Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 70 - MO HealthNet Division
Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability
Section 13 CSR 70-3.330 - Telemedicine Services
Universal Citation: 13 MO Code of State Regs 70-3.330
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: The purpose of this rule is to establish the division's guidelines regarding coverage and reimbursement for telemedicine services. The goal of this policy is to allow greater access to care for MO HealthNet participants.
PUBLISHER'S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here.
(1) Administration.
(A) The telemedicine program shall be
administered by the MO HealthNet Division (MHD). This rule is established
pursuant to the authority granted to the Missouri Department of Social
Services, MO HealthNet Division, to promulgate rules governing the practice of
telemedicine in the MO HealthNet Program and to provide services under
established, approved MO HealthNet benefits.
(B) Definitions.
1. Asynchronous store-and-forward shall mean
the transfer of a participant's clinically important digital samples, such as
still images, videos, audio, text files, and relevant data from an originating
site through the use of a camera or similar recording device that stores
digital samples that are forwarded via telecommunication to a distant site for
consultation by a consulting provider without requiring the simultaneous
presence of the participant and the participant's treating provider.
A. Asynchronous store-and-forward technology
shall mean cameras or other recording devices that store images which may be
forwarded via telecommunication devices at a later time.
B. Asynchronous store-and-forward transfer
shall mean the collection of a participant's relevant health information and
the subsequent transmission of that information from an originating site to a
provider at a distant site without the participant being present.
2. Distant site shall mean a
telemedicine site where the health care provider providing the telemedicine
service is physically located.
3.
Originating site shall mean a telemedicine site where the MO HealthNet
participant receives the telemedicine service. Originating sites include, but
are not necessarily limited to health care provider facilities, participants'
homes, and schools. For the purposes of asynchronous store-and-forward
transfer, the originating site shall also mean the location from which the
referring provider transfers information to the distant site.
4. Licensed health care provider-patient
relationship shall mean that a health care provider licensed under Chapter 334,
RSMo, and/or other providers utilizing telemedicine, shall ensure that a
properly established provider-patient relationship exists with the participant
who receives telemedicine services.
5. Telemedicine shall mean the delivery of
health care services by means of information and communication technologies
that facilitate the assessment, diagnosis, consultation, treatment, education,
care management, and self-management of a participant's health care while such
participant is at the originating site and the provider is at the distant site.
Telemedicine shall also include the use of telephonic or asynchronous
store-and-forward technology. Telemedicine services must be performed with the
same standard of care as an in-person, face-to-face service.
6. Health care professional shall mean a
physician or other health care practitioner licensed, accredited, or certified
by the state of Missouri to perform specified health services consistent with
state law.
7. Health care provider
or provider shall mean a health care professional or a health care
facility.
8. Health care service
shall mean a service for the diagnosis, prevention, treatment, cure, or relief
of a health condition, illness, injury, or disease, including but not limited
to the provision of drugs or durable medical equipment.
(2) Providers.
(A) Any licensed/enrolled health care
professional shall be authorized to provide telemedicine services if such
services to MHD participants are within the scope of practice for which the
health care provider is licensed and are provided with the same standard of
care as services provided in person. This shall not prohibit a health care
entity from reimbursing nonclinical staff for services otherwise allowed by
law. This includes applied behavior analysis services rendered by a registered
behavior technician under the supervision of a licensed behavior analyst or
licensed psychologist or any individual provider delivering services within a
Department of Mental Health (DMH) licensed, contracted, and/or certified
organization.
(B) In order to treat
participants in this state through the use of telemedicine, health care
providers shall be fully licensed to practice in this state and shall be
subject to regulation by their respective professional boards. In addition,
psychologists licensed in a Psychology Interjurisdictional Compact (PSYPACT)
state may render telemedicine services under the Authority to Practice
Interjurisdictional Telepsychology, according to the requirements in the
PSYPACT.
(C) A health care provider
utilizing telemedicine at either a distant site or an originating site shall be
enrolled as a MO HealthNet provider pursuant to
13 CSR
65-2.020 and be fully licensed for practice in the
state of Missouri. A health care provider utilizing telemedicine must do so in
a manner that is consistent with the provisions of all laws governing the
practice of the provider's profession and shall be held to the same standard of
care as a provider employing in-person behavioral health or medical health
care.
