Last updated 06/04/2024
Definitions
“Telehealth” means healthcare services, including behavioral health services, provided by a healthcare provider, as defined in this Section, to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer technology, or synchronous interaction between a provider at a distant site and a patient at an originating site, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient, and transfer of medical data. The term “telehealth” shall not include any of the following:
- Electronic mail messages and text messages that are not compliant with applicable requirements of the Health Insurance Portability and Accountability Act of 1996, as amended, 42 U.S.C. 1320d et seq.
- Facsimile transmissions.
SOURCE: LA Revised Statutes 40:1223.3, (Accessed Jun. 2024).
“Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or other licensed practitioner and a beneficiary are not in the same location. The telecommunications system shall include, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the beneficiary at the originating site and the physician or other licensed practitioner at the distant site. The telecommunications system must be secure, ensure patient confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act.”
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 166. (As issued 6/27/22), & MCO Manual (updated 6/11/24), pg. 176, (Accessed Jun. 2024).
Behavioral Health Outpatient Services, Outpatient Therapy by Licensed Practitioners: Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or LMHP and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.
Rehabilitation: For dates of service on or after May 1, 2023, telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician, LMHP, or other qualified professional (see staff qualifications) and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.
Addiction Services: Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or LMHP and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.
SOURCE: LA Dept. of Health, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 113, 171 & 199 (As issued 5/13/24). (Accessed Jun. 2024).
Telecare is a delivery of care services to recipients in their home by means of telecommunications and/or computerized devices to improve outcomes and quality of life, increase independence and access to health care, and reduce health care costs. Telecare services include the following:
- Activity and sensor monitoring;
- Health status monitoring; and
- Medication dispensing and monitoring.
See manual for description of monthly telecare services.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-24 (As issued 4/13/22). (Accessed Jun. 2024).
EPSDT Health and IDEA Related Services
Telemedicine/telehealth is not a covered service, but is a service delivery method. Louisiana Medicaid encourages the use of this delivery method, when appropriate, for any and all healthcare services (i.e., not just those related to COVID-19 symptoms). Louisiana Medicaid allows for the telemedicine/telehealth mode of delivery for many common healthcare services.
SOURCE: LA Dept. of Health, Provider Manual, Chapter Twenty of the Medicaid Svcs. Manual, Section 20.1, p. 13 (As issued 3/14/24). (Accessed Jun. 2024).
Last updated 06/04/2024
Live Video
POLICY
Louisiana Medicaid only reimburses the distant site for services provided via telemedicine. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person.
The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth. NOTE: The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid beneficiaries.
Medicaid covered services provided using telemedicine must be identified on claim submissions by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the -95 modifier must be present on the claim to receive reimbursement
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165-166 (as issued 6/27/22). (Accessed Jun. 2024).
Telemedicine/telehealth is the use of an interactive audio and video telecommunications system to permit real time communication between a distant site health care practitioner and the beneficiary. There is no restriction on the originating site (i.e., where the beneficiary is located) and it can include, but is not limited to, a healthcare facility, school, or the beneficiary’s home.
Medicaid covered services provided via telehealth/telemedicine shall be identified on claim submissions by appending the Health Insurance Portability and Accountability Act (HIPAA) of 1996 compliant place of service (POS) or modifier to the appropriate procedure code, in line with current policy
SOURCE: LA Admin. Code 50: Sec. 501 & 503, p. 36 (Accessed Jun. 2024).
The MCO shall reimburse the distant site provider for services provided via telemedicine/telehealth. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person.
The MCO shall require the provider to include in the enrollee’s clinical record documentation that the service was provided through the use of telemedicine/telehealth.
The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid enrollees.
SOURCE: MCO Manual (updated 6/11/24), pg. 176, (Accessed Jun. 2024).
ELIGIBLE SERVICES/SPECIALTIES
The department shall periodically review policies regarding Medicaid reimbursement for telehealth services to identify variations between permissible reimbursement under that program and reimbursement available to healthcare providers under the Medicare program.
