000-212. services per transmission:
Office of a physician or practitioner,
Outpatient hospital, including a Critical Access
Hospital (CAH),
Rural Health Clinic (RHC),
Federally Qualified Health Center (FQHC),
Community Mental Health/Private Mental Health
Center,
Therapeutic Group Home,
Indian Health Service Clinic, and
School-based clinic.
The telepresenter must be one of the following and
physically present at all times for the originating site to
receive the originating site facility fee:
Physician,
Physician assistants,
Nurse practitioners,
Psychologists, and
Licensed clinical social workers (LCSW)
Licensed Professional Counselor.
Source: Code of MS Rules 23-225, Rule. 1.5(B). (Accessed Oct.
2017).
Facility fee provided.
Source: State of Mississippi. State Plan Under Title XIX of the
Social Security Act. Medical Assistance Program. Attachment
4.19-B. 3/31/15. (Accessed Oct. 2017).

Miscellaneous

To practice telemedicine, physicians must establish a
valid physician-patient relationship by the following:

Verifying the identity of the patient;

Conducting an appropriate exam that meets the

applicable standard of care. This exam need not
be in person if the technology is sufficient to
provide the same information to the physician as
if the exam had been performed face to face;

Establishing a diagnosis;

Discussing with the patient the diagnosis, and

the risks and benefits of various treatment
options, to obtain informed consent;

Insuring the availability of appropriate follow-up

care;

Maintaining a complete medical record.

Source: Code of MS Rules 50-013-2635 (2012).

A health insurance plan may limit coverage to health

care providers in a telemedicine network approved by
the plan.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: MS Code Sec. 83-9-351.

Comments:

Professional Board Telehealth-Specific Regulations

Board of Medical Licensure (Part 2635)

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