SOUTH CAROLINA
Although there is no parity law in South Carolina and no legislation had been entered in the 2015 legislative session, the Palmetto State pioneers in other areas, bringing the benefits of telemedicine to many more patients.
South Carolina developed a statewide telepsychiatry network for all hospitals operating emergency departments, which has collectively had the effect of increased quality, timeliness of triage, assessment and initial treatment of patients. The network also allows hospitals to direct critical personnel and financial resources to more pressing needs, helping hospitals realize significant savings.
Ready to find out more about South Carolina’s telemedicine policy? Keep on reading.
Parity Law
A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services. There is as of yet no telemedicine parity law in South Carolina despite a multi-year effort to introduce legislation regarding coverage under private insurance.
Type of Telemedicine Covered
South Carolina Medicaid will reimburse for live telemedicine and tele-psychiatry, but South Carolina prohibits the use of “cell phone video” to facilitate a telemedicine encounter.
South Carolina’s Medicaid Home Again Program for Community Long Term Care is a program that transitions residents of nursing care facilities into their own homes. The Home Again program covers specific remote monitoring, including body weight, blood pressure, oxygen saturation, blood glucose levels, and basic heart rate information, at a minimum. Providers must meet certain conditions to participate.
Covered Health Services
The following remote services are covered:
Office or other outpatient visits
Inpatient consultation
Individual psychotherapy
Pharmacologic management
Psychiatric diagnostic interview examination and testing
Neurobehavioral status examination
Electrocardiogram interpretation and report only
Echocardiography
These community mental health services are ineligible for coverage:
Injectables
Nursing services
Crisis intervention
Individual, family, group and multiple family psychotherapy
Psychological testing which require “hands-on” encounters
Mental health assessment by non-physician, and
· Service Plan Development.
Billing Codes
Both the referring physician and the psychiatrist must use the correct codes with the modifier “TM.”
Eligible Healthcare Providers
Eligible telemedicine providers in South Carolina include:
Practitioner offices
Hospitals (inpatient and outpatient)
Rural health clinics
Federally qualified health centers
Community mental health centers
Services provided by allied health professionals are not covered.
There must be a certified or licensed health care professional at the referring site to present and remain available as clinically appropriate.
Online Prescriptions
Prescribing for a patient not personally examined by telehealth provider may be suitable under certain circumstances that include:
admission orders for a newly hospitalized patient
medication orders or prescriptions, including pain management, from a hospice physician for a patient admitted to a certified hospice program
prescribing for a patient of another licensee for whom the prescriber is taking call, continuing medication on a short-term basis for a new patient prior to the patient’s first appointment, an appropriate prescription in a telemedicine encounter where the threshold information to make an accurate diagnosis has been obtained, or prescribing an opiate antagonist to someone in a position to assist a person at risk of an opiate-related overdose.
Once again, the medical board states that prescribing online based on the use of Internet questionnaires is inappropriate and unprofessional.
Informed Patient Consent
A physician has a duty to disclose the diagnosis, the general nature of the contemplated procedure, the material risks involved in the procedure, the probability of success associated with the procedure, the prognosis if the procedure is not carried out, and the existence of any alternatives to the procedure.
Restrictions on Locations
Medicaid imposes restrictions on the covered services, patient settings and
Designates eligible distant site providers as a condition of payment.
Distant sites must be located in the South Carolina Medical Service Area, which is the state of South Carolina and areas in North Carolina and Georgia, within 25 miles of the South Carolina border.
Provider-Patient Relationship
South Carolina allows a patient-provider relationship to be established via telemedicine.
Documenting Barriers to In-Person Care
Providers must obtain prior approval from NC Medicaid for all services delivered via telemedicine and tele-psychiatry.
Additionally, in order to be reimbursed telehealth all services must be:
Medically necessary;
The procedure, product, or service is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs;
The procedure, product, or service can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide;
The procedure, product, or service is furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider.
Reimbursement Rates
Telehealth reimbursement rates for a telemedicine service are the same as the comparable in-person medical service.
Other Reimbursable Fees
The referring site is eligible to receive a facility fee.
Helpful Resources
Center for Connected Health Policy
The American Telemedicine Association State Policy Matrix
South-East Regional Telehealth Resource Center for South Carolina