To the extent practicable, notwithstanding any other law to the contrary, after conducting a review provided for in Subsection A of this Section, the department may modify its administrative rules, policies, and procedures applicable to Medicaid reimbursement for telehealth services as necessary to provide for a reimbursement system that is comparable to that of the Medicare program for those services.
SOURCE: LA Statute RS 40:1255.2 (Accessed Jun. 2024).
When otherwise covered, services located in the Telemedicine appendix of the CPT manual, or its successor, may be reimbursed when provided by telemedicine/telehealth. In addition, other specified services may be reimbursed when provided by telemedicine/telehealth and these services are explicitly noted in this manual.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (as issued 6/27/22). (Accessed Jun. 2024).
In the event that the federal or state government declares an emergency or disaster, the Medicaid Program may temporarily cover services provided through the use of an interactive audio telecommunications system, without the requirement of video, if such action is deemed necessary to ensure sufficient services are available to meet beneficiaries’ needs.
SOURCE: LA Admin Code, Sec. 50:I.505, (Accessed Jun. 2024).
When otherwise covered, the MCO shall cover services located in the Telemedicine appendix of the CPT manual, or its successor, when provided by telemedicine/telehealth. In addition, the MCO shall cover other services provided by telemedicine/telehealth when indicated as covered via telemedicine/telehealth in Medicaid program policy. The MCO shall ensure adequate availability of telemedicine/telehealth during declared emergencies, disasters, and pandemics. Physicians and other licensed practitioners must continue to adhere to all existing clinical policy for all services rendered. Providing services through telemedicine/telehealth does not remove or add any medical necessity requirements.
SOURCE: MCO Manual (revised 6/11/24, pg. 176, (Accessed Jun. 2024).
Treatment-in-place ambulance services
Effective for dates of service on or after May 12, 2023, the Louisiana Medicaid Program provides coverage for initiation and facilitation of telehealth services by qualified Louisiana Medicaid enrolled ambulance providers.
SOURCE: LA Admin Code, Title 50, Part IX, Subpart 1, Ch. 13, Sec. 1301, p. 336 (Accessed Jun. 2024).
A physician directed treatment-in-place service is the facilitation of a telehealth visit by an ambulance provider.
Each paid treatment-in-place ambulance claim must have a separate and corresponding paid treatment-in-place telehealth claim, and each paid treatment-in-place telehealth claim must have a separate and corresponding paid treatment-in-place ambulance claim or a separate and corresponding paid ambulance transportation claim. Reimbursement for both an emergency transport to a hospital and an ambulance treatment-in-place service for the same incident is not permitted.
SOURCE: LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 2/16/24), (Accessed Jun. 2024).
Payment of treatment-in-place ambulance services is restricted to those identified on the Physician Directed Ambulance Treatment-in-Place Fee Schedule and edit claims for non-payable procedure codes as follows:
- If a treatment-in-place ambulance claim is billed with mileage, the entire claim document shall be denied;
- If an unpayable procedure code, that is not mileage, is billed on a treatment-in-place ambulance claim, only the line with the unpayable code will be denied;
- Claims for allowable telehealth procedure codes must be billed with procedure code G2021. The G2021 code shall be accepted, paid at $0.00, and used by the transportation provider to identify treatment-in-place telehealth services; and
- As with all telehealth claims, providers must include POS identifier “02” or “10” and modifier “95” with their claim to identify the claim as a telehealth service. Providers must follow CPT guidance relative to the definition of a new patient versus an established patient.
See valid treatment in place ambulance claim modifier list.
If the beneficiary being treated-in-place has a real-time deterioration in their clinical condition necessitating immediate transport to an emergency department, as determined by the ambulance provider (i.e., EMT or paramedic), telehealth provider, or beneficiary, the ambulance provider cannot bill for both the treatment-in-place ambulance service and the transport to the emergency department. In this situation, the ambulance provider shall bill for the transport to the emergency department only. The transportation broker shall require ambulance providers to submit pre-hospital care summary reports when ambulance treatment-in-place and ambulance transportation claims are billed for the same beneficiary with the same date of service.
