Program Administrator: Alaska Dept. of Health and Social Services, Division of Public Assistance

Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center 2900 12th Ave. N., Ste. 30W
Billings, MT 59101
(888) 662-5601
www.nrtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data through audio, video, or data communications that are engaged in over two or more locations between providers who are physically separated from the patient or from each other.”

Source: AK Admin. Code, Title 7, 12.449 (2012). “Alaska Medicaid will pay for telemedicine services delivered in the following manner:
• Interactive method: Provider and patient interact in ‘real time’ using video/camera and/or dedicated audio conference equipment.
• Store-and-forward method: The provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.
• Self-monitoring method: The patient is monitored in his or her home via a telemedicine application, with the provider indirectly involved from another location.”

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services, Early and Periodic Screening, Diagnosis, and Treatment, Hospice Care, Inpatient Psychiatric Services, Independent Laboratory Services, Appendices. (Accessed Jul. 2015).

Telemedicine is identical to a “traditional” health-care visit except it uses a different “mode of delivery;” with telemedicine, the healthcare provider and the patient are not in the same physical location. Instead, providers use telemedicine applications, such as video, audio, and/or digitized image transmissions, to link the patient and the provider.

There are two primary telemedicine methods, or applications: Interactive and store-and-forward. With the interactive method, video/camera equipment and/or audio equipment is used to hold a “real-time” (live) consultation between a patient and a healthcare provider at a different location. The store-and-forward method, however, requires healthcare providers to send digital images, sounds, or previously recorded video to another provider at a different location. This “consulting” provider then reviews the information and reports his or

STATE LAW/REGULATIONS MEDICAID PROGRAM
her findings to the provider who sent the information.

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Tribal Facility Services. Updated 6/4/13. (Accessed Jul. 2015).
Live Video Reimbursement
(See Medicaid column) Alaska’s Medicaid program will reimburse for services “provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis”

Source: AK Admin. Code, Title 7, 110.625(a) (2012).

Alaska Medicaid will pay for a covered medical service furnished through telemedicine application if the service is:
• Covered under traditional, non-telemedicine methods;
• Provided by a treating, consulting, presenting or referring provider;
• Appropriate for provision via telemedicine Eligible services:
• Initial or one follow-up office visit;
• Consultation made to confirm diagnosis
• A diagnostic, therapeutic or interpretive service
• Psychiatric or substance abuse assessments;
• Individual psychotherapy or pharmacological management services.

Source: AK Dept of Health and Social Svcs., AK Alaska Medical Assistance Provider Billing Manuals, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, (Accessed Jul. 2015) & AK Admin. Code, Title 7, 110.630 (2012).

No reimbursement for:

• Home and community-based waiver services;
• Pharmacy;
• Durable medical equipment;
• Transportation;
• Accommodation services;
• End-stage renal disease;
• Direct-entry midwife;
• Private duty nursing;
• Personal care assistants;
• Visual care, dispensing or optician services;
• Technological equipment and systems associated with telemedicine application.

Source: AK Admin. Code, Title 7, 110.635 (2012) & AK Dept of Health and Social Svcs., AK Alaska Medical Assistance Provider Billing Manual, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures,

STATE LAW/REGULATIONS MEDICAID PROGRAM
(Accessed Jul. 2015)
Store and Forward Reimbursement
(See Medicaid column) Alaska Medicaid will reimburse for services delivered through store-and-forward.

Source: AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manual, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, (Accessed Jul. 2015)

To be eligible for payment under store-and-forward the service must be “provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider.”

Source: AK Admin. Code, Title 7, 110.625(a) (2012).
Remote Patient Monitoring Reimbursement
(See Medicaid column) Alaska Medicaid will reimburse for services delivered through self-monitoring.

Source: AK Dept of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manual, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, (Accessed Jul. 2015)

To be eligible for payment under self monitoring or testing, “the services must be provided by a telemedicine application based in the recipient’s home, with the provider only indirectly involved in the provision of the service.”

Source: AK Admin. Code, Title 7, 110.625(a) (2012).
Email/Phone/FAX
(see Medicaid column) No reimbursement for telephone. No reimbursement for FAX.

Source: AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manual, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, (accessed Jul. 2015)

Reimbursement for phone, only if part of a dedicated audio conference system.
No reimbursement for FAX.

Source: AK Admin Code, Title 7, 110.625 (2012).
Online Prescribing
Physicians are prohibited from prescribing medications based solely on a patient-supplied history received by telephone, FAX, or electronic format.

Source: AK Admin. Code, Title 12, Sec. 40.967. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Recently Passed Legislation (Now Effective)
A physical examination is not necessary to prescribe drugs if:
• The prescription drug is not a controlled substance or a controlled substance is prescribed by a physician when an appropriate licensed health care provider is present;
• The physician is located within the state and a physician or provider is available for follow up care; and
• The person consents to sending a copy of all records.

Source: AK Statute, Sec. 08.64.364.
Consent
No reference found. No reference found.
Location
No reference found. No reference found.
Cross-State Licensing
No reference found. No reference found.
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

Source: AK Admin. Code, Title 7, 110.635(b) (2012).

Community Behavioral Health Services
The department will pay a community behavioral health services provider for facilitation of a telemedicine session if:
• The Telemedicine communication equipment is supplied by the provider;
• The electronic connection used by the treating provider and the recipient are established and maintained by the provider;
• The provider remains available during the telemedicine session to reestablish failed connection before the intended end of the telemedicine session; and
• The provider documents in the recipient’s clinical record a note summarizing the facilitation of each telemedicine session (although the facilitating provider is not required to document a clinical problem or treatment goal

STATE LAW/REGULATIONS MEDICAID PROGRAM
as these are to be documented by the treating provider).

This service may be rendered to the following eligible recipients:
• Child or adult experiencing a substance use disorder or emotional disturbance
• Adult experiencing a serious mental illness

Source: AK Admin. Code, Title 7, 135.290.
Miscellaneous

Comments: Alaska and Hawaii are the only two states with Medicare coverage of store and forward services.

Program Administrator: Arkansas Department of Human Services

Regional Telehealth Resource Center South Central Telehealth Resource Center 4301 W. Markham St. #519
Little Rock, AR 72205 (855) 664-3450
learntelehealth.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
Recently Passed Legislation (Effective Jul. 1, 2016) “Telemedicine” means the medium of delivering clinical healthcare services by means of real-time two-way electronic audio-visual communications, including without limitation the application of secure video conferencing, to provide or support healthcare delivery that facilitates the assessment, diagnosis, consultation, or treatment of a patient’s health care while the patient is at an originating site and the healthcare professional is at a distant site.”

Source: AR Code 23-79-1601(5). Arkansas Medicaid defines telemedicine services as “medical services performed as electronic transactions in real time. In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time.”

Source: 016 06 06 Code of AR Rules and Regs. (CARR) 024
(2012).

The Medicaid manual describes telemedicine as, “Interactive electronic consultations are physician consultations, “face-to-face” in real time, via two-way electronic data exchange.”

Source: AR Provider Manual, Section II: Physician/Independent Labe/CRNA/Radiation Therapy Center, p. 33. (Accessed Jul. 2015)

Recently Passed Legislation (Effective Jul. 1, 2016) “Telemedicine” means the medium of delivering clinical healthcare services by means of real-time two-way electronic audio-visual communications, including without limitation the application of secure video conferencing, to provide or support healthcare delivery that facilitates the assessment, diagnosis, consultation, or treatment of a patient’s health care while the patient is at an originating site and the healthcare professional is at a distant site.

Source: AR Code 23-79-1601(5).
Live Video Reimbursement
A health plan shall cover the telehealth-delivered services of an Arkansas-licensed physician on the same basis it would if the services were delivered in-person.

Will apply to all health benefit plans delivered, issued for delivery, reissued, or extended in Arkansas on or after Jan. 1, 2016 or at any time when any term of the health benefit plan is changed Arkansas Medicaid will reimburse for up to two visits per patient, per year. A benefit extension request may be approved if it is medically necessary.

Covered visits:

• Consults;
• Fetal echography and echocardiography;

STATE LAW/REGULATIONS MEDICAID PROGRAM
or any premium adjustment is made thereafter.

Source: AR Code 23-79-1602(c) (1).

A distant site provider will not utilize telemedicine to treat a patient located in Arkansas unless a professional relationship exists between the healthcare provider and the patient or as otherwise meets the definition of a professional relationship as defined in Section 17-80- 117(a)(4). (See Comments section below).

Existence of a professional relationship is not required in the following circumstances:

• Emergency situations where life or health of the patient is in danger or imminent danger or
• Simply providing information in a generic nature not meant to be specific to an individual patient.

Source: AR Code 17-80-117(e) (1). • Non-emergency visits in a physician’s office, a clinic or a hospital outpatient department;
• Inpatient hospital visits;
• Federally Qualified Health Centers (FQHC) encounters.

Source: AR Provider Manual, Section II: Physician/Independent Lab/CRNA/Radiation Therapy Center, p. 69. (Accessed Jul. 2015)

Source: (fetal echography and echocardiography): AR Provider Manual, Section II: Hospital/CAH/End Stage Renal Disease, p. 32. and Section II: Rural Health Clinics, p. 6. (Accessed Jul. 2015)

Source (FQHC only): AR Provider Manual, Section II: Federally Qualified Health Center, p. 11. (Accessed Jul. 2015)

There is reimbursement for live video for “Telepsych” services under the Rehabilitative Services for Persons with Mental Illness (RSPMI) program. See Medicaid manual for list of rehabilitative services that can be provided through telemedicine to beneficiaries under age 21 and above age 21.

Note: These services are only available when, at a minimum, the Arkansas Telehealth Network (ATN) recommended audio video standards for real-time, two- way interactive audiovisual transmissions are met. Providers also must be able to link or connect to ATN, to ensure HIPAA compliance. Providers must receive prior authorization.

