With the adoption of the complete parity law in 2015, Minnesota became one of the leaders in telemedicine practice in the U.S. The officials mandated reimbursement to employee health plans, private payers, and Medicaid for telemedicine in the same way as in traditional, in-person medical practice. Unlike in many other states, insurers in Minnesota are also required to cover for store-and-forward technology and dental plans.
Minnesota medical authorities realized the benefits of telemedicine on time and focused on supporting and developing the practice. With many Minnesotans living in remote or rural regions, the healthcare system was struggling to deliver appropriate treatment to all requesting patients. Telemedicine came to the rescue.
With the COVID-19 outbreak, the inadequacy of the system became evident on the national level. Many states that have a conservative approach to telehealth are facing a challenge in caring for those affected by the virus and even for those suffering from other medical conditions.
The Benefits of Telemedicine in Minnesota
Minnesota law defines telemedicine as the delivery of healthcare services or consultations while the recipient is at an originating site and the licensed healthcare provider at a distant site.
The two parties should communicate via real-time interactive video conferences or use store-and-forward technology to provide or support healthcare delivery. Other means of digital communication such as emails, audio-only calls, text messages, or facsimile transmissions do not constitute telehealth.
The idea of using digital technology for medical purposes, especially in replacing the traditional visit, revolutionized the healthcare system. In Minnesota, telemedicine proved to be crucial in:
- Enabling easier access to primary and specialist care to residents living in remote regions
- Allowing a more comfortable patient experience by reducing travel time and waiting hours
- Releasing the pressure off the overcrowded hospitals and acute care facilities
- Reducing the costs per visit on both the patient’s and the the insurer’s side
Telemedicine is an efficient model of providing treatment without engaging the non-essential resources. It can serve as a triage, as well, determining the condition of the patients and advising further medical care accordingly.
The state of Minnesota was struggling with the shortage of medical professionals, and telehealth was an effective solution to the problem. Rural hospitals were particularly affected. Specialist care was the biggest concern for the medical authorities, and introducing remote care saved many lives in Minnesota.
The Difference Between Telemedicine and Telehealth in Minnesota
Minnesota law does not offer a clear distinction between the terms telemedicine and telehealth. The two appear to be synonymous, although telehealth is more frequently used in the legal documents.
The Medical Assistance Program, Minnesota’s Medicaid agency, uses both terms equally and does not specify any difference between them. Practitioners from the state of Minnesota should check the terminology used in the residing states of their patients because certain jurisdictions do recognize subtle differences between the two terms.
Minnesota Telemedicine Landscape
The number of telemedicine visits increased rapidly between 2011 and 2015, which was one of the main reasons for the introduction of the new law. Several studies showed that telehealth encountered growth from 10,113 visits in 2010 to a staggering 86,238 visits in 2015. The studies did not focus on the effectiveness of the model, but the constant rise in demand is proving that it is efficient.
It is evident that the patients respond well to the benefits of remote care and that they keep using the service after the initial introduction to it. The numbers have skyrocketed since the beginning of the pandemic because people can seek care or treatment without unnecessary exposure to the virus.
Non-metro patients seem to have embraced telemedicine first, opting for specialty consultations, which were scarce in the rural areas. Metropolitan patients used primary care services more often.
What began as a way to deliver better care to patients in remote regions turned out to be an improvement in healthcare delivery throughout the state. That is why the Minnesota Department of Health continues to work with providers on constantly upgrading the service.
How to Practice Telehealth in Minnesota
Minnesota Board of Medical Practice (MBMP) provides specific guidelines for the practitioners of telemedicine in the state. Their focus is on keeping the quality of care equal to that in traditional practice. Telemedicine providers will be held accountable in the same way the traditional practitioners are.
The guidelines cover the most critical aspects of practice:
- Doctor-patient relationship
- Medical records
- Online prescriptions
- Evaluation of the patient
- Standards of care and conduct
Unlike most other states, Minnesota allows the providers without the Minnesota medical license to treat MN patients. They should possess a valid license from some other American state and must prove that it has never been restricted or revoked.
