Last updated 08/05/2024
Consent Requirements
The provider must document the same information as for a comparable in-person service and be maintained at both the originating and distant site of the telehealth services provided including, but not limited to:
- Signed consent for treatment using telehealth
SOURCE: MS Admin. Code 23, Part 225, Rule 1.6(A). (Accessed Aug. 2024).
The Division of Medicaid defines physician verbal orders as physician orders that are verbally communicated by telephone, telehealth or face-to-face to authorized medical personnel regarding medications, treatments, interventions or other beneficiary care.
SOURCE: MS Admin Code, Title 23, Part 203, Rule 1.11, (Accessed Aug. 2024).
Last updated 08/05/2024
Definitions
“Telemedicine” means the delivery of health care services such as diagnosis, consultation, or treatment through the use of HIPAA-compliant telecommunication systems, including information, electronic and communication technologies, remote patient monitoring services and store-and-forward telemedicine services. Telemedicine, other than remote patient monitoring services and store-and-forward telemedicine services, must be “real-time” audio visual capable. The Commissioner of Insurance may adopt rules and regulations addressing when “real-time” audio interactions without visual are allowable, which must be medically appropriate for the corresponding health care services being delivered.
SOURCE: MS Code Sec. 83-9-351. (Accessed Aug. 2024).
The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which includes, but is not limited to, telehealth services, remote patient monitoring services, teleradiology services, store-and-forward and continuous glucose monitoring services.
The Division of Medicaid defines telehealth services as the delivery of health care by an enrolled Mississippi Medicaid provider, through a real-time communication method, to a beneficiary who is located at a different site. The interaction must be:
- Live,
- Interactive, and
- Audiovisual.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.1 (Accessed Aug. 2024).
Last updated 08/05/2024
Email, Phone & Fax
The following are not considered telehealth services:
- Telephone conversation
- Chart reviews
- Electronic mail messages
- Facsimile transmission
- Internet services for online medical evaluation, or
- Communication through social media or,
- Any other communication made in the course of usual business practices including, but not limited to,
-
- Calling in a prescription refill, or
- Performing a quick virtual triage.
SOURCE: MS Admin. Code 23, Part 225, Rule. 1.4. (Accessed Aug. 2024).
During a state of emergency, Telehealth services are expanded to include use of telephonic audio that does not include video when authorized by the State of Mississippi.
A beneficiary may use the beneficiary’s personal telephonic land line in addition to a cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care in a synchronous format with a distant-site provider.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Aug. 2024).
Last updated 04/05/2024
Live Video
POLICY
Mississippi Medicaid and private payers are required to provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation, including services that are performed by out-of-network providers.
SOURCE: MS Code Sec. 83-9-351. (Accessed Apr. 2024).
Providers of telehealth services must be an enrolled Mississippi Medicaid provider acting within their scope-of-practice and license or medical certification or Mississippi Department of Health (MDSH) certification and in accordance with state and federal guidelines, including but not limited to, authorization of prescription medications at both the originating and distant site.
The Division of Medicaid requires that providers utilize telehealth technology sufficient to provide real-time interactive communications that provide the same information as if the telehealth visit was performed in-person. Equipment must also be compliant with all applicable provisions of the Health Insurance Portability and Accountability Act (HIPAA).
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.2 (Accessed Apr. 2024).
ELIGIBLE SERVICES/SPECIALTIES
The Division of Medicaid covers medically necessary telehealth services as a substitution for an in-person visit for consultations, office visits, and/or outpatient visits when all the required medically appropriate criteria is met which aligns with the description of the Current Procedural Terminology (CPT) evaluation and management (E&M) and Healthcare Common Procedure Coding System (HCPCS) guidelines.
The Division of Medicaid does not:
- Cover a telehealth service if that same service is not covered in an in-person setting.
- Cover a separate reimbursement for the installation or maintenance of telehealth hardware, software and/or equipment, videotapes, and transmissions.
- Cover early and periodic screening, diagnosis, and treatment (EPSDT) well child visits through telehealth.
- Cover physician or other practitioner visits through telehealth for: Non-established beneficiaries, and/or Level VI or V visits.
- Cover the installation or maintenance of any telecommunication devices or systems.
