Last updated 05/27/2024
Definition
Telemedicine is defined as the use of electronic information and communication technology to deliver healthcare services including without limitation, the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a client. Telemedicine includes store-and-forward technology and remote client monitoring.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated April 1, 2024 & Section III Billing Documentation. Rule 305.000. Updated Jan. 1, 2022 (Accessed May 2024).
Provider-Led Arkansas Shared Savings Entity (PASSE) Program
The use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient. It included store-and-forward technology and remote patient monitoring. The following activities will not be considered a reportable encounter when delivered to a member of the PASSE:
- Audio-only communication, including without-limitation, interactive audio;
- A facsimile machine;
- Text messaging; or
- Electronic mail systems.
Virtual services are telemedicine, telehealth, e-consulting, and provider home visits that are part of a patient care treatment plan and are provided at the individual’s home or in a community setting. These services are provided using mobile secure telecommunication devices, electronic monitoring equipment, and include clinical provider care, behavioral health therapies, speech, occupational and physical therapy services, and treatment provided to an individual at their residence.
SOURCE: PASSE Program (1/1/23) Section II, Program Policy. (Accessed May 2024)
Rural Health Centers
Arkansas Medicaid defines telemedicine services as medical services performed as electronic transactions in real time.
SOURCE: AR Medicaid Provider Manual. Section II Rural Health. Rule 211.300. p. 6, Updated 2/1/24. (Accessed May 2024).
“Telemedicine” means the use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient.
Telemedicine includes store-and-forward and remote patient monitoring.
For the purposes of this subchapter, “telemedicine” does not include the use of:
- Audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan.
- As with other medical services covered by a health benefit plan, documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of conversation, medical decision-making, and plan of care after the contact.
- The documentation described in subdivision (7)(C)(i)(b)of this section is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
- A facsimile machine;
- Text messaging; or
- Email
SOURCE: AR Code 23-79-1601(7). (Accessed May 2024).
Ambulance Services
“Telemedicine” means the use of audiovisual electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient.
“Telemedicine” includes store-and-forward technology and remote patient monitoring.
“Telemedicine” does not include the use of audio-only electronic technology.
SOURCE: AR Code 20-13-108 & 23-79-2702, (Accessed May 2024).
Last updated 05/27/2024
Live Video
POLICY
Arkansas Medicaid provides payment to a licensed or certified healthcare professional or a licensed or certified entity for services provided through telemedicine if the service provided through telemedicine is comparable to the same service provided in-person.
Coverage and reimbursement for services provided through telemedicine will be on the same basis as for services provided in-person. While a distant site facility fee is not authorized under the Telemedicine Act, if reimbursement includes payment to an originating site (as outlined in the above paragraph), the combined amount of reimbursement to the originating and distant sites may not be less than the total amount allowed for healthcare services provided in-person.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. p. I-13 Updated Jan. 1, 2022 (Accessed May 2024).
Arkansas Medicaid shall provide payment for telemedicine healthcare services to licensed or certified healthcare professionals or entities that are authorized to bill Arkansas Medicaid directly for healthcare services. Coverage and reimbursement for healthcare services provided through telemedicine shall be reimbursed on the same basis as healthcare services provided in person.
SOURCE: Section III Billing Documentation. Rule 305.000. , p. III-8 Updated Jan. 1, 2022. (Accessed May 2024).
Rural Health Centers
In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time.
SOURCE: AR Medicaid Provider Manual. Section II Rural Health. Rule 211.300. p. II-6 Updated 2/1/24. (Accessed May 2024).
Occupational Therapy, Physical Therapy and Speech-Language Pathology Services
An enrolled provider may be reimbursed for medically necessary occupational therapy, physical therapy, and speech-language pathology services delivered through telemedicine.
The service provider is responsible for ensuring service delivery through telemedicine is equivalent to in-person, face-to-face service delivery.
- The service provider is responsible for ensuring the calibration of all clinical instruments and the proper functioning of all telecommunications equipment.
- All services delivered through telemedicine must be delivered in a synchronous manner, meaning through real-time interaction between the practitioner and client via a telecommunication link.
- A store and forward telecommunication method of service delivery where either the client or practitioner records and stores data in advance for the other party to review at a later time is prohibited, although correspondence, faxes, emails, and other non-real time interactions may supplement synchronous telemedicine service delivery.
