Telemedicine: Expanding
Access to Medicaid
Services
Presentation to:
National Association of State Medicaid
Directors
Patr...
2
Federal Guidance on
Medicaid and Telemedicine
CMS (Health Care Financing Administration) issued
guidance in 2001 on Medi...
3
Federal Guidance on
Medicaid and Telemedicine (Cont)
Advises that states should consider factors such as the
quality of ...
4
Virginia Medicaid’s
Interests in Telemedicine Coverage
Improved patient access to medical services
Improved patient comp...
5
Virginia Medicaid at a Glance
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
Enroll...
6
Virginia Medicaid
Telemedicine Coverage
Virginia Medicaid started with a telemedicine pilot project in
1995. Services co...
7
Virginia Medicaid
Telemedicine Coverage (Cont)
Pilot project was limited to three Virginia localities; one was
for psych...
8
Virginia Medicaid
Telemedicine Coverage (cont)
Virginia Medicaid expanded telemedicine coverage July 1,
2003 to be state...
9
Virginia Medicaid
Telemedicine Coverage (Cont)
Providers now recognized for telemedicine:
– Physicians
– Nurse practitio...
10
Reimbursement process uses the Health Insurance Claim
form (CMS-1500):
– Spoke practitioner, where patient is located, ...
11
Provider of telemedicine services is expected to fully
comply with service documentation and other coverage
and billing...
12
Telemedicine Billing In
Virginia Medicaid
Telemedicine billing has been low for Virginia Medicaid;
predominant service ...
13
Telemedicine, Virginia Medicaid
Managed Care Organizations
Currently, 60 percent of the Virginia Medicaid population is...
14
Future Possibilities for Virginia
Medicaid Telemedicine Coverage
Coverage of telemedicine for home health services.
A t...
15
Future Possibilities for Virginia
Medicaid Telemedicine Coverage (Cont)
Use of telemedicine for home health patients de...
16
Coverage of telemedicine “store and
forward”
Store and forward involves electronic
medical information, such as video, ...
17
Store and forward applications include:
– Screening of diabetics for retinopathy
– Screening for retinopathy of prematu...
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Patrick W. Finnerty

