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                                                                                 Center for Connected Health Policy

           Indiana


           Medicaid Program:  Indiana Medicaid

           Program Administrator:  Indiana Family and Social Services Administration

           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 services refer to a specific method of   No reference found.
            delivery of certain services, including medical exams
            and consultations, which are already reimbursed by
            Medicaid.  Telemedicine uses videoconferencing
            equipment allowing a medical provider to render an
            exam or other service to a patient at a distant
            location.”

            Source: IN Admin. Code, Title 405, 5-38-1 (2012).

            “Telehealth services means the use of
            telecommunications and information technology to
            provide access to health assessment, diagnosis,
            intervention, consultation, supervision and information
            across a distance.”

            “Telemedicine services means a specific method of
            delivery of services, including medical exams and
            consultations and behavioral health evaluations and
            treatment, including those for substance abuse, using
            videoconferencing equipment to allow a provider to
            render an examination or other service to a patient at
            a distant location.  The term does not include the use
            of the following: (1) a telephone transmitter for
            transtelephonic monitoring. (2) a telephone or any
            other means of communication for the consultation
            from one (1)) provider to another provider.”

            Source: IN Code, 12-15-5-11.
            Live Video Reimbursement














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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                             MEDICAID PROGRAM

            (see Medicaid column)                             Indiana Code requires reimbursement for video
                                                              conferencing for FQHC, Rural Health Clinic, Community
                                                              Mental Health Centers, and Critical Access Hospital
                                                              providers.

                                                              Source: IN Code, 12-15-5-11.

                                                              Indiana Medicaid will reimburse for live video, as long as
                                                              certain conditions are met.

                                                              The hub site provider must determine if it is medically
                                                              necessary for a medical professional to be at the spoke
                                                              site.

                                                              For a medical professional to receive reimbursement for
                                                              professional services in addition to payment for spoke
                                                              services, medical necessity must be documented. If it is
                                                              medically necessary for a medical professional to be with
                                                              the member at the spoke site, the spoke site is permitted
                                                              to bill an evaluation and management code in addition to
                                                              the fee for spoke services.  There must be documentation
                                                              in the patient's medical record to support the need for the
                                                              provider's presence at the spoke site.  The documentation
                                                              is subject to post-payment review.

                                                              Source (authorization): IN Admin. Code, Title 405, 5-38-1 (2012).

                                                              Source (hub-spoke provider reimbursement): IN Admin. Code, Title
                                                              405, 5-38-4 (2012) & IN Health Coverage Programs Provider Manual,
                                                              Chapter 8, Billing Instructions, p. 139 (Jun. 5, 2014).
                                                              http://provider.indianamedicaid.com/ihcp/manuals/chapter08.pdf

                                                              Reimbursement for the following:

                                                              Consultations
                                                              Office or other outpatient visit
                                                              Individual psychotherapy
                                                              Psychiatric diagnostic interview
                                                              Pharmacologic management
                                                              End-stage renal disease (ESRD) services

                                                              Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p. 140 (Jun. 5, 2014).

                                                              No reimbursement for the following:

                                                                 •   Ambulatory surgical centers;
                                                                 •   Outpatient surgical services;
                                                                 •   Home health agencies or services;
                                                                 •   Radiological services;
                                                                 •   Laboratory services;
                                                                 •   Long-term care facilities, including nursing
                                                                     facilities, intermediate care facilities, or community
                                                                     residential facilities for the developmentally
                                                                     disabled;
                                                                 •   Anesthesia services or nurse anesthetist services;
                                                                 •   Audiological services;

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                             MEDICAID PROGRAM

                                                                 •   Chiropractic services;
                                                                 •   Care coordination services;
                                                                 •   Durable medical equipment, medical supplies,
                                                                     hearing aids, or oxygen;
                                                                 •   Optical or optometric services;
                                                                 •   Podiatric services;
                                                                 •   Services billed by school corporations;
                                                                 •   Physical or speech therapy services;
                                                                 •   Transportation services;
                                                                 •   Services provided under a Medicaid waiver.

                                                              Source: IN Admin. Code, Title 405, 5-38-4 (2012) & IN Health
                                                              Coverage Programs Provider Manual, Chapter 8, Billing
                                                              Instructions, p. 139-40 (Jun. 5, 2014).
            Store and Forward Reimbursement
            (see Medicaid column)                             Indiana Medicaid will not reimburse for store and forward
                                                              services.