Services delivered through telemedicine are reimbursed in the same manner and subject to the same benefit limits as in-person, face-to-face service delivery. View or print the billable telecommunication codes and descriptions.
SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed May 2024).
ELIGIBLE SERVICES/SPECIALTIES
A health benefit plan [includes Arkansas Medicaid] shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in person, unless this subchapter specifically provides otherwise.
A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in person.
SOURCE: AR Code 23-79-1602(c). (Accessed May 2024).
Covered counseling services are outpatient services. Specific Counseling Services are available to inpatient hospital patients (as outlined in Sections 240.000 and 220.100), through telemedicine, and to nursing home residents. Counseling Services are billed on a per unit or per encounter basis as listed. All services must be provided by at least the minimum staff within the licensed scope of practice to provide the service.
Telemedicine is listed as an allowed delivery mode for certain services throughout the Counseling Services Manual (formerly the Outpatient Behavioral Health Services manual).
SOURCE: AR Medicaid Manual, Section II Counseling Services, Updated Apr. 1, 2024, (Accessed May 2024).
Occupational Therapy, Physical Therapy and Speech-Language Pathology Services
An enrolled provider may be reimbursed for medically necessary occupational therapy, physical therapy, and speech-language pathology services delivered through telemedicine.
Occupational therapy, physical therapy, and speech-language pathology evaluation and treatment planning services may not be conducted through telemedicine and must be performed through traditional in-person methods.
SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed May 2024).
Rural Health Centers
Arkansas Medicaid covers RHC encounters and two ancillary services (fetal echography and echocardiography) as “telemedicine” services.
Arkansas Medicaid defines telemedicine services as medical services performed as electronic transactions in real time. In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time. Physician interpretation of fetal ultrasound is covered as a telemedicine service if the physician views the echography or echocardiography output in real time while the patient is undergoing the procedure.
SOURCE: AR Medicaid Provider Manual. Section II Rural Health. Rule 211.300. Updated 2/1/24. (Accessed May 2024).
Patient-Led Arkansas Shared Savings Entity (PASSE) Program
Virtual services can be provided using mobile secure telecommunication devices, electronic monitoring equipment and include clinical provider care, behavioral health therapies, speech, occupational and physical therapy services, and treatment provided to an individual at their residence. Virtual provider services may use various evidence-based and innovative independence at-home strategies. They may include the provision of on-going care management, remote telehealth monitoring and consultation, face to face or through the use secure web-based communication and mobile telemonitoring technologies to remotely monitor and evaluate the patient’s functional and health status. Virtual and telehealth services are provided in lieu of providing the same services at a practice site or provided at the individual’s place of residence.
SOURCE: PASSE Program, Section. II, p. 8, (1/1/23). (Accessed May 2024).
A healthcare professional may use telemedicine to perform group meetings for healthcare services, including group therapy.
Telemedicine for group therapy provided to adults who are participants in a program or plan authorized and funded under 42 U.S.C. § 1396a, as approved by the United States Secretary of Health and Human Services, may only be permitted if the Centers for Medicare and Medicaid Services allows telemedicine for group therapy provided to adults.
Telemedicine shall not be used for group therapy provided to a child who is eighteen (18) years of age or younger.
SOURCE: AR CODE 17-80-404 (Accessed May 2024).
Home Health
The face-to-face encounter may occur through telemedicine when applicable to the program manual of the performing provider of the encounter.
SOURCE: AR Medicaid Provider Manual. Section II Nurse Practitioner. Rule 203.020, II-7. Updated 1/1/24 (Section updated 7-1-17) & AR Medicaid Provider Manual. Section II Home Health. Rule 206.000, II-5. Section updated July 1, 2017 (overall manual updated 1/1/24), & AR Medicaid Provider Manual. Section II Certified Nurse-Midwife. Rule 204.101, II-6. Section updated July 1, 2017. (Overall manual updated 1/1/24, (Accessed May 2024).
Behavioral Health Conditions and Services
Screening for behavioral health conditions and behavioral health services as described in subsection (a) of this section may be provided via telemedicine and reimbursed by the Arkansas Medicaid Program as required under § 20-77-141.
SOURCE: AR Code 20-77-149, (Accessed May 2024).
Ambulance Services – Newly Passed Legislation
An ambulance service’s operators may triage and transport a patient to an alternative destination in this state or treat in place if the ambulance service is coordinating the care of the patient through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.
