Page 22 Telehealth and Remote Patient Monitoring RPM for Long Termand Post Acute Care A Primer and Provider Selection Guide 2013

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does not provide coverage or payment for Medicare be determined based on the patient’s characteristics
home health services provided via a telecommuni- and the need for and receipt of the Medicare cov-
cations system (i.e. home telehealth, or RPM are not ered services ordered by the physician. If a physi-
covered under PPS). The law does not permit the cian intends that telehealth services be furnished
substitution or use of a telecommunications system while a patient is under a home health plan of care,
to provide any covered home health services paid the services should be recorded in the plan of care
under the home health PPS, or any covered home along with the Medicare covered home health ser-
health service paid outside of the home health PPS. vices to be furnished.” 46
As stated in 42 CFR 409.48(c), a visit is an episode
of personal contact with the beneficiary by staff of
the home health agency (HHA), or others under 6.2 Medicaid Coverage
arrangements with the HHA for the purposes of Medicaid and the Children’s Health Insurance
providing a covered service. 44 Program (CHIP) provide health coverage to nearly

However, this provision clarifies that there is noth- 60 million Americans, including children, preg-
ing to preclude a home health agency from adopt- nant women, parents, seniors and individuals with
ing telemedicine or other technologies they believe disabilities. In order to participate in Medicaid,
promote efficiencies, but those technologies will not federal law requires states to cover certain popula-

be specifically recognized or reimbursed by Medi- tion groups (mandatory eligibility groups) and
care under the home health benefit. This provision gives them the flexibility to cover other population
does not waive the current statutory requirement groups (optional eligibility groups). States set indi-
for a physician certification of a home health plan vidual eligibility criteria within federal minimum
of care under current §§1814(a)(2)(C) or 1835(a) standards. Medicaid coverage is based on financial
(2)(A) of the Act. Within its home health agency and other non-financial eligibility criteria that are
45
manual, CMS states that “an HHA may adopt used in determining Medicaid eligibility. In order to
telehealth technologies that it believes promote ef- be eligible for Medicaid, individuals need to satisfy
ficiencies or improve quality of care. Telehomecare federal and state requirements regarding residency,
encounters do not meet the definition of a visit set immigration status, and documentation of U.S.
forth in regulations at 42 CFR 409.48(c) and the citizenship; these criteria vary by state. 47
telehealth services may not be counted as Medicare The Center for Telehealth and e-Health Law
covered home health visits or used as qualifying (CTeL) completed a 50 state survey which reviewed
services for home health eligibility. An HHA may each state’s telehealth reimbursement policies.
not substitute telehealth services for Medicare cov- CTeL’s research found that 45 states have some
ered services ordered by a physician. However, if an type of reimbursement for services provided via
HHA has telehealth services available to its clients, telehealth. There are many factors that states use
a doctor may take their availability into account to determine the scope of coverage for telehealth
when he or she prepares a plan of treatment (i.e. applications, such as the quality of equipment, type
may write requirements for telehealth services into of services to be provided, and location of providers
the POT). Medicare eligibility and payment would

Telehealth and Remote Patient Monitoring for Long-Term and Post-Acute Care:
A Primer and Provider Selection Guide 2013