Telemedicine law in Minnesota is largely defined for the purposes of reimbursement by Medical Assistance. “Telemedicine” is specifically defined as

the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission does not constitute telemedicine consultations or services. A communication between a licensed health care provider and a patient that consists solely of an e-mail or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time two-way interactive audio, and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, that facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care.

For purposes of Medical Assistance:

(a) Medical assistance covers medically necessary services and consultations delivered by a licensed health care provider via telemedicine in the same manner as if the service or consultation was delivered in person. Coverage is limited to three telemedicine services per enrollee per calendar week. Telemedicine services shall be paid at the full allowable rate.
(b) The commissioner shall establish criteria that a health care provider must attest to in order to demonstrate the safety or efficacy of delivering a particular service via telemedicine. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide via telemedicine;
(2) has written policies and procedures specific to telemedicine services that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during, and after the telemedicine service is rendered;
(4) has established protocols addressing how and when to discontinue telemedicine services; and
(5) has an established quality assurance process related to telemedicine services.
(c) As a condition of payment, a licensed health care provider must document each occurrence of a health service provided by telemedicine to a medical assistance enrollee. Health care service records for services provided by telemedicine must meet the requirements set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
(1) the type of service provided by telemedicine;
(2) the time the service began and the time the service ended, including an a.m. and p.m. designation;
(3) the licensed health care provider’s basis for determining that telemedicine is an appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission of the telemedicine service and records evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician’s telemedicine consultation with another physician, the written opinion from the consulting physician providing the telemedicine consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapter, “telemedicine” is defined as the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers, or a licensed health care provider and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time two-way, interactive audio and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care.
(e) For purposes of this section, “licensed health care provider” means a licensed health care provider under section 62A.671, subdivision 6, and a mental health practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision 26, working under the general supervision of a mental health professional; “health care provider” is defined under section 62A.671, subdivision 3; and “originating site” is defined under section 62A.671, subdivision 7.

The big questions in this definitions are what do they mean by “originating site” and “distant site.”

The Originating Site is the location of an eligible patient at the time the service is being furnished via a telecommunication system. Authorized originating sites include:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility
  • End-stage renal disease facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living, shelter or temporary lodging
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School
The Distant Site simply means a site at which a licensed health care provider is located while providing health care services or consultations by means of telemedicine.

These are covered:

  1. Interactive audio and video telecommunications that permit real-time communication between the distant site physician or practitioner and the recipient. The services must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face encounter. Audio/video telecommunications must be conducted over a secure encrypted website as specified by the Health Insurance Portability Act of 1996 Privacy and Security rules.
  2. “Store and Forward”: The asynchronous transmission of medical information to be reviewed at a later time by a physician or practitioner at the distant site. Medical information may include, but is not limited to, video clips, still images, x-rays, MRIs, EKGs, laboratory results, audio clips and text. The physician at the distant site reviews the case without the patient being present. Store and forward substitutes for an interactive encounter with the patient present; the patient is not present in real-time.
  3. Covered telemedicine services include but are not limited to the following:
    1. Consultations
    2. Telehealth consults: emergency department of initial inpatient care
    3. Subsequent hospital care services with the limitation of one telemedicine visit every 30 days per eligible provider
    4. Subsequent nursing facility care services with the limitation of one telemedicine visit every 30 days
    5. End-stage renal disease services
    6. Individual and group medical nutrition therapy
    7. Individual and group diabetes self-management training with a minimum of one hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training
    8. Smoking cessation
    9. Alcohol and substance abuse (other than tobacco) structured assessment and intervention services
    10. Mental health services except for the mental health services listed in the non-covered section below.
    11. Certain EIDB services for Medicaid members only, when performed by mental health professional level providers and Level I or Level II providers.
  4. Telemedicine services are limited to three per week per member
  5. Two-way interactive video when there isn’t a physician in the ER and the nursing staff are caring for the member at the originating site or the ER physician requests the opinion or advice of a specialty physician at a “hub” site

These are not covered:

  1. Scheduled telephone visits
  2. Electronic connections, such as Skype, that are not conducted over a secure encrypted website as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy and Security rules.
  3. Day treatment
  4. Partial hospitalization programs
  5. Residential treatment services
  6. Case management face-to-face contact
  7. More than one reading or interpretation of diagnostic tests such as x-rays, lab tests, and diagnostic assessments
  8. Materials sent to members, other providers or facilities
  9. Prescription renewals
  10. Scheduling a test or appointment
  11. Clarification of issues from a previous visit
  12. Reporting test results
  13. Non-clinical communication
  14. Communication via telephone, email or facsimile
  15. Connection charges, or origination, set-up or site fees

See also:

Telemedicine – MHCP Provider Manual http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_008926#Telemedicine

Telemedicine Delivery of Mental Health Services – MHCP Provider Manual http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_160257
http://www.health.state.mn.us/e-health/summit/2016/docs/s14.pdf
Minn. Stat. 256B.0625, Subd. 3b
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