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Statutes, Regulations and Policy

Statutes

Regulations

Federal Communications Commission

Policy

Medicaid coverage of telehealth services in Alaska

AAC: Title 7: Part 8: Chapter 10: Article 15


Telemedicine Services
Section
620. Scope.
625. Telemedicine applications; limitations.
630. Conditions for payment.
635. Exclusions.
639. Definitions.
7 AAC 110.620. Scope
(a) The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients as provided in AS 47.07.
(b) For a provider to receive payment under 7 AAC 110.620 - 7 AAC 110.639, the provider's use of telemedicine applications must comply with the standards set out in AS 47.07 and 7 AAC 105 - 7 AAC 160 for the medical service provided by the type of provider, including
(1) provisions that affect the efficiency, economy, and quality of service; and
(2) coverage limitations.

History: Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199

Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040

7 AAC 110.625. Telemedicine applications; limitations
(a) The department will pay a provider for a telemedicine application if the provider provided the medical services through one of the following methods of delivery in the specified manner:
(1) live or interactive; to be eligible for payment under this paragraph, the service must be provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis; medical services provided by a telephone that is not part of a dedicated audio conference system or by a facsimile machine are not eligible for payment under this paragraph;
(2) store-and-forward; to be eligible for payment under this paragraph, the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider;
(3) self-monitoring or testing; to be eligible for payment under this paragraph, the services must be provided by a telemedicine application based in the recipient's home, with the provider only indirectly involved in the provision of the service.
(b) The department will only make a payment for a telemedicine application if the service is limited to
(1) an initial visit;
(2) a follow-up visit;
(3) a consultation made to confirm a diagnosis;
(4) a diagnostic, therapeutic, or interpretive service;
(5) a psychiatric or substance abuse assessment;
(6) psychotherapy; or
(7) pharmacological management services on an individual recipient basis.

History: Eff. 2/1/2010, Register 193
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040

7 AAC 110.630. Conditions for payment
(a) The department will pay for telemedicine applications provided by a treating, consulting, presenting, or referring provider for a medical service covered by Medicaid and provided within the scope of the provider's license.
(b) A treating or consulting provider must use applicable modifiers as described in 7 AAC 145.050 for billing for a telemedicine application.
(c) A presenting, referring, or consulting provider is subject to the conditions for payment that are described in 7 AAC 145.005.
(d) A presenting provider is only eligible to receive Medicaid payment for a live or interactive telemedicine application as described in 7 AAC 110.625(a) (1).
History: Eff. 2/1/2010, Register 193
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040

7 AAC 110.635. Exclusions
(a) The department will not pay for the following services provided by telemedicine application:
(1) home and community-based waiver services;
(2) pharmacy services;
(3) durable medical equipment services;
(4) transportation services;
(5) accommodation services;
(6) end-stage renal disease services;
(7) direct-entry midwife services;
(8) private-duty nursing services;
(9) personal care assistant services;
(10) visual care, dispensing, or optician services.
(b) The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.
History: Eff. 2/1/2010, Register 193
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040

7 AAC 110.639. Definitions
In 7 AAC 110.620 - 7 AAC 110.639,
(1) "consulting provider" means a provider who evaluates the recipient and appropriate medical data or images through a telemedicine mode of delivery upon recommendation of the referring provider;
(2) "presenting provider" means a provider who
(A) introduces a recipient to a consulting provider for examination, observation, or consideration of medical information; and
(B) may assist in the telemedicine consultation;
(3) "referring provider" means a provider who evaluates a recipient, determines the need for a consultation, and arranges the services of a consulting provider for the purpose of diagnosis or treatment;
(4) "telemedicine" means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data, audio, visual, or data communications that are performed over two or more locations between providers who are physically separated from the recipient or from each other.
History: Eff. 2/1/2010, Register 193

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