If a beneficiary is offered treatment-in-place services declines the services, ambulance providers should include procedure code G2022 on claims for ambulance transportation to an emergency department. Use of this informational procedure code is optional and does not affect the establishment of medical necessity of the service or reimbursement of the ambulance transportation claim. The G2022 code shall be accepted, paid at $0.00, and used by the transportation provider to identify beneficiary refusal of treatment-in-place services
Payment of the treatment-in-place services is restricted to those identified on the Treatment-in-Place Telehealth Services Fee Schedule.
SOURCE: MCO Manual (revised 6/11/24), pg. 88-89, & LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 2/16/24), (Accessed Jun. 2024).
Behavioral Health Services
Assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services [CPST allowed in Rehabilitation Services section and services allowed within intensive outpatient or outpatient treatment may be provided in Addiction Services section] may be reimbursed when provided via telecommunication technology when the following criteria is met:
- The telecommunication system used by physicians and LMHPs must be secure, ensure member confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- The services provided are within the practitioner’s telehealth scope of practice as dictated by the respective professional licensing board and accepted standards of clinical practice;
- The member’s record includes informed consent for services provided through the use of telehealth;
- Services provided using telehealth must be identified on claims submission using by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the 95 modifier must be present on the claim to receive reimbursement;
- Assessments and evaluations conducted by an LMHP through telehealth should include synchronous, interactive, real-time electronic communication comprising both audio and visual elements unless clinically appropriate and based on member consent; and
- Providers must deliver in-person services when telehealth is not clinically appropriate or when the member requests in-person services.
- Group psychotherapy is only allowed via telehealth when utilized for Dialectical Behavioral Therapy (DBT) and must include synchronous, interactive, real-time electronic communication comprising of both audio and visual elements. [in Outpatient Services, Outpatient Therapy by Licensed Practitioners section only, not Addiction section)
Exclusions: Methadone admission visits conducted by the admitting physician within Opioid Treatment Programs are not allowed via telecommunication technology. [in Addiction section only].
LMHP’s providing assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services offered within Opioid treatment programs may be reimbursed when conducted via telecommunication technology. The LMHP is responsible for acting within the telehealth scope of practice as decided by the respective licensing board. The provider must bill the procedure code (CPT codes) with modifier “95”, as well as the correct place of service, either POS 02 (other than home) or 10 (home). Reimbursement will be at the same rate as a face-to-face service. Exclusions: Methadone admission visits conducted by the admitting physician within OTPs are not allowed via telecommunication technology.
SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 113-114, 199-200 & 270 (As issued 5/13/24). (Accessed Jun. 2024).
Parent-Child Interaction Therapy
Fidelity is then directly assessed via the following requirement: Applicants must have their treatment sessions observed by a certified PCIT Trainer. Observations may be conducted in real time (e.g., live or online/telehealth) or through video recording.
Dialectical Behavioral Therapy
As an outpatient therapy service delivered by licensed practitioners, allowed modes of delivery include individual, family, group, on-site, off-site, and tele-video. Telehealth delivery is allowed if it includes synchronous, interactive, real-time electronic communication comprising both audio and visual elements.
A comprehensive DBT program is typically provided in an outpatient setting. Telehealth is an allowed modality, and use of telehealth for DBT skills training groups in particular may support continued and consistent client engagement, especially when travel or transportation is a barrier to client engagement.
Components of DBT may be delivered, with some adaptation, in a residential or inpatient setting; however, this would not be billed as a separate service, instead would be part of the active treatment plan reimbursed as part of the comprehensive inpatient or psychiatric residential treatment facility (PRTF) rate
Only direct staff face-to-face time with the individual or family may be billed. DBT is a face-to-face intervention with the individual present. Telehealth delivery is allowed if it includes synchronous, interactive, real-time electronic communication comprising both audio and visual elements. Services provided using telehealth must be identified on claims submission by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the 95 modifier must be present on the claim to receive reimbursement;
SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, 415, 461, 470 (As issued 5/13/24). (Accessed Jun. 2024).