Source: AR Provider Manual, Section II: Rehabilitative Services for Persons with Mental Illnesses, p. 15. (Accessed Jul. 2015)

Live video services will be reimbursed the same as if the services were provided in-person if conditions in AR Code 17-80-117 such as provision of services provided by an Arkansas licensed or certified healthcare provider, professional relationship (see Comments section) and eligible originating site.

Will go into effect July 1, 2016.

Source: AR Code 23-79-1602.
Store and Forward Reimbursement
Store and forward shall not be considered telemedicine, but the use of it is not prohibited.

Source: AR Code 17-80-117(b) (4) (A). Arkansas Medicaid defines telemedicine as “Interactive electronic consultations are physician consultations, “face-to-face” in real time, via two-way electronic data exchange.” This would exclude store and forward.

Source: AR Provider Manual, Section II: Physician/Independent Labe/CRNA/Radiation Therapy Center, p. 33. (Accessed Jul. 2015)

Store and forward shall not be considered telemedicine, but the use of it is not prohibited.

Source: AR Code 17-80-117(b) (4) (A).

STATE LAW/REGULATIONS MEDICAID PROGRAM

Radiology procedures are reimbursed as telemedicine when billed properly.

Source: AR Provider Manual, Section II: Physician/Independent Labe/CRNA/Radiation Therapy Center, p. 132. (Accessed Jul. 2015)
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found. No reference found.
Online Prescribing
Without a prior and proper patient-provider relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

Source: AR Code Annotated Sec. 17-92-1003 (2012).

The standards of appropriate practice in traditional health care professional-patient settings shall govern the licensed healthcare professional’s treatment recommendations made via electronic means, including issuing a prescription via telemedicine.

Source: AR Code 17-80-117(b). No reference found.
Consent
The healthcare professional shall follow applicable state and federal laws, rules and regulations for informed consent.

Source: AR Code 17-80-117(c) (1). The healthcare professional shall follow applicable state and federal laws, rules and regulations for informed consent.

Source: AR Code 17-80-117(c) (1).
Location
Patients must be in a physician’s office or a hospital.

Source: 016 06 Code of AR Rules and Regs. (CARR) 036 (2012). Eligible Originating Site

• In-patient or non-emergency hospital
• Physician office or clinic
• Ambulatory surgical center
• FQHC; or
• Emergency department.

Source: AR Provider Manual, Section II: Physician/Independent Lab/CRNA/Radiation Therapy Center, p. 132. (Accessed Jul. 2015)

Not to go into effect until July 1, 2016:
Eligible Originating site is the offices of a healthcare professional or a licensed health care entity where the patient is located at the time services are provided via telemedicine. The home of a patient in connection with treatment for end-stage renal disease is also an eligible originating site.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: AR Code 17-80-117(a) (4).
Cross-State Licensing
An out of state physician utilizing an electronic medium who performs an act that is part of a patient care service that was initiated in Arkansas, including interpretation of an X-ray, that would affect the diagnosis or treatment, is engaged in the practice of medicine and subject to regulation by the Arkansas State Medical Board.

Source: AR Code Revised 17-95-206 (2012)

Healthcare providers must be fully licensed or certified in Arkansas to provide services in the state unless the out- of-state provider is only providing episodic consultation services.

Source: AR Code 17-80-117(d) (1-2). Healthcare providers must be fully licensed or certified in Arkansas to provide services in the state unless the out- of-state provider is only providing episodic consultation services.

Source: 17-80-117(d) (1-2).
Private Payers
Recently Passed Legislation (Effective Jan. 1, 2016) A health plan shall cover the telehealth-delivered services of an Arkansas-licensed physician on the same basis it would if the services were delivered in-person.

Will apply to all health benefit plans delivered, issued for delivery, reissued, or extended in Arkansas on or after Jan. 1, 2016 or at any time when any term of the health benefit plan is changed or any premium adjustment is made thereafter.

Source: AR Code 23-79-1602(c) (1). No reference found.
Site/Transmission Fee
A facility fee is not prohibited, but it is not mandated.

Source: AR Code 23-79-1602(d) (3). A facility fee is not prohibited, but it is not mandated.

Will go into effect July 1, 2016.

Source: AR Code 23-79-1602(d) (3).
Miscellaneous
The Board of Examiners in Speech-Language Pathology and Audiology defines “telepractice” as telespeech, teleaudiology, teleSLP, telehealth or telerehabilitation when used separately or together.

It defines “telepractice service” as the application of telecommunication technology equivalent in quality to services delivered face-to-face to deliver speech- language pathology or audiology services, or both, at a distance for assessment, intervention or consultation, or both.

Source: AR Code Sec. 17-100-103.

COMMENTS:

Recently Passed Legislation

Arkansas prohibits the use of telemedicine to administer drugs that provide medical abortions.

Source: AR Bill SB 53 (2015).

A “professional relationship” between healthcare provider and patient means at a minimum:

• The healthcare professional has previously conducted an in-person examination and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The healthcare professional personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship, and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;
• The treatment is provided by a healthcare professional in consultation with, or upon referral by, another healthcare professional who has an ongoing relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;
• An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional;
• A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients; or
• A relationship exists in other circumstances as defined by rule of a licensing or certification board for other healthcare professionals under the jurisdiction of the appropriate board and their patients if the rules are no less restrictive than the rules of the Arkansas State Medical Board.

Source: 17-80-117(a) (4).

Program Administrator: Colorado Dept. of Health Care Policy and Financing

Regional Telehealth Resource Center: Southwest Telehealth Resource Center PO Box 245105
Tucson, AZ 85724
(520) 626-4498
www.southwesttrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine means the delivery of medical services and any diagnosis, consultation, or treatment using interactive audio, interactive video, or interactive data communication.”

Source: CO Revised Statutes 12-36-102.5 (2012).

Effective on or after Jan. 1, 2017

Telehealth means a mode of delivery of healthcare services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions and store-and- forward transfers. Telehealth does not include the delivery of health care services via telephone, facsimile machine or electronic mail.

Source: CO Revised Statutes 10-16-123(2) (h) (4) (e) (I & II) (2015).

Workers’ Compensation
Telehealth is often used to encompass a broader definition of remote health care that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs and continuing medical education are all considered part of telemedicine and telehealth.

Source: 7 CO Regs. Rule 18. No reference found.
Live Video Reimbursement
Health plans for patients in counties with 150,000 or fewer residents cannot require face-to-face contact Colorado Medicaid will reimburse for medical and mental health services. Services shall be subject to

STATE LAW/REGULATIONS MEDICAID PROGRAM
between a provider and a patient for services that could be appropriately provided through telemedicine, subject to the terms and conditions of the health benefit plan.

Source: CO Revised Statutes 10-16-123 (2012).

(also see Medicaid column & “Private Payers” section)

Effective Jan. 1, 2017:

A health benefit plan that is issued, amended or renewed shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to the terms and conditions of the plan.

Source: CO Revised Statutes 10-16-123(2) (a) (2015). reimbursement policies developed by the medical assistance program.

Reimbursement must be the same as in-person services.

Source: CO Revised Statutes 25.5-5-320 (2012) & CO Medical Assistance Program, Telemedicine Manual, p. 2 (Apr. 2015). (Accessed Jul. 2015)

Colorado Medicaid does not pay for provider or patient education when education is the only service provided via telemedicine.

No enrolled managed care organization may require face-to-face contact between a provider and a client for services appropriately provided through telemedicine if:

• The client resides in a county with a population of 150,000 or fewer residents and
• The county has the technology necessary to provide telemedicine services.

The use of telemedicine is not required when in-person care by a participating provider is available to an enrolled client within a reasonable distance.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 2 (Apr. 2015), (Accessed Jul. 2015).
Store and Forward Reimbursement
No reimbursement based upon definition of “telemedicine” which describes telemedicine as “interactive” implying that it happens in real time.

Source: CO Revised Statutes 12-36-102.5 (2012).

Effective Jan. 1, 2017:

A health benefit plan that is issued, amended or renewed shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to the terms and conditions of the plan. Reimbursement based upon the definition of “telehealth”.

Source: CO Revised Statutes 10-16-123(2) (a) (2015). The CO Medical Assistance Program will only reimburse for “live” telemedicine, excluding store and forward. Peripherals, such as transmission of a live ultrasound exam, may be reimbursed.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 3 (Apr. 2015), (Accessed Jul. 2015).
Remote Patient Monitoring Reimbursement
(see Medicaid column) The CO Medical Assistance Program will reimburse for Remote Patient Monitoring at a flat fee set by the state board when all these requirements are met:

• The patient is receiving services from a home health provider for at least one of the following: congestive heart failure, chronic obstructive pulmonary disease, asthma, or diabetes;
• The patient requires monitoring at least five

STATE LAW/REGULATIONS MEDICAID PROGRAM
times weekly to manage the disease, as ordered by a physician or podiatrist;
• The patient has been hospitalized two or more times in the last 12 months for conditions related to the disease;
• The patient or caregiver misses no more than five monitoring events in a 30-day period;
• The patient’s home has space for all program equipment and full transmission capability.

Source: (Reimbursement): CO Revised Statutes 25.5-5-321 (2012). Source: (Requirements): 10 CO Code of Regulation 2505-10.

Additional restrictions apply. See Colorado Code of Regulations for more information.

Medicaid Home Health will reimburse for services only if the patient has no other insurance.

Source: 10 CO Code of Regulation 2505-10.
Email/Phone/FAX
Private payers and the managed care system are not required to cover telephone or FAX services.

Source: CO Revised Statutes 10-16-123 and Colorado Revised Statutes 25.5-5-414 (2012).