Minnesota-based physicians who treat patients from other states must comply with the regulation of the originating site. The Gopher State has joined the Interstate Medical Licensure Compact which assists with cross-state licensing procedures.
According to MBMP, the provider and the patient do not have to meet in person to establish the relationship. A virtual encounter will suffice. Certain standards have to be met, so the practitioners should make sure that they:
- Verify the identity and location of the patient
- Provide their name, contact details, and credentials to the patient
- Explain all the benefits and limitations of the treatment
Minnesota law does not require the informed patient consent before the beginning of the telemedicine services. Consent is implied when the patient joins a virtual appointment. That said, any communication conducted through emails, chat or text messages, audio-only calls, and facsimile transmissions will not be considered a telemedicine visit.
The doctor must be able to perform a physical examination, assessment of the mental state of the patient, and access prior medical history if it is available. Only then is the evaluation of the patient considered valid, both in traditional and telehealth practice.
It is the responsibility of the practitioner to determine whether telemedicine is the appropriate method to deliver treatment to the patient. In case it is not, the physician should recommend other options for receiving the required medical care.
The practitioners must keep precise and clear records on all the patients that they see, according to Minnesota regulations. The proper medical record should contain:
- All patient-related communication, including external consultations with specialists
- Prior medical history if it is available
- Prescriptions, including notes on allergies and intolerance
All documents are private and are subject to doctor-patient confidentiality regulations. The providers are responsible for data privacy and protection. Medical records must be available to patients on request.
MBMP allows telehealth providers to prescribe medication during the treatment. In-person visits are not mandatory. The Board states that prescriptions are not valid unless the practitioner:
- Conducts a complete examination and evaluation of the patient
- Establishes a diagnosis based on the patient’s condition
- Takes into consideration the underlying conditions and contraindications to the treatment
Online prescriptions are subject to the same rules as traditional ones. The telemedicine providers must comply with the federal law in the case of certain controlled substances, and it is their responsibility to follow such regulations. Emails, text messages, audio-only calls, and facsimile transmissions do not meet the Minnesota standards and cannot be used for prescribing medication.
Standards of Care and Conduct
The Board imposes strict rules when it comes to healthcare. Telemedicine providers are not exempt from these regulations and must meet or exceed the standards of care and conduct. MBMP expects the physicians to:
- Provide secure communication with the patient, meaning that all tools and channels must be HIPAA compliant and protected from third-party breaches or the loss of data
- Ensure that emergency backup plans are available for patients whose condition deteriorates and who need hospitalization or acute care
Failing to meet the required standards is subject to disciplinary measures by the Board.
Minnesota Telemedicine Reimbursement Policy
According to the Minnesota telemedicine parity law, the reimbursement for live-video telemedicine and store-and-forward technology is obligatory to private payers and Medicaid. The Gopher State insurers also cover remote patient monitoring, although it is considered to be a subtype of store-and-forward service as per the telehealth parity law.
Remote patient monitoring
Private payers reimburse for the telehealth services in Minnesota in the same way they do for in-person visits. There are no limitations to the type of service covered. The health carriers can establish specific criteria that the telemedicine provider should meet to qualify for reimbursement. The carrier may ask the practitioner to demonstrate that remote care treatment is safe, effective, and appropriate for the patient’s condition.
The fees that apply to telehealth services must be equivalent to those in traditional practice. The limitations based on the geographic location of the patient do not apply.
Medical Assistance, the MN Medicaid agency, does not offer a separate definition of telemedicine/telehealth. The program covers live-video and store-and-forward services. It also reimburses for remote patient monitoring, but the service is considered a part of store-and-forward. Approval must be granted for remote patient monitoring before the treatment.
The fees for telehealth services must be equal to those in traditional practice. The program covers three services per week per beneficiary. Medicaid does impose certain restrictions when it comes to telemedicine. The program will not reimburse for:
- Electronic communication that is not HIPAA compliant
- Communication via emails, texts, chats, and audio-only calls
- Appointment or test scheduling
- Prescription renewals
- Reporting on lab and test results
- Visits scheduled to clarify any issues from previous appointments
- Non-clinical consultations
- Partial hospitalization or day treatment
- Residential treatment services
Further restrictions apply to the eligible originating site, services, and providers. They are listed below.