Ambulance Providers – Managed Care Organizations
Physician directed treatment-in-place service is the facilitation of a telehealth visit by an ambulance provider.
Each paid treatment-in-place ambulance claim must have a separate and corresponding paid treatment-in-place telehealth claim, and each paid treatment-in-place telehealth claim must have a separate and corresponding paid treatment-in-place ambulance claim or a separate and corresponding paid ambulance transportation claim.
MCO Manual: The MCO may not reimburse for both an emergency transport to a hospital and an ambulance treatment-in-place service for the same incident.
Medical Transportation Manual: Reimbursement for both an emergency transport to a hospital and an ambulance treatment-in-place service for the same incident is not permitted.
SOURCE: LA Medicaid Managed Care Organization (MCO) Manual, p. 88 (Updated 6/11/24), & LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 2/16/24), (Accessed Jun. 2024).
Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)
Louisiana Medicaid allows for the telemedicine/telehealth mode of delivery for many common healthcare services.
Permissible Telecommunications Systems:
- All services eligible for telemedicine/telehealth may be delivered via an interactive audio/video telecommunications system;
- A secure, HIPAA-compliant platform is preferred, if available. However, for the duration of the COVID-19 event, if a HIPAA-compliant system is not immediately available at the time it is needed, providers may use everyday communications technologies such as cellular phones with widely available audio/video communication platforms;
- Providers should follow guidance from the Office for Civil Rights at the Department of Health and Human Services for software deemed appropriate for use during this event;
- For the duration of the COVID-19 event, in cases where an interactive audio/video system is not immediately available at the time it is needed, an interactive audio-only system (e.g., telephone) without the requirement of video may be employed, unless noted otherwise;
- For use of an audio-only system, the same standard of care must be met, and the need and rationale for employing an audio-only system must be documented in the clinical record; and
- Please note, some telemedicine/telehealth services described below require delivery through an audio/video system due to the clinical nature of these services. Where applicable, this requirement is noted explicitly.
As always, providers must maintain the usual medical documentation to support reimbursement of the visit. In addition, providers must adhere to all telemedicine/telehealth-related requirements of their respective professional licensing boards.
Reimbursement for services delivered through telemedicine/telehealth is at the same level as reimbursement for in-person services.
Providers must indicate place of service 02 and must append modifier -95.
SOURCE: LA Dept. of Health, Provider Manual, Chapter Twenty of the Medicaid Svcs. Manual, Section 20.1, p. 19-20 (As issued 3/14/24). (Accessed Jun. 2024).
Consultations are to be face-to-face contact in one-on-one sessions. These are services for which a parent would otherwise seek medical attention at a physician or health care provider’s office. Telemedicine/telehealth is not a covered service, but is an applicable service delivery method. When otherwise covered by Louisiana Medicaid, telemedicine/telehealth is allowed for all CPT codes located in Appendix P of the CPT manual. This service is available to all Medicaid individuals eligible for EPSDT.
SOURCE: LA Admin Code, Title 50, Part XV, Subpart 5, Ch. 95, Sec. 9503, p. 393 (Accessed Jun. 2024).
The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:
- An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
- Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
- The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.
For services rendered in the natural environment (home and community). “Community”: environment where children of same age with no disabilities or special needs participate such as childcare centers, agencies, libraries, and other community settings. Services can be provided via “teletherapy” specific POS/modifier combinations.
POS/modifier combination must be one of these two choices:
- POS 12 (Home) and Procedure Modifier U8; or
- POS 99 (Other Place of Service) and Procedure Modifier U8.
- POS 02 (Teletherapy) and Procedure Modifiers 95 and U8.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, EPSDT Health and IDEA, Part C- Early Steps, Section 47.5.1, p. 21 (As issued on 2/27/23), (Accessed Jun. 2024).
