Alabama Medicaid has a program to tele monitor patients with CHF, hypertension, and Diabetes through our Bio Monitoring program. Here is an excerpt from our Provider Manual explaining the program:
39.10 Program Enhancements
The following enhancements are designed to help the PMP achieve the overall program goal of establishing a medical home for our recipients that is accountable and cost-effective.
39.10.1 In Home Monitoring Program
The In Home Monitoring Program is a collaborative program between the Alabama Medicaid Agency; Alabama Department of Public Health (ADPH); and the University of South Alabama, Center for Strategic Health Innovation (USACSHI). Patients with a diagnosis of Congestive Heart Failure, Diabetes, or Hypertension are eligible for enrollment in this in-home monitoring program. The goal of the program is to decrease exacerbation episodes, emergent care visits, hospital admissions and medical costs. Referrals for In Home Monitoring may be accepted from any source, including physicians, Patient 1st Care Coordinators, Patient Care Networks, patient or caregiver, the Health Department, hospitals, home health agencies, or community based organizations. Orders for In Home Monitoring along with the specific parameters for daily monitoring must be obtained from the patient’s PMP prior to evaluation and admission.
An ADPH Nurse Care Manager evaluates the patient, provides any needed equipment including a scale, glucometer, blood pressure cuff, and phone with a speaker. The patient data is transmitted through an automated phone system, which may be accessed through a landline or cell phone. The data is sent to a secure, web-based data collection and documentation system developed by USACSHI named the Real-Time Medical Electronic Date Exchange (RMEDE), which is monitored by the ADPH Nurse Care Managers on a daily basis.
Alerts are generated to the ADPH Nurse Care Manager when a patient’s data reports are outside their specific parameters. The Primary Medical Provider or ADPH Nurse Care Manager will follow-up with the patient and determine what services are needed. In addition to the alert feature, the RMEDE system will generate valuable patient data reports monthly for each PMP participating in the In Home Monitoring Program. Summary data will also be provided to Medicaid for monitoring the program.
To refer a patient to the In Home Monitoring Program, contact the local Alabama Department of Public Health Home Health Agency, or call the ADPH Home Health State Office at 1-800-225-9770.
Enrollment: ADPH is enrolled with provider type 05 (home health) and provider specialty 970 (disease management).
ADPH Billing Instructions: ADPH bills on a UB-04 claim form using the following codes:
• Revenue Code: 789
• Procedure Code: G9008-U4 (ADPH Nurse Case Management)
Billing Units: 5 minutes equals one unit
Carolyn Miller, LCSW, PIP
Associate Director, Project Development and Quality Improvement
Managed Care Division
Office: 334-353-5539 | Fax: 334-353-7632