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                                                                                 Center for Connected Health Policy

           Maine


           Medicaid Program:  MaineCare

           Medicaid Program Administrator:  Maine Dept. of Health and Human Services

           Regional Telehealth Resource Center:
           Northeast Telehealth Resource Center
           11 Parkwood Drive
           Augusta, ME 04330
           (207) 622-7566 / (800) 379-2021
           www.netrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telemedicine, as it pertains to the delivery of health   “Telehealth” is interactive, visual, real-time
            care services, means the use of interactive audio, video  telecommunication, and must be a medically appropriate
            or other electronic media for the purpose of diagnosis,   means of provider-patient interaction.
            consultation or treatment. ‘Telemedicine’ does not
            include the use of audio-only telephone, facsimile   Source: MaineCare Benefits Manual, General Administrative
            machine or e-mail.”                                Policies and Procedures, 10-144 Ch. 101, p. 20 (Jan. 1, 2014).

            Source: ME Revised Statutes Annotated. Title 24, Sec. 4316
            (2012).
            Live Video Reimbursement

            Maine law requires coverage for services provided   MaineCare will reimburse for live video when there is a
            through telemedicine, which includes live video.   compelling benefit for the patient in order for telehealth
                                                               services to be appropriate and related to physical, social
            Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).   or geographic issues that make delivering the service in
                                                               person difficult.  This includes:
            (See Medicaid column & “Private Payers” section)
                                                                   •   For physical issues, a member's medical
                                                                       condition makes a face-to-face encounter that
                                                                       entails significant travel inadvisable or
                                                                       impossible;
                                                                   •   For social issues, the family or other support
                                                                       system does not support a member traveling a
                                                                       distance for a face-to-face encounter, or does
                                                                       not allow the member to take the time that travel
                                                                       will require;
                                                                   •   For geographic issues, there is a lack of
                                                                       medical/psychiatric/mental health expertise
                                                                       locally, limited transportation resources, or a
                                                                       long wait for such local care.

                                                               Source: Code of ME Rules. 10-144-101 & MaineCare Benefits
                                                               Manual, General Administrative Policies and Procedures, 10-144
                                                               Ch. 101, p. 20 (Jan. 1, 2014).

                                                               Providers must receive pre-authorization from the
                                                               Department for telehealth services.

                                                               Source: Code of ME Rules. 10-144-101 & MaineCare Benefits
                                                               Manual, General Administrative Policies and Procedures, 10-144

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Ch. 101, p. 20 (Jan. 1, 2014).

                                                                Pre-authorization information must include:

                                                                   •   The names, provider numbers and licensure
                                                                       level of individual providers who utilize
                                                                       telehealth to provide services;
                                                                   •   A list of the procedure codes to be used;
                                                                   •   A rationale for needing telehealth capabilities for
                                                                       the services being proposed;
                                                                   •   The specific criteria used in determining when
                                                                       telehealth services are more appropriate than
                                                                       face-to-face services;
                                                                   •   A plan for quality assurance activities
                                                                       specifically related to patient satisfaction and
                                                                       outcomes for telehealth services;
                                                                   •   Educational information that will be provided to
                                                                       the patient at the time of the member's visit.

                                                               Source: Code of ME Rules. 10-144-101 & MaineCare Benefits
                                                               Manual, General Administrative Policies and Procedures, 10-144
                                                               Ch. 101, p. 20-1 (Jan. 1, 2014).

                                                               Telehealth can substitute for a face-to-face encounter
                                                               under the Home Health Services program.

                                                               Source: MaineCare Benefits Manual, Home Health Services, Ch.
                                                               III, Sec. 40, p. 1 (Sept. 1, 2011).

            Store and Forward Reimbursement
            No reference found.                                No reimbursement based upon definition of telehealth,
                                                               which is described as occurring in “real-time”.

                                                               Source: MaineCare Benefits Manual, General Administrative
                                                               Policies and Procedures, 10-144 Ch. 101, p. 20 (Jan. 1, 2014).

