Home interactive video conferencing and monitoring are covered and reimbursable services under Kansas Medicaid. Coverage and reimbursement for home monitoring was made possible due to federal funding from the Money Follows the Person (MFP) demonstration. The Kansas Frail Elderly MFP waiver program offers home monitoring, helping beneficiaries effectively manage their chronic illness and recognize early signs of problematic issues so intervention can occur before their health declines. Beneficiaries in assisted living, residential health care, or home-plus facilities (i.e. long-term care facilities which assist no more than 8 individuals diagnosed with functional impairments) are not eligible for home monitoring under this waiver program.
Adults 65 years of age and older qualify for home monitoring if they also meet the following
- Diagnosed with one or more qualifying chronic illness;
- Have had two or more hospitalizations, including ER visits, within the last year;
- Enrolled in the MFP waiver program to transition from a nursing facility back into the community;
- Need disease management consultation and education;
- Have a landline or wireless connection;
- Perform daily monitoring for at least seven consecutive days.
Prior authorization is not required. Registered nurses (RNs) and licensed practical nurses (LPNs) with RN supervision are eligible to set up, supervise, and provide patient home monitoring. At a minimum, home monitoring equipment should be capable of monitoring daily heart rate, blood pressure, mean arterial pressure, weight, oxygen saturation, and temperature. Home health agencies and county health departments may bill for telehealth services based on the rate of $6 per unit/day each month. Medicaid will also reimburse a telehealth installation and training fee at a maximum rate of $70 per patient, up to 2 per patient per calendar year.
- No more often than every two weeks if the patient is also receiving skilled services.
- At least every 60 days if the patient is receiving nonskilled services only.
- Home telehealth uses real-time, interactive, audio/video telecommunication equipment to monitor beneficiaries in the home setting as opposed to a nurse visiting the home. This technology may be used to monitor the beneficiary for significant changes in health status, provide timely assessment of chronic conditions, and provide other skilled nursing services.
- Home telehealth services must be provided by an RN or LPN. Agencies may bill skilled nursing services on the same date of service as telehealth services.
Source: Kansas Medical Assistance Program HOME HEALTH AGENCY FEE-FOR-SERVICE PROVIDER MANUAL BENEFITS & LIMITATIONS
(Begins on page 7)
Note: Use modifier GT (interactive telecommunication) with the following codes when filing claims to Medicaid for home telehealth visits: T1030 and T1031.
Home Telehealth Service Limitation
Appendix III Updated 05/2011
- Providers must bill T1030 and T1031 with modifier GT for home telehealth skilled nursing visits. These codes are per visit.
- Providers must bill T1030 and T1031 with both modifiers GY and GT for home telehealth skilled nursing visits for Medicare-eligible beneficiaries with a Medicaid-covered benefit plan.
- PAs are entered for no more than 60 days. Home telehealth services cannot be approved for durations of more than 60 days. Additional documentation may be required to support continuation of home telehealth service requests that exceed 60 days.
- Telehealth visits must be provided by a RN or LPN.
- Telehealth visits must use face-to-face, real-time, interactive video contact to monitor beneficiaries in the home setting as opposed to a nurse visiting the home. This technology can be used to monitor a beneficiary’s health status and to provide timely assessment of chronic conditions and other skilled nursing services.
- HCBS beneficiaries eligible for face-to-face skilled nursing visits provided by a home health agency (05-050) may also receive home telehealth visits with documentation of medical necessity and PA. The PA request must include units to cover the duration and frequency of home telehealth visits.
Source: Kansas Medical Assistance Program HOME HEALTH AGENCY FEE-FOR-SERVICE PROVIDER MANUAL BENEFITS & LIMITATIONS (AIII-8)