遠程醫療常見問題
一般遠程醫療科目：
通用遠程醫療
什麼是遠程醫療？
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
提供者指導
誰決定是否通過遠程醫療提供服務？
一般而言，醫療保健提供者會在患者同意下，確定醫療保障或服務是否臨床適合透過遠程醫療方式提供。
誰可以使用遠程醫療提供醫療服務？
根據福利和機構代碼 14132.725 (b) (2) (A)，提供以遠程醫療方式提供 Medi-Cal 保障的保障或服務的醫療保健提供者，必須符合商和職業守則（B & P 守則）第 2290.5 (a) (3) 條的要求，或是 DHCS 以其他方式指定提供遠程醫療服務的提供者類型。 通過遠程醫療提供的服務計費的提供商必須註冊為 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.
提供者是否能夠使用遠程醫療建立新的患者與提供者關係？
視頻同步互動：提供者（包括 FQHCS/RHCS）可以通過同步視頻遠程醫療訪問與新患者建立關係。
註：在專業精神健康服務中，為新患者建立護理是指由持牌臨床醫生進行的心理健康評估。 為了在藥物醫藥和藥物 Medi-Cal 有組織分配系統中的藥物使用治療目的，為新患者建立護理是指美國成癮醫學協會標準評估。
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.
提供一種遠程醫療方式（例如，僅有音頻同步遠程醫療）的提供者是否需要提供其他遠程醫療模式（例如視頻同步遠程醫療）？
隨著時間的推移，但不早於 2024 年 1 月 1，Medi-Cal 將要求提供者逐步採用一種方法，在通過遠程醫療提供護理時，可為患者提供視頻遠程醫療模式的選擇。 具體來說，如果提供商提供僅提供音頻遠程醫療服務，則該提供商還將被要求提供視頻服務的選項。 本署將於 2023 年就此規定發出指引，該指引將考慮寬頻接入的可用性以及 Medi-Cal 供應商使用所需技術的能力。
如果家居是源地點，持牌提供者是否需要與患者一起？
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.
如果我在醫院擁有特權和證明，我是否需要在原住院的特權和證明才能在該醫院照顧病人？
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 是否允許州外提供商通過遠程醫療提供服務？
通過遠程醫療方式提供 Medi-Cal 保障福利或服務的持牌醫療服務提供者，必須在加利福尼亞州擁有許可，註冊為 Medi-Cal 轉譯提供商或非醫生醫生 (NMP)，並與已註冊的 Medi-Cal 提供者集團附屬關係。 醫療保健提供者通過遠程醫療提供服務的註冊 Medi-Cal 提供商組必須符合所有 Medi-Cal 計劃註冊要求，並且必須位於加利福尼亞州或邊境社區。
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.
擁有在另一州的醫療保健從業人員執照並受部落健康計劃僱用的人，不需要在加利福尼亞州獲得許可，才能為加利福尼亞州或邊界社區的部落健康計劃提供服務（商業和職業守則第 719 節）。
供應商可以使用哪些資源？
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.
保障 & 補償
Medi-Cal 涵蓋通過遠程醫療提供哪些類型的服務？
Medi-Cal 涵蓋多種服務和交付系統的同步遠程醫療（例如視頻同步互動和僅音頻同步互動）和異步遠程醫療（例如，存儲和轉發和電子諮詢），包括身體健康，牙科，專科和非專科心理健康，以及 SUD 服務（國家計劃藥物 Medi-Cal 和藥物 Medi-Cal 組織交付系統/DMC-ODS）。 Medi-Cal 涵蓋通過 1915 年（c）豁免計劃、針對性案件管理（TCM）計劃和地方教育機構 Medi-Cal 計費選項計劃（LEA-BOP）通過遠程醫療提供的同步和異步遠程醫療服務。 通過遠程醫療提供的服務必須符合 CPT 或 HCPCS 代碼的程序定義和組件。 Medi-Cal 還涵蓋遠端患者監控 (RPM)；詳情請參閱下面的問題。
有關這些程序的特定信息，請參閱 Medi-Cal 特殊計劃的常見問題。
Medi-Cal 是否支付通過遠程醫療服務所提供的服務與對面提供的相同服務（即付款平等）支付相同的費率？
是的Medi-Cal 為遠程醫療提供的專業醫療服務支付相同的費率與親身提供的服務費用相同。 請參閱此頁面的「付款和索償」部分。
如何獲得遠程醫療服務的報酬？
Medi-Cal 只會在醫療服務提供者為病人提供符合帳單代碼定義的醫療必需專業服務、根據循證醫學和/或透過遠距醫療提供的最佳實踐在臨床上是適當的，以及符合病人同意和醫療保密要求的情況下支付費用。 請參閱 Medi-Cal Telehealth 提供者手冊或其他適當的 DHCS 提供者指南，以瞭解關於遠距健康計費的限制和指南。