Eligible Originating Sites
MN Medicaid explicitly states which originating sites are considered eligible when billing for telemedicine services provided to Medical Assistance patients at those sites. These include:
- Office of physician or practitioner
- Hospital (inpatient or outpatient)
- Critical access hospital (CAH)
- Rural health clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital-based or CAH-based renal dialysis center (including satellites)
- Skilled nursing facility (SNF)
- End-stage renal disease (ESRD) facilities
- Community mental health center
- Dental clinic
- Residential facilities, such as a group home and assisted living, shelter or group housing
- 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)
Medical professionals eligible to provide telemedicine services to Minnesota Medicaid members are:
- Nurse practitioners
- Physician assistant
- Nurse midwife
- Clinical nurse specialist
- Registered dietitian or nutrition professional
- Clinical psychologist
- Clinical social worker
- Dentist, dental hygienist, dental therapist, advanced dental therapist
- Mental health professional, when following requirements and services limitations
- Certified genetic counselor
- Podiatrist Speech therapist
- Occupational therapist
MN Medicaid also defines types of medical services that can be provided via telemedicine. They include:
- Telehealth consults: emergency department or initial inpatient care
- Ensuing hospital care services limited to one telemedicine encounter every 30 days per eligible provider
- Ensuing nursing facility care services limited to one telemedicine encounter every 30 days
- End-stage renal disease services
- Individual and group medical nutrition therapy
- 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
- Smoking cessation
- Alcohol and substance abuse (other than tobacco) structured assessment and intervention services
Teledentistry in Minnesota
MN Medicaid is among the rare programs that include teledentistry. This practice proved to be excellent in the prevention of serious conditions. Live-video and store-and-forward technologies are reimbursed for Medicaid beneficiaries. Available teledentistry services are:
- Periodic oral evaluation
- Limited oral exam
- Oral evaluation for patients under three years of age
- Comprehensive oral evaluation
- Intraoral radiographic imaging
- Bitewing radiographic imaging
- Panoramic radiographic imaging
- Medical dental consultation
Choosing the Right Platform for Telehealth in Minnesota
It is imperative to select the appropriate platform for telemedicine, especially if the rules and regulations are as strict as in Minnesota. To be able to qualify for reimbursement from private payers and Medicaid, the practitioners must opt for reliable technology as it can make or break the practice.
Curogram is a web-based telemedicine platform that meets all the necessary standards for telemedicine in Minnesota. Our communication tools are encrypted and have password protection, while the entire interface is user-friendly.
We provide comprehensive solutions to medical professionals who seek to establish telehealth practices or to incorporate the service into their existing business. Some of the benefits of opting for Curogram are:
- Two-way texting feature, through which the providers can send reminders, while the patients can schedule appointments or make inquiries
- A user-friendly interface where practitioners can set up virtual clinics and waiting rooms
- A secure, HIPAA compliant internal communication tool, ideal for quick and safe information exchange among employees
Another important aspect of our platform is the integration with ANY EHR (electronic health records). This prevents double and manual entries and allows for the better use of resources.
Curogram EHR integrations
Telehealth and COVID-19
The current national health crisis showed that remodeling of the U.S. healthcare system is necessary and urgent. The hospitals and acute care units were struggling to provide for all the patients even before the outbreak. Telemedicine might be the solution to the problem since the states with progressive remote care policies, Minnesota included, are offering a better response to the COVID-19 situation.
Some of the MN telehealth providers are assisting hospitals in New York in dealing with the pandemic. The public health crisis has struck NYC the hardest. Local medical professionals need all the help they can get just to stay afloat. The practical procedures, such as intubation, still have to be performed on-site, but respirator management, remote patient monitoring, and triage can be conducted from distant sites.
With all available resources engaged in fighting the coronavirus, telemedicine practitioners are stepping up by treating easier cases, or the ones that are affected by other illnesses.
The pandemic proved that remote care is the future of medicine, and Minnesota can serve as an example to other states on how to make the most out of this practice.