Telemedicine for Medicaid

At Sunshine Health, we know that the more options your Medicaid patients, our members, have to see and communicate with their healthcare providers, the better. That is why we are here to support you as you expand or begin using telemedicine to effectively and efficiently deliver healthcare services to your patients.

Telemedicine can help you:

  • Engage patients to take a more active role in their health
  • Treat patients with non-emergent health issues remotely, or after hours
  • Improve efficiency with fewer no-show appointments
  • Expand your geographic reach, especially to patients in rural areas
  • Refer patients to out-of-area specialists
  • Improve health outcomes and care coordination

To help ensure our members have access to the healthcare services they need, we are committed to helping you overcome barriers in the delivery of telemedicine. Please call us if you have questions or need assistance with issues like technology, billing or reimbursement.

   Telemedicine Training

Sunshine Health is excited to offer monthly Telemedicine Training.

How to sign up

  1. Click the link below to register for the webinar.
  2. A webinar invitation will be sent to you via email. Once the invitation is received, click on the link provided in the email to register (this step is required for attendance).
  3. You will receive a confirmation email with a link and instructions for joining the webinar. NOTE: Please check junk folder if confirmation is not received.
  4. When you join the webinar, the call-in telephone number and an attendee passcode will be displayed.

Training highlights

  • Telemedicine guidelines and requirements
  • Telemedicine defined
  • Methods to provide telemedicine
  • Billing guidelines
  • Reimbursable services
  • Educational material and resources

State Regulations on Telemedicine

The Agency for Health Care Administration (AHCA) contracts with Medicaid health plans to provide services to members. The transition to a new contract begins Dec. 1, 2018, and continues until Feb. 1, 2019. As part of this contract, members will have access to providers through expanded telemedicine.

Highlights of the coming changes:

  • Allows providers to be reimbursed for telemedicine services to the same extent they would be covered if provided through an in-person visit.
  • Coverage requirements cannot be more restrictive for telemedicine than those established for services provided in person.
  • Broadens options for telemedicine by covering store-and-forward and remote patient monitoring services, when appropriate.
  • Stresses member choice. Members can always choose a face-to-face encounter if they prefer and should never be required to use telemedicine services.

The AHCA Policy (PDF) provides additional information about the state’s telemedicine rules and regulations. AHCA’s Telehealth Advisory Council was set up to monitor and submit reports on the status and scope of telehealth activities in Florida. The group submitted its final report (PDF) in October 2017. We encourage you to read the report as it contains helpful information about telemedicine/telehealth.

Technology

  • Interactive audio and video telecommunications must meet AHCA requirements per Rule 59G-1.057, F.A.C. and 45 CFR 164.312.
  • The technology must provide real time communications between the distant site provider or practitioner and the member.
  • All communications must be on a secure network in compliance with HIPAA Encryption and Redundancy requirements. Encryption is the conversion of plaintext into cipher text using a key to make the conversion.

Telemedicine FAQ

Telemedicine includes the use of interactive audio, video or other electronic media for providing a diagnosis, consultation or treatment, as defined by Agency for Health Care Administration guidelines.

Benefits include:

  • Improving access and quality of care for members who are homebound or live in rural areas
  • Strengthening physician-patient relationships
  • Increasing care coordination and communication
  • Reducing healthcare costs
  • Enhancing coverage for primary care physicians, specialists and behavioral health providers

Yes, telemedicine services are available to recipients of the Statewide Medicaid Managed Care (SMMC) programs of Medicaid, Long Term Care and Child Welfare.

No, unless the provider is delivering services that normally require prior authorization.

Practitioners who may furnish and receive payment for covered telemedicine services (subject to Florida State law) include:

  • Physicians
  • Nurse practitioners
  • Physician assistants
  • Nurse-midwives
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Registered dietitians or nutrition professionals

Sunshine Health will cover services provided via telemedicine to the same extent that Sunshine Health covers the same services in person. The provider must be licensed within the State of Florida and a member must be present and participating in the visit.

The initial cost of telemedicine equipment to receive and transmit services is not covered, as well as:

  • Telephone conversations
  • Electronic mail messages
  • Facsimiles
  • Services rendered via a webcam or Internet based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance
  • Video cell phone interactions
  • Failed or unsuccessful transmissions

No, but they do need complete and submit the telemedicine attestation with affirmative answers for Items 2-8. Only one attestation per TIN is required.

Their claims will be denied.

The appropriate medical documentation must appear in the member’s medical record to justify medical necessity for the level of service reimbursed.

  • The record must reflect the level of service billed and must be legible
  • Documentation must be maintained at both the origination and distant sites to substantiate the services provided
  • Services must be clearly and separately identified in the member’s medical record
  • Documentation must indicate the services were rendered via telemedicine and the location of the originating and distant sites
  • All other Florida Medicaid documentation guidelines apply to services rendered via telemedicine. Examples include but are not limited to chart notes; start and stop times; date of visits; provider’s signature; service provider’s credentials; signed member consent form; and, physician findings, diagnosis, illness, prescribed treatment, and more

An originating site is the location where a member is at the time the telemedicine service occurs.

A distant site is where the provider/specialist is seeing the patient at a distance. A distant site is also known as a hub site, specialty site, consulting site, referral site or provider/physician site.

  • Utilize place of service (02).