Alabama

Last updated 11/20/2024

Consent Requirements

Providers must obtain prior written or verbal consent from the recipient before services are rendered.

Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, pg. 3, (Accessed Nov. 2024).

For ABA therapy or PBS services listed above provided via telemedicine, enrolled providers 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: …

• Providers must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis), (Ch. 37, p. 16-17). Jul. 2024. (Accessed Nov. 2024).

Remote Patient Monitoring (RPM) Services

A practitioner must obtain patient consent before furnishing or billing RPM services. Consent may be verbal or written but must be documented in the medical record, and includes informing them about:

• The availability of RPM services and applicable cost sharing
• That only one practitioner can furnish and be paid for RPM services during a calendar month
• The right to stop RPM services at any time (effective at the end of the calendar month)

Informed patient consent by the recipient or caregiver, when appropriate, must be obtained prior to rendering RPM services or if the patient chooses to change the practitioner who will render the services.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3), Oct. 2024. (Accessed Nov. 2024).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Oct. 2024, C-1, (Accessed Nov. 2024).

Last updated 11/20/2024

Definitions

Telehealth medical services means “digital health, telehealth, telemedicine, and the applicable technologies and devices used in the delivery of telehealth. The term does not include incidental communications between a patient and a physician.

• Digital Health is defined as “the delivery of health care services, patient education communications, or public health information via software applications, consumer devices, or other digital media.”
• Telehealth is defined as “the use of electronic and telecommunications technologies, including devices used for digital health, asynchronous and synchronous communications, or other methods, to support a range of medical care and public health services.”
• Telemedicine is defined as “a form of telehealth referring to the provision of medical services by a physician at a distant site to a patient at an originating site via asynchronous or synchronous communications, or other devices that may adequately facilitate and support the appropriate delivery of care. The term includes digital health but does not include incidental communications between a patient and a physician.”

The term irregular or infrequent services refers to “telehealth medical services” occurring less than 10 days in a calendar year or involving fewer than 10 patients in a calendar year.

Synchronous is defined as “the real-time exchange of medical information or provision of care between a patient and a physician via audio/visual technologies, audio-only technologies, or other means.”

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

Last updated 11/20/2024

Email, Phone & Fax

The telemedicine visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber.

Providers meeting the telemedicine provider requirements listed above must append one of the following modifiers indicating the mode of telemedicine service delivery:

• GT for covered telemedicine services delivered via audio and visual telecommunications.
• FQ for covered telemedicine services delivered via audio only telecommunications.

Additional modifiers may be required. Refer to the chapter of the Provider Billing Manual that describes services provided for further information.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

In a Provider ALERT issued on April 26, 2023, the Alabama Medicaid Agency (Medicaid) indicated audio-only telecommunications would be reimbursed at parity with services delivered face-to-face for dates of services through September 30, 2023, and on October 1, 2023, new rates for audio-only would be established.

Effective immediately, Medicaid will continue to reimburse services rendered via audio-only telecommunications at parity with approved services delivered face-to-face and will continue to monitor utilization.

Providers should refer to Chapter 112 – Telemedicine Services for more information. Claims not billed correctly are subject to post-payment review and recoupments.

SOURCE: AL Medicaid, Provider Alert, Reimbursement for Services Delivered via Audio-Only Telecommunications, 9/11/23, (Accessed Nov. 2024).

Telephone consultations are not covered.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p. 24). Oct. 2024. (Accessed Nov. 2024).

Telephone consultations are not authorized.

SOURCE:  AL Admin. Code r. 560-X-6-.14, (Accessed Nov. 2024).

Therapy Services

*Effective June 1, 2023, procedure codes 92507, 92508, and 92523 can be reimbursed for Audio-Only Telecommunication and only be used in lieu of the audio and video telecommunication where telemedicine is approved by Medicaid.

Providers must place the “FQ” modifier on the claim to designate that the service was rendered via audio only telecommunication method.