Effective on or after Jan. 1, 2017

Telehealth does not include the delivery of health care services via telephone, facsimile machine or electronic mail.

Source: CO Revised Statutes 10-16-123(2) (h) (4) (e) (II) (2015). No reimbursement for telephone. No reimbursement for FAX.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 3 (Apr. 2015), (Accessed Jul. 2015).
Online Prescribing
Pharmacists are prohibited from dispensing prescription drugs if they know, or should have known, that it was on the basis of an internet-based questionnaire,
an Internet-based consult, or a telephone consultation, all without a valid pre-existing patient-practitioner relationship.

Source: 3 CO Code of Regulation 719-1 (2012).

Workers’ Compensation
The physician-patient relationship/psychologist-patient relationship can be established through live audio/video services.

Source: 7 CO Regs. Rule 18. No reference found.
Consent
Providers shall give all first-time patients a written statement that includes the following:

The Medicaid requirement for face-to-face contact

STATE LAW/REGULATIONS MEDICAID PROGRAM

• The patient may refuse telemedicine services at any time, without loss or withdrawal of treatment;
• All applicable confidentiality protections shall apply to the services;
• The patient shall have access to all medical information from the services, under state law.

Source: CO Revised Statutes 25.5-5-320 (2012).

Workers’ Compensation
The patient needs to give consent.

Source: 7 CO Regs. Rule 18. between provider and client may be waived prior to treating the client through telemedicine for the first time. The rendering provider must furnish each client with all of the following written statements which must be signed by the client or the client’s legal representative:

• The client retains the option to refuse the delivery of health care services via telemedicine at any time without affecting the client’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the client would otherwise be entitled.
• All applicable confidentiality protections shall apply to the services.
• The client shall have access to all medical information resulting from the telemedicine services as provided by applicable law for client access to his or her medical records.

These requirements do not apply in an emergency.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 4 (Apr. 2015), (Accessed Jul. 2015).
Location
Workers’ Compensation
Services provided via telecommunications technologies are not covered if the client has access to comparable service within 30 miles of his/her place of residence.

Telehealth facilities can bill for the originating site fee if the site is in a:
• County outside of a Metropolitan Statistical Area (MSA), or
• A Health Professional Shortage Area, either located outside of an MSA or in a rural census tract, as determined by the office of Rural Health Policy within the Health Resources and Services Administration (HRSA)

Authorized originating sites include:
• The office of a physician or practitioner
• A hospital
• A critical access hospital (CAH)
• A rural health clinic (RHC)
• A federally qualified health center (FQHC)
• A hospital based or critical access hospital based renal dialysis center (including satellite)
• A skilled nursing facility (SNF)
• Community Mental Health Center

Source: 7 CO Regs. Rule 18. No reference found.
Cross-State Licensure
No reference found. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Private Payers
Health plans for patients in counties with 150,000 or fewer residents cannot require face-to-face contact between a provider and a patient for services that could be appropriately provided through telemedicine.

These services are subject to all terms and conditions of the health plans.

Source: CO Revised Statutes 10-16-123 (2012).

Effective Jan. 1, 2017:

A health benefit plan that is issued, amended or renewed shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to the terms and conditions of the plan.

Source: CO Revised Statutes 10-16-123(2) (a) (2015). No reference found.
Site/Transmission Fee
Effective Jan. 1, 2017:

A carrier shall include in the payment for telehealth interactions reasonable compensation to the originating site for the transmission cost incurred during the delivery of health care services through telehealth except for when the originating site is a private residence.

Source: CO Revised Statutes 10-16-123(2) (c) (2015). The CO Medical Assistance Program will reimburse for transmission costs, at a rate set by their state department.

Source: CO Revised Statutes 25.5-5-320 (2012).

The originating site may bill for a facility fee. Eligible providers for a facility fee includes:
• Physician
• Clinic
• Osteopath
• FQHC
• Psychologist
• MA Psychologist
• Physician Assistant
• Nurse Practitioner
• Rural Health Clinic

Source: CO Medical Assistance Program, Telemedicine Manual, p. 5 (Apr. 2015), (Accessed Jul. 2015).
Miscellaneous
Effective Jan. 1, 2017:

A provider is not required to document or demonstrate that a barrier to in-person care exists to trigger coverage under a health benefit plan for services provided through telehealth.

Source: CO Revised Statutes 10-16-123(2) (c) (2015).

Comments: Colorado law includes in its definition of “health care services” the rendering of services via telemedicine.

Program Administrator: Delaware Health and Social Services Dept., Division of Social Services

Regional Telehealth Resource Center: Mid-Atlantic Telehealth Resource Center PO Box 800711
Charlottesville, VA 22908-0711
(434) 906-4960 / (855) MATRC4U
www.matrc.org

Recent Policy Developments:
In July 2012, the state Medicaid program began reimbursing for telemedicine services. This decision was made administratively, with no change in state law.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telehealth, as set forth in the Board’s rules and regulations, means the use of electronic communications to provide and deliver a host of health- related information and healthcare services, including physical therapy and athletic training related information and services, over large and small distances. Telehealth encompasses a variety of healthcare and health promotion activities, including education, advice,
reminders, interventions, and monitoring of intervention.”

Source: DE Code. Title 24, Sec. 2602.

Recently Passed Legislation
Group and Blanket Insurance, & Health Insurance Contracts
Also applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Physical Therapy, Mental Health, Psychology, Diatetic and Nutrition Therapy, and Clinical Social Work
Telehealth means the use of information and communications technologies consisting of telephone, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

Source: DE House Bill 69 (2015); Title 18, Sec. 3370; & Title 18,
Sec. 3571R; DE Code Title 24, Sec. 1702, Sec. 502, Sec. 701, Sec.
1101, Sec. 1902, Sec. 2002, Sec. 2101, Sec. 2502, Sec. 3002, Sec.
3502, Sec. 3802, & Sec. 3902.

Recently Passed Legislation
Group and Blanket Insurance, & Health Insurance Contracts
Telemedicine means a form of telehealth which is the “Telemedicine is the use of telecommunication and information technologies to provide clinical health care at a distance”.

Source: DE Dept. of Health and Social Svcs., Press Release DHSS-59-2012, (Jun. 27, 2012). (Accessed Jul. 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
delivery of clinical health care services by means of real time two-way audio, visual or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support healthcare delivery which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in the state, while such patient is at an originating site and the health care provider is at a distant site.

Source: DE House Bill 69 (2015); Title 18, Sec. 3370; & Title 18, Sec. 3571R.

Recently Passed Legislation
Applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Physical Therapy, Mental Health, Psychology, Diatetic and Nutrition Therapy, Clinical Social Work
Telemedicine means a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support healthcare delivery which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

Source: DE House Bill 69 (2015) & DE Code Title 24, Sec. 1702,
Sec. 502, Sec. 701, Sec. 1101, Sec. 1902, Sec. 2002, Sec. 2101,
Sec. 2502, Sec. 3002, Sec. 3502, Sec. 3802, & Sec. 3902.
Live Video Reimbursement
No reference found. The Delaware Medical Assistance Program will reimburse for “telemedicine-delivered services.”

Source: DE Dept. of Health and Social Svcs., Press Release DHSS-59-2012, (Jun. 27, 2012). (Accessed Jul. 2015).

The GT modifier (which indicates the service occurred via interactive audio and video telecommunication system) can be used for Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program.

Source: DE School Based Health Services Specific Policy Manual, pg. 62 (May 19, 2013). (Accessed Jul. 2015).
Store and Forward Reimbursement

STATE LAW/REGULATIONS MEDICAID PROGRAM
No reference found. No reference found.
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found. Federally Qualified Health Centers
Telephone consultations are covered services that are included in the payment made to the FQHC and should not be billed as an encounter.

Source: Delaware FQHC Provider Specific Policy Manual, pg. 5. (Accessed Jul. 2015).
Online Prescribing
Pharmacists are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to
an Internet pharmacy through an Internet site.

Source: DE Code, Title 16 Sec. 4744 (2012).

Recently Passed Legislation
APRNs and Physicians
Establishing a proper provider-patient relationship includes:
• Verifying the location of requesting patient;
• Disclosing the provider’s identity and credentials;
• Obtaining consent;
• Establishing a diagnosis through acceptable medical practices, including a physical exam;
• Discuss with patient the diagnosis;
• Ensure availability of distant site provider or coverage of patient for follow up care; and
• Provide written visit summary to patient

Physician & APRNs
Without a prior patient-provider relationship providers are prohibited from issuing prescriptions based on internet questionnaire, internet consult or a telephone consult.

Prescriptions through telemedicine and under a physician-patient relationship may include controlled substances, subject to limitations set by the Board.

Source: DE House Bill 69 (2015); Title 24, Sec. 1769D & DE Code Title 24, Sec. 1932.

Physicians
Prior to a diagnosis and treatment a physician using telemedicine must either provide:
• An appropriate in-person exam; No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Have another DE licensed practitioner at the originating site with the patient at the time of diagnosis;
• Diagnosis must be based using both audio and visual communication; or
• The service meets standards of establishing a patient-physician relationship included as part of evidenced-based clinical practice guidelines in telemedicine developed by major medical specialty societies.

Source: DE House Bill 69 (2015); Title 24, Sec. 1769D .
Consent
Recently Passed Legislation
Informed consent must be obtained to establish a physician-patient relationship over telehealth.

Source: DE House Bill 69 (2015); Title 24, Sec. 1769D & DE Code Title 24, Sec. 1932. No reference found.
Location
No reference found. Eligible originating sites:
• Hospitals;
• Federally qualified health centers (FQHC);
• Public health clinics;
• Program for All-Inclusive Care for the Elderly (PACE) centers.

