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Telepractice: DMAS Coverage of Speech Therapy Services Delivered Using Videoconferencing Jeff Nelson, Policy Analyst Senior, Division of October 4, 2011 Policy and Research, DMAS Charlottesville DMAS Coverage of Telepractice “Telepractice”- Speech therapy services listed in an IEP, which are delivered to a child at school, using videoconferencing by a speech therapist at a remote location Telepractice is considered by DMAS as part of “telemedicine” 2 DMAS Interests in Telemedicine Coverage Improved Medicaid recipient access to medical services due to lack of available providers Improved Medicaid recipient compliance with treatment Medical services rendered at an earlier stage of disease, improving long-term patient outcomes Reduction in service expenditures such as hospitalizations and transportation Allows for an opportunity to work proactively with providers; has potential to be a “win-win” situation Virginia Medicaid Telemedicine Coverage Expansion, 2003 Virginia Medicaid expanded telemedicine coverage from a pilot project in a few areas of the state to statewide in 2003 Services where telemedicine may be utilized include: – Evaluation and management, office visits – Range of individual psychotherapies – Full range of consultations – Select clinical services such as in cardiology and obstetrics 4 DMAS Telemedicine Coverage Providers currently recognized by DMAS for telemedicine: – Physicians – Nurse practitioners – Nurse midwives – Clinical nurse specialists – Clinical psychologists – Clinical social workers – Licensed professional counselors 5 DMAS Telemedicine Coverage Originating sites (where the recipient is located) were expanded in October 2009 to include: ‒Certified Outpatient – Rural Health Centers Rehabilitation Facilities –Program for All-Inclusive Care ‒ Community Services Boards for the Elderly ‒ Dialysis Centers – Plus physicians and other providers on previous page ‒ Federally Qualified Health Centers ‒ Health Department Clinics ‒ Hospitals ‒ Nursing Homes 6 DMAS Telemedicine Coverage Early telemedicine model? Telepractice Nationally and in Virginia American Speech-Language-Hearing Association supports telepractice saying “Telepractice is an appropriate model of service delivery for the professions of speech-language pathology and [audiology]”. Research studies support telepractice as a means for delivering speech therapy services Ten states are utilizing telepractice in the schools Speech-Language-Hearing Association of Virginia (SHAV) wrote a letter to DMAS supporting telepractice Telepractice Development in Virginia Virginia telepractice experience- Virginia Department of Education granted funds to James Madison University for a pilot project to work on telepractice in the schools (2009) Two school divisions ( Brunswick and Wise Counties) participated in the pilot with a focus on: – Development of telepractice in schools as a service delivery method – Data collection to document student outcomes In preparing for the pilot, 9 Telepractice Development in Virginia – Sought approval and support from licensing boards – Collaborated to identify site, timelines, and scope of services Each site had the use of a videoconferencing unit for the sessions Service delivery involved a speech therapist at JMU using videoconferencing to provide services to the school children 10 DMAS Telepractice Coverage DMAS considers telepractice as another means for delivering speech therapy services Providers must continue to meet DMAS school provider qualifications Service documentation requirements in the DMAS Local Education Agency Provider Manual are to be followed. The telepractice service is to be noted in the documentation DMAS Telepractice Coverage Telepractice Model for DMAS - Pilot Project DMAS enrolled school division with: – A speech therapist at a remote location – A qualified school aide with child during telepractice session 12 DMAS Telepractice Coverage All billing for telepractice is under the DMAS assigned school division provider number. This includes situations where school divisions contract for speech therapy services 13 DMAS Telepractice Coverage Two invoices are billed by the school division for each telepractice session: For services by the speech therapist, the following codes continue to be applicable: – Assessment, 92506 – Individual visit, 92507 – Group session, 92508 14 DMAS Telepractice Coverage In addition, – An invoice is completed with billing for the qualified school aide with child, Q3014 All invoices must include “GT” in the procedure modifier field Providers are included in the Random Moment Time Study. Telepractice services are included under the cost settlement process 15 DMAS Telepractice Coverage Equipment necessary for telepractice encounters at each site: – Two way interactive, high definition videoconferencing console with software – Video camera – Flat screen display monitor – Fax-copier-printer – Document camera, as an option – High speed connection with the other site 16 Questions? Contact DMAS staff Jeff Nelson- 804-371-8857 or email@example.com 17