                                                              Source: IN Admin. Code, Title 405, 5-38-4 (2012).

                                                              However, there is reimbursement for store and forward
                                                              technology to facilitate other reimbursable services.
                                                              Separate reimbursement of the spoke-site payment is not
                                                              provided for this technology.

                                                              Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p 139, (Jun. 5, 2014).
            Remote Patient Monitoring Reimbursement

            (see Medicaid column)                             Indiana Code requires Medicaid to reimburse providers
                                                              who are licensed as a home health agency for telehealth
                                                              services.

                                                              Source: IN Code, 12-15-5-11.

                                                              Indiana Medicaid will reimburse providers for telehealth
                                                              services provided as home health services.

                                                              Must have one of the following conditions:
                                                                  •   Chronic obstructive pulmonary disease
                                                                  •   Congestive heart failure
                                                                  •   Diabetes

                                                              Must initially have two or more of the following events
                                                              related to one of the conditions listed above within the
                                                              previous twelve months:
                                                                  •   Emergency room visit
                                                                  •   Inpatient hospital stay

                                                              A licensed registered nurse must perform the reading of
                                                              transmitted health information.

                                                              Source: IN Admin Code, Title 405, 5-16-3.1.

                                                              Indiana Medicaid considers telemedicine as “not a


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                             MEDICAID PROGRAM

                                                              telephone transmitter for transtelephonic monitoring.”

                                                              Source: IN Admin. Code, Title 405, 5-38-1 (2012).
            Email/Phone/FAX
            No reference found for email.                     No reference found for email.
            No reimbursement for telephone.                   No reimbursement for telephone.
            No reference found for FAX.                       No reference found for FAX.

            Source: IN Admin. Code, Title 405, 5-38-1 (2012).   Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p. 139 (Jun. 5, 2014).
            Online Prescribing

             A documented patient evaluation, including history   No reference found.
             and physical evaluation adequate to establish
             diagnoses and identify underlying conditions or
             contraindications to the treatment recommended or
             provided, must be obtained prior to issuing e-
             prescriptions.

             Source: IN Admin. Code, Title 844, 5-3-2 (2012).

             Indiana has established a pilot program to provide
             telehealth services to patients in Indiana without the
             establishment of an in person patient-physician
             relationship.  The pilot includes the issuance of
             prescription when medically necessary, with the
             exception of controlled substances.

             Source: IN Code, 25-22.5-14.
            Consent

            No reference found.                               The spoke site must obtain patient consent.  The consent
                                                              must be maintained at the hub and spoke sites.

                                                              Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p. 141 (Jun. 5, 2014).
            Location

            The patient must be physically present at the spoke   Indiana Code requires the amendment of the Medicaid
            site and participate in the visit.                state plan (by Dec. 1, 2013) to eliminate the current twenty
                                                              mile distance restriction.
            Source: IN Admin. Code, Title 405, 5-38-4 (2012).
                                                              Source: IN Code, 12-15-5-11.

                                                              There is reimbursement for telemedicine services only
                                                              when the hub and spoke sites are greater than 20 miles
                                                              apart.

                                                              Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p. 140 (Jun. 5, 2014).

                                                              Reimbursement for telemedicine services is available to
                                                              the following providers regardless of the distance between
                                                              the provider and recipient:
                                                                 •   Federally Qualified Health Centers
                                                                 •   Rural Health Clinics

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                             MEDICAID PROGRAM

                                                                 •   Community mental health centers
                                                                 •   Critical access hospitals

                                                              Source: IN Admin Code, 405 5-38-4.
            Cross-State Licensing

            No reference found.                               No reference found.


            Private Payers
            No reference found.                               No reference found.

            Site/Transmission Fee
            No reference found.                               Spoke sites are reimbursed a facility fee.

                                                              Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p. 141 (Jun. 5, 2014).
            Miscellaneous

                                                              For patients receiving ongoing telemedicine services, a
                                                              physician should perform a traditional clinical evaluation at
                                                              least once a year, unless otherwise stated in policy. The
                                                              hub physician should coordinate with the patient’s primary
                                                              care physician.

                                                              Source: IN Health Coverage Programs Provider Manual, Chapter 8,
                                                              Billing Instructions, p. 141 Jun. 5, 2014).








































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