Source: DE Dept. of Health and Social Svcs., Press Release DHSS-59-2012, (Jun. 27, 2012). (Accessed Jul. 2015).
Cross-State Licensing
No reference found. No reference found.
Private Payers
Recently Passed Legislation
Private payers must provide coverage for the cost of health care services provided through telemedicine, and telehealth as directed through regulations by the Department.

Insurers must pay for telemedicine services at the same rate as in-person.

Source: DE House Bill 69 (2015); Title 18, Sec. 3370; & Title 18, Sec. 3571R. No reference found.
Site/Transmission Fee
Recently Passed Legislation
Private payers: Payment for telemedicine must include reasonable compensation to the originating or distant site for the transmission cost.

Source: DE House Bill 69 (2015); Title 18, Sec. 3370; & Title 18, The originating site will be reimbursed a facility fee for the telemedicine space and equipment.

Source: DE Dept. of Health and Social Svcs., Press Release DHSS-59-2012, (Jun. 27, 2012). (Accessed Jul. 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
Sec. 3571R.
Miscellaneous

Comments:

New Legislation Passed Relating to:
• Physical Therapists and Athletic Trainers (Source: DE Statute Title 24, Sec. 2602)

Program Administrator: Georgia Dept. of Community Health

Regional Telehealth Resource Center: Southeast Telehealth Resource Center PO Box 1408
Waycross, GA 31501
(888) 138-7210
www.setrc.us

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider’s practice, of health care delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical visit with a patient. Standard telephone, facsimile transmissions, unsecured e-mail, or a combination thereof do not constitute telemedicine services.”

Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). “Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patients’ health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video telecommunication equipment.”

“Closely associated with telemedicine is the
term ’telehealth,’ which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Telehealth is the use of telecommunication technologies for clinical care (telemedicine), patient teachings and home health, health professional education (distance learning),
administrative and program planning, and other diverse
aspects of a health care delivery system.”

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 2, (Oct. 2014). (Accessed Jul. 2015).
Live Video Reimbursement
Georgia requires coverage of telemedicine services (which includes live video), subject to contract terms and conditions. (See “Private Payers” section).

Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012). Georgia Medicaid will reimburse for live video when the service is “medically necessary, the procedure is individualized, specific, consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.”

Eligible services:

• Office visits;
• Pharmacologic management;
• Limited office psychiatric services;
• Limited radiological services;
• A limited number of other physician fee schedule services.

Source: GA Dept. of Community Health, GA Medicaid

STATE LAW/REGULATIONS MEDICAID PROGRAM
Telemedicine Handbook, p. 2-3, (Oct. 2014). (Accessed Jul. 2015).

Georgia Medicaid will reimburse for mental health services for residents in nursing homes via telemedicine (although not available in all areas of the state) for “dual eligibles” (Medicaid and Medicare).

Nursing facilities and community behavioral health rehabilitation (CBHRS) service providers can arrange for the provision of specialized services to residents either in nursing facilities, via telemedicine or at the CBHRS location for residents in the Preadmission Screening and Resident Review Serious Mental Illness and dually diagnosed populations.

Source: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facilities,
p. 189 (Jul. 1, 2015) and Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 61 (Jul. 1, 2015).
Store and Forward Reimbursement
No reference found. Georgia Medicaid will not reimburse for store and forward because these services do not include direct, in-person patient contact.

However, telemedicine handbook indicates that cardiography, echocardiography, ultrasounds and x- rays are services that can be performed via telemedicine (which is defined as occurring in real-time).

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 4 & p. 8, (Oct. 2014). (Accessed Jul. 2015).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reimbursement for FAX.
No reimbursement for telephone. No reimbursement for email.

Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). No reimbursement for FAX.
No reimbursement for telephone. No reimbursement for email.

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 8, (Oct. 2014). (Accessed Jul. 2015).
Online Prescribing
Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult.

Source: GA Rules & Regulations revised 360-3-.02 (2012). No reference found.
Consent
No reference found in statute. The referring provider must obtain prior written consent.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 5, (Oct. 2014). (Accessed Jul. 2015).
Location
No reference found. Eligible originating sites:

• Provider offices;
• Hospitals;
• Critical Access Hospitals (CAH);
• Rural Health Clinics (RHC);
• Federally Qualified Health Centers (FQHC);
• Skilled nursing facilities;
• Community mental health centers;
• GA public health clinics;
• School-based clinics. Eligible distant sites:
• Provider offices;
• Hospitals;
• Critical Access Hospitals (CAH);
• Rural Health Clinics (RHC);
• Federally Qualified Health Centers (FQHC);
• Skilled nursing facilities;
• Community mental health centers;
• GA public health clinics.

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 3, (Oct. 2014). (Accessed Jul. 2015).

FQHCs and RHCs cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

Source: GA Dept. of Community Health, CA Medicaid Rural Health Clinic Services Handbook, p. 48 and FQHC Handbook, (Jul. 2015) p. 42.
Cross-State Licensure
Must be a Georgia licensed practitioner.

Source: GA Admin. Code Sec. 360-3-.07 Providers must have a Georgia license.

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 3, (Oct. 2014). (Accessed Jul. 2015).
Private Payers
Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012). No reference found.
Site/Transmission Fee
No reference found. Rural Health Clinics and FQHCs can collect a telehealth origination site facility fee.

Source: GA Dept. of Community Health, CA Medicaid Rural Health

STATE LAW/REGULATIONS MEDICAID PROGRAM
Clinic Services Handbook, p. 48 (Jan. 2015) and FQHC Handbook, p. 42 (Jul. 2015).

Originating sites can bill for a facility fee.

The cost of telemedicine equipment and transmission is not a covered service (unless a technical component of an x-ray, ultrasound or electrocardiogram is performed).

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 3, (Oct. 2014). (Accessed Jul. 2015).
Miscellaneous
Other Non-Covered Services:
• Services rendered via web cam or internet based technologies that are not part of a secured network and do not meet HIPAA encryption compliance
• Video cell phone interaction

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 3, (Oct. 2014). (Accessed Jul. 2015).

Comments: Patients who are eligible for both Medicare and Medicaid (known as dual eligibles), will receive mental health care through Medicare, with Medicaid the payer of last resort. Though not available in all areas of the state, Medicare-funded mental health services are currently provided to nursing home residents via telemedicine, face-to-face visits by providers in the nursing home, and nursing home resident visits to psychiatric/mental health clinics or offices, for those individuals able to travel.

GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facilities, p. 202 (Jul. 1, 2015).

New Regulations Passed
• GA Composite Medical Board (Source: GA Admin. Code Sec. 360-3-.07)

Program Administrator: Idaho Dept. of Health and Welfare

Regional Telehealth Resource Center:
The Northwestern Regional Telehealth Resource Center 2900 12th Ave. N., Ste. 30W, Billings, MT 59101
(888) 662-5601
www.nrtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telehealth is an electronic real-time synchronized audio-visual contact between a consultant and participant related to the treatment of the participant. The consultant and participant interact as if they were having a face-to-face service.”

Source: ID Administrative Code 16.03.10.681 (2012).

Psychiatric Telehealth is an electronic real time synchronous audio-visual contact between a physician and participant related to the treatment of the participant. The participant is in one (1) location, called the hub site, with specialized equipment including a video camera and monitor, and with the hosting provider. The physician is at another location, called the spoke site, with specialized equipment. The physician and participant interact as if they were having a face-to- face service.

Source: ID Administrative Code 16.03.09 Sec. 502

Recently Passed Legislation
Telehealth services means health care services provided by a provider to a person through the use of electronic communications, information technology, asynchronous store and forward transfer or synchronous interaction between a provider at a distant site and a patient at an originating site. Such services include, but are not limited to, clinical care, health education, home health and facilitation of self-managed care and caregiver support.

Source: ID House Bill 189 (2015)& ID Code Sec. 54-5603. Telehealth is an electronic, real time, synchronized, audio-visual contact between a qualified provider and a participant using specialized equipment.

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Live Video Reimbursement
(see Medicaid column) Idaho Medicaid will reimburse for a limited number of mental health and developmental disabilities (DD) services. They include:

• Psychotherapy with evaluation and

STATE LAW/REGULATIONS MEDICAID PROGRAM
management
• Psychiatric diagnostic interview
• Pharmacological management
• DD therapeutic consultation
• DD crisis intervention

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Source: Idaho MMIS Provider Handbook: allopathic and Osteopathic Physicians. Jun. 2015, p. 29. (Accessed Jul. 2015).

Psychiatric telehealth services not provided through Idaho Behavioral Health Plan is limited to psychiatric services for:
• Diagnostic assessment
• Pharmacological management
• Psychotherapy with evaluation and management services

Services are not reimbursed when provided through a videophone or webcam.

Source: ID Administrative Code 16.03.09 Sec. 502

Through the Children’s Waiver Services, Idaho Medicaid will reimburse for crisis intervention consults, or individual consults by a therapeutic consultant via live video.

Source (service type): ID Administrative Code 16.03.10.683 (2012).
Store and Forward Reimbursement
No reference found. Idaho Medicaid will only reimburse for interactive audio and video permitting “real-time communication”, therefore excluding store and forward from coverage.

Source: Idaho MMIS Provider Handbook: allopathic and Osteopathic Physicians. Jun. 2015, p. 29. (Accessed Jul. 2015).

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found. No reimbursement for telephone, email or fax.

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Online Prescribing
Prescribing physicians must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
underlying conditions and/or contraindications to the treatment.

Prescriptions based solely on online questionnaires or consults outside of an ongoing clinical relationship are prohibited.

Source: ID Code § 54-1733 (2012).

Recently Passed Legislation

Prescriptions can be issued as long as there is an established provider-patient relationship, provided that the prescription is not for a controlled substance unless prescribed in compliance with 21 USC section 802(54)(A).
No drug can be prescribed for the purpose of abortion. If a provider-patient relationship is not yet established,
the provider must take appropriate steps to establish the relationship by use of two-way audio and visual interaction, provided that the applicable Idaho community standard of care has been satisfied.

