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Coverage criteria policies

Telemedicine – Minnesota Health Care Programs

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for telemedicine services.

Coverage

HealthPartners supports the use of telemedicine as an alternative to an office visit. Access to these services is limited to care that meets all of the conditions of this policy.

The following provider types are eligible to provide telemedicine services:

  • Physicians
  • Nurse practitioner
  • Physician assistant
  • Nurse midwife
  • Clinical nurse specialist
  • Registered dietician or nutrition professional
  • Dentist, dental hygienist, dental therapist, advanced dental therapist
  • Mental health professional, when following the requirements and service limitations listed in the Telemedicine Delivery of Mental Health Services section.
  • Pharmacist
  • Certified genetic counselor
  • Podiatrist
  • Speech therapist
  • Physical therapist
  • Occupational therapist
  • Audiologist
  • Mental health professionals who are qualified under Minnesota Statute 245.462 Subd. 18 or mental health practitioners working under the supervision of a mental health professional.

Indications that are covered

  1. Interactive audio and video telecommunications that permit real-time communication between the distant site physician or practitioner and the recipient. The services must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face encounter. Audio/video telecommunications must be conducted over a secure encrypted website as specified by the Health Insurance Portability Act of 1996 Privacy and Security rules.
  2. “Store and Forward”: The asynchronous transmission of medical information to be reviewed at a later time by a physician or practitioner at the distant site. Medical information may include, but is not limited to, video clips, still images, x-rays, MRIs, EKGs, laboratory results, audio clips and text. The physician at the distant site reviews the case without the patient being present. Store and forward substitutes for an interactive encounter with the patient present; the patient is not present in real-time.
  3. Covered telemedicine services include but are not limited to the following:
    1. Consultations
    2. Telehealth consults: emergency department of initial inpatient care
    3. Subsequent hospital care services with the limitation of one telemedicine visit every 30 days per eligible provider
    4. Subsequent nursing facility care services with the limitation of one telemedicine visit every 30 days
    5. End-stage renal disease services
    6. Individual and group medical nutrition therapy
    7. Individual and group diabetes self-management training with a minimum of one hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training
    8. Smoking cessation
    9. Alcohol and substance abuse (other than tobacco) structured assessment and intervention services
    10. Mental health services except for the mental health services listed in the non-covered section below.
    11. Certain EIDB services for Medicaid members only, when performed by mental health professional level providers and Level I or Level II providers.
  4. Telemedicine services are limited to three per week per member
  5. Two-way interactive video when there isn’t a physician in the ER and the nursing staff are caring for the member at the originating site or the ER physician requests the opinion or advice of a specialty physician at a “hub” site

Indications that are not covered

  1. E-visits
  2. Scheduled telephone visits
  3. Electronic connections, such as Skype, that are not conducted over a secure encrypted website as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy and Security rules.
  4. Prescription renewals
  5. Scheduling a test or appointment
  6. Clarification of issues from a previous visit
  7. Reporting test results
  8. Non-clinical communication
  9. Communication via telephone, email or facsimile
  10. Day treatment
  11. Partial hospitalization programs
  12. Residential treatment services
  13. Case management face-to-face contact
  14. More than one reading or interpretation of diagnostic tests such as x-rays, lab tests, and diagnostic assessments
  15. Materials sent to members, other providers or facilities
  16. Originating site facility fee

Definitions

Telemedicine is the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. Telemedicine may be provided by real-time two-way, interactive audio and visual communications, including secure videoconferencing or store-and-forward technology to provide or support health care delivery. The telemedicine services facilitate the patient’s assessment, diagnosis, consultation, treatment, education, and care management.

Originating Site – is the location of an eligible HPCare member at the time the service is being furnished via a telecommunication system. Authorized originating sites include:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility
  • End-stage renal disease facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living, shelter or temporary lodging
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School
  • Correctional facility-based office

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. Telemedicine – MHCP Provider Manual http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_008926#Telemedicine
  2. Telemedicine Delivery of Mental Health Services – MHCP Provider Manual http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_160257

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Policy activity

  • 06/16/2016 - Date of origin
  • 11/06/2018 - Effective date
Review date
  • 11/2018
Revision date
  • 11/06/2018

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