Supports Waiver
Virtual delivery of onsite day habilitation should be utilized during times that does not allow the beneficiary to attend in person (i.e. medical issues/surgery, an emergency where a provider agency may be closed) or when the beneficiary chooses to not attend in person. Virtual delivery is not the typical delivery method. In order to participate in virtual delivery of the service, the beneficiary should be independent or have natural supports, as this service cannot be billed at the same time as another service. The beneficiary should also have the technology necessary to participate in the virtual service (i.e., internet connection, laptop, smartphone, and/or tablet).
See manual for virtual delivery guidelines.
SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 8/21/23), (Accessed Jun. 2024).
Applied Behavior Analysis
Louisiana Medicaid will reimburse the use of telehealth, when appropriate, for rendering certain ABA services for the care of patients or to support the caregivers of beneficiaries.
Telehealth requires prior authorization for services. Subsequent assessments and behavior treatment plans can be performed remotely via telehealth only if the same standard of care can be met.
Previously approved prior authorizations can be amended to increase units of care and/or to reflect re-assessment goals.
The codes listed below can be performed via telehealth; however, requirements for reimbursement are otherwise unchanged from Section 4.5 – Reimbursement of this manual chapter. See manual for relevant CPT codes.
SOURCE: LA Dept of Health, Applied Behavior Analysis, pg. 12, (As issued on 4/22/24), & Healthy Louisiana Informational Bulletin 24-13, May 6, 2024, (Accessed Jun. 2024).
RHCs/FQHCs
If a covered service is provided via an interactive audio and video telecommunications system (telemedicine), providers must refer to Chapter 5 of the Professional Services Provider Manual on www.lamedicaid.com for specific billing instructions.
SOURCE: LA Dept. of Health, FQHCs, Ch. 22, (as issued 6/30/22), & RHCs, Ch. 40, (as issued 6/30/22), pg. 33, (Accessed Jun. 2024).
ELIGIBLE PROVIDERS
Distant site means the site at which the physician or other licensed practitioner is located at the time the services are provided.
The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid beneficiaries.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22) (Accessed Jun. 2024).
Distant site means the site at which the physician or other licensed practitioner is located at the time the telehealth services are provided.
SOURCE: Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 113, 172, & 199 (As issued 5/13/24). (Accessed Jun. 2024).
Rural health clinics (RHC) and federally qualified health clinics (FQHC): Reimbursement for these services will be at the all-inclusive prospective payment rate on file for the date of service (DOS).
SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Jun. 2024).
FQHC manual refers to provider manual for billing instructions for telemedicine services.
SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pg. 33, (As issued on Jun. 30, 2022) & Rural Health Clinic Manual, Chapter 40, Sec. 40.4, pg. 33 (As issued on Jun. 30, 2022). (Accessed Jun. 2024).
Distant Site: The distant site refers to where the provider is located. The preferred location of a distant site provider is in a healthcare facility. However, if there is disruption to a healthcare facility or a risk to the personal health and safety of a provider, there is no formal limitation as to where the distant site provider can be located, as long as the same standard of care can be met.
SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on 3/14/24), (Accessed Jun. 2024).
Treatment-in-place ambulance services
Ambulance providers interested in offering physician directed treatment-in-place telehealth services must complete the following:
- enroll as a CMS ET3 model participant;
- enter into a partnership with a qualified, Louisiana Medicaid enrolled healthcare provider to furnish treatment-in-place telehealth services to Louisiana Medicaid beneficiaries; and
- notify the Department of Health of its partnerships with each telehealth provider.
- Reimbursement for initiation and facilitation of telehealth services shall be made according to the established physician directed treatment-in-place telehealth service fee schedule or billed charges, whichever is the lesser amount.
Initiation and facilitation of physician directed treatment-in-place telehealth services are performed by Louisiana Medicaid enrolled ambulance providers on site, with no transport, using audio and video telecommunications systems that permit real-time communication between a qualified, Medicaid enrolled, licensed medical practitioner and the beneficiary.