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Patrick W. Finnerty

  1. 1. Telemedicine: Expanding Access to Medicaid Services Presentation to: National Association of State Medicaid Directors Patrick W. Finnerty, Director Va. Department of Medical Assistance Services November 13, 2008 Washington, D.C.
  2. 2. 2 Federal Guidance on Medicaid and Telemedicine CMS (Health Care Financing Administration) issued guidance in 2001 on Medicaid and telemedicine. Among the items discussed: – No formal definition exists for telemedicine under the Medicaid program – Federal Medicaid law does not recognize telemedicine as a distinct service – Medicaid reimbursement for services furnished through telemedicine is available at the state’s option as a cost- effective alternative to the more traditional ways of providing care
  3. 3. 3 Federal Guidance on Medicaid and Telemedicine (Cont) Advises that states should consider factors such as the quality of the equipment, type of services to be provided and location of providers (such as remote rural sites) when deciding on the scope of telemedicine coverage Medicaid reimbursement must satisfy Federal requirements of efficiency, economy, and quality of care
  4. 4. 4 Virginia Medicaid’s Interests in Telemedicine Coverage Improved patient access to medical services Improved patient compliance with treatment Medical services rendered at an earlier stage of disease, improving long-term patient outcomes Reduction in service expenditures such as hospitalizations and transportation Allows for an opportunity to work proactively with physicians and other providers; has potential to be a “win-win” situation
  5. 5. 5 Virginia Medicaid at a Glance 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Enrollees ABD Children Adults Approximately 60% of enrollees are in Managed Care Organizations (MCOs) Total FY 2008 budget: $5.8 billion 260,465 489,893 123,620 Total Enrollment: 873,978
  6. 6. 6 Virginia Medicaid Telemedicine Coverage Virginia Medicaid started with a telemedicine pilot project in 1995. Services covered were: – Some consultations – One psychotherapy service – Select clinical services in cardiology and colposcopy Used Virginia defined billing codes Only physicians recognized as providers Reimbursed providers at hub and spoke site, using the existing fee schedule
  7. 7. 7 Virginia Medicaid Telemedicine Coverage (Cont) Pilot project was limited to three Virginia localities; one was for psychiatric care and the other two were for medical consultations Virginia Medicaid was one of the first states with telemedicine coverage
  8. 8. 8 Virginia Medicaid Telemedicine Coverage (cont) Virginia Medicaid expanded telemedicine coverage July 1, 2003 to be statewide. Governor Warner announced the coverage in July 2003 at a community health event in southwest Virginia Additional services covered – Evaluation and management, office visits – Individual psychotherapy – Full range of consultations – Select clinical services such as in cardiology and obstetrics
  9. 9. 9 Virginia Medicaid Telemedicine Coverage (Cont) Providers now recognized for telemedicine: – Physicians – Nurse practitioners – Nurse midwives – Clinical nurse specialists – Clinical psychologists – Clinical social workers – Licensed professional counselors
  10. 10. 10 Reimbursement process uses the Health Insurance Claim form (CMS-1500): – Spoke practitioner, where patient is located, bills a telemedicine code for presenting patient – Hub practitioner bills for services such as consultation – Reimbursement is according to Virginia Medicaid fee schedule – A procedure modifier for telemedicine is entered on the claim form – No telemedicine equipment costs recognized in reimbursement Virginia Medicaid Telemedicine Coverage (Cont)
  11. 11. 11 Provider of telemedicine services is expected to fully comply with service documentation and other coverage and billing requirements described in the Virginia Medicaid provider manuals Virginia Medicaid telemedicine coverage is similar to Medicare coverage but is not tied to rural area definitions for the originating site Virginia Medicaid Telemedicine Coverage (Cont)
  12. 12. 12 Telemedicine Billing In Virginia Medicaid Telemedicine billing has been low for Virginia Medicaid; predominant service is psychiatric consults, especially pharmacologic management. Other Medicaid programs have reported low billing as well. Possible explanations as to why telemedicine is not appearing in claims data include: – Providers not using telemedicine billing modifier on claims form – Telemedicine as part of the larger bundle of services rendered to patients with particular diagnoses – Contracts for services with hospitals/clinics do not break out telemedicine
  13. 13. 13 Telemedicine, Virginia Medicaid Managed Care Organizations Currently, 60 percent of the Virginia Medicaid population is in enrolled in a Managed Care Organization (MCO) MCOs are to cover telemedicine at least to the extent the select services are covered for the fee-for-service population Limited data on Virginia Medicaid MCOs’ reimbursement for telemedicine; psychiatric consults appear to be most frequent use
  14. 14. 14 Future Possibilities for Virginia Medicaid Telemedicine Coverage Coverage of telemedicine for home health services. A telemedicine station is in the Medicaid recipient’s home connected to a station at the home health agency office Telemedicine applications for Medicaid recipients at home include: – Post-operative care – High risk pregnancies – Asthma – Diabetes – Congestive Heart Failure
  15. 15. 15 Future Possibilities for Virginia Medicaid Telemedicine Coverage (Cont) Use of telemedicine for home health patients depends on the diagnosis, medical need, permission of the patient, and patient’s ability to use the equipment Home health providers are interested in telemedicine because care is delivered more efficiently. The home health nurse can serve more patients in a day than when the care is delivered conventionally. The telemedicine visit is not intended to substitute for needed physical visits to the home by the nurse Studies have documented savings particularly due to fewer hospitalizations and shorter hospital lengths of stay. Medicaid transportation is reduced
  16. 16. 16 Coverage of telemedicine “store and forward” Store and forward involves electronic medical information, such as video, still images, and MRIs, which is stored and transmitted for review by a physician or other practitioner at a later time. – The patient is not present when the physician conducts the review but findings are reported back to the patient’s primary care provider Future Possibilities for Virginia Medicaid Telemedicine Coverage (Cont)
  17. 17. 17 Store and forward applications include: – Screening of diabetics for retinopathy – Screening for retinopathy of prematurity – Dermatology – Other Pediatric subspecialties Store and forward can be inexpensive for the spoke and hub sites because the electronic medical information, such as a digital picture, simply needs to be captured and transmitted to the physician or other practitioner Virginia Medicaid will continue to explore additional areas for use of telemedicine Future Possibilities for Virginia Medicaid Telemedicine Coverage (Cont)

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