New York State Medicaid: Telemedicine Overview

1. New York State Medicaid:Telemedicine Overview Gregory Allen, Director Division of Program Development and Management January 9, 2012

2. 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

3. MRT # 153Expanded Coverage of Telemedicine • Charged the Department to further promote and enhance coverage of telemedicine by providing payment incentives and reducing coverage barriers.

4. 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)

5. 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.

6. 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.

7. 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.

8. 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

9. 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/2006/administrator/2006-09-22_mandated_credentialing_guidance.pdf