Michigan is a state with precarious telemedicine and telehealth laws. While Michigan does have a telemedicine parity law and a telehealth law—the peculiar wording of the state’s telehealth legislation creates uncertainty among healthcare professionals. 

Michigan’s Medicaid program does offer clear, more detailed definitions of telemedicine, telehealth, and telepractice, but is extremely strict when it comes to its reimbursement policy.

Let’s take a closer look at all the relevant laws, regulations, and policies, so you can have a better understanding of the current state of telemedicine and telehealth in the State of Michigan.

Telemedicine and telehealth in Michigan state law

Michigan enacted its private insurance parity law in 2012. The main idea behind Michigan’s parity law was to legally enforce the coverage of telemedicine services by private payers. For the sake of reimbursement, telemedicine is treated the same way as in-person medical aid.

There are some limitations regarding telemedicine in Michigan. House Bill 5421 defines telemedicine as the “use of electronic media to link patients with healthcare professionals in different locations.” 

The Bill also states that, in order for remote services provided to be considered telemedicine, medical professionals must examine the patients via a two-way, interactive audio or video system. Given the “real-time” interaction requirement, this definition explicitly excludes the following forms of doctor-patient remote communication:

• Store-and-forward technology
• Email
• Facsimile transmission of protected health information

Michigan’s 2012 parity law concerned only the reimbursement of remote healthcare services. It did not provide any guidance regarding eligible healthcare providers or originating sites. The Bill also failed to provide any information on obtaining patient consent and establishing a doctor-patient relationship.

The new 2016 law—Senate Bill 753—sought to fill in those blanks by adding six new sections to Michigan’s public health code. Let’s take a look at all the changes SB 753 introduced, so you can get a better idea regarding the current state of telemedicine in Michigan.

Michigan telehealth law and policies

With SB 0753, Michigan legislators wanted to cover all aspects of telemedicine and clearly define remote medical care standards. What’s interesting is that the new law met some resistance, even among the most avid proponents of telemedicine. 

Some parties pointed out that telemedicine in Michigan was already thriving and expressed fear that the new regulations might limit innovation in remote healthcare delivery. The Bill did pass, and the concerns of healthcare providers and entrepreneurs regarding telehealth practice standards were somewhat alleviated. 

Among the most notable changes, the new law introduced a more comprehensive term—telehealth—as a “replacement” of the rigid, outdated telemedicine definition. Under SB 753, telehealth is defined as “the use of electronic information and telecommunication technologies to support or promote:”

1. Long-distance clinical health care
2. Patient and medical professional health-related education
3. Public health
4. Health administration

The new definition also states that telehealth may include telemedicine, but isn’t limited to it. Although the intent was to provide a more inclusive term, the new law does not define modalities of telehealth, and reimbursement is still limited to two-way, real-time audio or video communication. 

The only discernible difference between the two terms comes from the fact that the new law provides a definition of a medical professional. Under SB 753, everyone engaging in the practice of a health profession is considered a health professional. 

This implies that all professionals licensed to practice medicine in the State of Michigan can offer their services remotely—not just physicians. Although the law does not provide a comprehensive list of eligible providers, it does define “prescribers”.

Online prescriptions

SB 753 provides a list of prescribers—medical professionals who can prescribe medication following a virtual appointment with the patient. 

Prescribers in Michigan law are:

1. Physicians
2. Dentists
3. Doctors of osteopathic medicine and surgery
4. Podiatrists
5. Optometrists

All of the prescribers listed above must be licensed to practice medicine in the State of Michigan. Note that this doesn’t exclude other medical professionals from delivering healthcare services remotely—it merely pertains to issuing online prescriptions. 

The law also prohibits the prescription of controlled substances via telehealth. For said substances, an in-person visit is mandatory.

Informed patient consent

Michigan’s Telehealth Law, as Senate Bill 753 is often referred to, imposes a new requirement for medical professionals practicing telehealth. Before offering any type of medical aid through telehealth, providers must obtain informed patient consent directly or indirectly. The consent does not have to be written. Judging from the wording of the section 16284 of SB 753, oral consent is sufficient.

One thing to keep in mind is that you will have to maintain records of obtained consent. Although the Telehealth Law doesn’t explicitly state this, it is implied through the fact that telehealth is held to the same standards of care as in-person examination.

This further means that professionals offering remote medical care will have to keep medical records of all remote patient encounters. You must update and maintain your electronic health record (EHR) in the same way you would if the healthcare services were delivered in-person.

Without a proper telehealth solution, you would have to do this manually and waste valuable time that you could spend treating patients on administrative work. That’s why we’ve made sure Curogram integrates with any EHR. 

