The document outlines Alabama Medicaid's telemedicine policy, which began covering psychiatry and dermatology via telemedicine in 2010 and expanded to all physician specialties in 2012. To participate, physicians must be licensed in Alabama, enrolled as a Medicaid provider, and submit a telemedicine agreement form. Telemedicine services must use interactive audio/video and comply with privacy and security standards. Utilization has grown from $3,800 in 2010 to over $31,800 in 2014, mostly for mental health services. The policy also discusses the creation of Regional Care Organizations to coordinate care for Medicaid beneficiaries starting in 2015.

1. Telemedicine Policy
Dr. Melinda Rowe
Assistant Medical Director
October 17, 2014

2. Alabama Medicaid Telemedicine
• History
– Began coverage for Psychiatry and Dermatology
specialists in 2010
• 50 mile limitation
– Expanded to all physician types with Alabama
Medical license in 2012
• 50 mile limitation removed
– No origination or transmission fees

3. Alabama Medicaid Telemedicine
• All physicians with
– Alabama medical license
– Enrolled as Alabama Medicaid provider
– Regardless of location
• Are eligible to participate in Telemedicine
Program to provide
– Medically necessary telemedicine services to
Alabama Medicaid eligible recipients

4. Alabama Medicaid Telemedicine
• In order to participate in Alabama Medicaid
Agency (AMA) telemedicine program:
– Physicians must be enrolled with AMA with
specialty type 931 (Telemedicine Service)
– Physician must submit the Telemedicine Service
Agreement/Certification form located on AMA
website at http://mediciaid.alabama.gov
– Physician must obtain prior consent from
recipient/patient before services are rendered;
counts as part of benefit limit of 14 annual
physician office visits currently allowed

5. Alabama Medicaid Telemedicine
• Telemedicine services must be
administered via interactive audio and
video telecommunications system with
2-way communication between distant
site physician and origination site
where recipient is located
• Does not include phone, e-mail, or fax
between physician, recipient, or
consultation between two physicians

6. Alabama Medicaid Telemedicine
• Telemedicine health care providers shall
ensure telecommunication technology and
equipment used at both physician and
recipient sites is sufficient to allow
appropriate evaluation, diagnosis, and/or
treatment of recipient for services billed
• Transmissions must employ acceptable
encryption to protect confidentiality/integrity
of transmission information and acceptable
authentication/identification procedures for
sender/receiver

7. Alabama Medicaid Telemedicine
• Provider shall maintain appropriately trained staff
immediately available in person to recipient
receiving telemedicine service to attend to any
emergencies that may occur during session
• Physician shall implement confidentiality
protocols that specify individuals who have
access to electronic records, usage of unique
passwords, ensure system to prevent
unauthorized access, ensure system to
track/record access to electronic medical info

8. Alabama Medicaid Telemedicine
• Procedure codes covered for telemedicine
– Consultations (99241-99245, 99251-99255)
– Office or other outpatient visits (99201-99205,
99211-99215)
– Individual psychotherapy (90804-90809)
– Psychiatric diagnostic (90801)
– Neurobehavioral status exam (96116)
• Bill procedure codes with modifier GT
• No reimbursement currently—origination site
or transmission fees

9. Other Events
•Alabama Board of Medical Examiners 1/2014
Telehealth policy:
−CRNP, CNM, PA can provide services if within
scope of their practice, their license and
collaborative agreement
−Distant site provider must comply with all
applicable laws/rules in jurisdiction where
patient resides or seeks medical care
−May not use to prescribe non-malignant pain
with scheduled/controlled medications

10. Other Events (continued)
• American Medical Association guiding
principles June 2014:
− Must provide face to face exam before
telemedicine visits start
− Physician must have licensure within state
where patient resides and service is being
performed
− Same standard of care that applies to
traditional health care setting should also
apply to telemedicine

11. AMA Telemedicine Utilization
2010 - 2014
FY 10 $ 3,800
FY 11 $ 4,300
FY 12 $ 5,900
FY 13 $18,000
FY 14 $31,800
Over 4000 claims for Medicaid/Medicare dual
eligibles; 306 Medicaid only and most PSY

12. AMA Telemedicine Utilization (cont)
• Dual eligibles (Medicare/Medicaid)
− Majority of visits in Community Mental
Health Centers ($29,674)
− Physician Office ($5,469)
• Medicaid
− Majority of visits occur in office ($10,372)
− Skilled nursing facilities ($249)

13. AMA Regional Care Organizations
(RCOs)
• Alabama Code § 22-6-150 et seq—creation
of provider-based nonprofit corporations
paid on capitated basis to provide
– full scope of Medicaid benefits,
– care coordination, and
– a medical home for Medicaid beneficiaries
• 5 Regions AE

14. AMA RCOs
5 Regions
− A thru E
− Smallest region
7 counties
− Largest region
21 counties

15. AMA RCOs (Continued)
• 9/30/14: 12 Probationary RCO applications
• 4/1/15: RCO provider networks in place
• 10/1/16: RCO accepts capitation payments
from Alabama Medicaid
• RCO can provide more than essential
benefits

16. Medicaid Telemedicine
• For more Telemedicine details go to
Chapter 28 of Alabama Medicaid
Provider Manual on website at
www.medicaid.alabama.gov
For RCO details, click on RCO icon
• Questions
• Thank you