All services provided by ambulance providers during the initiation and facilitation of the physician directed treatment-in-place intervention are covered by the associated BLS-E, emergency base rate, or the ALS1-E, Level 1 emergency base rate.
Ambulance providers are not eligible to submit a claim for reimbursement or receive payment for other services (except for supplies) at the scene.
If a beneficiary must be transported to an emergency department (ED) due to poor internet connection, which resulted in a failed physician directed treatment-in-place encounter, or the beneficiary’s condition deteriorates, the ambulance provider may submit a claim for reimbursement and receive compensation for the transport to the ED, but not for initiation and facilitation of the telehealth service.
The entity seeking reimbursement for the corresponding physician directed treatment-in-place telehealth service must be an enrolled Louisiana Medicaid provider.
Reimbursement to the ambulance providers for initiation and facilitation of the physician directed treatmentin-place telehealth service requires a corresponding treatment-in-place telehealth service. The corresponding treatment-in-place telehealth service is demonstrated via a Louisiana Medicaid paid treatment-in-place telehealth service claim.
SOURCE: LA Admin Code, Title 50, Part IX, Subpart 1, Ch. 13, Sec. 1301-1305, p. 336 (Accessed Jun. 2024).
Valid rendering providers are licensed physicians, advanced practice registered nurses, and physician assistants.
SOURCE: MCO Manual (revised 6/11/24), pg. 89, & LA Dept. of Health and Hospitals, Medical Transportation, Sec. 10.8, (As issued on 2/16/24), (Accessed Jun. 2024).
School Based Health Centers provide convenient access to preventive and acute care services for students who might otherwise have limited or no access to health care. This care may be provided onsite or through telehealth.
SOURCE: LA Admin Code, Title 50, Park XV, Subpart 5, Ch. 91, pg. 388 (Accessed Jun. 2024).
ELIGIBLE SITES
Originating site means the location of the Medicaid beneficiary [enrollee, member] at the time the services are provided. There is no restriction on the originating site and it can include, but is not limited to, a healthcare facility, school, or the beneficiary’s [enrollee’s] home.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (As issued 6/27/22), & MCO Manual (revised 6/11/24), pg. 175, & Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 113, 172, 199 (As issued 5/13/24). (Accessed Jun. 2024).
The Centers for Medicare and Medicaid Services (CMS) added a new place of service (POS) for telehealth services provided in the patient’s home effective for dates of service on and after January 1, 2022. Providers are required to use the appropriate POS, either 02 (other than home) or 10 (home) with modifier 95 for the billing of telemedicine/telehealth services based on the beneficiary’s location at the time of service.
SOURCE: LA Dept. of Health, Informational Bulletin 19-11. (May 18, 2022). (Accessed Jun. 2024).
Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.
SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Jun. 2024).
Originating Site: The originating site refers to where the patient is located. There is currently no formal limitation on the originating site and this can include, but is not limited to, the patient’s home.
SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on 3/14/24), (Accessed Jun. 2024).
GEOGRAPHIC LIMITS
A BHS provider that is not a licensed mental health professional or a provisionally licensed mental health professional acting within his/her scope of practice may not provide telehealth services outside of its geographic service area.
SOURCE: LA Admin Code 48:I Sec. 5605, (Accessed Jun. 2024).
FACILITY/TRANSMISSION FEE
Louisiana Medicaid only reimburses the distant site provider.
SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22). (Accessed Jun. 2024).
Last updated 06/04/2024
Remote Patient Monitoring
POLICY
Community Choices Waiver
Telecare is a delivery of care services to beneficiaries in their home by means of telecommunications and/or computerized devices to improve outcomes and quality of life, increase independence and access to health care, and reduce health care costs. Telecare services include the following:
- Activity and Sensor Monitoring,
- Health status monitoring, and
- Medication dispensing and monitoring.