Source: ID House Bill 189 (2015)& ID Code Sec. 54-5603 through 5607.
Consent
A patient’s consent must be obtained.

Source: ID House Bill 189 (2015)& ID Code Sec. 54-5608. Participant informed consent is required.

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Location
No reference found. Telehealth services are only covered for participants who live in a rural HPSA or MSA where there is a shortage of qualified providers. The provider must document when there is no provider available to provide the services in person.

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Cross-State Licensing
Recently Passed Legislation
Idaho adopted the Federation of State Medical Board (FSMB)’s model language for an interstate medical licensure compact.

Source: ID House Bill 150. ID Code Title 54, Ch. 18. No reference found.
Private Payers
No reference found. No reference found.
Site/Transmission Fee

STATE LAW/REGULATIONS MEDICAID PROGRAM
No reference found. ID Medicaid does reimburse for the transmission fee of the originating and distant site for mental health services.
Source: Idaho MMIS Provider Handbook: Allopathic and Osteopathic Physicians. Jun. 2015, p. 29. (Accessed Jul. 2015).

Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).
Miscellaneous

Comments:

Idaho has a “Telehealth Council” that meets regularly to coordinate and develop a comprehensive set of standards, policies, rules and procedures for the use of telehealth and telemedicine in Idaho.

Source: State of Idaho. Telehealth Council. (Accessed Jul. 2015)

Program Administrator: Indiana Family and Social Services Administration

Regional Telehealth Resource Center: Upper Midwest Telehealth Resource Center 2901 Ohio Boulevard, Ste. 110
Terre Haute, IN 47803 (855) 283-3734 ext. 232
www.umtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine services refer to a specific method of delivery of certain services, including medical exams and consultations, which are already reimbursed by Medicaid. Telemedicine uses videoconferencing equipment allowing a medical provider to render an exam or other service to a patient at a distant location.”

Source: IN Admin. Code, Title 405, 5-38-1 (2012).

“Telehealth services mean the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across a distance.”

“Telemedicine services mean a specific method of delivery of services, including medical exams and consultations and behavioral health evaluations and treatment, including those for substance abuse, using videoconferencing equipment to allow a provider to render an examination or other service to a patient at a distant location. The term does not include the use of the following: (1) a telephone transmitter for transtelephonic monitoring. (2) a telephone or any other means of communication for the consultation from one (1)) provider to another provider.”

Source: IN Code, 12-15-5-11.

For Private Payer Reimbursement

“Telemedicine services” means health care services delivered by use of interactive audio, video, or other electronic media, including:

• Medical exams and consultations
• Behavioral health, including substance abuse evaluations and treatment
• The term does not include delivery of health care services through telephone for transtelephonic monitoring; telephone or any other means of Telehealth services are defined as the scheduled remote monitoring of clinical data through technologic equipment in the member’s home.

Telemedicine services refer to a specific method of delivery of certain services, including medical exams and consultations, which are already reimbursed by Medicaid. Telemedicine uses video conferencing equipment to allow a medical provider to deliver an exam or other services to a patient at a distant location.

In any telemedicine service, there will be a hub site, a spoke site, an attendant to connect the patient to the specialist at the hub site, a computer or television so that the patient has real-time, interactive and face-to- face communication with the hub specialist/consultant via the interactive television technology.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
communication for the consultation for one (1) provider to another provider.

Source: IN Code, 27-8-34 (2015) & 27-13-7-22 (2015).
Live Video Reimbursement
Reimbursement for live video, see Private Payer section.

Source: IN Code, 27-8-34 (2015) & 27-13-7-22 (2015). Indiana Code requires reimbursement for video conferencing for FQHC, Rural Health Clinic, Community Mental Health Centers, and Critical Access Hospital providers regardless of the distance between provider and patient…

Source: IN Code, 12-15-5-11.

Indiana Medicaid will reimburse the following services when provided via live video when services are medically necessary and hub and spoke are 20 miles apart:
• Consultation
• Office Visit
• Psychotherapy
• Psychiatric diagnostic interview
• End-stage renal disease (ESRD) services
• Pharmacologic management

The hub site physician or practitioner must determine if it is medically necessary for a medical professional to be at the spoke site.

For a medical professional to receive reimbursement for professional services in addition to payment for spoke services, medical necessity must be documented. If it is medically necessary for a medical professional to be with the member at the spoke site, the spoke site is permitted to bill an evaluation and management code in addition to the fee for spoke services. There must be documentation in the patient’s medical record to support the need for the provider’s presence at the spoke site. The documentation is subject to post-payment review.
Source (authorization): IN Admin. Code, Title 405, 5-38-1 (2012). Source (hub-spoke provider reimbursement): IN Admin. Code,
Title 405, 5-38-4 (2012) & IN Medicaid Provider Manual. July 1,
2015. P. 853-863. (Accessed Jul. 2015).

No reimbursement for the following:

• Ambulatory surgical centers;
• Outpatient surgical services;
• Home health agencies or services;
• Radiological services;
• Laboratory services;
• Long-term care facilities, including nursing

STATE LAW/REGULATIONS MEDICAID PROGRAM
facilities, intermediate care facilities, or community residential facilities for the developmentally disabled;
• Anesthesia services or nurse anesthetist services;
• Audiological services;
• Chiropractic services;
• Care coordination services;
• Durable medical equipment, medical supplies, hearing aids, or oxygen;
• Optical or optometric services;
• Podiatric services;
• Services billed by school corporations;
• Physical or speech therapy services;
• Transportation services;
• Services provided under a Medicaid waiver.

Source: IN Admin. Code, Title 405, 5-38-4 (2012) & IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).
Store and Forward Reimbursement
No reimbursement for store and forward due to definition of “telemedicine services”.

Source: IN Code, 27-8-34 (2015) & 27-13-7-22 (2015). Indiana Medicaid will not reimburse for store and forward services.

Source: IN Admin. Code, Title 405, 5-38-4 (2012).

However, there is reimbursement for store and forward technology to facilitate other reimbursable services. Separate reimbursement of the spoke-site payment is not provided for this technology.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).
Remote Patient Monitoring Reimbursement
No reimbursement for remote patient monitoring due to definition of “telemedicine services”.

Source: IN Code, 27-8-34 (2015) & 27-13-7-22 (2015). Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.

Source: IN Code, 12-15-5-11.

Indiana Medicaid will reimburse providers for telehealth services provided as home health services.

Must have one of the following conditions:
• Chronic obstructive pulmonary disease
• Congestive heart failure
• Diabetes

Must initially have two or more of the following events related to one of the conditions listed above within the previous twelve months:
• Emergency room visit
• Inpatient hospital stay

STATE LAW/REGULATIONS MEDICAID PROGRAM
A licensed registered nurse must perform the reading of transmitted health information.

Source: IN Admin Code, Title 405, 5-16-3.1.

IN Medicaid will reimburse RPM when there is prior authorization when services are medically necessary for patients with uncontrolled chronic conditions, as evidenced by emergency room visits and inpatient hospital stays directly related to the chronic condition.

A licensed RN must read the transmitted health information the day the data is received.

Eligible chronic conditions include congestive heart failure, chronic obstructive pulmonary disease and diabetes.

Reimbursement only available for home health agencies and members must be approved for other home health services.

Other criteria apply to obtain prior authorization.

IN Medicaid Provider Manual. July 1, 2015. P. 853-863.
(Accessed Jul. 2015).
Email/Phone/FAX
No reference found for email.
No reimbursement for telephone. No reference found for FAX.

Source: IN Admin. Code, Title 405, 5-38-1 (2012). Telemedicine is not the use of:
• Telephone transmitter for transtelephonic monitoring; or
• Telephone or any other means of communication for consultation from one provider to another.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).
Online Prescribing
A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to issuing e-prescriptions.

Source: IN Admin. Code, Title 844, 5-3-2 (2012).

Indiana has established a pilot program to provide telehealth services to patients in Indiana without the establishment of an in person patient-physician relationship. The pilot includes the issuance of prescription when medically necessary, with the exception of controlled substances.

Source: IN Code, 25-22.5-14. No reference found.
Consent

STATE LAW/REGULATIONS MEDICAID PROGRAM
A health care provider (as defined in Indiana Code 16-18- 2-163(a)) may not be required to obtain a separate additional written health care consent for the provision of telemedicine services.

Source: IN Code, 16-36-1-15 (2015). The spoke site must obtain patient consent. The consent must be maintained at the hub and spoke sites.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).
Location
The patient must be physically present at the spoke site and participate in the visit.

Source: IN Admin. Code, Title 405, 5-38-4 (2012). Indiana Code requires the amendment of the Medicaid state plan (by Dec. 1, 2013) to eliminate the current twenty mile distance restriction.

Source: IN Code, 12-15-5-11.

There is reimbursement for telemedicine services only when the hub and spoke sites are greater than 20 miles apart.

Telemedicine services may only be offered in an inpatient, outpatient or office setting.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).

Reimbursement for telemedicine services is available to the following providers regardless of the distance between the provider and recipient:
• Federally Qualified Health Centers
• Rural Health Clinics
• Community mental health centers
• Critical access hospitals

Source: IN Admin Code, 405 5-38-4 & Health Coverage Programs Provider Manual, Chapter 8, Billing Instructions, p. 140 (Jun. 5, 2014), (Accessed Jul. 2015).
Cross-State Licensing
No reference found. No reference found.
Private Payers
Accident and sickness insurance (dental or vision insurance is excluded) policies and individual or group contracts must provide coverage for telemedicine services in accordance with the same clinical criteria as would be provided for services provided in person.