The division does not consider the following telehealth services:
- Telephone conversations,
- Chart reviews;
- Electronic mail messages;
- Facsimile transmission;
- Internet services for online medical evaluations, or
- Communication through social media, or
- Any other communication made in the course of usual business practices including, but not limited to,
- Calling in a prescription refill, or
- Performing a quick virtual triage.
The Division of Medicaid reimburses all providers delivering a medically necessary telehealth service at the distant site at the current applicable Mississippi Medicaid fee-for-service rate or encounter for the service provided. The provider must include the appropriate modifier on the claim indicating the service was provided through telehealth.
Providers delivering simultaneous distant and originating site services to a beneficiary are reimbursed:
- The current applicable Mississippi Medicaid fee-for-service rate for the medical service(s) provided, and
- Either the originating or distant site facility fees, not both, except for RHC, FQHC and CMHC when such services are appropriately provided by the same organization.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.3-1.5 (Accessed Apr. 2024).
The Division of Medicaid covers up to twelve (12) in-person or telehealth tobacco cessation counseling sessions per State Fiscal Year, when provided by:
- A physician, or
- Other licensed practitioner that has prescriptive authority, operating within their scope of practice.
SOURCE: MS Admin. Code Title 23, Part 200, Rule. 5.4 (Accessed Dec. 2023).
ELIGIBLE PROVIDERS
At the distant site the following provider types are allowed to render telehealth services:
- Physicians,
- Physician assistants,
- Nurse practitioners,
- Psychologists,
- Licensed Clinical Social Workers (LCSW),
- Licensed Professional Counselors (LPCs),
- Licensed Marriage and Family Therapists (LMFTs),
- Board Certified Behavior Analysts or Board-Certified Behavior Analyst Doctorals
- Community Mental Health Centers (CMHCs)
- Private Mental Health Centers
- Federally Qualified Health Centers
- Rural Health Clinics; or
- Physical, occupational or speech therapy
- Mississippi State Department of Health (MSDH) clinics.
The Division of Medicaid requires a telepresenter who meets the requirements of Miss. Admin Code Part 225, Rule 1.1.D. at the originating site unless the originating site is the beneficiary’s home or as determined by the Division.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.3(B) and (C). (Accessed Apr. 2024).
The Mississippi Division of Medicaid will allow additional coverage of telehealth services during a state of emergency as declared by either the Governor of Mississippi or the President of the United States. See administrative code for details of enhanced services that will terminate at the discretion of the MS Division of Medicaid.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Apr. 2024).
Effective July 1, 2021 & Repealed on July 1, 2024
The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement. The division is further authorized and directed to reimburse FQHCs, RHCs and CMHCs for both distant site and originating site services when such services are appropriately provided by the same organization.
SOURCE: MS Code Section 43-13-117 (Accessed Apr. 2024).
Rural Health Clinics
An encounter for face-to-face telehealth services provided by the RHC acting as a distant site provider. MS Medicaid reimburses a RHC for both the distant and originating provider site when such services are appropriately provided by the RHC.
SOURCE: MS Admin Code Title 23, Part 212, Ch. 1, Rule. 1.5 (Accessed Apr. 2024).
Federally Qualified Health Centers
An encounter for face-to-face telehealth services provided by the FQHC acting as a distant site provider. MS Medicaid reimburses a FQHC for both the distant and originating provider site when such services are appropriately provided by the FQHC.
SOURCE: MS Admin. Code Title 23, Part 211, Rule. 1.5. (Accessed Apr. 2024).
Home Health Services
A face-to-face encounter, for home health services, as an in person visit, including telehealth, which occurs between a physician or allowed non-physician practitioner and a beneficiary for the primary reason the beneficiary requires home health services and must occur no more than ninety (90) days before or thirty (30) days after the start of home health services.
SOURCE: MS Admin Code, Title 23, Part 215, Ch. 1: Home Health Services, Rule 1.1, (Accessed Apr. 2024).
ELIGIBLE SITES
The Division of Medicaid covers telehealth services at the following locations: At the following originating sites:
- Office of a physician or practitioner,
- Outpatient Hospital (including a Critical Access Hospital (CAH)),
- Rural Health Clinic (RHC),
- Federally Qualified Health Center (FQHC),
- Community Mental Health/Private Mental Health Centers,
- Therapeutic Group Homes,
- Indian Health Service Clinic,
- School-based clinic,
- School which employs a school nurse,
- Inpatient hospital setting, or
- Beneficiary’s home.
