Remote Patient Monitoring

POLICY

Remote patient monitoring services means the use of synchronous or asynchronous digital technologies that collect or monitor medical, patient–reported, and other forms of health care data for Program recipients at an originating site and electronically transmit that data to a distant site provider to enable the distant site provider to assess, diagnose, consult, treat, educate, provide care management, suggest self–management, or make recommendations regarding the Program recipient’s health care.

SOURCE: MD Health General Code 15-141.2; Code of Maryland Admin. Regs., Sec. 10.09.96.02(B)(14). (Accessed May 2024).

RPM is a service which uses digital technologies to collect medical and other forms of health data from individuals and electronically transmits that information securely to health care providers for assessment, recommendations, and interventions.

Existing MD Medicaid guidance and regulation limits reimbursement for remote patient monitoring to certain chronic conditions. Preauthorization requirements also apply.

SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed May 2024).

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 5. Updated Aug. 2023. (Accessed May 2024).

Covered Services

Remote patient monitoring services include:

• Installation;
• Education for the participant in the use of the equipment; and
• Daily monitoring of vital signs and other medical statistics.

The remote patient monitoring provider shall establish an intervention process to address abnormal data measurements in an effort to prevent avoidable hospital utilization.

Physician, nurse practitioner, and physician assistant providers who establish remote patient monitoring programs shall be responsible for:

• Establishing criteria for reporting abnormal measurements;
• Informing the participant of abnormal results; and
• Monitoring results and improvements in patient’s ability to self-manage chronic conditions.

Medical interventions by a physician, nurse practitioner, or physician assistant based on abnormal results shall be reimbursed according to COMAR 10.09.02.07.

A home health agency shall:

• Have an order by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner who has examined the patient and with whom the patient has an established, documented and ongoing relationship;
• Report abnormal measurements to the participant and to the ordering provider; and
• Send the ordering provider a weekly summary of monitoring results, including improvement in patient’s ability to self-manage chronic conditions.

SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.06. (Accessed May 2024).

Remote Ultrasound Procedures and Remote Fetal Nonstress Tests – Effective October 1, 2024

The Maryland Medical Assistance Program shall provide, subject to the limitations of the State budget, comprehensive medical, dental, and other health care services, including services provided in accordance with § 15–141.5 regarding remote ultrasound procedures and remote fetal non stress tests using Current Procedural Terminology codes, for all eligible  pregnant women whose family income is at or below 250 percent of the poverty level for the duration of the pregnancy and for 1 year immediately following the end of the woman’s pregnancy, as permitted by the federal law.

The program shall provide reimbursement for a remote fetal non stress test in the same manner as an on-site fetal non stress test.

The Program shall issue guidance for program providers to carry out this section.

SOURCE: MD General Health Code 15-103, 15.141.5 as proposed to be amended and added by HB 1078 (2024 Legislative Session). (Accessed May 2024).

CONDITIONS

Telehealth definition includes remote patient monitoring. The Program is required to reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth regardless of patient and provider location.

From July 1, 2021, to June 30, 2025, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:

• Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
• Any room and board fees.

The Department may adopt regulations to carry out this section.

SOURCE: MD Health General Code 15-141.2 (a-b, h), as amended by HB 1148/SB 582/SB 534 (2023 Legislative Session). (Accessed May 2024).

Existing guidance states Medicaid recipients diagnosed with one of the following conditions qualify:

• Chronic Obstructive Pulmonary Disease
• Congestive Heart Failure
• Diabetes (Type 1 or 2)

The participant must be enrolled in Medicaid, consent to RPM, have an internet connection and capability to use monitoring tools and have one of the following scenarios within the most recent 12-month period:

• Two hospital admissions with the same qualifying medical condition as the primary diagnosis
• Two emergency room department visits with the same qualifying medical condition as the primary diagnosis
• One hospital admission and one emergency department visit with the same qualifying medical condition as the primary diagnosis.

SOURCE: MD Home Health Transmittal No. 64.  Jan. 10, 2018. MD General Provider Transmittal No. 85. Feb. 12, 2018, MD Remote Patient Monitoring Transmittal No. 1, Jan 10, 2018. (Accessed May 2024).

A participant is eligible to receive remote patient monitoring services if:

• The participant is enrolled in the Maryland Medical Assistance Program on the date the service is rendered;
• The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease;
• The participant has the internet connections necessary to host the equipment in the home;
• The participant is at risk for avoidable hospital utilization due to a poorly controlled chronic disease capable of being monitored via remote patient monitoring; and
• The provision of remote patient monitoring may reduce the risk of preventable hospital utilization and promote improvement in control of the chronic condition.

SOURCE: Code of Maryland Admin Regs., Sec. 10.09.96.05. (Accessed May 2024).