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2024, pg. 9 & 17, (Accessed Nov. 2024).

Rehabilitative Services (ASD) – DMH

Acceptable service provision that qualify as Mental Health Care Coordination includes but is not limited to: Telephone or face to face consultation with a contract provider, doctor, therapist, school teacher, school counselor and/or other professional that is working with the child external to your agency regarding the treatment needs of the child.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2024, Ch. 110, p. 9, (Accessed Nov. 2024).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Oct. 2024, C-1, (Accessed Nov. 2024).

Targeted Case Management

Some core elements of targeted case management can be provided through telephone.  See manual.

SOURCE:  AL Medicaid Management Information system Provider Manual, Targeted Case Management, Oct. 2024, Ch. 106, (Accessed Nov. 2024).

Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP)

Care management activities can be provided in person, virtually and telephonically as indicated in each population’s Care Management Activity Schedule, Care Management Activity Criteria, and the ACHN Payment, Activity, & staffing documents.

Examples of duties to be completed by these staff members include but are not limited to assessments, reassessments, care plan development and monitoring, referrals, case documentation, face-to-face and virtual or telephonic encounters with recipients.

The following components of care management visits/encounters maybe provided telephonically, face to face, or virtually according to the applicable Care Management Activity Schedule. Below is more information on these components.

Telephonic Encounters

The Agency’s expectation for telephonic encounters requires a team approach to the delivery of thorough, conscientious, and person-centered care management that is consistent with that of face-to-face visits. Telephonic encounters may be provided as outlined in each population’s Care Management Activity Schedule.

Prior to providing services a verbal consent to receive care management services shall be discussed and obtained from the recipient. Documentation of a verbal consent shall be maintained in the HIMS for each date of service for which payment is requested.

Some case management tasks can be completed via text messages (e.g., texting a recipient to notify them of a scheduled call, or to advise them of your attempts to reach). However, no paid care management activity is allowed via text messaging. The PCCM-e must adhere to all HIPAA standards regarding texting recipients for the provision of health care services.

See manual for more details.

SOURCE:  AL Medicaid Management Information system Provider Manual, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP), Oct. 2024, Ch. 40,(Accessed Nov. 2024).

Early Intervention Services

The 6 month review can be done via telephone with the parent by the therapist or special instructor. A sign-in sheet is required as documentation for billing the 6 month review

Service may be provided in the child’s natural environment or via telephone or various videoconference mediums.

* An exception to face-to-face contacts is the 6 month review of the treatment plan. The 6 month review plan is allowable to be billed when the service plan is reviewed by telephone. It may still be done face-to-face if preferred by the parent.

SOURCE:  AL Medicaid Management Information system Provider Manual, Early Intervention Services, Oct. 2024, Ch. 108, (Accessed Nov. 2024).

Waiver Services

Personal Emergency Response System Services (PERS) (S5160Modifier UD – LAH) (S5160Modifier UC – ID) (S5160Modifier UD/HW – LAH) (S5160Modifier UC/HW – ID) (S5161Modifier UD – LAH) (S5161Modifier UC – ID) (S5161Modifier UD/HW – LAH) (S5161Modifier UC/HW – ID) Personal Emergency Response System (PERS) Services provides a direct telephonic or other electronic communications link between waiver recipients and health professionals to secure immediate assistance in the event of a physical, emotional or environmental emergency. PERS may also include cellular telephone service used when a conventional PERS is less cost-effective or is not feasible. PERS may include installation, monthly fee (if applicable), upkeep and maintenance of devices or systems as appropriate.

SOURCE:  AL Medicaid Management Information system Provider Manual, Waiver Services, Oct. 2024, Ch. 107, p. 39, (Accessed Nov. 2024).

Pharmacy

Prescriptions dispensed by telephone for drugs other than Schedule II drugs are acceptable without subsequent signature of the practitioner.