Source: IN Code, 27-8-34 (2015) & 27-13-7-22 (2015). No reference found.
Site/Transmission Fee
No reference found. Spoke sites are reimbursed a facility fee.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).
Miscellaneous

STATE LAW/REGULATIONS MEDICAID PROGRAM
For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The hub physician should coordinate with the patient’s primary care physician.

Source: IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).

COMMENTS: Indiana establishes a telehealth services pilot program utilizing telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, treatment, supervision and information across a distance.

Source: IN Administrative Code 844 Section 5-8-2 (2015).

Program Administrator: Kansas Dept. of Health and Environment

Regional Telehealth Resource Center: Heartland Telehealth Resource Center 3901 Rainbow Blvd MS 1048
Kansas City, KS 66160 (877) 643-4872
heartlandtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
No reference found. “Telemedicine is the use of communication equipment to link health care practitioners and patients in different locations. This technology is used by health care providers for many reasons, including increased cost efficiency, reduced transportation expenses, improved patient access to specialists and mental health providers, improved quality of care, and better communication among providers.”

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 26 (Dec. 2014). (Accessed Jul. 2015).
Live Video Reimbursement
No reference found. Kansas Medicaid will reimburse for live video, for the following services:

• Office visits;
• Individual psychotherapy;
• Pharmacological management services. The patient must be present at the originating site.
Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 26 (Dec. 2014). (Accessed Jul. 2015).

Non-Prepaid Ambulatory Health Plan (PAHP) Outpatient Mental Health
Office visits and individual psychotherapy is reimbursed at the same rate as face to face services.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Non PAHP Outpatient Mental Health, p. 18 (May 2014). (Accessed Jul. 2015).
Store and Forward Reimbursement
No reference found. Kansas Medicaid requires the patient to be present at the originating site indicating store and forward will not be reimbursed.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 26 (Dec. 2014). (Accessed Jul. 2015).
Remote Patient Monitoring Reimbursement
No reference found. Kansas Medicaid will reimburse for home telehealth. The policy states:

“Home telehealth uses real-time, interactive, audio/video telecommunication equipment to monitor patients in the home setting, as opposed to a nurse visiting the home.

This technology may be used to monitor the patient for significant changes in health status, provide timely assessment of chronic conditions, and provide other skilled nursing services.

Services must be provided by a registered nurse or licensed practical nurse. Agencies may bill skilled nursing services on the same date of service as telehealth services.”

Source: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health, p. 33 (Jul. 2015). (Accessed Jul. 2015).

Providers are eligible for reimbursement of home telehealth services that meet the following criteria:

• Prescribed by a physician;
• Considered medically necessary;
• Signed beneficiary consent for telehealth services;
• Skilled nursing service;
• Does not exceed two visits per week for non- Home and Community Based Services patients.

Prior authorization required.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health Agency, p. 67 (Jul. 2015). (Accessed Jul. 2015).
Email/Phone/FAX
No reference found. No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 26 (Dec. 2014). (Accessed Jul. 2015).
Online Prescribing
Physicians must have a pre-existing patient-prescriber relationship. Physicians are prohibited from prescribing No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
drugs on the basis of an internet-based questionnaire or consult, or telephone consult.

Source: KS Admin. Regs., Sec. 68-2-20 (2012).
Consent
No reference found. Written consent for telehealth home services is required.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health Agency, p. 67 (Jul. 2015). (Accessed Jul. 2015).
Location
No reference found.
Cross-State Licensing
No reference found. No reference found.
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. No reference found.
Miscellaneous

Program Administrator: LA Dept. of Health and Hospitals

Regional Telehealth Resource Center:
TexLa Telehealth Resource Center 3601 4th Street, Ste. 2B440 Lubbock, TX 79430
(806) 743-4440
http://www.texlatrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine is the practice of health care delivery, diagnosis, consultation, treatment, and transfer of medical data using interactive telecommunication technology that enables a health care practitioner and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously. Neither a telephone conversation nor an electronic mail message between a health care practitioner and patient, or a true consultation as may be defined by rules promulgated by the board pursuant to the Administrative Procedure Act, constitutes telemedicine.”

Source: LA Revised Statutes 37:1262 (2012).

Telehealth means a mode of delivering healthcare services that utilizes information and communication technologies to enable the diagnosis, consultation, treatment, education, care management and self- management of patients at a distance from healthcare providers. Telehealth allows services to be accessed when providers are in a distant site and patients are in the originating site. Telehealth facilitates patient self- management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.

Source: LA Revised Statutes HB 1280 (2014) & Title 40 Sec. 1300.383. “Telemedicine is the use of medical information exchanges from one site to another via electronic communications to improve a recipient’s health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two- way, real time interactive communication between the patient at the originating site, and the physician or practitioner at the distant site.”

Source: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 156 (As revised on May 28, 2015). (Accessed Jul. 2015).
Live Video Reimbursement
Louisiana law requires reimbursement to the originating site physician for a live video consultation if he/she is physically present during the exam and interacts with the distant-site physician. (See “Private Payers” section below)

Source: LA Revised Statutes 22:1821 (2012). Louisiana Medicaid reimburses for “services provided via an interactive audio and video telecommunications system.”

Source: LA Register, Volume 31, 2032 (2012).

Louisiana Medicaid only reimburses the distant site provider.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 156 (As revised on May 28, 2015). (Accessed Jul. 2015).
Store and Forward Reimbursement
There is no reimbursement requirement based upon the definition of “telemedicine” which describes telemedicine as an interaction “via two-way video and audio transmission”.

Source: LA Revised Statutes 37:1262 (2012). Louisiana Medicaid will not provide reimbursement for store and forward based upon the definition of “telemedicine” which describes telemedicine as including “audio and video equipment permitting two- way, real time interactive communication” therefore excluding store and forward.

Source: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 156 (As revised on May 28, 2015). (Accessed Jul. 2015).
Remote Patient Monitoring Reimbursement
No reference found. Under the Community Choices Waiver, Louisiana Medicaid will reimburse an installation fee and a monthly maintenance fee for:
• TeleCare Activity and Sensor Monitoring,
• Health status monitoring, and
• Medication and monitoring.

Activity and Sensor Monitoring
At a minimum the system must:
• Monitor the home’s points of egress and entrance;
• Detect falls;
• Detect movement or lack of movement;
• Detect whether doors are opened or closed; and
• Provide a push button emergency alert system.

Providers of assistive devices and medical equipment must be a licensed home health agency.

Certain standards apply for the medical equipment and supplies used.

Limitations
• Services must be pre-approved
• Services must be based on verified need.
• Benefit must be determined by an independent assessment on any item that costs over $500.
• All items must reduce reliance on other Medicaid state plan or waiver services
• All items must meet applicable standards of manufacture, design and installation
• The items must be on the Plan of Care developed by the support coordinator.

A recipient is not able to receive Telecare Activity and Sensor Monitoring services and traditional PERS services.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Where applicable, recipients must use Medicaid State Plan, Medicare or other available payers first.

Source: LA Dept. of Health and Hospitals, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, p. 39-43 (as revised on Jul. 8, 2015). (Accessed Jul. 2015).
Email/Phone/FAX
No reimbursement for email.
No reimbursement for telephone. No reference found for FAX.

Source: LA Revised Statutes 37:1262 (2012). No reference found.
Online Prescribing
Only physicians certificated by a specialty board of the Greater New Orleans Community Health Connection
American Board of Medical Specialties or the American Provider Manual
Osteopathic Association shall use telemedicine to The use of a telemedicine communications system may
prescribe amphetamines or narcotics. substitute for a face-to-face, “hands on” encounter for
consultation, office visits, individual psychotherapy and
pharmacologic management.
Telemedicine, including the issuance of any prescription
via electronic means, shall be held to the same
prevailing and usually accepted standards of medical practice as those in traditional, face-to-face settings. Source: LA Dept. of Health and Hospitals, Greater New Orleans
Community Health Connection Provider Manual, Chapter Forty- seven of the Medicaid Svcs. Manual, p. 43 (as revised Feb. 20,
2015). (Accessed Jul. 2015).
An online, electronic or written mail message, or a
telephonic evaluation by questionnaire or otherwise,
does not satisfy the standards of appropriate care.

Source (amphetamines and narcotics): LA Admin. Code
46:XLV.7513 (2012).
Source (prevailing standards): LA Admin. Code 46:XLV.7505
(2012).
No physician practicing telemedicine can prescribe a
controlled dangerous substance prior to conducting an
appropriate in-person patient history or physical
examination of the patient.

Source: LA Revised Statutes Sec. 1300.381 & HB 1280 (2014).
Consent
Physicians must inform telemedicine patients of the relationship between the physician and patient, and the role of any other health care provider with respect to management of the patient. The patient may decline to receive telemedicine services and withdraw from such care at any time.

Source: LA Admin. Code 46:XLV.7511 (2012). No reference found.
Location
No reference found. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Cross-State Licensing
A telemedicine license may be issued to out-of-state physicians, as long as they hold a full and unrestricted license in another state or U.S. territory.

Out-of-state telemedicine providers cannot open an office, meet with patients or receive calls from patients within Louisiana.

A licensed health care provider must be in the examination room with the patient during telemedicine services.

Source: LA Revised Statutes 37:1276.1 (2012).

LA state agencies and professional boards can regulate the use of telehealth including licensing of out-of-state healthcare providers.

Source: LA Revised Statutes Sec. 1300.381 & HB 1280 (2014). No reference found.
Private Payers
Reimbursement must be made to the originating site physician if he/she is physically present during the exam and interact with the distant-site physician.

Originating-site physician fees shall be at least 75 percent of the normal fee for an intermediate office visit.

No reference found for distant-site physician reimbursement.

