Maine Expands Telehealth to Curb COVID-19

With the need to for folks to hunker down in their homes, the legislature has expanded Maine’s ability to conduct telehealth services. Below is summary of telehealth and the changes made to the program.

Telehealth –
Includes real time audio-visual communication and “store and forward” where images can be reviewed by a specialist.

Telehealth may be used for clinical interactions that replicate an in-person consultation and for group therapy for multiple individuals with common conditions such as substance use disorder. Store and forward includes images that can be reviewed by specialists. Telehealth monitoring is a service generally provided in the home of the individual to monitor chronic conditions. Clinical information (such as blood pressure, pulse, weight, oxygen levels etc) is uploaded into a site monitored by nurses on a daily basis. Telephonic coverage is limited to circumstances when technology fails, and the clinical encounter can be completed effectively by telephone. Telepsychiatry is a good example of a service that may utilize a telephone engagement when technology isn’t working.

Parity –
Maine law prohibits commercial carrier denial of coverage for telehealth services if the same services would be covered if it was provided through an in-person consultation covered by the health plan.

Telehealth Coverage –

• Medicare has strict regulations on telehealth eligible services, patient and provider location and billing criteria
• MaineCare has a specific chapter dedicated to telehealth coverage. In general, if a MaineCare covered service can be safety delivered by telehealth, it is a covered telehealth service.
• Commercial Carriers – If carrier covers in-person care, it must cover telehealth as well. See section on parity above. LD 1263 – Public Law Ch. 289

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Current Bill: LD 1974 An Act to Promote Telehealth – This bill has three sections.

• Target Case Management is covered by MaineCare and this clarifies that telehealth can be used by case managers to electronically communicate with clients at a distance. This is particularly urgent given workforce challenges, driving distances to clients and the current COVID-19 virus emergency.
• Interprofessional Electronic Consultations – This section of the bill is permissive stating that commercial carriers may adopt Medicare coverage policy for Interprofessional Electric consultations (generally referred to as consults). The permissive language allows carriers to negotiate coverage with providers and may include rural health clinics and federally qualified health centers.
• DHHS Telehealth Advisory Group – This section of the bill eliminates the cap of 4 meetings per year so the group can meet as needed to fulfill responsibilities.