Over-the-counter medications require a prescription from a physician or other practitioner legally licensed by the State of Alabama to prescribe the drugs authorized under the program. Telephone prescriptions are acceptable for OTCs.

Hemophilia Management Standards of Care: A pharmacist, nurse, and/or a case representative assigned to each patient.  A case representative shall maintain, at a minimum, monthly telephone contact with the patient or family/caregiver.

SOURCE:  AL Medicaid Management Information system Provider Manual, Pharmacy Services, Oct. 2024, Ch. 27, p. 5, 14, 25, (Accessed Nov. 2024).

Last updated 11/20/2024

Live Video

POLICY

This general information is related to the telehealth medical services rendered by Alabama Medicaid (Medicaid) providers. Providers are expected to comply with Alabama’s Telehealth Medical Services law (Code of Alabama, Sections 34-24-701 through 34-24-707) at all times.

Services must be administered via an interactive audio or audio and video telecommunications system which permits two-way communication between the distant site provider and the site where the recipient is located (this does not include electronic mail message or facsimile transmission between the provider and recipient).

Providers meeting the telemedicine provider requirements listed above must append one of the following modifiers indicating the mode of telemedicine service delivery:

• GT for covered telemedicine services delivered via audio and visual telecommunications.
• FQ for covered telemedicine services delivered via audio only telecommunications.

Additional modifiers may be required. Refer to the chapter of the Provider Billing Manual that describes services provided for further information.

Reimbursement for services provided via telemedicine, audio only and audio and video telecommunications, will be paid at parity to those services provided face-to-face. Medicaid will continue to monitor and reevaluate, if deemed necessary.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

Telemedicine: Telemedicine services are covered for limited specialties and under special circumstances. Refer to the Alabama Medicaid Provider Manual, Chapter 28 for details on coverage.

SOURCE: AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Nov. 2024).

Therapy Services

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site and at the provider site, is sufficient to allow the provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid. Transmissions must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission information. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2024, pg. 17, (Accessed Nov. 2024).

Several manual chapters refer to telemedicine chapter for information.

ELIGIBLE SERVICES/SPECIALTIES

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Services must be within the provider’s scope of license.

Services must be provided to a recipient that is an established patient of the provider or practice or due to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition.

A covered telemedicine service will count towards each recipient’s benefit limit of 14 annual physician office visits.

Specific covered services list provided in manual by provider type (page. 8-10).

Services NOT Eligible for Reimbursement for Telemedicine Services

Common examples of services via telemedicine not considered for reimbursement (not exhaustive):

• Chart reviews
• Electronic mail messages (between providers and recipients)
• Facsimile transmissions (between providers and recipients)
• Consultation between two providers
• Internet based communications that are not HIPAA-compliant or secure
• Services not directly provided by an enrolled provider or by office staff
• Services not normally charged for during an office visit
• Services not specifically listed in Provider Billing Manual chapters
• Communication that is not secure or HIPAA-compliant (e.g., Skype, FaceTime)

Exceptions may be made to the lists for providers and services not reimbursable under this policy in the event of a public health emergency, however, separate guidance would be issued in those instances.

BMI Requirements

The BMI will be required for office visits including the telemedicine visits. The BMI is required at least once per calendar year on all claims with procedure codes 99202-99205, 99211- 99215, and 99242-99245 and EPSDT procedure codes 99382-99385 and 99392-99395. Providers should use subjective data to calculate the BMI which can include providers asking the recipient for his or her height and weight during the telemedicine visit. The BMI should be calculated, based on the information provided by the recipient, and appended to the claim for reimbursement. The BMI should also be documented in the recipient’s medical record.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024 (Accessed Nov. 2024).

Telemedicine services are covered for limited specialties and under special circumstances.

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Nov. 2024).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.  Some services in manual specify that they can be delivered in person or via telemedicine.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA, Ch. 105,  Oct. 2024. (Accessed Nov. 2024).

ABA Therapy Services

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used at the recipient site and at the provider site, is sufficient to allow the provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2024, pg. 17, (Accessed Nov. 2024).

