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New York State Medicaid:Telemedicine Overview

Gregory Allen, DirectorDivision of Program Development and Management

January 9, 2012

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Telemedicine

• Telemedicine has been an evolving Medicaid program area:– September 2006

• Medicaid began reimbursing for specialty consultations performed via telemedicine

• Limited to Emergency Room and inpatient hospital consultations

– February 2010• Coverage was expanded to patients in hospital

outpatient departments• Policy clarification – telemedicine consultations are

not limited to any specific physician specialties

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MRT # 153Expanded Coverage of Telemedicine

• Charged the Department to further promote and enhance coverage of telemedicine by providing payment incentives and reducing coverage barriers.

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MRT # 153Expanded Coverage of Telemedicine

• Effective for dates of service on or after October 1, 2011 -– Telemedicine coverage expanded to include

Article 28 hospitals, Diagnostic and Treatment Centers (D&TCs), and Federally Qualified Health Centers (FQHCs)

– Practitioners who may provide telemedicine service at the hub site include:• Physician Specialists (including Psychiatrists)• Certified Diabetic Educators (CDEs)• Certified Asthma Educators (CAEs)

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Telemedicine Requirements

• Requirements include:– The patient must be physically present at the

originating “spoke” site. The physician specialist and/or CDE/CAE is located at the “hub” site.

– The physician specialist at the “hub” site, who is performing the consult, must be licensed in NYS, enrolled in Medicaid, and credentialed/privileged at both the “hub” and “spoke” site hospital and/or D&TC.• The “spoke” site may enter into a contract with

the hub site for physician credentialing.

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Telemedicine Requirements(cont.)

• The request and medical need for the telemedicine consult and the findings of the consulting practitioner must be documented in the patient’s medical record.

• Consistent with Medicare guidelines, the telemedicine consultation must be “real time” and provided vial a fully interactive, secure two-way audio visual telecommunication system.

– “Store and forward” is not covered.

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TelemedicinePhysician Credentialing/Privileging

• “Spoke” site hospitals must ensure that physicians providing consultations by telemedicine are appropriately credentialed and privileged.

– The “spoke” site may enter into a contract with the hub site for physician credentialing.

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Telemedicine Billing

• There has been growth in the delivery of services to Medicaid enrollees via telemedicine.

• A review of data telemedicine consults shows an increase in Medicaid expenditures and utilization over the past year:

• CY 2010: Under $100; 7 claims • CY 2011: $15,490; 667 claims

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Telemedicine – Medicaid Updates

• Expanded Coverage of Telemedicine (September 2011 Medicaid Update)

• http://www.health.ny.gov/health_care/medicaid/program/update/2011/sept2011mu_special1.pdf

• Diabetes and Asthma Self-Management Training (October 2008 Medicaid Update)

• http://www.health.ny.gov/health_care/medicaid/program/update/2008/2008-10.htm#dia

• September 22, 2006 “Dear CEO Letter”• http://www.health.ny.gov/professionals/hospital_administrator/letters/200

6/administrator/2006-09-22_mandated_credentialing_guidance.pdf