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Remote Patient Monitoring Rules Colorado

The Colorado Medical Assistance Program will reimburse for Remote Patient Monitoring at a flat fee set by the state board.


Source: CO Revised Statutes 25.5-5-321) (Accessed Aug. 2019).


Monitoring of health care status may be provided remotely through Home Health Telehealth services.


Source: 10 CO Code of Regulation 2505-10 8.524. (Accessed Aug. 2019). 


CO Medicaid reimburses telehealth services including installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the member’s clinical status that will allow Home Health agencies to intercede before 
a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.


Source: CO Medical Assistance Program, Home Health Billing Manual, p. 12 (8/198/19), & CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2019). 

A member is eligible only if they meet the following criteria:


• Member must receive Home Health services from provider who has opted to provide telehealth services
• Member must require frequent and on-going monitoring/management of their disease or condition
• Member’s home environment must be compatible with the use of the equipment
• Member or caregiver must be willing and able to comply with vital sign self-monitoring

 

Member must have one or more of the following diagnoses:


1. Congestive Heart Failure
2. Chronic Obstructive Pulmonary Disease 
3. Asthma
4. Diabetes
5. Other diagnosis or condition deemed appropriate by the Department or its designee


Source: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2019). 


Conditions


The following requirements must be met:


• Client is receiving services from a home health provider for at least one of the following: congestive heart failure, chronic obstructive pulmonary disease, asthma, or diabetes;
• Client requires monitoring at least five times weekly to manage the disease, as ordered by a physician or podiatrist;
• Client has been hospitalized two or more times in the last 12 months for conditions related to the disease or, if the patient has received home health services for less than 6 months, the patient has been hospitalized at least once in the last 3 months, experiences an acute exacerbation of a qualifying diagnosis that requires telemonitoring, or experiences a new onset of a qualifying disease that requires ongoing monitoring;
• Client or caregiver misses no more than five monitoring events in a 30-day period;
• Client’s home has space for all program equipment and full transmission capability.


Source: 10 CO Code of Regulation 2505-10 8.525. Page 224 (Accessed Aug. 2019). 


Provider Limitations


Any home health agency is eligible to provide services.


Source: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Aug. 2019). 


Acute home health agencies and long-term home health agencies are reimbursed for the initial installation and education of telehealth monitoring equipment and can be billed once per client per agency. The agency can also bill for every day they receive and review the client’s clinical information.
No prior authorization needed, but agencies should notify the Department or its designee when a client is enrolled in the service.


Source: CO Medical Assistance Program, Home Health Billing Manual, p. 12 (6/18). (Accessed Mar. 2019). 

Home Health services are eligible for reimbursement under Medicaid only when the services meet all of the following requirements: 


A. Services are provided for the treatment of an illness, injury, or disability which may include mental disorders. 
B. Services are medically necessary. 
C. Services are reasonable in amount, duration, and frequency.
D. Services are provided under a plan of care as defined at Section 8.524 DEFINITIONS. 
E. Services are provided on an intermittent basis, as defined at Section 8.524, DEFINITIONS. 
F. The only alternative to Home Health services is hospitalization or the emergency room; or the client’s medical records accurately justify a medical reason that the services should be provided in the client’s home instead of a physician’s office, clinic, or other outpatient setting, according to one or more listed guidelines.


Source: 10 CO Code of Regulation 2505-10 8.523. Pg. 216. (Accessed Aug. 2019).