An MCO shall provide its enrollees medically necessary remote patient monitoring services as described in COMAR 10.09.96.

SOURCE: Code of Maryland Admin Regs., Sec. 10.67.06.26-5. (Accessed May 2024).

Remote Ultrasound Procedures and Remote Fetal Nonstress Tests – Effective October 1, 2024

The Maryland Medical Assistance Program shall provide remote ultrasound procedures and remote fetal non stress tests coverage using Current Procedural Terminology codes, for all eligible pregnant women whose family income is at or below 250 percent of the poverty level for the duration of the pregnancy and for 1 year immediately following the end of the woman’s pregnancy, as permitted by the federal law, if the patient is in a residence or a location other than the office of the patient’s provider.

SOURCE: MD General Health Code 15-103, 15.141.5 as proposed to be amended and added by HB 1078 (2024 Legislative Session). (Accessed May 2024).

PROVIDER LIMITATIONS

The Department may specify in regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients via telehealth. If the Department specifies by regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this subsection, the regulations shall include all types of health care providers that appropriately provide telehealth services.

The Program is not required to reimburse a health care provider for a health care service delivered in person or through telehealth that is:

• Not a covered health care service under the Program; or
• Delivered by an out–of–network provider unless the health care service is a self–referred service authorized under the Program.

SOURCE: MD General Health Code 15-141.2(g-h). (Accessed May 2024).

Eligible Providers:

• Home Health Agencies
• Hospitals
• Clinics
• Federally Qualified Health Centers
• Managed Care Organizations
• Health Professionals (Physicians, Nurses, Physician Assistants)

SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed May 2024).

Remote patient monitoring is not a substitute for delivery of care. Provider shall see patients in person periodically for follow-up care.  To provide remote patient monitoring, the provider shall be enrolled with an active status as a Maryland Medical Assistance Program provider on the date the service is rendered and be a:

• Physician;
• Physician assistant;
• Certified nurse practitioner; or
• Home health agency when remote patient monitoring services are prescribed by a physician; and
• Meet the requirements for participation in the Medical Assistance Program as set forth in COMAR 10.09.36.03.

Medical Record Documentation. A remote patient monitoring provider shall:

• Maintain documentation using either electronic or paper medical records;
• Retain remote patient monitoring records according to the provisions of Health-General Article, §4-403, Annotated Code of Maryland;
• Submit the preauthorization on a form developed by the Department; and
• Include the participant’s consent to participate in remote patient monitoring.

SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.04. (Accessed May 2024).

Home health agencies may only be reimbursed for remote patient monitoring when the service is ordered by a physician.

SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.07. (Accessed May 2024).

Remote Ultrasound Procedures and Remote Fetal Nonstress Tests – Effective October 1, 2024

The provider shall the same standard of care that the provider would follow when providing services on-site.

The program shall require that a provider offering a remote ultrasound procedure or remote fetal non stress test use digital technology to collect any health data from the patient and electronically transmit the information in a secure manner to a health care provider in a different location for interpretation and recommendations that is compliant with the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and approved by the Federal Food and Drug Administration.

SOURCE: MD General Health Code 15-103, 15.141.5 as proposed to be amended and added by HB 1078 (2024 Legislative Session). (Accessed May 2024).

OTHER RESTRICTIONS

The Department may preauthorize services when the provider submits to the Department adequate documentation demonstrating the:

• Participant’s condition meets the criteria listed in Regulation .05 of this chapter; and
• Participant has not already been preauthorized for two episodes during the past rolling calendar year.

The RPM reimbursement rate is an all-inclusive rate of $125 per 30 days of monitoring which covers equipment installation, participant education for using the equipment, and daily monitoring of the information transmitted for abnormal data measurements.

Reimbursement does not include RPM equipment, upgrades to RPM equipment or internet service for participants.

The Program does not cover more than:

• 2 months of remote patient monitoring services per episode; and
• Two episodes per year per participant.

SOURCE: MD Home Health Transmittal No. 64.  Jan. 10, 2018, Code of Maryland Admin Regs, Sec. 10.09.96.06, Sec. 10.09.96.07, Sec. 10.09.96.08. (Accessed May 2024).

Remote Ultrasound Procedures and Remote Fetal Nonstress Tests – Effective October 1, 2024

A remote fetal non stress test for which reimbursement is provided shall require the use of remote monitoring solutions that are cleared by the Federal Food and Drug Administration for on-label use for monitoring:

• Fetal Heart Rate
• Maternal Heart Rate
• Uterine Activity

SOURCE: MD General Health Code 15-103, 15.141.5 as proposed to be amended and added by HB 1078 (2024 Legislative Session). (Accessed May 2024).