Source: LA Revised Statutes 22:1821 (2012). No reference found.
Site/Transmission Fee
No reference found. No reference found.
Miscellaneous
Louisiana law requires that a physician who uses telemedicine establish a proper physician-patient relationship.

Physicians must:

• Verify the identity of the patient;
• Conduct an appropriate exam;
• Establish a proper diagnosis;
• Establish a treatment plan;
• Create a written plan for follow up care.

Source: LA Admin. Code 46:XLV.7509 (2012).

Comments:

Louisiana recently passed specific standards for its telemedicine physicians.

Source: LA Statute Sec. 1300.381 & House Bill 1280 (2014).

Louisiana has created a Task Force on Telehealth access to advise the legislature and the Department of Health and Hospitals on policies and practices that expand access to telehealth services.

Source: LA House Concurrent Resolution 88 (2014).

Program Administrator: MD Dept. of Social Services

Regional Telehealth Resource Center Mid-Atlantic Telehealth Resource Center PO Box 800711
Charlottesville, VA 22908-0711
(434) 906-4960 / (855) MATRC4U
www.matrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telehealth means the use of telecommunications and information technologies for the exchange of information from one site to another, for the provision of health care to an individual from a provider through hardwire or Internet connection.”

Source: MD Health Occupations Annotated Sec. 2-101 (2012).

Telemedicine means, as it relates to the delivery of health care services, the use of interactive audio, video, or other telecommunications or electronic technology:
1. By a health care provider to deliver a health care service that is within the scope of practice of the health care provider at a site other than the site at which the patient is located; and
2. That enables the patient to see and interact with the health care provider at the time the health care service is provided to the patient.

Source: Health General Code 15-105.2.

“Telemedicine means the practice of medicine from a distance in which intervention and treatment decisions and recommendations are based on clinical data, documents, and information transmitted through telecommunications systems.”

Source: Code of Maryland Admin. Regs. Sec. 10.32.05.02

“Telemedicine means the delivery of medically necessary services to a patient at an originating site by a consulting provider, through the use of technology- assisted communication.”

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.02.

Perinatal and Neonatal Referral Center Standards: “Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a licensed health care provider to deliver “Telemedicine means the delivery of medically necessary services to a participant at an originating site by a consulting provider, through the use of technology- assisted communication.”

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p.
8. (Accessed Jul. 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
a health care service within the scope of practice of the health care provider at a site other than the site at which the patient is located, in compliance with COMAR 10.32.05.and including at least two forms of communication.

Source: MD COMAR Sec. 30.08.12.
Live Video Reimbursement
Maryland law requires private insurers to provide coverage for telemedicine services (subject to terms and conditions of contract), which includes live video.

(See “Private Payers” section).

Source: MD Insurance Code Annotated Sec. 15-139 (2012).

Maryland law requires the state Medicaid program to provide coverage for live video telemedicine services (subject to terms and conditions of contract), the same as it does for private payers.

Source: Health General Code 15-105.2.

The Department may not reimburse telemedicine services by an originating and distant site provider located in different facilities in the same hospital campus.

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.11.

The Department shall grant approval to allow originating and consulting site providers to receive State and federal funds for providing telemedicine services if the telemedicine provider meets certain requirements.

Telemedicine providers must be part of a private practice, hospital or other health care system.

• Must be an agreement between a medical assistance-approved originating site provider and consulting provider.

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.03-04.

Providers must have a written contingency plan when telemedicine is unavailable.

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.07. Reimbursement for telemedicine is required by Maryland Medical Assistance if the health care service is medically necessary and provided:
• For the treatment of cardiovascular disease or stroke;
• In an emergency department setting; and
• When an appropriate specialist is not available.

Source: MD Insurance Code Sec. 15-105.2

The Maryland Medical Assistance Program will reimburse for medically necessary consultation services rendered by an approved consulting provider.

Eligible Distant Site Providers:
• Free standing renal dialysis centers
• Federally Qualified Health Centers
• Hospitals, including EDs
• Local health departments
• Nursing facilities
• Physicians
• Nurse practitioners
• Nurse midwives

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 4-6 & Code of Maryland Admin. Regs. Sec. 10.09.49.05-07.

Using “Hub-and-Spoke” models, providers mutually approved by DHMH will engage in agreements to both deliver care and bill Medicaid for approved telemedicine services, using fee-for-service reimbursement practices.

Source: Telemedicine Provider Information. MD Department of Health and Mental Hygiene. Oct. 1, 2014. (Accessed Jul. 2015).

Managed Care
MCOs shall provide coverage for medically necessary telemedicine services.

Source: Code of Maryland Admin. Regs. Sec. 10.09.67.31.

Mental Health
Maryland Medicaid will reimburse for telemental health services.

A distant site provider must be a psychiatrist with either

STATE LAW/REGULATIONS MEDICAID PROGRAM
a Medicaid provider number or is a psychiatrist in an FQHC or outpatient mental health clinics. The distant site must be in Maryland.

Eligible services:
• Psychiatric diagnostic interview examination
• Individual psychotherapy
• Pharmacologic management

Both the distant and originating telemedicine providers must submit an application to the Maryland Mental Health Administration describing how the originating and distant site will comply with relevant regulations.

The originating site may bill for a “tele-presenter” if it is medically necessary.

Source: MD Department of Health and Mental Hygiene, Maryland Value Options, Provider Alert. Telemental Health. July 12, 2011 p.
2. (Accessed Jul. 2015).
Store and Forward Reimbursement
No reimbursement based upon definition of “telemedicine” which describes telemedicine as “interactive”.

Source: MD Insurance Code Annotated Sec. 15-139 (2012).

The department may provide reimbursement for services delivered through store and forward technology.

Source: Health General Code 15-105.2. Maryland Medicaid does not cover store and forward.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 6 (Accessed Jul. 2015) & Code of Maryland Admin. Regs. Sec. 10.09.49.11.

Providers of health care services delivered through telemedicine must use video and audio transmission with less than a 300 millisecond delay.

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.08.
Remote Patient Monitoring Reimbursement
The department may provide reimbursement for services delivered through remote patient monitoring technology.

Source: Health General Code 15-105.2. No reimbursement for home health monitoring services.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 6 (Accessed Jul. 2015) & Code of Maryland Admin. Regs. Sec. 10.09.49.11.
Email/Phone/FAX
No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: MD Insurance Code Annotated Sec. 15-139 (2012) & Health General Code 15-105.2. No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p.
6. (Accessed Jul. 2015) & Code of Maryland Admin. Regs. Sec. 10.09.49.11.
Online Prescribing
A physician-patient relationship can be established through real time auditory communications or real-time visual and auditory communications. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: Code of Maryland Admin. Regs. Sec. 10.32.05.02
Consent
Telehealth providers must inform patients and consultants of the following:

• The inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in-person service delivery;
• The knowledge, experiences, and qualifications of the consultant providing data and information to the provider of the telehealth services need not be completely known to and understood by the provider;
• The quality of transmitted data may affect the quality of services provided by the provider;
• That changes in the environment and test conditions could be impossible to make during delivery of telehealth services;

Telehealth services may not be provided by correspondence only.

Source: Code of MD Reg., 10.41.06.04 (2012).

Except when providing interpretive services, the physician must obtain and document patient consent.

Source: Code of Maryland Admin. Regs. Sec. 10.32.05.06 Consent is required unless there is an emergency.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 5 (Accessed Jul. 2015) & Code of Maryland Admin. Regs. Sec. 10.09.49.06.
Location
No reference found. Eligible originating sites:
• Free standing renal dialysis centers
• Federally Qualified Health Centers
• Hospitals, including EDs
• Local health departments
• Nursing facilities
• Physicians
• Nurse practitioners
• Nurse midwives

Originating sites must be approved. MD hospitals will only be approved as originating sites if a specialist is not available to provide timely consultation and diagnostic evaluation.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 4 (Accessed Jul. 2015).

Distant site provider must be located within the State, the District of Columbia, or a contiguous state.

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.07.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Mental Health
Originating sites are limited to outpatient mental health clinics (OMHC), hospitals and FQHCS in designated rural geographic areas.

A distant site provider must be a psychiatrist with either a Medicaid provider number or is a psychiatrist in an FQHC or OMHC. The distant site must be in Maryland.

Source: MD Department of Health and Mental Hygiene, Maryland Value Options, Provider Alert. Telemental Health. July 12, 2011 p. 1-2. (Accessed Jul. 2015).
Cross-State Licensing
MD has exceptions to its MD-only licensed physicians for physicians practicing in the adjoining states of Delaware, Virginia, West Virginia, and Pennsylvania.

Source: MD Health Occupations Code Annotated Sec. 14-302 (2012).

A physician providing services through telemedicine must have a Maryland license if they are located in Maryland, or if the patient is in Maryland.

Source: COMAR 10.32.05.03 Originating site providers can engage in agreements with distant site providers in Maryland, the District of Columbia, or a contiguous state for telemedicine consultation services.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p.
4. (Accessed Jul. 2015).
Private Payers
Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: MD Insurance Code Annotated Sec. 15-139 (2012). No reference found.
Site/Transmission Fee
No reference found. Originating sites are eligible for:
• A transaction fee; or
• If the originating site is a hospital, the appropriate revenue code; and
• If the originating site is an out-of-state hospital, a telemedicine transaction fee.

Source: MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 6 (Accessed Jul. 2015) & Code of Maryland Admin. Regs. Sec. 10.09.49.05.

Mental Health
The originating site is eligible for a facility fee.

Source: MD Department of Health and Mental Hygiene, Maryland Value Options, Provider Alert. Telemental Health. July 12, 2011 p.
4. (Accessed Jul. 2015).
Miscellaneous

Comments: The Maryland Health Care Commission has a Telemedicine Task Force to study the use of telehealth throughout the State.