The Division of Medicaid requires a telepresenter who meets the requirements of Miss. Admin Code Part 225, Rule 1.1.D. at the originating site unless the originating site is the beneficiary’s home or as determined by the Division.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.3. (Accessed Apr. 2024).
The Division of Medicaid defines the telepresenter as medical personnel who:
- Is a Mississippi Medicaid provider, or employed by a Mississippi Medicaid provider and directly supervised by the provider or an appropriate employee of the provider if the medical personnel’s license or certification requires supervision,
- Is trained to use the appropriate technology at the originating site,
- Is able to facilitate comprehensive exams under the direction of a distant site practitioner who is, or is employed by, a Mississippi Medicaid provider.
- Must remain in the exam room for the entirety of the exam unless otherwise directed by the distant site provider for the appropriate treatment of the beneficiary, and
- Must act within the scope of their practice, license, or certification.
SOURCE: MS Admin Code Title 23, Part 225, Rule 1.1. (Accessed Apr. 2024).
The Mississippi Division of Medicaid will allow additional coverage of telehealth services during a state of emergency as declared by either the Governor of Mississippi or the President of the United States. Details of enhanced services include the following that will terminate at the discretion of the Mississippi Division of Medicaid:
A beneficiary may seek treatment utilizing telehealth services from an originating site not listed in the Mississippi Medicaid State Plan regarding Telehealth (SPA 3.1-A Introductory Pages 1 and 2). These emergency exceptions include the following:
- A beneficiary’s residence may be an originating site without prior approval by the Division of Medicaid.
- Health care facilities not listed in the State Plan wishing to act as an originating site must first be granted approval by the Division of Medicaid before rendering originating site telehealth services.
When the beneficiary receives services in the home, the requirement for a telepresenter to be present may be waived.
See regulation for additional details.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Apr. 2024).
The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs)) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement. The division is further authorized and directed to reimburse FQHCs, RHCs and CMHCs for both distant site and originating site services when such services are appropriately provided by the same organization.
SOURCE: MS Code Section 43-13-117 – Sunsets July 1, 2024, (Accessed Dec. 2023).
Division of Medicaid (DOM) added place of service (POS) code 10 to indicate a Telehealth service was provided to a beneficiary located at their home. POS code 10 may not be loaded with updated billing rules at MESA Go-Live. Providers should continue to submit claims with the appropriate POS code. Impacted claims with POS 10 will be adjusted, and there will be no additional action needed by Providers.
SOURCE: MS Medicaid Provider Bulletin, Vol. 28 Issue 3 (Sept. 2022). (Accessed Apr. 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
The Division of Medicaid reimburses the enrolled Medicaid provider at the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission in addition to reimbursement for a separately identifiable covered service if performed.
The following providers are eligible to receive the originating site facility fee for telehealth services per transmission:
- Office of a physician or practitioner,
- Outpatient hospital, including a Critical Access Hospital (CAH),
- Rural Health Clinic (RHC),
- Federally Qualified Health Center (FQHC),
- Community Mental Health/Private Mental Health Center,
- Therapeutic Group Home,
- Indian Health Service Clinic,
- School-based clinic, or
- School which employs a nurse.
The originating site provider can only bill for an encounter or Evaluation and Management (E&M) visit if a separately identifiable covered service is performed.
An inpatient hospital’s originating site fee is included in the All Patient Refined/Diagnosis Related Group (APR-DRG) payment.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.5(A). (Accessed Apr. 2024).
Federally Qualified Health Centers
The Division of Medicaid reimburses a fee per completed transmission for telehealth services provided by the RHC acting as an originating site provider. The FQHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate in effect as of January 1, 2021.
SOURCE: MS Admin. Code Title 23, Part 211, Rule. 1.5. (Accessed Apr. 2024).
Rural Health Clinics
MS Medicaid provides a fee per completed transmission for telehealth services provided by the RHC acting as an originating site provider. The RHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate in effect as of January 1, 2021.