SOURCE: AR Code 20-13-108, (Accessed May 2024).
On and after January 1, 2024, a healthcare insurer [includes Medicaid] that offers, issues, or renews a health benefit plan in this state shall provide coverage for:
- An ambulance service to:
- Treat an enrollee in place if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
- Triage or triage and transport an enrollee to an alternative destination if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
- An encounter between an ambulance service and enrollee that results in no transport of the enrollee if:
- The enrollee declines to be transported against medical advice; and
- The ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.
See statute for additional restrictions.
The reimbursement rate for an ambulance service whose operators triage, treat, and transport an enrollee to an alternative destination, or triage, treat, and do not transport an enrollee if the enrollee declines to be transported against medical advice, if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint under this section shall be at least at the rate:
- Contracted with a local government entity where the alternative destination is located; or
- Established by the Workers’ Compensation Commission under its schedule for emergency Advance Life Support Level 1.
SOURCE: AR Code 23-79-2703, (Accessed May 2024).
Ground ambulance triage, treat, and transport to alternative location/destination services (T3AL) may be covered only when provided by an ambulance company that is licensed and is an enrolled provider in the Arkansas Medicaid Program. An ambulance service may triage and transport a beneficiary to an alternative destination or treat in place if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. Telemedicine rules are described in Section 105.190 and must be followed unless instructions are given within Section II of the prevailing Medicaid manual. The use of audio-only electronic technology is not allowed for T3AL services.
For the purposes of T3AL, a behavioral health specialist is a board-certified psychiatrist or an Independently Licensed Practitioner who can provide counseling services to Medicaid beneficiaries in the Outpatient Behavioral Health program.
SOURCE: AR Medicaid Provider Manual. Section II Transportation. Rule 214.100, II-7 to 8. Updated 2/1/24, (Accessed May 2024).
Group Therapy – General Professional Requirement (Not Medicaid exclusive)
A healthcare professional may use telemedicine to perform group meetings for healthcare services, including group therapy.
Telemedicine for group therapy provided to adults who are participants in a program or plan authorized and funded under 42 U.S.C. § 1396a, as approved by the United States Secretary of Health and Human Services, may only be permitted if the Centers for Medicare and Medicaid Services allows telemedicine for group therapy provided to adults.
Telemedicine shall not be used for group therapy provided to a child who is eighteen (18) years of age or younger.
SOURCE: AR CODE 17-80-404 (Accessed May 2024).
Life360 HOMES
The Rural Life360 will provide the following care coordination supports: … Provide intensive care coordination and coaching supports for enrolled clients. Intensive care coordination and coaching include: … Providing supports through any of the following:
- Home visits in such frequency as is necessary to assist the client meet his/her documented PCAP goals
- Office visits
- Video-supported visits
- Telephone or text message contacts in conjunction with in-person visits
SOURCE: AR Medicaid Provider Manual. Section II Life360 HOMES. Rule 210.500 & 210.600, Updated 11-1-23. (Accessed May 2024).
AR Independent Assessment (ARIA)
Behavioral Health Services:
A reassessment will be completed by staff employed by the independent assessment contractor utilizing the current approved assessment instrument (ARIA), which was approved prior to April 1, 2021, to assess functional need. An interview will be conducted in person for initial assessments, with the option of using telemedicine to complete Behavioral Health reassessments. The telemedicine tool must meet the 1915(i) requirement for the use of telemedicine under 42 CFR 441.720 (a)(1)(i)(A) through (C).
To continue to receive Complex Care services, members must receive a complex care assessment annually and be assessed as needing Complex Care services. A reassessment will be completed by appropriate DHS-approved staff using the appropriate Complex Care assessment tool. If a member does not meet the need for Complex Care services, the member will be placed back in Tier 3. An in-person interview will be conducted for initial assessments, with the option of using telemedicine to complete reassessments for members who meet the criteria for Complex Care. The telemedicine tool must meet the 1915(i) requirement for the use of telemedicine under 42 CFR 441.720 (a)(1)(i)(A) through (C).
SOURCE: AR Medicaid Provider Manual, Section II, AR Independent Assessment (ARIA), 210.100 & .600, 1-1-24, (Accessed May 2024).