Everything’s updated automatically, and you can send visit summaries and other medical documents to patients quickly and easily, in a 100% secure, fully HIPAA compliant manner. 

That said, there is one exception to the consent rule in Michigan’s telehealth law. Consent isn’t necessary if a medical professional is providing remote services to an inmate who’s “under the jurisdiction of the department of corrections and is housed in a correctional facility.”

In-person examination

Michigan’s Telehealth Law does not state that an in-person examination is required in order to provide telehealth services. The trouble is, the law doesn’t explicitly state that a valid doctor-patient relationship can be established solely through telehealth. 

The fact that law is left open to interpretation in this regard resulted in uncertainty among Michigan’s healthcare providers. Some providers opt to only offer telehealth services to their existing patients, provided they cannot come in for in-person examinations, while others are a bit more liberal and also admit new patients remotely.

The Michigan Department of Licensing and Regulatory Affairs may promulgate rules under the law, in consultation with its respective professional licensing boards. We firmly believe it would be beneficial to include a statement regarding the validity of doctor-patient relationships that result solely from telehealth visits. This will help instill confidence in healthcare providers and encourage remote healthcare services.

Reimbursement

We’ve already mentioned that Michigan’s parity law requires private insurers to reimburse healthcare professionals for remote services delivered via two-way audio or audio-video communication. 

That said, the new Telehealth Law includes a dubious statement pertaining to reimbursement. It notes that the law doesn’t “require new or additional third-party reimbursement for health care services rendered by a health professional through telehealth”.

The language of SB 753 is atypical when compared to the telehealth laws of other states. The statement above is somewhat difficult to decipher and might appear to be in direct conflict with the parity law of 2012 at first glance.

It’s important to remember that the State of Michigan views telemedicine and telehealth separately. While reimbursement is mandatory for telemedicine, insurers are free to determine which telehealth services they will cover, if any, judging from the wording of SB 753.

What this means is that, if the remote medical services provided involve examination, treatment, and diagnosis, and are delivered via a two-way audio or audio-video platform, they are considered telemedicine and must be reimbursed. 

Any other form of remote medical care, such as consultations, is considered telehealth. In that case, SB 753 gives the insurers the discretion to determine whether or not said services will be covered. 

One thing to keep in mind is that Michigan’s Telehealth Law does not enforce a face-to-face requirement. This means healthcare professionals in Michigan can offer a wide range of telehealth services to their patients remotely but will need to inform the patients that such services may not be covered by their health insurance.

Michigan Medicaid policies

Michigan Medicaid takes a more thorough approach to telehealth. The program provides detailed guidelines regarding the type of telehealth it reimburses for, eligible healthcare professionals, and originating sites. 

Medicaid only reimburses for services delivered via live, two-way video communication between a patient at an eligible originating site and a medical professional at a distant site. Store-and-forward technology and remote patient monitoring are excluded from Michigan Medicaid’s reimbursement policy.

Medicaid telemedicine definitions

Whereas Michigan law provides vague definitions of telemedicine, telehealth, and associated activities, Medicaid does the polar opposite. Michigan Medicaid provides definitions covering various modalities of telemedicine:

1. Assertive Community Treatment Program (ACT)
2. Behavioral Health Treatment Services (BHT)
3. Medication Therapy Management
4. Speech-Language and Audiology Services; Medication Therapy Management

Assertive Community Treatment Program (ACT)

Regarding ACT, Medicaid defines telepractice as leveraging telecommunications and information technologies to provide psychiatric services to ACT consumers. Medicaid also adds that said services will be held to the same standards of care as in-person psychiatric services.

Behavioral Health Treatment Services (BHT)

When it comes to behavioral health treatment services, Medicaid defines telepractice exclusively as the transmission of encrypted data between two providers, for the purposes of delivering BHT services. In other words, remote doctor-patient communication will not be reimbursed and is discouraged. 

Medication Therapy Management (MTM)

Telepractice in medication therapy management is also limited to the transmission of encrypted medical data for the purpose of providing said services. In this instance, Medicaid notes that telepractice must be delivered via real-time interaction between the beneficiary at an originating site and the pharmacist at a distant site.

Speech-Language and Audiology Services; Medication Therapy Management

The same policy applies to speech-language and audiology services—only the transmission of encrypted data is allowed when necessary in aiding the provisioning of these services. Real-time interaction between the patient’s physical location (patient site) and the provider’s physical location (provider site) is necessary. 

From the definitions above, it's evident that Michigan Medicaid reimburses for both live-video telemedicine and telehealth, as well as store-and-forward technology. That said, Medicaid states that live video telemedicine should primarily be used when travel is impossible or prohibitive, or in instances where urgent medical care is necessary, and there’s an imminent health risk justifying the use of remote medical care.

