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Telemedicine regulations in Maryland

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A progressive voice in telemedicine

The Maryland Health Care Commission believes that the effective use of telehealth can increase access to care, reduce outcome disparities and create efficient healthcare delivery. In October 2012, Maryland became the 13th state to require private sector insurance companies to pay for telehealth services.

History of telemedicine regulations in Maryland

Senate Bill 781, Health Insurance – Coverage for Services Delivered through Telemedicine (2012)

The law requires that health insurers and managed care organizations provide coverage for health care services delivered using telehealth technology; coverage cannot be denied because services were provided through telehealth rather than in-person.

Senate Bill 798 (2013), Hospitals – Credentialing and Privileging Process – Telemedicine

Enables hospitals to rely on certain credentialing and privileging decisions made by a distant site hospital or telehealth entity.

Senate Bill 496 (2013), Maryland Medical Assistance Program – Telemedicine

Requires Maryland Medicaid to provide reimbursement for two pilot programs.

Senate Bill 198, Maryland Medical Assistance Program– Telemedicine

Expanded Maryland Medicaid telehealth reimbursement under certain circumstances.

Expansion of the Maryland Medical Assistance Program (2014)

The Maryland Medical Assistance program expanded reimbursement to all approved providers for services rendered to participants via telemedicine statewide, regardless of geographic location.

Getting Reimbursed for Telemedicine in Maryland

Private payer reimbursement for telemedicine in Maryland

 

Maryland has been ahead of the curve when it comes to private payer reimbursement for telemedicine. In 2012, they joined 12 other states in mandating reimbursement for this important method of patient care.

Definition

The law defines telemedicine as, “The delivery of health care services, the use of interactive audio, video or other telecommunications or electronic technology by a licensed health care provider to deliver a health care service within the scope of practice of the health care provider at a site other than the site at which the patient is located.”

Exclusions

Reimbursement is not required for the following:

  • An audio-only telephone conversation
  • An electronic mail message
  • A facsimile transmission

Payers Included

The reimbursement requirement applies to insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are delivered in the state and to health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the state.

Copayments and Maximums

Payers may impose a deductible, copayment or coinsurance amount. They may impose an annual dollar maximum (as permitted by federal law) on benefits for health care services that are delivered either through an in-person consultation or through telemedicine service if the limitations are applied equally.

Patient Site Requirements

A policy can not distinguish between patients in rural or urban locations.

Maryland Medical Assistance Program

Maryland’s state Medicaid program

Legacy Reimbursement Approach

Although the private payer reimbursement and the code of physicians in Maryland are quite progressive, the Medicaid program is less so, reflecting the legacy approach taken by Medicare. The Maryland Department of Health and Mental Hygiene’s (DHMH) Medical Assistance (Medicaid) Program reimburses approved health care providers for services delivered via telemedicine.

Hub-and-Spoke Model

Telemedicine in Maryland employs a “hub-and-spoke” model. The “hub”, or “distant site”, is the location of the medical specialist, who provides consultation services to the “spoke”, or “originating site”, where both provider and participant (patient) are located. Communication between the originating and distant sites involves real-time interaction via a secure, two-way audio and video telecommunication system.

Code of Maryland Physician Regulations

Maryland’s State Medical Board

Telemedicine Definition

For the purpose of regulating physician practices, Maryland defines telemedicine as, “The practice of medicine from a distance in which intervention and treatment decisions and recommendations are based on clinical data, documents, and information transmitted through telecommunications systems.”

 

Medical Decision Making

A physician shall ensure that the quality and quantity of data and other information is sufficient in making medical decisions before providing recommendations or making treatment decisions for a patient.

 

Interpretive Services

When a physician is providing interpretive services (official readings of images, tracings, or specimens), the physician shall ensure that there is no clinically significant loss of data from image acquisition through transmission to final image display.

 

Documentation

A physician practicing telemedicine shall (other than for interpretive services) obtain and document patient consent; create and maintain adequate medical records; follow requirements of Maryland and federal law and regulations with respect to the confidentiality of medical records and disclosure of medical records; and adhere to requirements and prohibitions found in Health Occupations Article, §§1-212, 1-301—1-306, and 14-404, Annotated Code of Maryland.

 

Physician-Patient Relationship

If a physician-patient relationship does not include prior in-person, face-to-face interaction with a patient, the physician shall incorporate real-time auditory communications or real-time visual and auditory communications to allow a free exchange of information between the patient and the physician performing the patient evaluation.

Frequently Asked Questions (FAQ)

Yes. A prior in-person, face-to-face interaction is not required. However, if it is absent the telemedicine encounter must incorporate real-time visual and auditory communications. Audio only telephone calls do not qualify for reimbursement.

Neither the Code of Physicians nor the private payer reimbursement regulations address this.

Yes. As are the standards related to medical records documentation and confidentiality.

Unfortunately, not at this time. Maryland Medicare uses a hub and spoke model for telemedicine requiring that the patient be at an originating site in the presence of another care provider. (This is not true for private payer reimbursement.)

Telehealth terms to know

Telemedicine

The practice of medicine from a distance in which intervention and treatment decisions and recommendations are based on clinical data, documents, and information transmitted through telecommunications systems.

Hub and Spoke

This model, used for Medicaid by Maryland, is designed to incorporate the services of a specialist via telemedicine with the patient and another provider participating together from the same location.

Interpretive Services

Official readings of images, tracings, or specimens. Interpretive services are permitted by the Maryland Code of Physicians, provided that the transmission service is of sufficient quality.

Store and Forward Technology

The transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site.

Originating Site

The location of an eligible Medicaid participant at the time the service being furnished via technology-assisted communication occurs, which is a site approved by DHMH to provide telemedicine services.

Distant Site

A site approved by DHMH to provide telemedicine services, at which the licensed consulting provider is located at the time the service is provided via technology-assisted communication.

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