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                                                                                 Center for Connected Health Policy

           Missouri


           Medicaid Program:  HealthNet

           Program Administrator:  Missouri Dept. of Social Services

           Regional Telehealth Resource Center:
           Heartland Telehealth Resource Center
           3901 Rainbow Blvd MS 1048
           Kansas City, KS 66160
            (877) 643-4872
           heartlandtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telehealth, the use of medical information exchanged   “Telehealth means the use of medical information
            from one site to another via electronic communications   exchanged from one (1) site to another via electronic
            to improve the health status of a patient.”        communications to improve the health status of a
                                                               patient. Telehealth means the practice of health care
            Source: MO Revised Statutes § 208.670 (2012).      delivery, evaluation, diagnosis, consultation, or
                                                               treatment using the transfer of medical data, audio
            Relating to Stroke Centers                         visual, or data communications that are performed over
            “Telemedicine-the use of medical information       two (2) or more locations between providers who are
            exchanged from one (1) site to another via electronic   physically separated from the patient or from each
            communications to improve patient's health status. A   other.”
            neurology specialist will assist the physician in the
            center in rendering a diagnosis. This may involve a   Source: MO Code of State Regulation, Title 13, 70-3.190 (2010).
            patient "seeing" a specialist over a live, remote consult
            or the transmission of diagnostic images and/or video   Telehealth Services are medical services provided
            along with patient data to the specialist.”        through advanced telecommunications technology from
                                                               one location to another. Medical information is
            Source:  MO Code of State Regulation Title 19, 30-40.710.   exchanged in real-time communication from an
                                                               originating site, where the participant is located, to a
                                                               distant site, where the provider is located, allowing them
                                                               to interact as if they are having a face-to-face, hands-on
                                                               session.

                                                               Source: MO HealthNet, Provider Manual, Behavioral Services,
                                                               Section 13, p. 53 (Oct. 23, 2013) & Physician Services, Section 13,
                                                               p. 121 (Apr. 14, 2014).
            Live Video Reimbursement
            Missouri Consolidated Health Care Plan (State      HealthNet will reimburse for live video for medically
            employees and retirees health plan)                necessary services.
            Telehealth services are covered on the same basis that
            the service would be covered when it is delivered in   Eligible providers:
            person.                                                •   Physicians;
                                                                   •   Advanced registered nurse practitioners,
            Source: MO Consolidated State Reg. 22:10-3.057.            including nurse practitioners with a mental
                                                                       health specialty;
            (also see Medicaid column)                             •   Psychologists.

                                                               Telehealth services are limited to:
                                                                   •   Consultation made to confirm a diagnosis;


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   Evaluation and management services;
                                                                   •   A diagnosis, therapeutic or interpretive service;
                                                                   •   Individual psychiatric or substance abuse
                                                                       assessment diagnostic interview examinations;
                                                                       or
                                                                   •   Individual psychotherapy

                                                               Reimbursement to the provider at the distant site is
                                                               made at the same amount as for an in-person service.

                                                               Source (reimbursement): MO Revised Statutes § 208.670 (2012).

                                                               Source (eligible providers): MO HealthNet, Provider Manual,
                                                               Behavioral Services, Section 13, p. 54 (Oct. 23, 2013) & Physician
                                                               Services, Section 13, p. 121 (Apr. 14, 2014).

                                                               Source (distant site reimbursement): MO Code of State
                                                               Regulation, Title 13, 70-3.190 (2010).

                                                               Source (psychiatrists): MO HealthNet, Community Psychiatric
                                                               Rehabilitation Program Manual, Sec. 13, pg. 55 (Feb. 27, 2014).
            Store and Forward Reimbursement
            No reference found.                                HealthNet will not reimburse for store and forward.

                                                               Source: MO HealthNet, Provider Manual, Behavioral Services,
                                                               Section 13, p. 53 (Oct. 23, 2013) & Physician Services, Section 13,
                                                               p. 121 (Apr. 14, 2014).
            Remote Patient Monitoring Reimbursement
            No reference found.                                Personal Emergency Response Systems (an electronic
                                                               device that is programmed to signal a response center
                                                               once the help button is activated) is available for
                                                               patients at high risk of being institutionalized.

                                                               Source: MO HealthNet, Provider Manual, Developmental
                                                               Disabilities Waiver Manual, Section 13, p. 19 (Feb. 25, 2014).

            Email/Phone/FAX
            No reference found.                                No reference found.

            Online Prescribing
            Prescribing or dispensing drugs without sufficient   No reference found.
            examination is prohibited.

            Source: MO Revised Statutes § 334.100 (2012).
            Consent

            Services related to pregnancy                       Providers must obtain written patient consent before
                                                                delivery of telehealth services.
             Telehealth providers are required to obtain patient
             consent.                                          Source: MO Code of State Regulation, Title 13, 70-3.190 (2010) &
                                                               Physician Services, Section 13, p. 123 (Apr. 14, 2014).
             Source: MO Revised Statutes § 376.1900.1
            Location
            Advanced Practice Registered Nurses who provides   Originating sites must be one of the following:


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            nursing services under a collaborative practice
            arrangement may provide those services outside of the   •   Physician or other health care provider office;
            geographic proximity requirements (stipulated in the   •   Hospital;
            written agreement with the collaborating physician)    •   Critical Access Hospital;
            when provided in a health professional shortage area.   •   Rural Health Clinic;
                                                                   •   Federally Qualified Health Center;
            Source: MO Revised Statutes § 335.175.1 (sunsets Jan. 1, 2020).   •   Missouri state habilitation center or regional
                                                                       office;
                                                                   •   Community mental health center;
                                                                   •   Missouri state mental health facility;
                                                                   •   Missouri state facility;

                                                               Source: MO HealthNet, Provider Manual, Behavioral Services,
                                                               Section 13, p. 54 (Oct. 23, 2013) & Physician Services, Section 13,
                                                               p. 121 (Apr. 14, 2014).
            Cross-State Licensing

            No reference found.                                No reference found.
            Private Payers

             Payers are required to provide coverage for services   No reference found.
             through telehealth, if the same service could have been
             provided through face to face diagnosis, consultation or
             treatment.
               Source: MO Revised Statutes § 376.1900.1


            Site/Transmission Fee
            Services related to pregnangy                      Originating sites are eligible to receive a facility fee;
            Payers are not required to reimburse telehealth    distant sites are not eligible.  The cost of an optional
            providers for site origination fees or costs for the   telepresenter is included in the facility fee.
            provision of telehealth.
                                                               Source: MO Code of State Regulations, Title 13, 70 3.190 (May 31,
            Source: MO Revised Statutes § 376.1900.1           2011) & Physician Services, Section 13, p. 121 (Apr. 14, 2014).
                                                               .

            Missouri Consolidated Health Care Plan (State
            employees and retirees health plan)
            Telehealth site origination fees or costs for the provision
            of telehealth services are not covered.

            Source: MO Consolidated State Reg. 22:10-3.060.
            Miscellaneous















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