Nurse-Family Partnership

NFP nurse visiting services include care coordination, assessments and screenings, case management, and preventative health education and counseling. These nursing services are tailored to each woman’s needs and delivered in-person or via telehealth in the home setting, or in an alternative community setting as indicated by recipient’s need.

Effective January 1, 2024, at least one of the minimal two monthly visits must be in-person or face-to-face to be eligible for reimbursement by Medicaid.

SOURCE: AL Medicaid Management Information System Provider Manual, Nurse Family Partnership, Ch. 41, Jul. 2024, (Accessed Nov. 2024).

Prescriptions for Certain Home Health Services

The required face-to-face visit may be conducted using telehealth systems.

SOURCE: AL Admin Code 560-X-6-.01, (Accessed Nov. 2024).

Behavioral Health

Refer to Chapter 112, Telemedicine Services, for general information and limitations.

SOURCE: AL Medicaid Management Information System Provider Manual, Behavioral Health, Ch. 34, Oct. 2024, (Accessed Nov. 2024).

A Well Child Check Up

Refer to Chapter 112, Telemedicine Services, for general benefit information and limitations.

SOURCE: AL Medicaid Management Information System Provider Manual, A Well Child Check-Up (EPSDT), A-5, Oct. 2024, (Accessed Nov. 2024).

Targeted Case Management

Refer to Chapter 112, Telemedicine Services, for general information and limitations.

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Management, Ch. 106-27, Oct. 2024, (Accessed Nov. 2024).

OTPs shall provide adequate: …  Initial medical examination.

• The screening and full examination may be completed via telehealth for those recipients being admitted for treatment at the OTP with either buprenorphine or methadone, if a practitioner or primary care provider determines that an adequate evaluation of the recipient can be accomplished via telehealth and according to state and federal law.

SOURCE:  AL. Admin Code 580-9-44-.29, (Accessed Oct. 2024).

ELIGIBLE PROVIDERS

Providers must submit the Telemedicine Service Agreement/Certification to Medicaid’s fiscal agent. The form is located on the Medicaid website at: www.medicaid.alabama.gov. Once the form is received, providers will be enrolled with Medicaid with a specialty type of 931 (Telemedicine Service). Providers must have the specialty type of 931 to bill for telemedicine services.

Provider Types Eligible for Reimbursement for Telemedicine Services

• Physicians
• Certified Registered Nurse Practitioners (CRNPs)
• Physician Assistants
• Rehabilitative Option Providers
• Psychologists
• Licensed Professional Counselors
• Associate Licensed Counselors
• Licensed Marriage and Family Therapist and Associates
• Licensed Master Social Workers
• Licensed Independent Clinical Social Workers
• Licensed Psychological Technicians
• Speech Therapists
• Optometrists
• Applied Behavior Analysts
• Early Intervention
• Children’s Rehabilitation Service
• Pharmacists/Pharmacies
• Targeted Case Management

Provider Types NOT Eligible for Telemedicine Reimbursement

• Physical Therapists
• Occupational Therapists
• DME suppliers
• Ambulance providers
• Chiropractors
• Home Infusion
• Laboratory

Refer to the respective Alabama Medicaid Provider Billing Manual chapter that describes the service rendered by providers listed above for general enrollment information.

Telemedicine Provider Requirements

Providers must identify themselves to the recipient with their credentials and name at the time of service.

Providers must obtain prior written or verbal consent from the recipient before services are rendered.

Telemedicine services may only be provided as a result of a patient’s request, part of an expected follow up, or a referral from the patient’s licensed physician with whom the patient has an established patient-physician relationship.

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Services must be within the provider’s scope of license.

Services must be provided to a recipient that is an established patient of the provider or practice or due to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition.

Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.

Only the provider rendering the services via telemedicine may submit for reimbursement for services.

Providers must indicate an in-state or qualifying bordering state site of practice address from which telemedicine services will be provided.

