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                                                                                 Center for Connected Health Policy

           Pennsylvania


           Medicaid Program:  Pennsylvania Medical Assistance Program (MA)

           Medicaid Program Administrator: Department of Public Welfare

           Regional 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

            No reference found.                                Telemedicine is the use of real-time interactive
                                                               telecommunications technology that includes, at a
                                                               minimum, audio and video equipment as a mode of
                                                               delivering consultation services.

                                                               Source: PA Department of Public Welfare, Medical Assistance
                                                               Bulletin 09-12-31,31-12-31, 33-12-30, May 23, 2012.
            Live Video Reimbursement

            No reference found.                                Pennsylvania Medicaid will reimburse for live video for
                                                               specialty consultations.

                                                               Eligible Providers (fee for service):
                                                                   •   Physicians
                                                                   •   Certified registered nurse practitioners
                                                                   •   Certified nurse midwives

                                                               Providers under a managed care system should contact
                                                               the appropriate managed care organization.

                                                               Source: PA Department of Public Welfare, Medical Assistance
                                                               Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012.

                                                               Telepsychiatry Services
                                                               PA Medicaid will reimburse licensed psychiatrists and
                                                               licensed psychologists for telepsychiatry outpatient
                                                               services including:
                                                                   •   Psychiatric diagnostic evaluations
                                                                   •   Psychological Evaluations
                                                                   •   Pharmacological management
                                                                   •   Consultations (with patient/family)
                                                                   •   Psychotherapy

                                                               Providers must have documented endorsement to
                                                               deliver mental services through telepsych from the
                                                               county mental health program and the HealthChoices
                                                               Behavioral Health Managed Care Organization, and this
                                                               endorsement must be submitted to the PA Office of
                                                               Mental Health and Substance Abuse Services regional
                                                               office for final approval.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                               Source:  PA Department of Public Health, Medical Assistance
                                                               Bulletin OMHSAS-14-01, Mar. 18, 2014.
            Store and Forward Reimbursement

            No reference found.                                Pennsylvania Medicaid will not reimburse for store and
                                                               forward.

                                                               Source: PA Department of Public Welfare, Medical Assistance
                                                               Bulletin 09-12-31,31-12-31, 33-12-30, May 23, 2012.
            Remote Patient Monitoring Reimbursement

            No reference found.                                PA Medicaid fee for service does not reimburse for
                                                               remote patient monitoring.  However, see “Comments”
                                                               section below.

                                                               Source: PA Department of Public Welfare, Medical Assistance
                                                               Bulletin 09-12-31,31-12-31, 33-12-30, May 23, 2012.
            Email/Phone/FAX
            No reference found.                                No reimbursement for email.
                                                               No reimbursement for telephone.
                                                               No reimbursement for FAX.

                                                               Source: PA Department of Public Welfare, Medical Assistance
                                                               Bulletin 09-12-31,31-12-31, 33-12-30, May 23, 2012.
            Online Prescribing

            No reference found.                                No reference found.
            Consent
            No reference found.                                Informed consent is required from individuals
                                                               participating in any services utilizing telepsych.

                                                               Source:  PA Department of Public Health, Medical Assistance
                                                               Bulletin OMHSAS-14-01, Mar. 18, 2014.
            Location
                                                               No reference found.

            Cross-State Licensing
            Pennsylvania issues extraterritorial licenses to   No reference found.
            physicians residing or practicing in an adjoining state,
            near the Pennsylvania boundary, and whose practice
            extends into Pennsylvania to practice in Pennsylvania.

            Pennsylvania bases its granting of this license on the
            availability of medical care in the area involved, and
            whether the adjoining state extends similar privileges to
            Pennsylvania physicians.

            Source: PA Statutes Annotated, Title 63 Sec. 422.34(a) and (c)(2).
            Private Payers
            No reference found.                                No reference found.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Site/Transmission Fee
            No reference found.                                Originating site may bill for facility fee.

                                                               Source: PA Department of Public Welfare, Medical Assistance
                                                               Bulletin 09-12-31,31-12-31, 33-12-30, May 23, 2012.

                                                               Source:  PA Department of Public Health, Medical Assistance
                                                               Bulletin OMHSAS-14-01, Mar. 18, 2014.
            Miscellaneous


           Comments:

                         Pennsylvania Department of Aging, Office of Long Term Aging, offers “TeleCare” services under the
                         Aging and Waiver program.  “TeleCare” is a model of service that uses technology with services that
                         allows people with chronic conditions to remain independent.  In-home technology is used to provide
                         services.  Health status measuring and monitoring; activity and sensor monitoring; and medication
                         dispensing and monitoring are used in the program.

                         Source: PA Dept. of Aging, Office of Long Term Aging, APD #09-01-05, Oct. 1, 2009.



















































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