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                                                                                 Center for Connected Health Policy

           Louisiana


           Medicaid Program:  Louisiana Medicaid

           Program Administrator:  LA Dept. of Health and Hospitals

           Regional Telehealth Resource Center:
           TexLa Telehealth Resource Center
                 th
           3601 4  Street, Ste. 2B440
           Lubbock, TX 79430
           (806) 743-4440
           http://www.texlatrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telemedicine is the practice of health care delivery,   “Telemedicine is the use of medical information
            diagnosis, consultation, treatment, and transfer of   exchanges from one site to another via electronic
            medical data using interactive telecommunication   communications to improve a recipient’s health.
            technology that enables a health care practitioner and a  Electronic communication means the use of interactive
            patient at two locations separated by distance to interact  telecommunications equipment that includes, at a
            via two-way video and audio transmissions          minimum, audio and video equipment permitting two-
            simultaneously. Neither a telephone conversation nor an  way, real time interactive communication between the
            electronic mail message between a health care      patient at the originating site, and the physician or
            practitioner and patient, or a true consultation as may be  practitioner at the distant site.”
            defined by rules promulgated by the board pursuant to
            the Administrative Procedure Act, constitutes      Source: LA Dept. of Health and Hospitals, Professional Svcs.
            telemedicine.”                                     Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.
                                                               156 (As revised on Aug. 21, 2014).
            Source: LA Revised Statutes 37:1262 (2012).

            Telehealth means a mode of delivering healthcare
            services that utilizes information and communication
            technologies to enable the diagnosis, consultation,
            treatment, education, care management and self-
            management of patients at a distance from healthcare
            providers.  Telehealth allows services to be accessed
            when providers are in a distant site and patients are in
            the originating site.  Telehealth facilitates patient self-
            management and caregiver support for patients and
            includes synchronous interactions and asynchronous
            store and forward transfers.

            Source: LA Revised Statutes HB 1280 (2014) & Title 40 Sec.
            1300.383.

            Live Video Reimbursement
            Louisiana law requires reimbursement to the originating  Louisiana Medicaid reimburses for “services provided
            site physician for a live video consultation if he/she is   via an interactive audio and video telecommunications
            physically present during the exam and interacts with   system.”
            the distant-site physician. (See “Private Payers” section
            below)                                             Source: LA Register, Volume 31, 2032 (2012).

                                                               Louisiana Medicaid only reimburses the distant site
            Source: LA Revised Statutes 22:1821 (2012).        provider.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                               Source: LA Dept. of Health and Hospitals, Professional Svcs.
                                                               Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.
                                                               156 (As revised on Aug. 21, 2014).
            Store and Forward Reimbursement
            There is no reimbursement requirement based upon the  Louisiana Medicaid will not provide reimbursement for
            definition of “telemedicine” which describes telemedicine  store and forward based upon the definition of
            as an interaction “via two-way video and audio     “telemedicine” which describes telemedicine as
            transmission”.                                     including “audio and video equipment permitting two-
                                                               way, real time interactive communication” therefore
            Source: LA Revised Statutes 37:1262 (2012).        excluding store and forward.

                                                               Source: LA Dept. of Health and Hospitals, Professional Svcs.
                                                               Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.
                                                               156 (As revised on Aug. 21, 2014).
            Remote Patient Monitoring Reimbursement

            No reference found.                                Under the Community Choices Waiver, Louisiana
                                                               Medicaid will reimburse an installation fee and a monthly
                                                               maintenance fee for:
                                                                   •   TeleCare Activity and Sensor Monitoring,
                                                                   •   Health status monitoring, and
                                                                   •   Medication and monitoring.

                                                               Activity and Sensor Monitoring
                                                               At a minimum the system must:
                                                                   •   Monitor the home’s points of egress and
                                                                       entrance;
                                                                   •   Detect falls;
                                                                   •   Detect movement or lack of movement;
                                                                   •   Detect whether doors are opened or closed; and
                                                                   •   Provide a push button emergency alert system.

                                                               Providers of assistive devices and medical equipment
                                                               must be a licensed home health agency.

                                                               Certain standards apply for the medical equipment and
                                                               supplies used.

                                                               Limitations
                                                                   •   Services must be pre-approved
                                                                   •   Services must be based on verified need.
                                                                   •   Benefit must be determined by an independent
                                                                       assessment on any item that costs over $500.
                                                                   •   All items must reduce reliance on other
                                                                       Medicaid state plan or waiver services
                                                                   •   All items must meet applicable standards of
                                                                       manufacture, design and installation
                                                                   •   The items must be on the Plan of Care
                                                                       developed by the support coordinator.