Note: This policy does not expand or grant any authority outside that authority granted to the provider by their respective licensure board or by federal or state law.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

The BMI will be required for all visits including the telemedicine visits. (Refer to Chapter 112, Telemedicine Services, for general benefit information and limitations.)

SOURCE: AL Medicaid Management Information System Provider Manual, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP) Billing, (Manual Ch. 40-p. 14). Oct. 2024, (Accessed Nov. 2024).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.

All services rendered by a physician, physician assistant, or nurse practitioner that meet the definition above should be billed under this code including those rendered via teleconference with a direct service or consultation recipient. Please refer to the section titled Telehealth Billing Guidelines for more information.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA, Sec. 105, Oct. 2024. (Accessed Nov. 2024).

The face-to-face encounter required for the ordering of home health services may be conducted using telehealth systems.

SOURCE: AL Medicaid Management Information System Provider Manual, Home Health (17-p. 2) Oct. 2024, (Accessed Nov. 2024).

The required face-to-face visit may be conducted using telehealth systems.

SOURCE: AL Medicaid Management Information System Provider Manual, Durable Medical Equipment, 14-10,  Oct. 2024. (Accessed Nov. 2024).

Therapy Services

The provider shall maintain appropriately trained staff, or employees, familiar with the recipient’s treatment plan, immediately available in-person to the recipient receiving a telemedicine service to attend to any urgencies or emergencies that may occur during the session. The provider shall implement confidentiality protocols that include, but are not limited to:

• specifying the individuals who have access to electronic records; and
• usage of unique passwords or identifiers for each employee or other person with access to the client records; and
• ensuring a system to prevent unauthorized access, particularly via the Internet; and
• ensuring a system to routinely track and permanently record access to such electronic medical information

These protocols and guidelines must be available to inspection at the telemedicine site and to the Medicaid Agency upon request.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2024, pg. 17, (Accessed Nov. 2024).

For ABA therapy or PBS services listed above provided via telemedicine, enrolled providers 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:

• Providers must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service).
• To be enrolled with the 931 specialty, providers must submit the Telemedicine Service Agreement/Certification form which is located on the Medicaid website at: www.medicaid.alabama.gov. Electronic signatures will be acceptable for the telemedicine agreement. The agreement may be uploaded through the provider web portal along with a request to add the 931 specialty. See Chapter 2 – Becoming a Medicaid Provider for further information.
• Providers must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2024, pg. 16-17, (Accessed Nov. 2024).

Provider-Based RHCs and RHCs Independent

When not physically present, the physician must be available at all times through direct telecommunication for consultation, assistance with medical emergencies or patient referral.

SOURCE:  AL Medicaid Management Information System Provider Manual, Provider-Based RHCs, Oct. 2024, Ch. 32, pg. 2, & AL Medicaid Management Information System Provider Manual, RHCs Independent, Oct. 2024, Ch. 36, pg. 3, (Accessed Nov. 2024).

Certified Registered Nurse Practitioner and Physician Assistant

CRNPs are assigned a provider type of 09 (Nurse Practitioner). Valid specialties for CRNPs include the following: …

• Telemedicine Service (931)

SOURCE: AL Medicaid Management Information System Provider Manual, Certified Registered Nurse Practitioner and Physician Assistant, Ch. 21 Oct. 2024, pg. 2, (Accessed Nov. 2024).

Eye Care Services

Opticians are assigned a provider type of 19. Optometrists are assigned a provider type of 18. Valid specialties for Eye Care providers include the following: …

• Telemedicine (931) Ophthalmologist and Optometrist

SOURCE: AL Medicaid Management Information System Provider Manual, Eye Care Services, Ch. 15, Oct. 2024, pg. 2, (Accessed Nov. 2024).