SOURCE: MS Admin Code Title 23, Part 212, Ch. 1, Rule. 1.5 (Accessed Apr. 2024).
The originating site is eligible to receive a facility fee, but facility fees are not payable to the distant site. Health insurance and employee benefit plans shall not limit coverage to provider-to-provider consultations only. Patients in a patient-to-provider consultation shall not be entitled to receive a facility fee.
SOURCE: MS Code Sec. 83-9-351. (Accessed Apr. 2024).
Last updated 08/05/2024
Miscellaneous
See documentation requirements in rule.
SOURCE: MS Admin. Code 23, Part 225, Rule 3.6 (Accessed Aug. 2024).
Last updated 08/05/2024
Out of State Providers
Providers of telehealth services must be an enrolled Mississippi Medicaid provider acting within their scope-of-practice and license or medical certification or Mississippi Department of Health (MDSH) certification and in accordance with state and federal guidelines, including but not limited to, authorization of prescription medications at both the originating and distant site.
For teleradiology, a consulting and referring provider is a licensed physician (or PA or NP for referring providers) who must be licensed in the state within the United States in which he/she practices.
SOURCE: MS Admin. Code 23, Part 225, Rule 3.1. (Accessed Aug. 2024).
Last updated 08/05/2024
Overview
Mississippi Medicaid reimburses certain providers for live video telehealth when there is a telepresenter with the patient. They also reimburse for store-and-forward teleradiology, and for remote patient monitoring for patients with certain chronic conditions. Telemedicine, other than remote patient monitoring services and store-and-forward telemedicine services, must be “real-time” audio visual capable.
Last updated 08/05/2024
Remote Patient Monitoring
POLICY
Policy applies to Private payers, MS Medicaid and employee benefit plans
“Remote patient monitoring services” means the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including:
- Monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry and other condition-specific data, such as blood glucose;
- Medication adherence monitoring; and
- Interactive video conferencing with or without digital image upload as needed.
Remote patient monitoring services aim to allow more people to remain at home or in other residential settings and to improve the quality and cost of their care, including prevention of more costly care. Remote patient monitoring services via telehealth aim to coordinate primary, acute, behavioral and long-term social service needs for high-need, high-cost patients. Specific patient criteria must be met in order for reimbursement to occur.
Remote patient monitoring services shall include reimbursement for a daily monitoring rate at a minimum of Ten Dollars ($10.00) per day each month and Sixteen Dollars ($16.00) per day when medication adherence management services are included, not to exceed thirty-one (31) days per month. These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.
A one-time telehealth installation/training fee for remote patient monitoring services will also be reimbursed at a minimum rate of Fifty Dollars ($50.00) per patient, with a maximum of two (2) installation/training fees/calendar year. These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.
To receive payment for the delivery of remote patient monitoring services via telehealth, the service must involve:
- An assessment, problem identification, and evaluation that includes:
- Assessment and monitoring of clinical data including, but not limited to, appropriate vital signs, pain levels and other biometric measures specified in the plan of care, and also includes assessment of response to previous changes in the plan of care; and
- Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care.
- Implementation of a management plan through one or more of the following:
- Teaching regarding medication management as appropriate based on the telemedicine findings for that encounter;
- Teaching regarding other interventions as appropriate to both the patient and the caregiver;
- Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services;
- Coordination of care with the ordering health care provider regarding telemedicine findings;
- Coordination and referral to other medical providers as needed; and
- Referral for an in-person visit or the emergency room as needed.
SOURCE: MS Code Sec. 83-9-353. (Accessed Aug. 2024).
The Division of Medicaid defines remote patient monitoring as using digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for interpretation and recommendation.
The Division of Medicaid reimburses for remote patient monitoring:
- Of devices when billed with the appropriate code, and
- For disease management:
- A daily monitoring rate for days the beneficiary’s information is reviewed.
- Only one (1) unit per day is allowed, not to exceed thirty-one (31) days per month.
- An initial visit to install the equipment and train the beneficiary may be billed as a set-up visit.
- Only one set-up is allowed per episode even if monitoring parameters are added after the initial set-up and installation.
- Only one (1) daily rate will be reimbursed regardless of the number of diseases/chronic conditions being monitored.