Life Choices Lifeline and Continuum of Care Program
The purpose of the Life Choices Lifeline and Continuum of Care Program is to provide a statewide telemedicine network and care program to provide community outreach, direct services, support, social services case management, care coordination, consultation, and referrals to:
- Encourage healthy childbirth;
- Support childbirth as an alternative to abortion;
- Promote family formation;
- Aid in successful parenting;
- Assist parents in establishing successful parenting techniques; and
- Increase families’ economic self-sufficiency.
SOURCE: AR Rules for Life Choices Lifeline and Continuum of Care Program, Sec. 102, (Lexis Nexis: 016 Dep of Human Services, 29 Div. of Medical Services, 009 Developmental Screens for Children), (Accessed May 2024).
Covered EIDT services are clinic-based services and cannot be delivered through telemedicine or at any location other than the licensed EIDT facility.
SOURCE: AR Rules and Regulations, Sec. 016.05.24-002, & AR Medicaid Provider Manual. Section II EIDT. Rule 221.000. Updated 4-1-24 (Accessed May 2024).
ELIGIBLE PROVIDERS
The distant site is the location of the healthcare provider delivering telemedicine services.
SOURCE: Section III Provider Billing Documentation. Rule 305.000. Updated Jan. 1, 2022 (Accessed May 2024).
Services at the distant site must be provided by an enrolled Arkansas Medicaid Provider who is authorized by Arkansas law to administer healthcare.
The professional or entity at the distant site must be an enrolled Arkansas Medicaid Provider.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022 & Section III Billing Documentation. Rule 305.000. Updated Jan. 1, 2022, (Accessed May 2024).
The provider of the distant site must submit claims for telemedicine services using the appropriate CPT or HCPCS code for the professional service delivered. The provider must use Place of Service two (02) (telemedicine distant site) when billing the CPT or HCPCS codes.
SOURCE: AR Medicaid Provider Manual. Section III Billing Documentation. Rule 305.000. Updated Jan. 1, 2022. (Accessed May 2024)
The distant site healthcare provider will not utilize telemedicine services with a client unless a professional relationship exists between the provider and the client. A professional relationship exists when, at a minimum:
- The healthcare provider has previously conducted an in-person examination of the client and is available to provide appropriate follow-up care;
- The healthcare provider personally knows the client and the client’s health status through an ongoing relationship and is available to provide follow-up care;
- The treatment is provided by a healthcare provider in consultation with, or upon referral by, another healthcare provider who has an ongoing professional relationship with the client and who has agreed to supervise the client’s treatment including follow-up care;
- An on-call or cross-coverage arrangement exists with the client’s regular treating healthcare provider or another healthcare provider who has established a professional relationship with the client;
- A relationship exists in other circumstances as defined by the Arkansas State Medical Board (ASMB) or a licensing or certification board for other healthcare providers under the jurisdiction of the appropriate board if the rules are no less restrictive than the rules of the ASMB.
- A professional relationship is established if the provider performs a face to face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination. (See ASMB Regulation 2.8);
- If the establishment of a professional relationship is permitted via telemedicine under the guidelines outlined in ASMB regulations, telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter and only under the safeguards established by the healthcare professional’s licensing board (See ASMB Regulation 38 for these safeguards including the standards of care); or
- The healthcare professional who is licensed in Arkansas has access to a client’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a client located in Arkansas to diagnose, treat, and if clinically appropriate, prescribe a noncontrolled drug to the client.
See Miscellaneous section for additional restrictions.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022 (Accessed May 2024).
Medication Assisted Treatment (MAT) for Opioid Use Disorder
The provider at the distance site shall use both the GT modifier and the X2 or X4 modifier on the service claim.
SOURCE: AR Medicaid Provider Manual Physician Section II-129, 2/1/24, (Accessed May 2024)
Providers are encouraged to use telemedicine services when in-person treatment is not readily accessible.
SOURCE: AR Admin. Rule 230.000 (Lexis Nexis: 016-06 CARR 036) p. 12 (9/1/2020) (Accessed May 2024).
Patient-Led Arkansas Shared Savings Entity (PASSE) Program
The provision of virtual care can include an interdisciplinary care team or be provided by individual clinical service provider.
SOURCE: PASSE Program, p. II-8 (1/1/23). (Accessed May 2024).