電子諮詢：當提供的福利或服務符合 AMA 定義的電子諮詢服務代碼的程序定義和組成部分，以及 Medi-Cal 提供者手冊中所述的任何要求時，遠端現場的醫療保健提供者可以使用 Medi-Cal 遠程醫療提供者手冊中列出的 CPT 代碼進行電子諮詢服務提供者收取電子諮詢服務提供者手冊。 電子諮詢政策不適用於 FQHC、RHCs 或 IHS-MOA 診所。 有關 FQHC、RHCs 或 IHS-MOA 診所特定的政策和帳單信息，提供者可參考相關第 2 部手冊中的農村健康診所（RHCs）和聯邦合格健康中心（FQHC）和印度健康服務（IHS），協議備忘錄（MOA）638，診所部分。
注意：與患者親自提供的 Medi-Cal 保障或服務不使用遠程醫療修改劑，並根據標準 Medi-Cal 政策計費。
Medi-Cal 是否支付原始網站和傳輸費用？
Medi-Cal 每次傳輸給原始站點的提供者支付原始網站費用，以通過遠程醫療（通過同步和/或非同步）來協調到遠程站點的服務。 每位使用 HCPCS 代碼 Q3014 的患者每天最多一次。 原始網站費用不適用於僅有音頻同步互動。
Medi-Cal 向原發地及遠處地點支付每位受益人每天最多 90 分鐘的傳輸費用，就使用雙向即時互動視訊系統（同步）提供的服務。 中華人民共和國人員代碼為 T1014。 傳輸費用不適用於僅供音訊的同步互動。
原始現場費和傳播費不適用於 FQHC、RHCS 或 IHS-MOA 診所。
有關索償和帳單的問題可以向電話服務中心（TSC）（800）541-5555（加州以外地區，請致電（916）636-1980。
原始或遠端網站的設置類型是否有任何限制？
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 會否補償考試室費用和/或支付設置遠程醫療營運的設備？
Medi-Cal 不支付購買遠程醫療設備的費用。 請參閱上一個關於原始網站費用的問題。
Medi-Cal 是否涵蓋病人遠端監控（遙距監控）？
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 託管護理計劃（MCP）是否涵蓋遠程醫療服務？
是的，Medi-Cal 託管護理計劃具有與 Medi-Cal FFS 相同的基本遠程醫療保障和補償政策。 計劃可以選擇提供超過 FFS 計劃所要求的額外保障和福利。
Medi-Cal 是否涵蓋聯邦合格健康中心（FQHC）、農村健康診所（RHCs）和印度健康服務（IHS）診所提供的遠程醫療服務？
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.
如果我對提交索償有疑問，我可以致電誰？
有關服務費索償和帳單的問題，可致電話服務中心（TSC）（800) 541-5555 或通過電子郵件至 Medi-CalOutreach@Xerox.com。 如需管理護理帳單問題，請聯繫 Medi-Cal 託管護理計劃。
病人權利 & 同意
患者在接受遠程醫療服務之前是否需要同意？
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.
提供者應如何證明同意？
醫療保健提供者可以通過讓受益人簽署一份可包含在病人的醫療記錄中的紙質或電子表格，或讓醫生在病人的醫療記錄中註明同意書。
提供者是否需要使用 DHCS 發佈的模型語言？
不 — 這是為了支持遵守法規。 請參閱 AB-32 遠程醫療（2021-2022 年）第二節 《福利及機構守則》第 14132.725 條。
醫療保健提供者必須在開始通過遠程醫療服務向 Medi-Cal 受益人提供一或多項醫療保健服務前或同時至少一次以書面或口頭方式向 Medi-Cal 受益人通知以下所有事項：
- 說明受益人有權使用可透過遠距醫療透過面對面訪提供的涵蓋服務；
- 解釋說，使用遠程醫療是自願性的，而 Medi-Cal 受益人可以隨時撤回使用遠程醫療的同意，而不影響他們未來獲得涵蓋的 Medi-Cal 服務的能力；
- 說明，當其他可用資源合理耗盡時，可提供 Medi-Cal 的交通服務，以及親身訪問的交通服務；
- 在提供商確定任何限制或風險的範圍內，與親身訪問相比，與通過遠程醫療服務接收服務相關的潛在限制或風險。
Visit the Model Patient Consent language webpage published by DHCS.
團體實務和系統是否能夠在受益人在實踐/系統內首次訪問期間，向不同提供者與遠程醫療提供的未來服務獲得同意（vs. 在收到每個個別提供商的遠程醫療服務之前）？
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.
通過遠程醫療接收服務有哪些常見的好處以及風險或限制？
優點：
- 接受醫療護理和治療更容易，更方便，更有效率
- 患者可以與提供者溝通，而無需在辦公室預約。
限制或風險：
- 如果需要面對面跟進，醫療評估/治療會延遲或無法獲得所需的治療。
- 電子設備可能在遠程醫療訪問期間故障。
我不想通過遠程醫療接收服務。 我在哪裡可以找到有關面對面訪問的交通支援服務的更多信息？
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.
未成年人可以在沒有父母或監護人的情況下給予同意（書面、口頭）嗎？
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.