The Division of Medicaid does not reimburse for the duplicate transmission or interpretation of remote patient monitoring data.
The Division of Medicaid does not cover remote patient monitoring for disease management as outlined in Miss. Admin. Code Part 225, Rule 2.3.B. for a beneficiary who is a resident of an institution that meets the basic definition of a hospital or long-term care facility.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 2.1 & 2.4 & 2.5. (Accessed Aug. 2024).
Continuous Glucose Monitoring
A continuous glucose monitoring (CGM) service when medically necessary, prior authorized by the UM/QIO, Division of Medicaid or designee, ordered by the physician who is actively managing the beneficiary’s diabetes and the beneficiary meets specific criteria. See admin code.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.3. (Accessed Aug. 2024).
“Remote Monitoring” is defined as the use of technology to remotely track health care data for a patient released to his or her home or a care facility, usually for the intended purpose of reducing readmission rates.
SOURCE: MS Code Title 30 Part 2635, Ch. 5 Rule 5.1. (Accessed Aug. 2024).
CONDITIONS
The Division of Medicaid covers remote patient monitoring, for disease management when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), Division of Medicaid or designee, ordered by a physician, physician assistant, or nurse practitioner for a beneficiary who meets the following criteria:
- Has been diagnosed with one (1) or more of the chronic conditions as defined by the Centers of Medicare and Medicaid Services (CMS) which include, but are not limited to:
-
Diabetes,
-
Congestive Heart Failure (CHF),
-
Chronic Obstructive Pulmonary Disease (COPD),
-
Heart disease,
-
Mental health, and
-
Sickle cell.
- Is capable of using the remote patient monitoring equipment and transmitting the necessary data or has a willing and able person to assist in completing electronic transmission of data.
The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner which includes, but not limited to:
- Implantable pacemakers,
- Defibrillators,
- Cardiac monitors,
- Loop recorders,
- External mobile cardiovascular telemetry, and
- Continuous glucose monitors.
SOURCE: MS Admin. Code 23, Part 225, Rule. 2.3. (Accessed Aug. 2024).
Qualifying patients for remote patient monitoring services must meet all the following criteria:
- Be diagnosed, in the last eighteen (18) months, with one or more chronic conditions, as defined by the Centers for Medicare and Medicaid Services (CMS), which include, but are not limited to, sickle cell, mental health, asthma, diabetes, and heart disease; and
- The patient’s health care provider recommends disease management services via remote patient monitoring.
SOURCE: MS Code Sec. 83-9-353. (Accessed Aug. 2024).
Continuous Glucose Monitoring
A continuous glucose monitoring (CGM) service when medically necessary, prior authorized by the UM/QIO, Division of Medicaid or designee, ordered by the physician who is actively managing the beneficiary’s diabetes and the beneficiary meets all of the following criteria:
- Has an established diagnosis of type I or type II diabetes mellitus that is poorly controlled as defined below:
- Unexplained hypoglycemic episodes,
- Nocturnal hypoglycemic episode(s),
- Hypoglycemic unawareness and/or frequent hypoglycemic episodes leading to impairments in activities of daily living,
- Suspected postprandial hyperglycemia,
- Recurrent diabetic ketoacidosis, or
- Unable to achieve optimum glycemic control as defined by the most current version of the American Diabetes Association (ADA).
- Be able, or have a caregiver who is able, to hear and view CGM alerts and respond appropriately.
- Has documented self-monitoring of blood glucose at least four (4) times per day.
- Requires insulin injections three (3) or more times per day or requires the use of an insulin pump for maintenance of blood glucose control.
- Requires frequent adjustment to insulin treatment regimen based on blood glucose testing results,
- Had an in-person visit with the ordering physician within six (6) months prior to ordering to evaluate their diabetes control and determined that criteria (1-4) above are met,
- Has an in-person visit every six (6) months following the prescription of the CGM to assess adherence to the CGM regimen and diabetes treatment plan.
The CGM is a Food and Drug Administration (FDA) approved medical device and is capable of accurately measuring and transmitting beneficiary blood data.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.3. (Accessed Aug. 2024).
PROVIDER LIMITATIONS
Providers of remote patient monitoring services must have protocols in place to address all of the following:
- A mechanism for monitoring, tracking and responding to changes in a beneficiary’s clinical condition, and
- A process for notifying the prescribing physician of significant changes in the beneficiary’s clinical signs and symptoms.
