Covered Services

Covered Services A. The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner which includes, but not limited to: 1. Implantable pacemakers, 2. Defibrillators, 3. Cardiac monitors, 4. Loop recorders, 5. External mobile cardiovascular telemetry, and 6. Continuous glucose monitors. B. The Division of Medicaid covers remote patient monitoring, for disease management when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), Division of Medicaid or designee, ordered by a physician, physician assistant, or nurse practitioner for a beneficiary who meets the following criteria: 1. Has been diagnosed with one (1) or more of the chronic conditions as defined by the Centers of Medicare and Medicaid Services (CMS) which include, but are not limited to: a) Diabetes, b) Congestive Heart Failure (CHF), c) Chronic Obstructive Pulmonary Disease (COPD), d) Heart disease, e) Mental health, and f) Sickle cell. 2. Is capable of using the remote patient monitoring equipment and transmitting the necessary data or has a willing and able person to assist in completing electronic transmission of data. C. Prior Authorization must include the following: 1. An order for remote patient monitoring services, signed and dated by the prescribing physician, 2. A plan of care, signed and dated by the prescribing physician, that includes transmission frequency and duration of monitoring requested, 3. Beneficiary’s diagnosis and risk factors that qualify the beneficiary for remote patient monitoring, 4. Attestation that the beneficiary is cognitively intact and able to operate the equipment or has a willing and able person to assist in completing transmission of data, and 5. Attestation that the beneficiary is not receiving duplicative services via disease management. D. Remote patient monitoring services must be provided in the beneficiary’s private residence.