远程医疗常见问题解答
一般远程医疗主题：
通用远程医疗
什么是远程医疗？
California law defines telehealth as the “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” See Business and Professions Code 2290.5
提供商指导
谁决定是否通过远程医疗提供服务？
一般来说，医疗保健提供者会确定某种福利或服务是否适合通过远程医疗方式提供，但须征得患者的同意。
谁可以使用远程医疗来提供医疗保健服务？
通过远程医疗方式提供 Medi-Cal 承保福利或服务的医疗保健提供者必须符合《商业和职业法典》（B&P 法典）第 2290.5(a)(3) 节的要求，或者属于 DHCS 指定的提供远程医疗服务的提供者类型，符合《福利和机构法典》14132.725 (b)(2)(A) 的规定。 通过远程医疗提供服务的收费提供商必须注册为 Medi-Cal 提供商。
For policy and billing information specific to FQHCs, RHCs or IHS-MOA clinics, providers may refer to the Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) and Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics sections in the appropriate Part 2 manual, as well as any relevant guidance issued during the COVID-19 PHE.
医疗服务提供者是否能够使用远程医疗来建立新的患者-医疗服务提供者关系？
视频同步互动：提供者（包括 FQHC/RHC）可以通过同步视频远程医疗访问与新患者建立关系。
注意：在专业心理健康服务中，对新患者的护理建立是指有执照的临床医生进行的心理健康评估。 对于药物医疗补助 (Drug Medi-Cal) 和药物医疗补助有组织递送系统中的物质使用治疗而言，新患者的护理建立参考美国成瘾医学协会标准评估。
Audio-only synchronous interaction: Providers may not establish a relationship with new patients via audio-only synchronous telehealth (i.e., over the phone), except for in the following instances: (1) When the visit is related to sensitive services as defined in subsection (n) of Section 56.06 of the Civil Code*; (2) When the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department specific requirements and consistent with federal and state laws, regulations, and guidance.
Asynchronous store and forward: Only FQHC and RHC providers may establish a new patient via asynchronous store and forward, subject to certain conditions: (1) the patient is physically present at an FQHC or RHC, or at an intermittent site of the FQHC or RHC, at the time the service is provided; (2) the individual who creates the patient records at the originating site is an employee or contractor of the FQHC or RHC, or other person lawfully authorized by the FQHC or RHC to create a patient record; (3) the FQHC or RHC determines that the billing provider is able to meet the applicable standard of care; (4) an FQHC patient who receives telehealth services shall otherwise be eligible to receive in-person services from that FQHC pursuant to Health Resources and Services Administration (HRSA) requirements.
* “Sensitive services” means all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender-affirming care, and intimate partner violence, and includes services described in Sections 6924, 6925, 6926, 6927, 6928, 6929, and 6930 of the Family Code, and Sections 121020 and 124260 of the Health and Safety Code, obtained by a patient at or above the minimum age specified for consenting to the service specified in the section.
提供一种远程医疗方式（例如，仅音频同步远程医疗）的提供商是否需要提供其他远程医疗方式（例如，视频同步远程医疗）？
随着时间的推移，但不早于1年2024月，Medi-Cal 将要求服务提供商逐步采用一种方法，让患者在通过远程医疗提供护理时可以选择视频远程医疗方式。 具体来说，如果提供商提供仅音频的远程医疗服务，则还需要提供视频服务选项。 该部门将于 2023 年发布有关此项要求的指导，其中将考虑宽带接入的可用性和 Medi-Cal 提供商对必要技术的使用。
如果在家中进行治疗，持照医疗服务提供者是否需要陪伴患者？
No, unless the distant site provider determines it is medically necessary for a health care provider to be with the patient. Please see the Medi-Cal Provider Manuals for Rural Health Clinics/Federally Qualified Health Centers and Indian Health Services MOA 638 clinics for requirements specific to the originating site.
如果我在我所在的医院拥有特权和证书，我是否需要在原医院也拥有特权和证书才能在该医院照顾病人？
Issues of privileges and credentialing for distant physicians to care for patients via telehealth are determined by the policies of the originating hospital. However, state law – see Business and Professions Code section 2290.5 (h) – and federal regulations –Title 42 of the Code of Federal Regulations, Part 482.12, 482.22 and 485.616 – allow hospitals to accept the privileges and credentials for providers at distant hospitals.
Medi-Cal 是否允许州外服务提供商通过远程医疗提供服务？
通过远程医疗方式提供 Medi-Cal 承保福利或服务的持照医疗保健提供者必须在加利福尼亚州获得许可，注册为 Medi-Cal 提供者或非医师医疗从业者 (NMP)，并隶属于注册的 Medi-Cal 提供者团体。 医疗保健提供者通过远程医疗为其提供服务的已登记 Medi-Cal 提供者组必须满足所有 Medi-Cal 计划登记要求，并且必须位于加利福尼亚州或边境社区。
For policy and billing information specific to FQHCs, RHCs or IHS-MOA clinics, providers may refer to the Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) and Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics sections in the appropriate Part 2 manual , as well as any relevant guidance issued during the COVID-19 PHE.