Remote patient monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.
The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner.
Continuous glucose monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 2.2 & 2.3. (Accessed Aug. 2024).
A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.
SOURCE: MS Code Sec. 83-9-353(18). (Accessed Aug. 2024).
Continuous Glucose Monitoring
Continuous glucose monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.2. (Accessed Aug. 2024).
OTHER RESTRICTIONS
A remote patient monitoring prior authorization request form may be required for approval of telemonitoring services. If prior authorization is required, the law lists certain requirements for the form.
The telemonitoring equipment must:
- Be capable of monitoring any data parameters in the plan of care; and
- Be a FDA Class II hospital-grade medical device.
The telemedicine equipment and network used for remote patient monitoring services should meet the following requirements:
- Comply with applicable standards of the United States Food and Drug Administration;
- Telehealth equipment be maintained in good repair and free from safety hazards;
- Telehealth equipment be new or sanitized before installation in the patient’s home setting;
- Accommodate non-English language options; and
- Have 24/7 technical and clinical support services available for the patient user.
SOURCE: MS Code Sec. 83-9-353 (Accessed Aug. 2024).
Providers of remote patient monitoring services must have protocols in place to address all of the following:
- A mechanism for monitoring, tracking and responding to changes in a beneficiary’s clinical condition, and
- A process for notifying the prescribing physician of significant changes in the beneficiary’s clinical signs and symptoms.
See admin code for list of requirements for prior authorization form.
Remote patient monitoring services must be provided in the beneficiary’s private residence.
SOURCE: MS Admin. Code 23, Part 225, Rule. 2.2 & 2.3. (Accessed Aug. 2024).
CGM service only when the blood glucose data is obtained from a Federal Drug Administration (FDA) approved durable medical equipment (DME) medical device for home use.
The Division of Medicaid does not require the provider to have a face-to-face office visit with the beneficiary to download, review and interpret the blood glucose data.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.3. (Accessed Aug. 2024).
Continuous glucose monitoring (CGM) service documentation must include, but is not limited to:
The beneficiary and/or care giver is capable of operating the continuous glucose monitoring system,
The beneficiary:
- Has an established diagnosis of type I or type II diabetes mellitus that is poorly controlled as defined in Miss. Admin. Code Part 225, Rule 4.3.A.1.a),
- Requires three (3) insulin injections per day, or use of an insulin pump, for maintenance of blood glucose control,
- Requires regular self-monitoring of at least four (4) times a day,
- Requires frequent adjustment to insulin treatment regimen based on blood glucose testing results,
- Had an in-person visit with the ordering physician within six (6) months prior to ordering to evaluate their diabetes control and determined that criteria (1-4) above are met,
- Has an in-person visit every six (6) months following the prescription of the CGM to assess adherence to the CGM regimen and diabetes treatment plan.
The CGM is a Food and Drug Administration (FDA) approved medical device and is capable of accurately measuring and transmitting beneficiary blood data.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 4.6. (Accessed Aug. 2024).
Last updated 08/05/2024
Store and Forward
POLICY
Policy applies to Private payers, MS Medicaid and employee benefit plans
“Store-and-forward telemedicine services” means the use of asynchronous computer-based communication between a patient and a consulting provider or a referring health care provider and a medical specialist at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients who otherwise have no access to specialty care. Store-and-forward telemedicine services involve the transferring of medical data from one (1) site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation.
Store-and-forward telemedicine services allow a health care provider trained and licensed in his or her given specialty to review forwarded images and patient history in order to provide diagnostic and therapeutic assistance in the care of the patient without the patient being present in real time. Treatment recommendations made via electronic means shall be held to the same standards of appropriate practice as those in traditional provider-patient setting.
A health insurance or employee benefit plan may limit coverage to health care providers in a telemedicine network approved by the plan.
Any patient receiving medical care by store-and-forward telemedicine services shall be notified of the right to receive interactive communication with the distant specialist health care provider and shall receive an interactive communication with the distant specialist upon request. If requested, communication with the distant specialist may occur at the time of the consultation or within thirty (30) days of the patient’s notification of the request of the consultation. Telemedicine networks unable to offer the interactive consultation shall not be reimbursed for store-and-forward telemedicine services.