The Arkansas Medicaid Program shall reimburse for the following behavioral and mental health services provided via telemedicine:
- Counseling and psychoeducation provided by a person licensed as:
- A psychologist;
- A psychological examiner;
- A professional counselor;
- An associate counselor;
- An associate marriage and family therapist;
- A marriage and family therapist;
- A clinical social worker; or
- A master social worker;
- Crisis intervention services;
- Substance abuse assessments;
- Mental health diagnosis assessments for an individual under twenty-one (21) years of age; and
- Group therapy for individuals who are eighteen (18) years of age or older under the current service definition determined by the Arkansas Medicaid Program and when provided via audio-visual technology that is compliant with the HIPPA and composed of beneficiaries of similar age and clinical presentation to qualified beneficiaries.
SOURCE: AR Code 20-77-141 (Accessed May 2024).
Ambulance Service
An ambulance service may:
- Treat a beneficiary in alternative location if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
- Triage or triage and transport a beneficiary to an alternative destination if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.
An encounter between an ambulance service and a beneficiary that results in no transport of the enrollee is allowable if the beneficiary declines to be transported against medical advice and the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint.
An encounter between an ambulance service and a beneficiary is billable as follows:
- The ambulance service may bill either a basic life support (BLS) or advanced life support (ALS) service according to the level of the service provided to the beneficiary, plus mileage. Mileage may be billed for treating in the alternative location (one-way mileage to the location of the beneficiary. Mileage rules set forth in Section 204.000, 205.000, 214.000, and 216.000 will otherwise be followed.
SOURCE: AR Medicaid Provider Manual. Section II Transportation. Rule 214.110, II-8. Updated 2/1/24, (Accessed May 2024).
ELIGIBLE SITES
Patient-Led Arkansas Shared Savings Entity (PASSE) Program
Virtual and telehealth services can be provided at the individual’s home or in a community setting.
SOURCE: PASSE Program, II-8 (1/1/23). (Accessed May 2024).
“Originating site” means a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine, which includes the home of a patient.
SOURCE: AR Code 23-79-1601(4) (Accessed May 2024).
School Based
Regardless of whether the provider is compensated for healthcare services, if a healthcare provider seeks to provide telemedicine services to a minor in a school setting and the minor client is enrolled in Arkansas Medicaid, the healthcare provider shall:
- Be the designated Primary Care Provider (PCP) for the minor client;
- Have a cross-coverage arrangement with the designated PCP of the minor client; or
- Have a referral from the designated PCP of the minor client.
If the minor client does not have a designated PCP, this section does not apply. Only the parent or legal guardian of the minor client may designate a PCP for a minor client.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022 (Accessed May 2024).
Early Intervention Day Treatment (EIDT)
Since EIDT services are clinic-based services, three services cannot be delivered through telemedicine or at any location other than through the licensed EIDT clinic. EIDT providers are considered all-inclusive, meaning a beneficiary attending an EIDT should have all of their habilitative occupational therapy, physical therapy, and speech-language pathology service needs performed by the EIDT program at the EIDT clinic.
SOURCE: AR Rules and Regulations, Sec. 016.05.24-002, (Accessed May 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Payment will include a reasonable facility fee to the originating site (the site at which the patient is located at the time telemedicine healthcare services are provided). In order to receive reimbursement, the originating site must be operated by a healthcare professional or licensed healthcare entity that is authorized to bill Medicaid directly for healthcare services.
There is no facility fee for the distant site. The professional or entity at the distant site must be an enrolled Arkansas Medicaid Provider. Any other originating sites are not eligible to bill a facility fee.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022. & Section III Billing Documentation. Rule 305.000. Updated Jan. 1, 2022, (Accessed May 2024).
The originating site shall submit a telemedicine claim under the billing providers “pay to” information, using HCPCS code Q3014. The code must be submitted for the same date of service as the professional code and must indicate the place of service (where the member was at the time of the telemedicine encounter). Except in the case of hospital facility claims, the provider who is responsible for the care of the member at the originating site shall be entered as the performing provider in the appropriate field of the claim. For outpatient claims that occur in a hospital setting, the provider must also use Place of Service code twenty-two (22) with the originating site billing Q3014. In the case of in-patient services, HCPCS code Q3014 is not separately reimbursable because it is included in the hospital per diem.
SOURCE: AR Medicaid Provider Manual. Section III Billing Documentation. Rule 305.000. III-8 to 9, Updated Jan. 1, 2022 (Accessed May 2024).
Federally Qualified Health Centers
Use procedure code and type of service code Y (paper claims only) to indicate telemedicine charges.