在其他州获得医疗保健从业人员执照并受雇于部落健康计划的个人无需在加利福尼亚州获得执照即可为加利福尼亚州或边境社区的部落健康计划提供服务（商业和职业法典第 719 条）。
提供商可以使用哪些资源？
Please see the DHCS Telehealth Resources webpage for helpful information for providers.
The California Telehealth Resource Center (CTRC) is a federally designated resource center dedicated to helping providers implement and sustain telehealth programs. Services include: program needs assessment for implementation or expansion, equipment selection, telehealth presenter training; operational workflow; contracting with specialists; billing; and credentialing and staff roles. In addition, CTRC also produces a Telehealth Program Developer Kit that can be downloaded from the CTRC website. It provides a step-by-step guide to help providers develop a telehealth program.
The Center for Connected Health Policy (CCHP) is a federally designated national telehealth resource center on policy. The CCHP works closely with all telehealth resource centers in the United States and provides technical assistance to state agencies and lawmakers on telehealth policy. For recent information on telehealth legislation and policy, visit the CCHP website.
保险范围及报销
Medi-Cal 涵盖通过远程医疗提供的哪些类型的服务？
Medi-Cal 涵盖多种服务和交付系统的同步远程医疗（例如视频同步交互和仅音频同步交互）和异步远程医疗（例如存储转发和电子咨询），包括身体健康、牙科、专业和非专业心理健康以及 SUD 服务（国家计划药物 Medi-Cal 和药物 Medi-Cal 有组织交付系统/DMC-ODS）。 Medi-Cal 涵盖通过 1915(c) 豁免计划、目标病例管理 (TCM) 计划和地方教育机构 Medi-Cal 计费选择计划 (LEA-BOP) 中的远程医疗提供的同步和异步远程医疗服务。 通过远程医疗提供的服务必须符合 CPT 或 HCPCS 代码的程序定义和组成部分。 Medi-Cal 还涵盖远程病人监控 (RPM)；请参阅下面的问题了解更多详情。
请参阅 Medi-Cal 特殊计划的常见问题解答，了解有关这些计划的具体信息。
Medi-Cal 对远程医疗提供的服务支付的费用是否与对面对面提供的相同服务支付的费用相同（即支付平价）？
是的。Medi-Cal 对远程医疗提供的专业医疗服务支付的费用与对面对面提供的服务支付的费用相同。 请参阅本页的付款和索赔部分。
我如何获得远程医疗服务的报酬？
只有当医疗服务提供者为患者提供医疗必需的专业服务，且该服务符合账单代码的定义、基于循证医学和/或最佳实践通过远程保健提供临床适当的服务，并符合患者同意和医疗保密要求时，加州医疗保险才会向医疗服务提供者支付费用。 有关远程医疗计费的限制和指导，请参阅《加州医疗保险远程医疗提供方手册》或其他适当的 DHCS 提供方指南。
电子咨询：当所提供的福利或服务符合 AMA 定义的电子咨询 CPT 代码的程序定义和组成部分以及 Medi -Cal 提供商手册中描述的任何要求时，远程站点的医疗保健提供者可以使用 Medi-Cal 远程医疗提供者手册中列出的 CPT 代码为电子咨询开具账单。 电子咨询政策不适用于 FQHC、RHC 或 IHS-MOA 诊所。 有关 FQHC、RHC 或 IHS-MOA 诊所的具体政策和账单信息，医疗服务提供者可以参考相应第 2 部分手册中的乡村卫生诊所 (RHC) 和联邦合格医疗中心 (FQHC) 以及印度健康服务 (IHS)、协议备忘录 (MOA) 638、诊所部分。
注意：Medi-Cal 承保的福利或亲自为患者提供的服务不使用远程医疗修饰符，并根据标准 Medi-Cal 政策进行计费。
Medi-Cal 是否支付起始站点和传输费用？
Medi-Cal 按每次传输向原始站点的提供商支付原始站点费用，以通过远程医疗、同步和/或异步的方式向远程站点协调服务。 使用 HCPCS 代码 Q3014，每个患者每天最多可进行一次。 纯音频同步互动不收取原会场费。
Medi-Cal 向发起站点和远程站点支付使用双向实时交互式可视电信系统（同步）提供的服务的传输费，每位受益人每天最高可达 90 分钟。 HCPCS 代码是 T1014。 纯音频同步互动不收取传输费。
FQHC、RHC 或 IHS-MOA 诊所不享受原始站点费用和传输费用。
有关索赔和账单的问题可以直接致电电话服务中心 (TSC) (800) 541-5555（加利福尼亚州以外请拨打 (916) 636-1980）。
对于原始站点或远程站点的设置类型是否有任何限制？
No. Medi-Cal does not limit the type of setting where telehealth services may be provided to a patient by a health care provider. For example, the type of setting where a patient may be seen (i.e., “originating site”) includes, but is not limited to a medical office, community clinic, or the patient’s home. Medi-Cal does not place limits on the type of distant sites, but requires providers to ensure and maintain patient privacy in any location from where they are delivering services.