Monthly telecare services consist of:
- Delivering, furnishing, maintaining and repairing/replacing equipment on an ongoing basis. This may be done remotely as long as all routine requests are resolved within three business days;
- Monitoring of recipient-specific service activities by qualified staff;
- Training the recipient and/or the recipient’s responsible representative in the use of the equipment;
- Cleaning and storing equipment;
- Providing remote teaching and coaching as necessary to the recipient and/or caregiver(s); and
- Analyzing data, developing and documenting interventions by qualified staff based on information/data reported.
Personal Emergency Response System (PERS) is also reimbursed under Community Choices Waiver, which sends alerts when emergency services are needed by the recipient.
Activity and Sensor Monitoring
This service is a computerized system that monitors the beneficiary’s in-home movement and activity for health, welfare, and safety purposes. The system is individually calibrated based on the beneficiary’s typical in-home movements and activities. The provider agency is responsible for monitoring electronically generated information, for responding as needed, and for equipment maintenance. At a minimum, the system shall include the following:
- Monitor the home’s points of egress;
- Detect falls;
- Detect movement or lack of movement;
- Detect whether doors are opened or closed; and
- Provide a push button emergency alert system.
Some systems also monitor the home’s temperature.
Health Status Monitoring
The health status monitoring service collects health-related data to assist the health care provider in assessing the beneficiary’s health condition and in providing beneficiary education and consultation. The data is collected electronically from the beneficiary using wireless technology or a phone line and assists the healthcare provider in assessing the beneficiary’s health. Health status monitoring may be beneficial to beneficiaries with chronic medical conditions such as congestive heart failure, diabetes, or pulmonary disease in monitoring the beneficiary’s:
- Weight;
- Oxygen saturation measurements (pulse oximetry); and
- Vital signs (pulse, blood pressure, etc.).
Peripheral equipment used must be capable of interfacing with the telecare health status monitoring equipment.
Medication Dispensing and Monitoring
The medication dispensing and monitoring service assists the beneficiary by dispensing medication and monitoring medication compliance. A remote monitoring system is individually pre-programed to dispense and monitor the beneficiary’s compliance with medication therapy. The provider or family caregiver is notified when there are missed doses or non-compliance with medication therapy.
Dispensing and monitoring devices must have the ability to send text or e-mail messages to the beneficiary’s caregiver should the medication not be taken or there is a problem with the equipment.
Dispensing and monitoring systems may include a web-based component for dosage programming, monitoring, and/or communication.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-25 (as issued on 3/11/24). (Accessed Jun. 2024).
Standards
Assistive Devices and Medical Supplies Provided by a Durable Medical Equipment (DME) provider that:
- Is enrolled to provide DME; and
- Has enrolled in Medicaid as an OAAS Waivers – assistive devices provider (provider type 17);
OR
Provided by a home health agency provider that:
- Is licensed to provide home health services;
- Is Medicare certified; and
- Has enrolled in Medicaid as an OAAS Waivers – assistive devices provider (provider type 17).
For personal emergency response systems (PERS), these services are provided by a provider that:
- Is enrolled in Medicaid as a PERS provider (provider type 16); and
- Has furnished verification (copy of letter from the manufacturer written on the manufacturer’s letterhead stationary) that the provider is an authorized dealer, supplier or manufacturer of a PERS product.
The PERS provider must install and support PERS equipment in compliance with all of the applicable federal, state, parish, and local laws and regulations, as well as meet manufacturer’s specifications, response requirements, maintenance records, and beneficiary education.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 78 and 84 (As issued 3/11/24). (Accessed Jun. 2024).
Technology Supports with Remote Features:
- Mobile Emergency Response System- an on-the-go mobile medical alert system, used in and outside the home. This system will cellular/GPS technology, two-way speakers and no base station required;
- Medication Reminder System- an electronic device programmed to remind individual to take medications by a ring, automated recording or other alarm. The electronic device may dispense controlled dosages of mediation and may include a message back to the center if a medication has not been removed from the dispenser. Requires ability to self administer medication with reminder and services face-to-face once per month;
- Monitoring Device, stand alone or intergraded, include all accessories, components and electronics not otherwise classified. Monitoring Feature device may be interactive audio and video;
- Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs;
- Purchase of emergency response system; and
- Other equipment used to support someone remotely may include but not limited to: electronic motion door sensor devices, door alarms, web-cams, telephones with modifications (large buttons, flashing lights), devices affixed to wheelchair or walker to send alert when fall occurs, text-to-speech software, intercom systems, tablets with features to promote communication or smart device speakers.
