Remote Patient Monitoring

POLICY

Policy applies to Private payers, MS Medicaid and employee benefit plans

“Remote patient monitoring services” means the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including:

• Monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry and other condition-specific data, such as blood glucose;
• Medication adherence monitoring; and
• Interactive video conferencing with or without digital image upload as needed.

Remote patient monitoring services aim to allow more people to remain at home or in other residential settings and to improve the quality and cost of their care, including prevention of more costly care. Remote patient monitoring services via telehealth aim to coordinate primary, acute, behavioral and long-term social service needs for high-need, high-cost patients. Specific patient criteria must be met in order for reimbursement to occur.

Remote patient monitoring services shall include reimbursement for a daily monitoring rate at a minimum of Ten Dollars ($10.00) per day each month and Sixteen Dollars ($16.00) per day when medication adherence management services are included, not to exceed thirty-one (31) days per month. These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.

A one-time telehealth installation/training fee for remote patient monitoring services will also be reimbursed at a minimum rate of Fifty Dollars ($50.00) per patient, with a maximum of two (2) installation/training fees/calendar year. These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.

To receive payment for the delivery of remote patient monitoring services via telehealth, the service must involve:

• An assessment, problem identification, and evaluation that includes:
  • Assessment and monitoring of clinical data including, but not limited to, appropriate vital signs, pain levels and other biometric measures specified in the plan of care, and also includes assessment of response to previous changes in the plan of care; and
  • Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care.
• Implementation of a management plan through one or more of the following:
  • Teaching regarding medication management as appropriate based on the telemedicine findings for that encounter;
  • Teaching regarding other interventions as appropriate to both the patient and the caregiver;
  • Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services;
  • Coordination of care with the ordering health care provider regarding telemedicine findings;
  • Coordination and referral to other medical providers as needed; and
  • Referral for an in-person visit or the emergency room as needed.

SOURCE: MS Code Sec. 83-9-353. (Accessed Apr. 2025).

The Division of Medicaid defines remote patient monitoring as using digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for interpretation and recommendation.

The Division of Medicaid reimburses for remote patient monitoring:

• Of devices when billed with the appropriate code, and
• For disease management:
  • A daily monitoring rate for days the beneficiary’s information is reviewed.
  • Only one (1) unit per day is allowed, not to exceed thirty-one (31) days per month.
  • An initial visit to install the equipment and train the beneficiary may be billed as a set-up visit.
  • Only one set-up is allowed per episode even if monitoring parameters are added after the initial set-up and installation.
  • Only one (1) daily rate will be reimbursed regardless of the number of diseases/chronic conditions being monitored.

The Division of Medicaid does not reimburse for the duplicate transmission or interpretation of remote patient monitoring data.

The Division of Medicaid does not cover remote patient monitoring for disease management as outlined in Miss. Admin. Code Part 225, Rule 2.3.B. for a beneficiary who is a resident of an institution that meets the basic definition of a hospital or long-term care facility.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 2.1 & 2.4 & 2.5. (Accessed Apr. 2025).

Continuous Glucose Monitoring

A continuous glucose monitoring (CGM) service when medically necessary, prior authorized by the UM/QIO, Division of Medicaid or designee, ordered by the physician who is actively managing the beneficiary’s diabetes and the beneficiary meets specific criteria.  See admin code.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.3. (Accessed Apr. 2025).

“Remote Monitoring” is defined as the use of technology to remotely track health care data for a patient released to his or her home or a care facility, usually for the intended purpose of reducing readmission rates.

SOURCE: MS Code Title 30 Part 2635, Ch. 5 Rule 5.1. (Accessed Apr. 2025).

CONDITIONS

The Division of Medicaid covers remote patient monitoring, for disease management when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), Division of Medicaid or designee, ordered by a physician, physician assistant, or nurse practitioner for a beneficiary who meets the following criteria:

• Has been diagnosed with one (1) or more of the chronic conditions as defined by the Centers of Medicare and Medicaid Services (CMS) which include, but are not limited to:
  • Diabetes,
  • Congestive Heart Failure (CHF),
  • Chronic Obstructive Pulmonary Disease (COPD),
  • Heart disease,
  • Mental health, and
  • Sickle cell.
• Is capable of using the remote patient monitoring equipment and transmitting the necessary data or has a willing and able person to assist in completing electronic transmission of data.