Michigan Medicaid is a bit more restrictive compared to programs in other states and views telemedicine as a necessity in specific situations rather than a substitute for in-person medical care. 

Eligible providers

Michigan Medicaid provides a detailed list of medical providers who are eligible for reimbursement when delivering specific medical services at a distance. 

Here’s a detailed list of eligible providers by Medicaid:

1. Physicians
2. Practitioners
3. BHT service providers
1. Board-certified behavior analysts
2. Board-certified assistant behavior analysts
3. Licensed psychologists
4. Limited licensed psychologists
5. Qualified behavioral health professionals
4. MTM service providers, when the beneficiary cannot physically access a face-to-face care setting
5. Speech-Language and Audiology Service providers
1. Licensed speech-language pathologists
2. Licensed Audiologists in Michigan
3. Speech-language pathologists and/or audiology candidates under the direction of a qualified SLP or audiologist
4. Limited licensed speech-language pathologists under the direction of a fully licensed SLP or audiologist

Eligible services

Michigan Medicaid will reimburse for the following telehealth services:

• Inpatient Consults
• Office or other outpatient consults and services
• Subsequent hospital care
• Psychiatric diagnostic procedures
• Training services regarding diabetes
• End-stage renal disease (ESRD) related services, provided there is at least one in-person visit per month—by a physician, nurse practitioner, or physician’s assistant—to examine the vascular site for ESRD services
• Behavior change intervention
• Behavior health and substance use disorder treatment
• Educational services
• Nursing facility subsequent care

Eligible originating sites

Michigan Medicaid does enforce some restrictions regarding the eligible originating sites—physical locations of the patients receiving remote medical care. Under the state’s Medicaid policy, eligible originating sites are:

• Hospitals (inpatient, outpatient, or Critical Access Hospitals)
• Physician or other providers’ offices, including medical clinics
• County mental health clinics or publicly funded mental health facilities
• Federally Qualified Health Centers
• Rural Health Clinics
• Hospital-based or CAH-based Renal Dialysis Centers
• Skilled nursing facilities
• Tribal Health Centers

In addition to these location restrictions, Michigan’s Medicaid program separately defines eligible originating sites for speech-language and audiology services and behavioral health therapy. 

For speech-language and audiology services, the patient site can be a school, patient’s home, or any other site the provider deems appropriate. When delivering remote behavioral health therapy services, the eligible originating sites can be:

• Patient’s home
• Clinic
• Center
• Other established sites the provider deems appropriate

Note that outside of these two types of services, Medicaid does not consider a patient’s home an eligible originating site. The outlook of the State of Michigan, and inherently, the state’s Medicaid program, is that telehealth services should support in-person medical care rather than substitute it. 

That’s the reason why Medicaid only considers sites where in-person medical care is immediately available to the patient to be eligible for reimbursement, excluding the two exceptions we listed above. 

Michigan telemedicine policy expansion in response to the COVID-19 emergency

Facing the COVID-19 emergency, the state issued a Medical Services Administration bulletin with general telemedicine expansions. The goal was to increase access to remote healthcare services during the emergency and make it easier for both patients and providers to receive/provide telemedicine services.

The biggest change the bulletin introduced was the removal of limitations regarding the type of communication necessary to provide remote medical care. 

For the duration of the emergency, the Michigan Department of Health and Human Services (MDHHS) allows healthcare providers to deliver telemedicine services via telephone only when a two-way audio-video connection is difficult or impossible to establish. 

Embrace telemedicine in Michigan with Curogram

Although Michigan’s legislation regarding telemedicine and telehealth leaves much to be desired, remote healthcare services do play a big part in the state’s overall medical system. If you’re looking to offer remote medical aid to patients and Medicaid program members, Curogram is the perfect solution. 

Curogram is a telemedicine platform designed specifically to enable healthcare professionals to deliver remote medical services to patients with ease. You get assigned a local number that you can use to communicate with patients via SMS and send them automated appointment reminders. They can always respond to the message to reschedule and ask any medical-related questions.

With Curogram, you can set up your virtual clinic in less than 48 hours! The platform allows you to host virtual appointments, share protected health information (PHI) with patients or among staff members, communicate with your business partners, and automate tedious administrative tasks. The best part is—you can do all this from a single dashboard!

Curogram is also fully HIPAA compliant and comes with built-in safeguards to ensure the safety and confidentiality of sensitive medical information. With Curogram, you don’t need to hire an IT wizard to set up a telemedicine solution for you or consult lawyers to make sure you don’t violate any of the HIPAA Rules and Regulations. We’ve taken care of all the technical details, so you can focus on doing what you do best—providing medical care to patients.

Here are some of the features Curogram provides that make it an ideal solution for providers who want to embrace telemedicine and telehealth:

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.