ELIGIBLE SITES

The following are required for the origination site where the patient is located:

• The site provider shall ensure that the telecommunication technology and equipment used at the origination site is HIPAA compliant and is sufficient to allow the appropriate evaluation, diagnosis, and/or treatment of the patient.
• The site provider shall implement protocols that ensure the same confidentiality of the telemedicine visit as for in-person visits.
• Regardless of the location of the recipient, it is the provider’s responsibility to ensure the telemedicine visit meets all required HIPAA rules and regulations regarding telemedicine visits.

The following sites are recognized by Medicaid as origination sites:

• Physician and practitioner offices
• Hospitals
• Rural Health Clinics (RHCs)
• Federally Qualified Health Centers (FQHCs)
• Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
• Skilled Nursing Facilities (SNFs)
• Community Mental Health Centers (CMHCs)
• Renal Dialysis Facilities
• Mobile Stroke Units
• Alabama Department of Public Health

Telemedicine services can be rendered to a recipient in their home. However, a recipient’s home should not be considered an origination site entitled to receive an origination site fee.

Note: If a Medicaid-enrolled provider performs another medically necessary service(s), the provider may bill for the covered service(s) in addition to providing his/her facility as an origination site and be eligible for reimbursement for the origination site facility fee and the other medically necessary service(s).

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, pg. 5, (Accessed Nov. 2024).

Certified Registered Nurse Practitioner and Physician Assistant

The following place of service codes apply when filing claims for CRNP services:

• 02 – Telemedicine Services

SOURCE: AL Medicaid Management Information System Provider Manual, Certified Registered Nurse Practitioner and Physician Assistant, Ch. 21 Oct. 2024, pg. 8, (Accessed Nov. 2024).

GEOGRAPHIC LIMITS

No reference found.

FACILITY/TRANSMISSION FEE

Effective April 1, 2020, Medicaid pays an origination site facility fee of $20.00. The origination fee will be limited to one per date of service per recipient and may be billed by all of the providers listed above under Origination Sites.

No origination site facility fee will be paid for an origination site not listed above.  See manual for billing instructions.

Note: If a Medicaid-enrolled provider performs another medically necessary service(s), the provider may bill for the covered service(s) in addition to providing his/her facility as an origination site and be eligible for reimbursement for the origination site facility fee and the other medically necessary service(s).

A recipient’s home should not be considered an origination site entitled to receive an origination site fee.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

Last updated 11/20/2024

Miscellaneous

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used is sufficient to allow the health care provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid and is HIPAA compliant.

Transmissions must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission information. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver.

The provider shall implement confidentiality protocols that include, but are not limited to:

• specifying the individuals who have access to electronic records;
• usage of unique passwords or identifiers for each employee or other person with access to the client records;
• ensuring a system to prevent unauthorized access, particularly via the internet; and
• ensuring a system to routinely track and permanently record access to such electronic medical information.

These protocols and guidelines must be available for inspection at the telemedicine site and to Medicaid upon request.

Documentation Requirements

Providers shall document in the medical record detailed information of the telemedicine visits including, but not limited to:

• Identification of the patient.
• Identification of parent or legal guardian attending the telemedicine visit if recipient is under the age of medical consent.
• Physical location of the patient, including the city and state.
• The medical record documentation must accurately reflect the services rendered and the level of medical decision making to substantiate the procedure code billed.
• The same “in” and “out” documentation is required for telemedicine as is required for current services with incremental timeframes provided in person.
• Identification of the provider including credentials.
• Patient’s consent for the use of telemedicine delivery of health care services. This consent must be documented in the recipient’s medical record.
• Condition for which the care is being provided.
• Medical necessity and appropriateness of services billed.
• Follow up care needed.
• Other relevant details of the visit, to include BMI recording, when applicable.

Prior authorization is not required for services to be delivered via telemedicine, though prior authorization may be required for the individual procedure codes billed. Refer to the Provider Billing Manual chapter that describes the service provided for prior authorization requirements.

Refer to Appendix A and the respective Alabama Medicaid Provider Billing Manual chapter that describes the service provided for information about Early and Periodic Screening, Diagnostic, and Testing (EPSDT) referrals.