Remote Technology Service Delivery: covers monthly response center/remote support monitoring fee and tech upkeep (no internet cost coverage)
Remote Technology Consultation: evaluation of tech support needs for an individual, including functional evaluation of technology available to address the person’s assess needs and support person to achieve outcomes identified in the POC.
SOURCE: LA Dept. of Health, Residential Options Waiver, Section 38.1, p. 47-48 (As issued 5/9/24). (Accessed Jun. 2024).
CONDITIONS
Health status monitoring:
Health status monitoring may be beneficial to beneficiaries with chronic medical conditions such as congestive heart failure, diabetes, or pulmonary disease in monitoring the beneficiary’s:
- Weight;
- Oxygen saturation measurements (pulse oximetry); and
- Vital signs (pulse, blood pressure, etc.).
Services must be based on a verified need of the beneficiary and the service must have a direct or remedial benefit with specific goals and outcomes.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 34-35 (as issued on 3/11/24). (Accessed Jun. 2024).
PROVIDER LIMITATIONS
Assistive devices and providers that provide telecare services under ADMS, must meet the following system requirements:
- Be UL listed/certified or have 501(k) clearance;
- Be web-based;
- Be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- Have beneficiary specific reporting capabilities for tracking and trending;
- Have a professional call center for technical support based in the United States; and
- Have on-going provision of web-based data collection for each beneficiary, as appropriate. This includes response to beneficiary self-testing, manufacturer’s specific testing, self-auditing, and quality control.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 84 (As issued 3/11/24). (Accessed Jun. 2024).
OTHER RESTRICTIONS
Where applicable, beneficiaries must use Medicaid state plan services, Medicare, or other available payers first. The beneficiary’s preference for a certain brand or supplier is not grounds for declining another payer in order to access waiver services.
Limitations
- Services must be based on a verified need of the beneficiary and the service must have a direct or remedial benefit with specific goals and outcomes.
- The benefit must be determined by an independent assessment on any item that costs over $500 and on all communication devices, mobility devices, and environmental controls.
- Independent assessments must be performed by individuals who have no fiduciary relationship with the manufacturer, supplier, or vendor of the item.
- All items must reduce reliance on other Medicaid State Plan or waiver services.
- All items must meet applicable standards of manufacture, design, and installation.
- The items must be on the POC developed by the support coordinator and are subject to approval by OAAS Regional office or its designee.
- A beneficiary will not be able to simultaneously receive telecare activity and sensor monitoring services and traditional PERS services.
Reimbursement for Telecare services includes a one-time installation fee that covers the cost of equipment installation and removal. A monthly maintenance fee includes a face-to-face visit by a qualified professional should the collected data warrant a visit. Should the beneficiary require additional visits during the month, those visits must be conducted by a nurse, authorized by the support coordinator, and provided under Nursing Service. If the data indicates a potential emergency, the provider may dispatch a qualified professional without consultation for approval with the support coordinator; however, the support coordinator must be contacted by the next business day to request retroactive approval.
Billing for PERS or Telecare services involves an installation fee and a monthly maintenance fee. Only one claim for each month is allowed. Claims for the monthly maintenance fee may be span-dated at the discretion of the provider. Partial months shall not be billed.
If a beneficiary who receives PERS or Telecare service moves to a different location or changes providers, reimbursement for a second installment is permissible.
Assistive devices/equipment and/or medical supplies (up to $500) are reimbursed in the amount authorized in the POC or POC revision. The PA is released upon completion and submission of the Assistive Devices and Medical Supplies form and the approved POC or POC revision by the support coordinator.
SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 32 & 35, 107, (As issued on 3/11/24). (Accessed Jun. 2024).