            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.
            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: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).  Source: Code of ME Rules. 10-144-101 (2012).

                                                               For Indian Health Services, a second tier consultation
                                                               can utilize direct email communications or telephone
                                                               consultation.

                                                               Source: MaineCare Benefits Manual, Indian Health Services, 10-
                                                               144 Ch. II, p. 5 (Mar. 21, 2012).

                                                               Telephone is also covered for:
                                                                   •   Targeted Case Management Services for
                                                                       purposes of monitoring and follow up activities
                                                                       can take place over the telephone.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   The Home and Community Benefits for the
                                                                       Elderly and for Adults with Disabilities for
                                                                       purposes of monitoring.
                                                                   •   Behavioral Health Services for purposes of
                                                                       crisis resolution services.

                                                               Source: MaineCare Benefits Manual, Targeted Case Management
                                                               Services, 10-144 Ch. 101, Sec. 13, p. 6 (Mar. 20, 2014).

                                                               Source: MaineCare Benefits Manual, Home and Community
                                                               Benefits for the Elderly and for Adults with Disabilities, 10-144
                                                               Ch. II, Sec. 19, p. 32 (Dec. 15, 2014).

                                                               Source: MaineCare Benefits Manual, Behavioral Health Services,
                                                               10-44 Ch. II, Sec. 65, p. 11 (Aug. 31, 2013).
            Online Prescribing
            No reference found.                                 Tele-pharmacy is allowed.

                                                                Tele-pharmacy is a method of delivering prescriptions
                                                                dispensed by a pharmacist to a remote site. Pharmacies
                                                                using tele-pharmacy must follow all applicable State and
                                                                Federal regulations, including use of staff qualified to
                                                                deliver prescriptions through tele-pharmacy.

                                                                Source: MaineCare Benefits Manual, Ch. 2, Pharmacy Services,
                                                                10-144 Chapter 101, p. 5 (Jan. 1, 2013).

                                                                Providers may dispense prescriptions via tele-
                                                                pharmacy; pre-authorization is required.

                                                               Source: MaineCare Benefits Manual, Ch. 2, Pharmacy Services, p.
                                                               33 (Jan. 1, 2013).
            Consent

            No reference found.                                Providers must deliver written educational information to
                                                               patients at their visit.

                                                               This information should be written at a sixth-grade
                                                               comprehension level, and include the following:

                                                                   •   Description of the telehealth equipment and
                                                                       what to expect;
                                                                   •   Explanation that the use of telehealth for this
                                                                       service is voluntary and that the same service is
                                                                       available in a face-to-face setting;
                                                                   •   Explanation that the member is able to stop the
                                                                       telehealth visit at any time and request a face-
                                                                       to-face service;
                                                                   •   Explanation that MaineCare will pay for
                                                                       transportation to a distant appointment if
                                                                       needed;
                                                                   •   HIPAA compliance information regarding the
                                                                       telehealth encounter.

                                                                Source: MaineCare Benefits Manual, General Administrative
                                                                Policies and Procedures, 10-144 Ch. 101, p. 21-2 (Jan. 1, 2014).


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Location
            No reference found.                                No reference found.

            Cross-State Licensing
            No reference found.                                No reference found.
            Private Payers

            Requires coverage of telemedicine services, subject to   No reference found.
            contract terms and conditions.

            Coverage must be provided in a manner that is
            consistent with coverage for in-person consultation.

            Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).
            Site/Transmission Fee

            No reference found.                                No reimbursement for site or transmission fees.

                                                               Source: MaineCare Benefits Manual, General Administrative
                                                               Policies and Procedures, 10-144 Ch. 101, p. 21 (Jan. 1, 2014).
            Miscellaneous

                                                               MaineCare will pay for transportation to a distant
                                                               appointment if needed.

                                                               Source: MaineCare Benefits Manual, General Administrative
                                                               Policies and Procedures, 10-144 Ch. 101, p. 21 (Jan. 1, 2014).








































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