See manual for instructions regarding cost sharing and completing the claim form.

Prescribing Medications

In accordance with Alabama’s Telemedicine Law, an enrolled provider may prescribe a legend drug, medical supplies, or a controlled substance via telemedicine if the prescriber is authorized to do so under state and federal law. However, a prescription for a controlled substance may only be issued via telemedicine if:

• The telemedicine visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber;
• The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
• The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

For targeted case management covered services eligible for telemedicine, the manual refers to Chapter 112, Telemedicine Services, for general information and limitations.

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt (106, p. 27). Oct. 2024. (Accessed Nov. 2024).

The Telemedicine Services Agreement cannot be submitted electronically.

SOURCE: AL Medicaid Management Information System Provider Manual, Becoming a Medicaid Provider, Ch. 2, p. 2. Oct. 2024. (Accessed Nov. 2024).

Recipient Signatures are not required in the following instances: …

• Treatment plan review, mental health consultation, pre-hospitalization screening, crisis intervention, family support, Assertive Community Treatment (ACT), Program for Assertive Community Treatment (PACT), and any non-face-to-face services that can be provided by telephone or telemedicine when provided by a Rehabilitation Option Provider or a physician meeting the telemedicine requirements as set forth in the Alabama Medicaid Administrative Code and the Alabama Medicaid Provider Manual. The provider must retain documentation in the medical record to show the services were rendered.

SOURCE: Alabama Admin. Code 560-X-1-.18, (Accessed Nov. 2024).

Alabama has a Rural Health Plan that incorporates telemedicine as a tool to help support both rural patients and providers.  See plan for details.

SOURCE: Alabama Admin Code 410-2-2-.04, as repealed and replaced, (Accessed Nov. 2024).

Last updated 11/20/2024

Out of State Providers

Telemedicine services may only be provided as a result of a patient’s request, part of an expected follow up, or a referral from the patient’s licensed physician with whom the patient has an established patient-physician relationship.

Services rendered via telecommunication system must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located. Per Alabama law, the provision of telemedicine medical services is deemed to occur at the patient’s originating site within this state.

Providers must indicate an in-state or qualifying bordering state site of practice address from which telemedicine services will be provided.

Note: This policy does not expand or grant any authority outside that authority granted to the provider by their respective licensure board or by federal or state law.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, pg. 3-4 (Accessed Nov. 2024).

Last updated 11/20/2024

Overview

AL Medicaid reimburses live video for a specific set of services and specific provider types.  See manual for full lists.  Although asynchronous is included in the definition of telehealth and telemedicine, the telemedicine policy makes no further mention of the modality.

Remote patient monitoring is reimbursed for certain conditions and providers and when the service meets certain requirements. An entire chapter of the Medicaid manual is dedicated to remote patient monitoring instructions.

Audio-only is reimbursed currently the same as face-to-face with FQ modifier.

Last updated 11/20/2024

Remote Patient Monitoring

POLICY

Remote Patient Monitoring (RPM), also known as In-home Remote Patient Monitoring, is a program that allows medical providers to monitor and manage acute and chronic health conditions while the patient is home. The goal of the program is to decrease exacerbation episodes, emergent care visits, hospital admissions, and medical costs and increase self-management of the disease/chronic condition.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1), Oct. 2024. (Accessed Nov. 2024).

RPM services include, but are not limited to:

• Initial home assessment for RPM
• Initial setup of RPM equipment
• Instructions and education about the use of monitoring devices
• Instructing the patient/care giver on data entry
• Instructing patient on optimum symptom control
• Direct patient contact, when necessary and as indicated
• Evaluate threshold violations
• Monitoring and follow up
• Diet/nutrition education
• Needs assessing/screening
• Making referrals for care when appropriate

RPM providers must also develop a process for addressing patient noncompliance. This process should include the expected actions of the patient and the RPM provider related to initial and on-going noncompliance issues. Noncompliance and the specified actions must be documented in the patient’s chart.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3-4), Oct. 2024. (Accessed Nov. 2024).

