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                                                                                 Center for Connected Health Policy

           Maryland


           Medicaid Program:  MD Medical Assistance Program

           Program Administrator:  MD Dept. of Social Services

           Regional Telehealth Resource Center
           Mid-Atlantic Telehealth Resource Center
           PO Box. 800711
           Charlottesville, VA 22908-0711
           (434) 906-4960 / (855) MATRC4U
           www.matrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telehealth means the use of telecommunications and    “Telemedicine means the delivery of medically
            information technologies for the exchange of information  necessary services to a participant at an originating site
            from one site to another, for the provision of health care  by a consulting provider, through the use of technology-
            to an individual from a provider through hardwire or   assisted communication.”
            Internet connection.”
                                                               Source: MD Department of Health and Mental Hygiene, Maryland
            Source: MD Health Occupations Annotated Sec. 2-101 (2012).   Medicaid 2014 Telemedicine Provider Manual. September 2014, p.
                                                               8.
            Telemedicine means, as it relates to the delivery of
            health care services, the use of interactive audio, video,
            or other telecommunications or electronic technology:
               1.  By a health care provider to deliver a health
                   care service that is within the scope of practice
                   of the health care provider at a site other than
                   the site at which the patient is located; and
               2.  That enables the patient to see and interact with
                   the health care provider at the time the health
                   care service is provided to the patient.

            Source: Health General Code 15-105.2.

            “Telemedicine means the practice of medicine from a
            distance in which intervention and treatment decisions
            and recommendations are based on clinical data,
            documents, and information transmitted through
            telecommunications systems.”

            Source:  Code of Maryland Admin. Regs. Sec. 10.32.05.02

            “Telemedicine means the delivery of medically
            necessary services to a patient at an originating site by
            a consulting provider, through the use of technology-
            assisted communication.”

            Source:  Code of Maryland Admin. Regs. Sec. 10.09.49.02.
            Live Video Reimbursement
            Maryland law requires private insurers to provide   Reimbursement for telemedicine is required by Maryland
            coverage for telemedicine services (subject to terms and  Medical Assistance if the health care service is
            conditions of contract), which includes live video.     medically necessary and provided:

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   For the treatment of cardiovascular disease or
            (See “Private Payers” section).                            stroke;
                                                                   •   In an emergency department setting; and
            Source: MD Insurance Code Annotated Sec. 15-139 (2012).   •   When an appropriate specialist is not available.

            Maryland law requires the state Medicaid program to
            provide coverage for live video telemedicine services   Source: MD Insurance Code Sec. 15-105.2

            (subject to terms and conditions of contract), the same   The Maryland Medical Assistance Program will
            as it does for private payers.                     reimburse for medically necessary consultation services
                                                               rendered by an approved consulting provider.
            Source: Health General Code 15-105.2.

            The Department shall grant approval to allow originating   Eligible Distant Site Providers:
            and consulting site providers to receive State and     •   Free standing renal dialysis centers
            federal funds for providing telemedicine services if the   •   Federally Qualified Health Centers
            telemedicine provider meets certain requirements.      •   Hospitals, including EDs
                                                                   •   Local health departments
            Telemedicine providers must be part of a private       •   Nursing facilities
            practice, hospital or other health care system.        •   Physicians
                                                                   •   Nurse practitioners
            Must be an agreement between a medical assistance-     •   Nurse midwives
            approved originating site provider and consulting
            provider.                                          Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Medicaid 2013 Telemedicine Provider Manual. September 2013, p.
            Source: Code of Maryland Admin. Regs. Sec. 10.09.49.03-04.   4-6 & Code of Maryland Admin. Regs. Sec. 10.09.49.05-07.
            http://www.dsd.state.md.us/comar/getfile.aspx?file=10.09.49.03.ht  http://www.dsd.state.md.us/comar/getfile.aspx?file=10.09.49.05.ht
                                                               m
            m