The charge associated with this procedure code should be an amount attributable to the telemedicine service, such as line (or wireless) charges. Medicaid will deny the charge and capture it in the same manner as with ancillary charges.
SOURCE: AR Medicaid Provider Manual. Section II FQHC. Rule 262.120. Updated 2/1/24. pg. II-34, (Accessed May 2024).
A health benefit plan shall provide a reasonable facility fee to an originating site operated by a healthcare professional or a licensed healthcare entity if the healthcare professional or licensed healthcare entity is authorized to bill the health benefit plan directly for healthcare services.
SOURCE: AR Code 23-79-1602(d) (1). (Accessed May 2024).
Last updated 05/27/2024
Miscellaneous
The distant site provider is prohibited from utilizing telemedicine with a patient unless a professional relationship exists between the provider and patient. See manual for ways to establish the relationship. A professional relationship is established if the provider performs a face-to-face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; or if the establishment of a professional relationship is permitted via telemedicine under the guidelines outlined in ASMB regulations. Telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter and only under the safeguards established by the healthcare professional’s licensing board (See ASMB Regulation 38 for these safeguards including the standards of care). See manual for full list of requirements on establishing a professional relationship. Special requirements also exist for providing telemedicine services to a minor in a school setting (see manual).
A healthcare provider providing telemedicine services within Arkansas shall follow applicable state and federal laws, rules and regulations regarding:
- Informed consent;
- Privacy of individually identifiable health information;
- Medical record keeping and confidentiality, and
- Fraud and abuse.
A health record is created with the use of telemedicine, consists of relevant clinical information required to treat a client, and is reviewed by the healthcare professional who meets the same
standard of care for a telemedicine visit as an in-person visit. A professional relationship does not include a relationship between a healthcare provider and a client established only by the following:
- An internet questionnaire;
- An email message;
- A client-generated medical history;
- Text messaging;
- A facsimile machine (Fax) and EFax;
- Any combination of the above; or
- Any future technology that does not meet the criteria outlined in this section.
The existence of a professional relationship is not required when:
- An emergency situation exists; or
- The transaction involves providing information of a generic nature not meant to be
specific to an individual client.
Once a professional relationship is established, the healthcare provider may provide healthcare services through telemedicine, including interactive audio, if the healthcare services are within
the scope of practice for which the healthcare provider is licensed or certified and in accordance with the safeguards established by the healthcare professionals licensing board.
SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022, (Accessed May 2024).
Occupational Therapy, Physical Therapy and Speech-Language Pathology Services
The plan of care and client service record must include the following:
- A detailed assessment of the client that determines they are an appropriate candidate for service delivery by telemedicine based on the client’s age and functioning level;
- A detailed explanation of all on-site assistance or participation procedures the therapist or speech-language pathologist is implementing to ensure:
- The effectiveness of telemedicine service delivery is equivalent to face-to-face service delivery; and
- Telemedicine service delivery will address the unique needs of the client.
- A plan and estimated timeline for returning service delivery to in-person if a client is not progressing towards goals and outcomes through telemedicine service delivery.
SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed May 2024).
Patient-Led Arkansas Shared Savings Entity (PASSE) Program
If the PASSE allows the use of telemedicine, the PASSE must document what services the PASSE allows, the settings allowed, and the qualifications for individuals to perform services via telemedicine.
SOURCE: AR Medicaid Provider Manual PASSE Program, (3/1/19). (Accessed May 2024).
The Department of Human Services shall establish the “Continuum of Care Program” for certain women and parents. The purpose of the program is to facilitate the operation of a statewide telemedicine support network that provides community outreach, consultations, and care coordination for women who are challenged with unexpected pregnancies. See statute for details.
SOURCE: AR Code Sec. 20-8-1003, (Accessed May 2024).
For purposes of a complex care home (which is a specific type of Provider owned, leased, or controlled supportive living residential setting that is certified to offer eligible beneficiaries a twenty-four (24) hour, seven (7) days a week specialized medical, clinical, and habilitative support and service array), a face-to-face crisis assessment of a beneficiary includes telemedicine.
Supportive Living: Face-to-face crisis assessment of a beneficiary within two (2) hours of an emergency/crisis (which may be conducted through telemedicine) unless a different time frame is within clinical standards guidelines and mutually agreed upon by the requesting party and the responding MHP.
SOURCE: AR Rules and Regulations Sec. 016.05.24-001, (Accessed May 2024).