Please see the Medi-Cal Provider Manuals for Rural Health Clinics/Federally Qualified Health Centers and Indian Health Services MOA 638 clinics for requirements specific to the originating site in those settings.
Medi-Cal 是否报销检查室费用和/或支付建立远程医疗业务的设备费用？
Medi-Cal 不支付远程医疗设备的购买费用。 请参阅先前有关原始站点费用的问题。
Medi-Cal 是否涵盖远程病人监控（电话监控）？
Yes, effective July 1, 2021, remote physiologic monitoring (RPM), also known as remote patient monitoring, was implemented for fee-for-service and managed care beneficiaries. RPM services are provided for established patients ages 21 and older and are reimbursable when ordered by and billed by physicians or other qualified health professionals (QHP).
Medi-Cal 管理式医疗计划 (MCP) 是否涵盖远程医疗服务？
是的，Medi-Cal 管理式医疗计划具有与 Medi-Cal FFS 相同的基本远程医疗覆盖和报销政策。 计划可以选择提供超出 FFS 计划要求的额外覆盖范围和福利。
Medi-Cal 是否涵盖联邦合格医疗中心 (FQHC)、乡村卫生诊所 (RHC) 和印第安人健康服务 (IHS) 诊所提供的远程医疗服务？
Yes, allowable costs associated with telehealth services may be included in the clinic’s Prospective Payment System (PPS) rate; however, FQHCs, RHCs, and IHS clinic PPS sites may not bill for originating site or transmission fees. Please see the Provider Manuals for RHCs/FQHCs and IHS MOA 638 clinics for scenarios about billing for services provided by telehealth.
如果我对提交索赔有疑问，我应该打电话给谁？
有关按服务收费索赔和账单的问题可以直接致电电话服务中心 (TSC) (800) 541-5555 或发送电子邮件至 Medi-CalOutreach@Xerox.com。 对于管理式医疗账单问题，请联系 Medi-Cal 管理式医疗计划。
患者权利和同意
患者在接受远程医疗服务之前是否需要征得同意？
Yes. State law requires the health care provider initiating the use of telehealth to obtain written or verbal consent once before the initial delivery of telehealth services. Medi-Cal has developed Telehealth Patient Consent Language, which includes language outlining a beneficiary’s right to in-person services, the voluntary nature of consent, the availability of transport to access in-person services if needed, and potential limitations/risks of receiving services via telehealth. Patient consent can be completed verbally or in writing. Patients who consent to synchronous video must separately consent to synchronous audio-only services.
提供商应如何记录同意？
医疗保健提供者可以通过让受益人签署可包含在患者医疗记录中的纸质或电子表格或让提供者在患者的医疗记录中注明同意来记录同意。
提供商是否必须使用 DHCS 发布的模型语言？
不，这是为了支持遵守法规。 请参阅 AB-32 远程医疗 (2021-2022) 第 2 节 福利和机构法典第 14132.725 条。
在通过远程医疗向 Medi-Cal 受益人提供一项或多项医疗服务之前或同时，医疗服务提供者应至少一次以书面或口头方式向 Medi-Cal 受益人传达以下所有信息：
- 解释受益人有权通过亲自面对面访问的方式通过远程医疗获得所涵盖的服务；
- 解释称使用远程医疗是自愿的，并且 Medi-Cal 受益人可以随时撤回使用远程医疗的同意，而不会影响他们将来获得涵盖的 Medi-Cal 服务的能力；
- 当其他可用资源已基本用尽时，说明 Medi-Cal 是否能够为亲自就诊的交通服务提供保障；
- 与亲自就诊相比，通过远程医疗接受服务的潜在限制或风险（只要提供者发现任何限制或风险）。
Visit the Model Patient Consent language webpage published by DHCS.
团体诊所和系统是否能够在受益人首次访问诊所/系统时，通过远程医疗获得不同提供商提供的未来服务的同意（相比之下）。 在从每个单独的提供商处接受远程医疗服务之前）？
A health care provider must communicate to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth. Group practices need to obtain and document a patient’s initial consent for purposes of telehealth services prior to the initiation of health care services via telehealth. If consent is documented by the group practice, it is not necessary for each provider rendering health care services via telehealth to document consent.
通过远程医疗接受服务有哪些常见的好处、风险或局限性？
好处：
- 就医治疗更加轻松、便捷、高效
- 患者无需到诊所预约即可与医疗服务提供者沟通。
限制或风险：
- 如果需要亲自随访，可能会出现医疗评估/治疗延迟或无法获得所需的治疗。
- 远程医疗访问期间电子设备可能会出现故障。
我不想接受远程医疗服务。 在哪里可以找到有关亲自访问的交通支持服务的更多信息？
Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies, if they attest that all other available resources have been reasonably exhausted.
未成年人无需父母或监护人陪同是否可以给予同意（书面、口头）？
Minors who receive confidential care, including sexual health, reproductive health, mental health under the Minor Consent Program, may consent to receive the same services via telehealth that are appropriate for telehealth. More information is available on the Minor Consent Program.