            Providers must have a written contingency plan when   Managed Care
            telemedicine is unavailable.                       MCOs shall provide coverage for medically necessary
                                                               telemedicine services.
            Source: Code of Maryland Admin. Regs. Sec. 10.09.49.07.
            http://www.dsd.state.md.us/comar/getfile.aspx?file=10.09.49.07.ht  Source: Code of Maryland Admin. Regs. Sec. 10.09.67.31.
            m                                                  http://www.dsd.state.md.us/comar/getfile.aspx?file=10.09.67.31.ht
                                                               m

                                                               Mental Health
                                                               Maryland Medicaid will reimburse for telemental health
                                                               services.

                                                               A distant site provider must be a psychiatrist with either
                                                               a Medicaid provider number or is a psychiatrist in an
                                                               FQHC or outpatient mental health clinics.  The distant
                                                               site must be in Maryland.

                                                               Eligible services:
                                                                   •   Psychiatric diagnostic interview examination
                                                                   •   Individual psychotherapy
                                                                   •   Pharmacologic management

                                                               Both the distant and originating telemedicine providers
                                                               must submit an application to the Maryland Mental
                                                               Health Administration describing how the originating and
                                                               distant site will comply with relevant regulations.

                                                               The originating site may bill for a “tele-presenter” if it is
                                                               medically necessary.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Value Options, Provider Alert. Telemental Health.  July 12, 2011 p.
                                                               2.
            Store and Forward Reimbursement

            No reimbursement based upon definition of          Maryland Medicaid does not cover store and forward.
            “telemedicine” which describes telemedicine as
            “interactive”.                                     Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Medicaid 2014 Telemedicine Provider Manual. September 2014, p.
            Source: MD Insurance Code Annotated Sec. 15-139 (2012).   6 & Code of Maryland Admin. Regs. Sec. 10.09.49.11.

            The department may provide reimbursement for       Providers of health care services delivered through
            services delivered through store and forward       telemedicine must use video and audio transmission
            technology.                                        with less than a 300 millisecond delay.

            Source: Health General Code 15-105.2.              Source: Code of Maryland Admin. Regs. Sec. 10.09.49.08.
            Remote Patient Monitoring Reimbursement

            The department may provide reimbursement for       No reimbursement for home health monitoring services.
            services delivered through remote patient monitoring
            technology.                                        Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Medicaid 2013 Telemedicine Provider Manual. September 2014, p.
            Source: Health General Code 15-105.2.              6 & Code of Maryland Admin. Regs. Sec. 10.09.49.11.
                                                               http://www.dsd.state.md.us/comar/getfile.aspx?file=10.09.49.11.ht
                                                               m.
            Email/Phone/FAX

            No reimbursement for email.                        No reimbursement for email.
            No reimbursement for telephone.                    No reimbursement for telephone.
            No reimbursement for FAX.                          No reimbursement for FAX.

            Source: MD Insurance Code Annotated Sec. 15-139 (2012) &   Source: MD Department of Health and Mental Hygiene, Maryland
            Health General Code 15-105.2.                      Medicaid 2013 Telemedicine Provider Manual. September 2014, p.
                                                               6 Code of Maryland Admin. Regs. Sec. 10.09.49.11.
            Online Prescribing

            A physician-patient relationship can be established   No reference found.
            through real time auditory communications or real-time
            visual and auditory communications.

            Source:  Code of Maryland Admin. Regs. Sec. 10.32.05.02
            Consent

            Telehealth providers must inform patients and      Consent is required unless there is an emergency.
            consultants of the following:
                                                               Source: MD Department of Health and Mental Hygiene, Maryland
               •   The inability to have direct, physical contact with   Medicaid 2013 Telemedicine Provider Manual. September 2014, p.
                                                               5 & Code of Maryland Admin. Regs. Sec. 10.09.49.06.
                   the patient is a primary difference between   http://www.dsd.state.md.us/comar/getfile.aspx?file=10.09.49.06.ht
                   telehealth and direct in-person service delivery;   m
               •   The knowledge, experiences, and qualifications
                   of the consultant providing data and information
                   to the provider of the telehealth services need
                   not be completely known to and understood by
                   the provider;
               •   The quality of transmitted data may affect the
                   quality of services provided by the provider;
               •   That changes in the environment and test

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                   conditions could be impossible to make during
                   delivery of telehealth services;

            Telehealth services may not be provided by
            correspondence only.

