C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-4, subsec. 144-101-I-4.03

Current through 2024-51, December 18, 2024

Subsection 144-101-I-4.03 - PROVIDER REQUIREMENTS

4.03-1Telehealth Services

In order to be eligible for reimbursement for Telehealth Services, a Health Care Provider must

A. Act within the scope of their license;

B. Be enrolled as a MaineCare provider;

C. Be otherwise eligible to deliver the underlying Covered Service according to the requirements of the applicable Section of the MBM; and

D. Be appropriately licensed, accredited, certified, and/or registered in the State where the Member is located during the provision of the Telehealth Service.

4.03-2Telemonitoring Services

In order to be eligible for reimbursement for Telemonitoring Services, a Health Care Provider must be a certified Home Health Agency pursuant to the MBM Chapter II, Section 40, Home Health Services. Compliance with all applicable requirements listed in Chapter II, Section 40, Home Health Services, is required.

The Health Care Provider ordering the service must be a Health Care Provider with prescribing privileges (physician, nurse practitioner or physician's assistant).

Health Care Providers must document that they have had a face-to-face encounter with the Member before a physician may certify eligibility for services under the home health benefit. This may be accomplished through interactive telehealth services, but not by telephone or e-mail.

C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-4, subsec. 144-101-I-4.03