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Telemedicine Regulations in Michigan

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Making Healthcare more Convenient and Affordable

After signing two pieces of legislation that ensured private payer reimbursement for telemedicine visits, Michigan governor,  Rick Snyder said, “Telemedicine offers an incredible opportunity to easily provide healthcare to Michigan’s elderly, disabled and rural communities, I applaud the Legislature’s initiative to use technology to save lives.” Indeed, Michigan is one of 24 states that have embraced telemedicine as a way to make healthcare more convenient, affordable and accessible for its citizens.

History of telemedicine regulations in Michigan

House Bills 5408 and 5421 (2010)

On June 28, 2012, two Michigan public acts went into effect contained the same language. “A group or non-group health care corporation certificate shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the health care corporation.”

Little Further Guidance

House bills 5408 and 5421 are the only reference in Michigan law to telemedicine. Additionally, the licensing boards have made no comment on the practice.

Getting Reimbursed for Telemedicine in Michigan

Private payer reimbursement for telemedicine in Michigan

 

In 2012 Michigan joined California, Virginia, Texas and others in requiring private payer reimbursement for telehealth visits. The law simply eliminates the face-to-face requirement for reimbursement.

Definition

The law defines telemedicine services as, “The use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine, the health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided.”

Exclusions

Because “real-time” interaction is required, reimbursement is not required for the following:

  • Store and Forward technology
  • An electronic mail message
  • A facsimile transmission

Policies Included

The law applies to all insurance certificates issued or renewed on or after January 1, 2013.

Parity

Because the law eliminated the face-to-face requirement, the insurer is responsible for coverage for the provision of the same service through telemedicine.

Copayments and Maximums

Telemedicine services are subject to all terms and conditions of the policy agreed upon between the patient and the health care corporation, including required copayments, coinsurances, deductibles, and approved amounts.

Patient Site Requirements

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

Michigan Department of Community Health (Medicaid)

Legacy Reimbursement Approach

Michigan has yet to innovate its approach to telemedicine under Medicaid beyond the Medicare model that requires a patient to be at a designated site for the delivery of remote medical services.

Hub-and-Spoke Model

The Michigan Department of Community Health reimburses approved health care providers for services delivered via telemedicine using 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.

Michigan Department of Licensing and Regulatory Affairs

Michigan’s State Medical Board

No Reference to Telemedicine

To date, the Michigan department of Licencing and Regulatory affairs has been silent on the issue of telemedicine. Generally, regulations do require the existence of a prior physician-patient relationship for online prescribing.

Frequently Asked Questions (FAQ)

Yes. There is nothing in the law that requires a prior face-to-face visit to ensure reimbursement for telehealth visits.

Yes. Regulations do require the existence of a prior provider-patient relationship before medication can be prescribed, but nothing in the law or regulations requires that the relationship be established in person.

Nothing in the law or regulations addresses this or requires an in person visit at any time.

Unfortunately, not at this time. Unlike for private payer reimbursement, Michigan 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.

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.

Telepresence

The use of a set of technologies that allows individuals to feel as if they were present, to give the appearance of being present, or to have an effect at a place other than their true location. Telepresence generally means the use of means HD quality audio/video.

Hub and Spoke

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

Remote Monitoring

Type of ambulatory healthcare where patients use mobile medical devices to perform a routine test and send the test data to a healthcare professional in real-time. Remote monitoring includes devices such as glucose meters for patients with diabetes and heart or blood pressure monitors for patients receiving cardiac care.

Centers for Medicare & Medicaid Services (CMS)

A federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and Health Insurance Portability and Accountability Act (HIPAA) standards.

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. Private payer reimbursement is not required in Michigan for store and forward technology.

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