                                                               A recipient is not able to receive Telecare Activity and
                                                               Sensor Monitoring services and traditional PERS
                                                               services.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                               Where applicable, recipients must use Medicaid State
                                                               Plan, Medicare or other available payers first.

                                                               Source: LA Dept. of Health and Hospitals, Community Choices
                                                               Waiver Provider Manual, Chapter Seven of the Medicaid Svcs.
                                                               Manual, p. 39-43 (as revised on Nov. 14, 2014).
            Email/Phone/FAX
            No reimbursement for email.                        No reference found.
            No reimbursement for telephone.
            No reference found for FAX.

            Source: LA Revised Statutes 37:1262 (2012).
            Online Prescribing

            Only physicians certificated by a specialty board of the   Greater New Orleans Community Health Connection
            American Board of Medical Specialties or the American   Provider Manual
            Osteopathic Association shall use telemedicine to   The use of a telemedicine communications system may
            prescribe amphetamines or narcotics.               substitute for a face-to-face, "hands on" encounter for
                                                               consultation, office visits, individual psychotherapy and
                                                               pharmacologic management.
            Telemedicine, including the issuance of any prescription
            via electronic means, shall be held to the same    Source: LA Dept. of Health and Hospitals, Greater New Orleans
            prevailing and usually accepted standards of medical   Community Health Connection Provider Manual, Chapter Forty-
            practice as those in traditional, face-to-face settings.   seven of the Medicaid Svcs. Manual, p. 43 (as revised Oct. 1,
                                                               2014).

            An online, electronic or written mail message, or a
            telephonic evaluation by questionnaire or otherwise,
            does not satisfy the standards of appropriate care.

            Source (amphetamines and narcotics): LA Admin. Code
            46:XLV.7513 (2012).

            Source (prevailing standards): LA Admin. Code 46:XLV.7505
            (2012).

            No physician practicing telemedicine can prescribe a
            controlled dangerous substance prior to conducting an
            appropriate in-person patient history or physical
            examination of the patient.

            Source: LA Revised Statutes Sec. 1300.381 & HB 1280 (2014).
            Consent

            Physicians must inform telemedicine patients of the   No reference found.
            relationship between the physician and patient, and the
            role of any other health care provider with respect to
            management of the patient.  The patient may decline to
            receive telemedicine services and withdraw from such
            care at any time.

            Source: LA Admin. Code 46:XLV.7511 (2012).
            Location
            No reference found.                                No reference found.



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Cross-State Licensing
            A telemedicine license may be issued to out-of-state   No reference found.
            physicians, as long as they hold a full and unrestricted
            license in another state or U.S. territory.

            Out-of-state telemedicine providers cannot open an
            office, meet with patients or receive calls from patients
            within Louisiana.

            A licensed health care provider must be in the
            examination room with the patient during telemedicine
            services.

            Source: LA Revised Statutes 37:1276.1 (2012).

            LA state agencies and professional boards can regulate
            the use of telehealth including licensing of out-of-state
            healthcare providers.

            Source: LA Revised Statutes Sec. 1300.381 & HB 1280 (2014).
            Private Payers
            Reimbursement must be made to the originating site   No reference found.
            physician if he/she is physically present during the exam
            and interact with the distant-site physician.

            Originating-site physician fees shall be at least 75
            percent of the normal fee for an intermediate office visit.

            No reference found for distant-site physician
            reimbursement.

            Source: LA Revised Statutes 22:1821 (2012).
            Site/Transmission Fee

            No reference found.                                No reference found.
            Miscellaneous
            Louisiana law requires that a physician who uses
            telemedicine establish a proper physician-patient
            relationship.

            Physicians must:

               •   Verify the identity of the patient;
               •   Conduct an appropriate exam;
               •   Establish a proper diagnosis;
               •   Establish a treatment plan;
               •   Create a written plan for follow up care.

            Source: LA Admin. Code 46:XLV.7509 (2012).

                         Comments:
                                    Louisiana recently passed specific standards for its telemedicine physicians.


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                                                                                 Center for Connected Health Policy

                                    Source: LA Statute Sec. 1300.381 & House Bill 1280 (2014).

                                    Louisiana has created a Task Force on Telehealth access to advise the legislature and
                                    the Department of Health and Hospitals on policies and practices that expand access to
                                    telehealth services.

                                    Source: LA House Concurrent Resolution 88 (2014).










































































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