The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner which includes, but not limited to:

• Implantable pacemakers,
• Defibrillators,
• Cardiac monitors,
• Loop recorders,
• External mobile cardiovascular telemetry, and
• Continuous glucose monitors.

SOURCE: MS Admin. Code 23, Part 225, Rule. 2.3. (Accessed Apr. 2025).

Qualifying patients for remote patient monitoring services must meet all the following criteria:

• Be diagnosed, in the last eighteen (18) months, with one or more chronic conditions, as defined by the Centers for Medicare and Medicaid Services (CMS), which include, but are not limited to, sickle cell, mental health, asthma, diabetes, and heart disease; and
• The patient’s health care provider recommends disease management services via remote patient monitoring.

SOURCE: MS Code Sec. 83-9-353. (Accessed Apr. 2025).

Continuous Glucose Monitoring

A continuous glucose monitoring (CGM) service when medically necessary, prior authorized by the UM/QIO, Division of Medicaid or designee, ordered by the physician who is actively managing the beneficiary’s diabetes and the beneficiary meets all of the following criteria:

• Has an established diagnosis of type I or type II diabetes mellitus that is poorly controlled as defined below:
  • Unexplained hypoglycemic episodes,
  • Nocturnal hypoglycemic episode(s),
  • Hypoglycemic unawareness and/or frequent hypoglycemic episodes leading to impairments in activities of daily living,
  • Suspected postprandial hyperglycemia,
  • Recurrent diabetic ketoacidosis, or
  • Unable to achieve optimum glycemic control as defined by the most current version of the American Diabetes Association (ADA).
• Be able, or have a caregiver who is able, to hear and view CGM alerts and respond appropriately.
• Has documented self-monitoring of blood glucose at least four (4) times per day.
• Requires insulin injections three (3) or more times per day or requires the use of an insulin pump for maintenance of blood glucose control.
• Requires frequent adjustment to insulin treatment regimen based on blood glucose testing results,
• Had an in-person visit with the ordering physician within six (6) months prior to ordering to evaluate their diabetes control and determined that criteria (1-4) above are met,
• Has an in-person visit every six (6) months following the prescription of the CGM to assess adherence to the CGM regimen and diabetes treatment plan.

The CGM is a Food and Drug Administration (FDA) approved medical device and is capable of accurately measuring and transmitting beneficiary blood data.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.3. (Accessed Apr. 2025).

PROVIDER LIMITATIONS

Providers of remote patient monitoring services must have protocols in place to address all of the following:

• A mechanism for monitoring, tracking and responding to changes in a beneficiary’s clinical condition, and
• A process for notifying the prescribing physician of significant changes in the beneficiary’s clinical signs and symptoms.

Remote patient monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.

The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner.

Continuous glucose monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 2.2 & 2.3. (Accessed Apr. 2025).

A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.

SOURCE: MS Code Sec. 83-9-353(18). (Accessed Apr. 2025).

Continuous Glucose Monitoring

Continuous glucose monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.2. (Accessed Apr. 2025).

Certified Community Behavioral Health Clinic

The CCBHC uses telehealth/telemedicine, video conferencing, remote patient monitoring, asynchronous interventions, and other technologies, to the extent possible, in alignment with the preferences of the person receiving services to support access to all required services.

For those presenting with emergency or urgent needs, the initial evaluation may be conducted by phone or through use of technologies for telehealth/telemedicine and video conferencing, but an in-person evaluation is preferred. If the initial evaluation is conducted telephonically, once the emergency is resolved, the person receiving services must be seen in person at the next subsequent encounter and the initial evaluation reviewed.

For individuals and families who live within the CCBHC’s service area but live a long distance from CCBHC clinic(s), the CCBHC should consider use of technologies for telehealth/telemedicine, video conferencing, remote patient monitoring, asynchronous interventions, and other technologies in alignment with the preferences of the person receiving services, and to the extent practical. These criteria do not require the CCBHC to provide continuous services including telehealth to individuals who live outside of the CCBHC service area. CCBHCS may consider developing protocols for populations that may transition frequently in and out of the services area such as children who experience out-of-home placements and adults who are displaced by incarceration or housing instability.

