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                                                                                 Center for Connected Health Policy

           Alabama


           Medicaid Program:  Alabama Medicaid

           Program Administrator:  Alabama Medicaid Agency

           Regional Telehealth Resource Center:
           Southeast Telehealth Resource Center
           PO Box 1408
           Waycross, GA 31501
           (888) 138-7210
           www.setrc.us


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            Telehealth medical service means “the practice of   There is no explicit definition of “telemedicine” given in
            medical care delivery initiated by a distant site provider   state Medicaid policy. However, the provider manual
            who is physically located at a site other than the site   states, “Services must be administered via an interactive
            where the patient is located, for the purposes of   audio and video telecommunications system which
            evaluation, diagnosis, consultation or treatment which   permits two-way communication between the distant site
            requires the use of appropriate telecommunication   physician and the origination site where the recipient is
            technology.”                                       located (this does not include a telephone conversation,
                                                               electronic mail message, or facsimile transmission
            Source:  AL Admin. Code 540-X-15-.05               between the physician, recipient, or a consultation
                                                               between two physicians).”

                                                               Source: AL Medicaid Management Information System Provider
                                                               Manual, p. 528, (Jan. 2015).
            Live Video Reimbursement

            No reference found.                                Alabama Medicaid reimburses for live video for the
                                                               following services:

                                                                   •   Consults;
                                                                   •   Office or other outpatient visits;
                                                                   •   Individual psychotherapy;
                                                                   •   Psychiatric diagnostic services;
                                                                   •   Neurobehavioral status exams.

                                                               However, for some specialties, special conditions or
                                                               circumstances must be present for reimbursement to

                                                               occur.

                                                               For all telemedicine services, an appropriately trained
                                                               staff member or employee familiar with the patient or the
                                                               treatment plan must be immediately available in person
                                                               to the patient.

                                                               AL Medicaid Management Information System Provider Manual,
                                                               p. 528, (Jan. 2015).

                                                               Source: AL Admin. Code r. 560-X-6-.14 (2011).
            Store and Forward Reimbursement



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            No reference found.                                No reference found.
            Remote Patient Monitoring Reimbursement

            Telehealth home care services prescribed by a provider  In Home Monitoring Program
            and delivered by a licensed certified home care agency
            are exempt from the standards laid out by the Alabama   Alabama Medicaid will reimburse remote patient
            Board of Medical Examiners.                        monitoring through the In Home Monitoring Program.

            Source: AL Admin. Code 540-X-15-.04                Patients with the following medical conditions may
                                                               register for the program:

                                                                   •   Diabetes
                                                                   •   Congestive Heart Failure

                                                               The Alabama Department of Public Health (ADPH) Nurse
                                                               Care Manager evaluates the patient, provides any
                                                               needed equipment such as a scale, glucometer, blood
                                                               pressure cuff and phone with a speaker.

                                                               Data transmission occurs through a secure telephone
                                                               call.

                                                               AL Medicaid Management Information System Provider Manual,
                                                               p. 701, (Jan. 2015).
            Email/Phone/FAX

            No reimbursement for telephone.                    No reimbursement for email.
            No reference found for email or FAX.               No reimbursement for telephone.
                                                               No reimbursement for FAX.
            Source: AL Admin Code r. 560-X-6-.14 (2011).
                                                               AL Medicaid Management Information System Provider Manual,
                                                               p. 528, (Jan. 2015).
            Online Prescribing
            Telehealth medical services provided at an established   No reference found.
            medical site is sufficient to establish a proper provider-
            patient relationship.

            Source: AL Admin. Code 540-X-15-.09

            A patient provider relationship includes:
               •   Establishing that the person requesting the
                   treatment is in fact the person he/she claims to
                   be;
               •   Establishing a diagnosis through the use of
                   acceptable medical practices, including patient
                   history, an appropriate physical examination,
                   and indicated diagnostic studies;
               •   Discussing with the patient the diagnosis, the
                   evidence for it, and the risks and benefits of
                   various treatment options; and
               •   Ensuring the availability of appropriate coverage
                   of the patient for follow-up care.

            Treatment and consultation recommendations made in a


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            telemedicine setting, including issuing a prescription via
            electronic means, will be held to the same standards of
            appropriate medical practice applied to traditional in-
            person clinical settings.

            An online or telephonic evaluation solely by
            questionnaire does not constitute an acceptable
            standard of care.

            Source:   AL Admin. Code 540-X-15-.11

            Services provided at sites other than Established
            Medical Sites
            Telehealth medical services may not be used to treat
            non-malignant pain with scheduled drugs, with the
            exception of patients who are enrolled in a qualified
            multidisciplinary hospice or palliative care program.

            Source: AL Admin. Code 540-X-15-.10

            Prescribing drugs to an individual the prescriber has not
            personally examined is usually inappropriate”.  Before
            prescribing a drug, the physician should make an
            informed medical judgment. Ordinarily, this will require
            that the physician personally perform an appropriate
            history and physical exam, make a diagnosis, and
            formulate a therapeutic plan, which might include a
            prescription.