            Source: Code of MD Reg., 10.41.06.04 (2012).

            Except when providing interpretive services, the
            physician must obtain and document patient consent.

            Source:  Code of Maryland Admin. Regs. Sec. 10.32.05.06
            Location

            No reference found.                                Eligible originating sites:
                                                                   •   Free standing renal dialysis centers
                                                                   •   Federally Qualified Health Centers
                                                                   •   Hospitals, including EDs
                                                                   •   Local health departments
                                                                   •   Nursing facilities
                                                                   •   Physicians
                                                                   •   Nurse practitioners
                                                                   •  Nurse midwives

                                                               Originating sites must be approved. MD hospitals will
                                                               only be approved as originating sites if a specialist is not
                                                               available to provide timely consultation and diagnostic
                                                               evaluation.

                                                               Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Medicaid 2013 Telemedicine Provider Manual. September 2014, p.
                                                               4 & Code of Maryland Admin. Regs. Sec. 10.09.49.07.

                                                               Distant site provider must be located within the State,
                                                               the District of Columbia, or a contiguous state.

                                                               Source: Code of Maryland Admin. Regs. Sec. 10.09.49.07.

                                                               Mental Health
                                                               Originating sites are limited to outpatient mental health
                                                               clinics (OMHC), hospitals and FQHCS in designated
                                                               rural geographic areas.

                                                               A distant site provider must be a psychiatrist with either
                                                               a Medicaid provider number or is a psychiatrist in an
                                                               FQHC or OMHC.  The distant site must be in Maryland.

                                                               Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Value Options, Provider Alert. Telemental Health.  July 12, 2011 p.
                                                               1-2.

            Cross-State Licensing
            MD has exceptions to its MD-only licensed physicians   Originating site providers can engage in agreements
            for physicians practicing in the adjoining states of   with distant site providers in Maryland, the District of
            Delaware, Virginia, West Virginia, and Pennsylvania.   Columbia, or a contiguous state for telemedicine
                                                               consultation services.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Source: MD Health Occupations Code Annotated Sec. 14-302
            (2012).                                            Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Medicaid 2013 Telemedicine Provider Manual. September 2014, p.
            A physician providing services through telemedicine   4.
            must have a Maryland license if they are located in
            Maryland, or if the patient is in Maryland.

            Source: COMAR 10.32.05.03
            Private Payers

            Requires coverage of telemedicine services, subject to   No reference found.
            contract terms and conditions.

            Source: MD Insurance Code Annotated Sec. 15-139 (2012).
            Site/Transmission Fee
            No reference found.                                Originating sites are eligible for:
                                                                   •   A transaction fee; or
                                                                   •   If the originating site is a hospital, the
                                                                       appropriate revenue code; and
                                                                   •   If the originating site is an out-of-state hospital,
                                                                       a telemedicine transaction fee.

                                                               Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Medicaid 2013 Telemedicine Provider Manual. September 2014, p.
                                                               6 Code of Maryland Admin. Regs. Sec. 10.09.49.05.

                                                               Mental Health
                                                               The originating site is eligible for a facility fee.

                                                               Source: MD Department of Health and Mental Hygiene, Maryland
                                                               Value Options, Provider Alert. Telemental Health.  July 12, 2011 p.
                                                               4.
            Miscellaneous



           Comments:    The Maryland Health Care Commission has a Telemedicine Task Force to study the use of
                         telehealth throughout the State.


























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