Telehealth/telemedicine may be used to connect individuals in crisis to qualified mental health providers during the interim travel time. Technologies also may be used to provide crisis care to individuals when remote travel distances make the 2-hour response time unachievable, but the ability to provide an in- person response must be available when it is necessary to assure safety. The CCBHC should consider aligning their programs with the CMS Medicaid Guidance on the Scope of and Payments for Qualifying Community-Based Mobile Crisis Intervention Services if they are in a state that includes this option in their Medicaid state plan.

The CCBHC directly, or through a DCO, provides screening, assessment, and diagnosis, including risk assessment for behavioral health conditions. In the event specialized services outside the expertise of the CCBHC are required for purposes of screening, assessment, or diagnosis (e.g., neuropsychological testing or developmental testing and assessment), the CCBHC refers the person to an appropriate provider. When necessary and appropriate screening, assessment and diagnosis can be provided through telehealth/telemedicine services. Note: See program requirement 3 regarding coordination of services and treatment planning.

The preferences of the person receiving services regarding the use technologies such as telehealth/telemedicine, video conferencing, remote patient monitoring, and asynchronous interventions.

In the event specialized or more intensive services outside the expertise of the CCBHC or DCO are required for purposes of outpatient mental and substance use disorder treatment the CCBHC makes them available through referral or other formal arrangement with other providers or, where necessary and appropriate, through use of telehealth/telemedicine, in alignment with state and federal laws and regulations.

SOURCE: MS Rule Title 24, (24-000-002), Rule 54.6-54.21 (Accessed Apr. 2025).

OTHER RESTRICTIONS

A remote patient monitoring prior authorization request form may be required for approval of telemonitoring services.  If prior authorization is required, the law lists certain requirements for the form.

The telemonitoring equipment must:

• Be capable of monitoring any data parameters in the plan of care; and
• Be a FDA Class II hospital-grade medical device.

The telemedicine equipment and network used for remote patient monitoring services should meet the following requirements:

• Comply with applicable standards of the United States Food and Drug Administration;
• Telehealth equipment be maintained in good repair and free from safety hazards;
• Telehealth equipment be new or sanitized before installation in the patient’s home setting;
• Accommodate non-English language options; and
• Have 24/7 technical and clinical support services available for the patient user.

SOURCE: MS Code Sec. 83-9-353 (Accessed Apr. 2025).

Providers of remote patient monitoring services must have protocols in place to address all of the following:

• A mechanism for monitoring, tracking and responding to changes in a beneficiary’s clinical condition, and
• A process for notifying the prescribing physician of significant changes in the beneficiary’s clinical signs and symptoms.

See admin code for list of requirements for prior authorization form.

Remote patient monitoring services must be provided in the beneficiary’s private residence.

SOURCE: MS Admin. Code 23, Part 225, Rule. 2.2 & 2.3. (Accessed Apr. 2025).

CGM service only when the blood glucose data is obtained from a Federal Drug Administration (FDA) approved durable medical equipment (DME) medical device for home use.

The Division of Medicaid does not require the provider to have a face-to-face office visit with the beneficiary to download, review and interpret the blood glucose data.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.3. (Accessed Apr. 2025).

Continuous glucose monitoring (CGM) service documentation must include, but is not limited to:

The beneficiary and/or care giver is capable of operating the continuous glucose monitoring system,

The beneficiary:

• Has an established diagnosis of type I or type II diabetes mellitus that is poorly controlled as defined in Miss. Admin. Code Part 225, Rule 4.3.A.1.a),
• Requires three (3) insulin injections per day, or use of an insulin pump, for maintenance of blood glucose control,
• Requires regular self-monitoring of at least four (4) times a day,
• Requires frequent adjustment to insulin treatment regimen based on blood glucose testing results,
• Had an in-person visit with the ordering physician within six (6) months prior to ordering to evaluate their diabetes control and determined that criteria (1-4) above are met,
• Has an in-person visit every six (6) months following the prescription of the CGM to assess adherence to the CGM regimen and diabetes treatment plan.

The CGM is a Food and Drug Administration (FDA) approved medical device and is capable of accurately measuring and transmitting beneficiary blood data.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.6. (Accessed Apr. 2025).