            Source: AL Admin. Code r. 540-X-9-.11 (2011).
            Consent

            A provider is required to obtain informed consent from   A written informed consent is required prior to an initial
            the patient.                                       telemedicine service.

            Source: AL Admin. Code r. 540-X-15-08.             AL Medicaid Management Information System Provider Manual,
                                                               p. 528, (Jan. 2015).
            Location
            The definition of an “Established Medical Site” is the   Originating site must be located in Alabama. The distant
            “location where a patient would present to seek medical  site may be located outside of Alabama as long as the
            care, where there is a patient site presenter, and where   physician has an Alabama license and is enrolled as an
            there are sufficient technology and medical equipment to  Alabama Medicaid provider.
            allow for an adequate physical evaluation which is
            appropriate for the patient's presenting complaint. A   For rehabilitative services, the originating site must be:
            defined provider-patient relationship is required. A
            patient's private home is not considered an established   •  Physician’s office;
            medical site, except for emergent conditions.”     •  Hospital;
                                                               •  Critical Access Hospital;
            Source: AL Admin. Code 540-X-15-.05                •  Rural Health Clinic;
                                                               •  Federally Qualified Health Center;
            Telehealth Medical Services at an Established      •  Community mental health center (to include co-
            Medical Site                                          located sites with partnering agencies;
               •   Telehealth medical services provided at an
                   established medical site may be used for all   •  Public health department.
                   patient visits, including initial evaluations to     AL Medicaid Management Information System Provider Manual,


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                   establish a proper provider-patient relationship   p. 773, (Jan. 2015).
                   between a distant site provider and a patient.
               •   For new conditions, a patient site presenter
                   must be reasonably available on site at the
                   established medical site to assist with the
                   provision of care. The distant site provider has
                   discretion to determine if a patient site presenter
                   is necessary for follow-up evaluation or
                   treatment of a previously diagnosed condition.
               •   Tasks may be delegated to the patient site
                   presenter, if they are qualified.
               •   A patient site presenter is not required for
                   mental health services, unless the patient may
                   be a danger to himself/herself or others.

            Source: AL Admin. Code 540-X-15-.09

            Telehealth Medical Services at a Site other than an
            Established Medical Site
            A distant site provider who provides telehealth medical
            services at a site other than an established medical site
            for a patient’s previously diagnosed condition must
            either:
               •   See the patient one time in a face to face visit
                   before providing telehealth medical care; or
               •   See the patient without an initial face-to-face
                   visit, provided the patient has received an in-
                   person evaluation by another provider who has
                   referred the patient for additional care, and the
                   referral is documented in the patient record.

            A patient site presenter is not required for a pre-existing
            condition previously diagnosed by a provider through a
            face-to-face visit or for mental health related services
            (unless the patient may be a danger to himself or
            others).

            A distant site provider may treat an established patient’s
            new symptoms which are unrelated to pre-existing
            conditions, provided that the patient is advised to see a
            provider in a face to face visit within 72 hours.  A distant
            site provider may not provide continuing telehealth
            medical services for these new symptoms to a patient
            who is not seen by a provider in a face to face visit
            within 72 hours.

            Each patient must be seen for an in-person evaluation at
            least once a year.

            Source: AL Admin. Code 540-X-15-.10.
            Cross-State Licensing

            A distant site provider must have a current and    Providers must have an Alabama license.
            unrestricted Alabama license.
                                                               AL Medicaid Management Information System Provider Manual,
            Source: AL Admin. Code 540-X-15-.05                p. 528, (Jan. 2015).

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


            “A special purpose license allowing practitioners
            licensed in other states to practice across state lines
            may be issued.”

            Source: Code of AL Sec. 34-24-502 - 507 (2012).
            Private Payers

            No reference found.                                No reference found.
            Site/Transmission Fee
            No reference found.                                No reimbursement for originating site or transmission
                                                               fees.

                                                               AL Medicaid Management Information System Provider Manual,
                                                               p. 528, (Jan. 2015).
            Miscellaneous
            The Alabama Board of Medical Examiners adopted new  Effective for dates of service 1/16/2012 and thereafter,
            rules to establish standards for telehealth medical   all physicians with an Alabama license, enrolled as a
            services.  See "comments" section for additional details   provider with the Alabama Medicaid Agency, regardless
            not included in the categories above.              of location, are eligible to participate in the Telemedicine
                                                               Program to provide medically necessary telemedicine
                                                               services to Alabama Medicaid eligible recipients. In
                                                               order to participate in the telemedicine program:

                                                               •  Physicians must be enrolled with Alabama Medicaid
                                                                  with a specialty type of 931 (Telemedicine Service)
                                                               •  Physician must submit the telemedicine Service
                                                                  Agreement/Certification form
                                                               •  Physician must obtain prior consent from the recipient
                                                                  before services are rendered.  This will count as part
                                                                  of each recipient’s benefit limit of 14 annual physician
                                                                  office visits currently allowed.

                                                               Source: AL Medicaid Management Information System Provider
                                                               Manual, p. 518, (Jul. 2014).

           Comment:
                         New Regulations Passed
                             •   AL Board of Medical Examiners (Source: AL Admin Code 540-X-15)






















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