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

2. 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. 3 MRT # 153 Expanded Coverage of Telemedicine Charged the Department to further promote and enhance coverage of telemedicine by providing payment incentives and reducing coverage barriers.

4. 4 MRT # 153 Expanded 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. 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. 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. 7 Telemedicine Physician 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. 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. 9 Telemedicine – Medicaid Updates Expanded Coverage of Telemedicine (September 2011 Medicaid Update) http://www.health.ny.gov/health_care/medicaid/program/update/2011/se pt2011mu_special1.pdfhttp://www.health.ny.gov/health_care/medicaid/program/update/2011/se pt2011mu_special1.pdf Diabetes and Asthma Self-Management Training (October 2008 Medicaid Update) http://www.health.ny.gov/health_care/medicaid/program/update/2008/20 08-10.htm#diahttp://www.health.ny.gov/health_care/medicaid/program/update/2008/20 08-10.htm#dia September 22, 2006 “Dear CEO Letter” http://www.health.ny.gov/professionals/hospital_administrator/letters/20 06/administrator/2006-09-22_mandated_credentialing_guidance.pdfhttp://www.health.ny.gov/professionals/hospital_administrator/letters/20 06/administrator/2006-09-22_mandated_credentialing_guidance.pdf