All health insurance and employee benefit plans in this state must provide coverage and reimbursement for the asynchronous telemedicine services of store-and-forward telemedicine services and remote patient monitoring services based on the criteria set out in this section. Store-and-forward telemedicine services shall be reimbursed to the same extent that the services would be covered if they were provided through in-person consultation.
Health care providers seeking reimbursement for store-and-forward telemedicine services must be licensed Mississippi providers that are affiliated with an established Mississippi health care facility in order to qualify for reimbursement of telemedicine services in the state. If a service is not available in Mississippi, then a health insurance or employee benefit plan may decide to allow a non-Mississippi-based provider who is licensed to practice in Mississippi reimbursement for those services.
A health insurance or employee benefit plan may charge a deductible, co-payment, or coinsurance for a health care service provided through store-and-forward telemedicine services or remote patient monitoring services so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.
In a claim for the services provided, the appropriate procedure code for the covered service shall be included with the appropriate modifier indicating telemedicine services were used. A “GQ” modifier is required for asynchronous telemedicine services such as store-and-forward and remote patient monitoring.
SOURCE: MS Code Sec. 83-9-353. (Accessed Aug. 2024).
The Division of Medicaid defines store-and-forward as telecommunication technology for the transfer of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image which is transmitted or forwarded via telecommunication to another site for teleconsultation and includes, but is not limited to, teleradiology services.
SOURCE: MS Admin Code Title 23, Part 225, Rule. 3.1 (Accessed Aug. 2024).
There is reimbursement for teleradiology services, however there is no reference to reimbursing for other specialties in regulation.
Teleradiology services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.
The use and delivery of teleradiology services does not alter a covered provider’s privacy obligations under federal/and or state law and a provider or entity operating telehealth services that involve protected health information (“PHI”) must meet the same HIPAA requirements the provider or entity would for a service provided in person.
SOURCE: MS Admin Code Title 23, Part 225, Rule. 3.2. (Accessed Aug. 2024).
“Store-and-Forward Transfer Technology” is defined as technology which facilitates the gathering of data from the patient, via secure email or messaging service, which is then used for formulation of a diagnosis and treatment plan, also known as ‘asynchronous communication.’
SOURCE: MS Admin Code Agency 30 Part 2635, Ch. 5 Rule 5.1. (Accessed Aug. 2024).
ELIGIBLE SERVICES/SPECIALTIES
The Division of Medicaid covers:
- One (1) technical and one (1) professional component for each teleradiology procedure only for providers enrolled as a Mississippi Medicaid provider and when there are no geographically local radiologist providers to interpret the images.
- The technical component of the radiological service is covered at the originating site.
- The professional component of the radiological service is covered at the distant site.
The Division of Medicaid does not cover:
- The transmission cost or any other associated cost of teleradiology,
- Both the technical and professional component of teleradiology services for one (1) provider, or
- One (1) provider billing for services performed by another provider.
The Division of Medicaid reimburses for:
- The technical component of the radiological service at the originating site for only providers enrolled as a Mississippi Medicaid provider.
- The professional component of the radiological service at the distant site only for providers enrolled as a Mississippi Medicaid provider.
If a hospital chooses to bill for purchased or contractual teleradiology services, the service must be billed under a physician group provider number only.
See regulations for documentation requirements for teleradiology.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 3.1 & 3.3 (Accessed Aug. 2024).
GEOGRAPHIC LIMITS
MS Medicaid only covers teleradiology when there are no geographically local radiologist providers to interpret images.
SOURCE: MS Admin. Code Title 23, Part 225, Rule. 3.3 (Accessed Aug. 2024).
TRANSMISSION FEE
A fee per completed transmission for telehealth services provided by the RHC acting as an originating site provider. The FQHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate in effect as of January 1, 2021.
SOURCE: MS Admin. Code Title 23, Part 211, Rule 1.5 (Accessed Aug. 2024).
The Division of Medicaid does not cover the transmission cost or any other associated cost of teleradiology.
SOURCE: Code of MS Rules 23-225, Rule. 3.4 (Accessed Aug. 2024).
