Subsection 144-101-I-4.02 - MEMBER ELIGIBILITY4.02-1Telehealth ServicesIf a Member is eligible for the underlying Covered Service to be delivered, and if delivery of the Covered Service via Telehealth Services is medically appropriate, as determined by the Health Care Provider, the Member is eligible for Telehealth Services.
4.02-2Telemonitoring ServicesIn order to be eligible for Telemonitoring Services, a Member must:
A. Be eligible for Home Health Services under Chapter II, Section 40, Home Health Services;B. Have a current diagnosis of a health condition requiring monitoring of clinical data at a minimum of five times per week, for at least one week;C. Have documentation in the patient's medical record that the patient is at risk of hospitalization or admission to an emergency room; OR
Have continuously received Telemonitoring Services during the past calendar year and have a continuing need for such services, as documented by an annual note from a Health Care Provider;
D. Have Telemonitoring Services included in the Member's Plan of Care. A notation from a Health Care Provider, dated prior to the beginning of service delivery, must be included in the Member's Plan of Care. MaineCare shall not reimburse for Telemonitoring Services if they began prior to the date recorded in the Provider's note.E. Reside in a setting suitable to support telemonitoring equipment; andF. Have the physical and cognitive capacity to effectively utilize the telemonitoring equipment or have a caregiver willing and able to assist with the equipment. C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-4, subsec. 144-101-I-4.02