(D) For purposes of the
provision of telemedicine services in the MO HealthNet Program, the
provider-patient relationship may be established by the following:
1. An in-person encounter through a medical
interview and physical examination;
2. Consultation with another health care
professional, or that health care professional's delegate, who has an
established relationship with the patient and an agreement with the health care
professional to participate in the patient's care; or
3. A telemedicine encounter, if the standard
of care does not require an in-person encounter, and in accordance with
evidence based standards of practice and telemedicine practice guidelines that
address the clinical and technological aspects of telemedicine.
(E) In order to establish a
provider-patient relationship through telemedicine-
1. The technology utilized shall be
sufficient to establish an informed diagnosis as though the medical interview
and physical examination had been performed in person; and
2. Prior to providing treatment, including
issuing prescriptions and physician certifications under Article XIV of the
Missouri Constitution, a physician who uses telemedicine shall interview the
patient, collect or review relevant medical history, and perform an examination
sufficient for diagnosis and treatment of the patient. A questionnaire
completed by the patient, whether via the telephone or internet, does not
constitute a medical interview and examination for provision of treatment via
telemedicine.
(F) A
provider agrees to conform to MO HealthNet program policies and instructions as
specified in the provider manuals, which are incorporated by reference and made
a part of this rule as published by the Department of Social Services, MO
HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its
website http://manuals.momed.com/manuals/,
April 14, 2022. This rule does not incorporate any subsequent amendments or
additions.
(3) Covered Services.
(A) A telemedicine service shall be
covered only if it is medically necessary.
(B) A telemedicine service must be performed
with the same standard of care as an in-person, face-to-face service. If the
same standard of care cannot be met, a telemedicine service shall not be
provided.
(4) Prior Authorization and Utilization Review.
(A)
Utilization Review. All services are subject to utilization review for medical
necessity and program compliance. Reviews can be performed before services are
furnished, before payment is made, or after payment is made. The standards and
processes for utilization review for telemedicine services shall be the same as
those for services not provided through telemedicine.
(B) Prior Authorization. Certain procedures
or services can require prior authorization from the MO HealthNet Division or
its authorized agents. Services for which prior authorization shall be obtained
remain subject to utilization review at any point in the payment process. A
service provided through telemedicine is subject to the same prior
authorization and utilization review requirements, standards, and processes
that exist for the service when not provided through telemedicine.
(C) Eligibility Determination. Prior
authorization of services does not guarantee an individual is eligible for a MO
HealthNet service. Providers must verify that an individual is eligible for a
specific program at the time services are furnished and must determine if the
participant has other health insurance.
(D) School Services. Prior to the provision
of telemedicine services in a school, the parent or guardian of the child shall
provide authorization for the provision of such service. Such authorization
shall include the ability for a parent or guardian to authorize services via
telemedicine in the school for the remainder of the school year.
(5) Reimbursement.
(A) Reimbursement to the health care provider
delivering the telemedicine service at the distant site shall be made at the
same amount as the current fee schedule for an in-person service.
(B) The originating site is eligible to
receive an originating site/facility fee.
(C) Reimbursement of the originating site fee
will be made according to the MO HealthNet Fee Schedule.
(6) Documentation for the Telemedicine Encounter.
(A) Patient records at the distant
and originating sites (if a referral is given at the originating site) are to
document the telemedicine encounter consistent with the service documentation
described in MO HealthNet provider manuals and bulletins.
(B) A health care provider shall keep a
complete medical record of a telemedicine service, provided to a participant,
including asynchronous store-and-forward images and follow applicable state and
federal statutes and regulations for medical record keeping and confidentiality
in accordance with 13 CSR 70-3.030.
(C) Records shall be maintained per standards
established by the Health Insurance Portability and Accountability Act of 1996
(HIPAA) and in accordance with
13 CSR
70-3.030.
(7) Confidentiality and Data Integrity.
(A) All telemedicine activities must comply
with the requirements of HIPAA.
(B)
A provider of a telemedicine service shall implement confidentiality protocols,
which shall be available for inspection by the department upon
request.
(C) Participant privacy
and confidentiality must be maintained at all times while receiving all
telemedicine services.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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