CONDITIONS

Remote Patient Monitoring (RPM) services are available to Medicaid eligible persons with a need for daily monitoring and with a diagnosis of one or more of the following conditions:

• Diabetes
• Gestational Diabetes (effective 10/1/2022)
• Hypertension
• Congestive Heart Failure
• Pediatric Asthma (effective 10/1/2022)

An order from the recipient’s primary care physician (PCP) is required prior to the start of rendering RPM service. Orders for RPM, along with the specific parameters for daily monitoring, must be obtained from the patient’s PCP prior to evaluation and admission. The order must be documented in the medical record. Orders must be signed and dated by the ordering practitioner and must be obtained annually.

Referrals for RPM may be accepted from any source, including physicians, ACHN Care Coordinators, patient or caregiver, the Health Department, hospitals, home health agencies, or community-based organizations.

A practitioner must obtain patient consent before furnishing or billing RPM services (see informed consent section for details).

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3), Oct. 2024, (Accessed Nov. 2024).

PROVIDER LIMITATIONS

Remote Patient Monitoring providers are assigned a provider type of 08 (Remote Patient Monitoring) and provider specialty 085 or 086.

Services rendered by non-physician practitioners, i.e., physician assistants, certified registered nurse practitioner, etc., must adhere to applicable guidelines, policies and procedures. Refer to Administrative Code chapters 6: Physicians and 49: Certified Register Nurse Practitioner (CRNP) for additional information.

A provider who contracts with Medicaid as an RPM provider is added to the Medicaid system with the National Provider Identifiers provided to the Agency at the time application is made. Appropriate provider specialty codes are assigned to enable the provider to submit requests and receive reimbursements for RPM related claims.

Any provider that can and is willing to pay the Alabama State Share may enroll as an RPM provider. A Memorandum of Understand (MOU) must be executed between the Medicaid Agency and the RPM provider. The MOU will outline the financial and medical responsibilities for the Medicaid Agency and the RPM provider.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 1-2), Oct. 2024. (Accessed Nov 2024).

OTHER RESTRICTIONS

Requirements for RPM include but not limited to:

• Ability to provide services statewide.
• Meet appropriate clinical staffing requirements.
• Provides and allows the recipients to keep user friendly, interactive audio and video technology monitoring equipment.
•  Accepts electronic submissions of referrals.
• Provides an in-home initial assessment.
• Transmits recipient data automatically in real time (a Medicare requirement).
• Reviews, intervenes and reports on the data promptly.
• Provides 24-hour-a-day, 7-day-a-week (24/7) access to physicians or other qualified health care professionals or clinical staff, to address urgent needs of recipients.
• Develops, monitors and updates a patient-centered care plan
• Ongoing, compliance monitoring.
• Program graduation, when appropriate.

Federal requirements mandate providers re-validate periodically with the Alabama Medicaid program. Providers will receive a notification when it is time to re-validate. Failure to re-validate and provide appropriate documentation to complete the enrollment process will result in an end-date being placed on the provider file. A new enrollment application must be submitted once a provider file has been closed due to failure to timely re-validate.

Medicaid will not separately reimburse for any direct care services, such as wound care, rendered by RPM providers. RPM services are restricted to the medical diagnosis outlined in section 111.2.

See manual for documentation and evaluation report requirements.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring, Ch. 111, Oct. 2024. (Accessed Nov. 2024).

Last updated 11/20/2024

Store and Forward

POLICY

Asynchronous is included in definition of telemedicine and telehealth but no further mention of it is made in telemedicine policy.

Services must be administered via an interactive audio or audio and video telecommunications system which permits two-way communication between the distant site provider and the site where the recipient is located (this does not include electronic mail message or facsimile transmission between the provider and recipient).

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found