Telehealth Clarification

February 24, 2014

This communication serves as a reminder of the MaineCare requirements surrounding the utilization of telehealth to provide services billed to MaineCare.

  • Telehealth, as defined by Section 1.06-2 of the MaineCare Benefits Manual, is an “interactive, visual, real-time communication”;

  • All services being provided via telehealth must be rendered in accordance with MaineCare Benefits Manual Section 1.06-2 (the list of requirements included in this communication is not a complete list of all telehealth requirements);

  • Reimbursement for telehealth is limited to those services already being rendered by that provider in compliance with the MaineCare Benefits Manual. For example, a registered nurse providing a MaineCare service within his or her scope of practice, as defined by state law, may be reimbursed for providing those MaineCare services via telehealth, assuming all MaineCare requirements identified in Section 1.06-2 of the MaineCare Benefits Manual are being followed;

  • Each request for credentialing to bill MaineCare for telehealth services will be reviewed by the MaineCare Medical Director. Each approval is for one year. Once approved a copy of the approval letter must accompany all claims submitted for telehealth services. The following information must be included in a request for credentialing:

    1. The name, provider ID number, licensure level and NPI of each provider who uses telehealth to provide services;
    2. A list of the procedure codes that will be used;
    3. A statement explaining the reason for needing telehealth for the service(s) being proposed;
    4. A statement explaining the specific criteria used in determining when telehealth services are more appropriate than face-to-face services;
    5. A plan for quality assurance activities specifically related to patient satisfaction and outcomes related to telehealth service; and
    6. Educational information that will be provided to the MaineCare member at the time of the member’s visit. This information should be written at a sixth grade reading level and at a minimum it should include the following information: a. Description of the telehealth equipment and what to expect;

    b. Explanation that the use of telehealth for this service is voluntary and that the same service is available in a face-to-face setting;

    c. Explanation that the member is able to stop the telehealth visit at any time and request a face-to-face service;
    d. Explanation that MaineCare will pay for transportation to a distant appointment if needed; and

    e. HIPAA compliance information regarding the telehealth encounter.

  1. Any additional information determined by the Department as necessary to protect members and ensure the integrity of the program.
  • The GT (Interactive Telecommunication) modifier must be used when billing for services provided via telehealth.

If you have any additional questions, please contact Dr. Kevin Flanigan, Medical Director, Office of MaineCare Services at kevin.flanigan@maine.gov.

You can read more about telehealth services in the MaineCare Benefits Manual Ch. 1, Section 1.

You can find a copy of the most recent MaineCare policy by going to: http://www.maine.gov/dhhs/oms/rules/index.shtml