Program Administrator: Michigan Dept. of Community Health

Regional Telehealth Resource Center: Upper Midwest Telehealth Resource Center 2901 Ohio Boulevard, Ste. 110
Terre Haute, IN 47803 (855) 283-3734 ext. 232
www.umtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine, the health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system, and the patient must be able to interact with the off-site health care professional at the time the services are provided.”

Source: MI Compiled Law Svcs. Sec. 500.3476 (2012). “Telemedicine is the use of telecommunication technology to connect a patient with a health care professional in a different location.”

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1503 (Jul. 1, 2015) & MI Department of Community Health Bulletin Telemedicine. Aug. 30, 2013. (Accessed Jul. 2015).

Speech-Language and Audiology Services “Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of speech-language and audiology services. Telepractice must be obtained through real-time interaction between the patient’s physical location (patient site) and the provider’s physical location (provider site).”

Source: MI Medical Services Administration Bulletin. MSA 15-22. School based services providers and billing agents. 7/1/15. (Accessed Jul. 2015).
Live Video Reimbursement
Michigan law states that “contracts shall not require face-to-face contact between a health care professional
and a patient for services appropriately provided through telemedicine”, which includes live video.

Source: MI Compiled Law Services Sec. 500.3476 (2012).

(See “Private Payers” section). Michigan Medicaid reimburses for the following services categories via live video:

• Inpatient Consults;
• Office or other outpatient consults
• Office or other outpatient services
• Psychiatric diagnostic procedures
• Subsequent hospital care
• Training services, diabetes
• End stage renal disease (ESRD) related services. However, there must be at least one in-person visit per month, by a physician, nurse practitioner, or physician’s assistant, to examine the vascular site for ESRD services.
• Behavior change intervention, individual
• Behavior health and/or substance abuse treatment services
• Education service, telehealth

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Nursing facility subsequent care

The initial visit for nursing facility services must be face- to-face.

Where face-to-face visits are required, telemedicine services may be used in addition to the required face-to- face visit, but cannot be used as a substitute.

• Physicians and practitioners are eligible to be distant site providers. Providers at the distant site can only bill services listed in the telemedicine services database.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1505 (Jul. 1, 2015) & MI Department of Community Health Bulletin Telemedicine. Aug. 30, 2013. (Accessed Jul. 2015).

Speech-Language and Audiology Services
MI Medicaid will reimburse for speech language and audiology services provided through their school based program.

The patient site may be located within the school, at the patient’s home or any other established site deemed appropriate by the provider.

Source: MI Medical Services Administration Bulletin. MSA 15-22. School based services providers and billing agents. 7/1/15. (Accessed Jul. 2015).
Store and Forward Reimbursement
No reimbursement based upon definition of “telemedicine” which describes telemedicine as occurring in “real time.

Source: MI Compiled Law Svcs. Sec. 500.3476 (2012). Michigan Medicaid does not reimburse for store and forward based upon the definition of telemedicine which describes telemedicine as occurring in “real time” and the patient’s ability to see and interact with the “off-site” practitioner at the time services are being provided.

Telecommunication systems using store and forward technology are not included in MI Medicaid’s telemedicine policy.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1503 (Jul. 1, 2015).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX Restrictions
No reference found. No reference found.
Online Prescribing
Providers must have an existing physician-patient relationship.

Source: MI Compiled Laws Sec. 333.17751 (2012). No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Consent
No reference found. No reference found.
Location
No reference found. Eligible originating sites:

• County mental health clinics or publicly funded mental health facilities;
• Federally Qualified Health Centers;
• Hospitals (inpatient, outpatient, or Critical Access Hospitals);
• Physician or other providers’ offices, including medical clinics;
• Hospital-based or CAH-based Renal Dialysis Centers;
• Rural Health Clinics;
• Skilled nursing facilities;
• Tribal Health Centers.

Source: MI Dept. of Community Health, Medicaid Provider Manual, p. 1504 (Jul. 1, 2015) & MI Department of Community Health Bulletin Telemedicine. Aug. 30, 2013. (Accessed Jul. 2015).

Speech-Language and Audiology Services
The patient site may be located within the school, at the patient’s home or any other established site deemed appropriate by the provider for reimbursement in their school based program.

Source: MI Medical Services Administration Bulletin. MSA 15-22. School based services providers and billing agents. 7/1/15. (Accessed Jul. 2015).
Cross-State Licensing
No reference found. No reference found.
Private Payers
Contracts shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health maintenance organization. Telemedicine services shall be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the contract.

Source: MI Compiled Law Services Sec. 500.3476 (2012). No reference found.
Site/Transmission Fee
No reference found. Originating site may bill for a facility fee.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1504 (Jul. 1, 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
Miscellaneous
No reimbursement for remote access for surgical procedures, and use of robotics.

Source: Dept. of Community Health, Medicaid Provider Manual, p. 1503 (Jul. 1, 2015).

Program Administrator: Mississippi Division of Medicaid

Regional Telehealth Resource Center: South Central Telehealth Resource Center 4301 W. Markham St. #519
Little Rock, AR 72205 (855) 664-3450
learntelehealth.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine is the practice of medicine using electronic communication, information technology or other means between a physician in one location and a patient in another location with or without an intervening health care provider. This definition does not include the practice of medicine through postal or courier services.”

Source: Code of MS Rules 50-013-2635 (2012).

Telemedicine means the delivery of health care services such as diagnosis, consultation, or treatment through the use of interactive audio, video or other electronic media. Telemedicine must be “real-time” consultation, and it does not include the use of audio-only telephone, e-mail or facsimile.

Source: MS Code Sec. 83-9-351. The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which includes, but is not limited to, telehealth services, remote patient monitoring services, teleradiology services, store-and-forward and continuous glucose monitoring services.

The Division of Medicaid defines telehealth services as the delivery of health care by an enrolled Medicaid provider, through a real-time communication method, to a beneficiary who is located at a different site. The interaction must be live, interactive, and audiovisual.

Source: Code of MS Rules 23-225, Rule. 1.1
Live Video Reimbursement
Mississippi Medicaid and private payers are required to provide coverage for live video consultations.

Source: MS Code Sec. 83-9-351.

(also see Medicaid column) There is live video reimbursement for Medicaid mental health medication evaluation and management.

Source: Code of MS Rules 23-206, Rule. 1.9, pg. 28.

Any enrolled Medicaid provider may provide telehealth services at the originating site. The following enrolled Medicaid providers may provide telehealth services at the distant site:

• Physicians,
• Physician assistants,
• Nurse practitioners,
• Psychologists, and
• Licensed Clinical Social Workers (LCSW).

Source: Code of MS Rules 23-225, Rule. 1.2(C).
Store and Forward Reimbursement

STATE LAW/REGULATIONS MEDICAID PROGRAM
Private payers, MS Medicaid and employee benefit plans are required to provide coverage at the same level as in-person consultation for store-and-forward telemedicine services.

A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.

Patients receiving medical care through store and forward must be notified of their right to receive interactive communication with the distant site provider. Telemedicine networks unable to offer this will not be reimbursed for store and forward telemedicine services.

Source: MS Code Sec. 83-9-353. There is reimbursement for tele-radiology services, however there is no reference to reimbursing for other specialties.

Source: Mississippi Division of Medicaid. Radiology Services Provider Reference Guide, pg. 4-5. March 2013. (Accessed Jul. 2015).

MS Medicaid is required to cover store and forward services to the same level as in-person services.

Source: MS Code Sec. 83-9-353.

(see State law/regulation column)

Source: MS Senate Bill 2646.
Remote Patient Monitoring Reimbursement
Private payers, MS Medicaid and employee benefit plans are required to provide coverage for remote patient monitoring services for Mississippi-based telehealth programs affiliated with a Mississippi health care facility.

A onetime telehealth installation/training fee is also reimbursed.

A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.

To qualify for reimbursement patients must meet all of the following criteria:
• Be diagnosed in the last 18 months with one or more chronic condition, as defined by CMS.
• Have a recent history of costly services; and
• The patient’s healthcare provider recommends disease management services via remote patient monitoring.

Remote patient monitoring prior authorization request form must be submitted to request telemonitoring services.

The law lists specific technology requirements.

Source: MS Code Sec. 83-9-353. MS Medicaid is required to cover remote patient monitoring services. (see State law/regulation column)

Source: MS Code Sec. 83-9-353.

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:

• Implantable pacemakers,
• Defibrillators,
• Cardiac monitors,
• Loop recorders, and
• External mobile cardiovascular telemetry.

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:

• Has been diagnosed with one (1) or more of the following chronic conditions of diabetes, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD);
• Has had two (2) or more hospitalizations in the previous twelve (12) months for one (1) of the chronic conditions listed above;
• Hospitalizations for two (2) different chronic conditions cannot be combined to satisfy the two (2) or more hospitalizations requirement; and
• Is capable of using the remote patient monitoring equipment and transmitting the

STATE LAW/REGULATIONS MEDICAID PROGRAM
necessary data or has a willing and able person to assist in completing electronic transmission of data.

Remote patient monitoring services must be provided in the beneficiary’s private residence.

Source: Code of MS Rules 23-225, Rule. 2.3.

The Division of Medicaid reimburses for remote patient monitoring:
• Of devices when billed with the appropriate code, and
• For disease management:
• A daily monitoring rate for days the beneficiary’s information is reviewed.
• Only one (1) unit per day is allowed, not to exceed thirty-one (31) days per month.
• An initial visit to install the equipment and train the beneficiary may be billed as a set-up visit. Only one set-up is allowed per episode even if monitoring parameters are added after the initial set-up and installation.
• Only one (1) daily rate will be reimbursed regardless of the number of diseases/chronic conditions being monitored.

Source: Code of MS Rules 23-225, Rule. 2.5.
Email/Phone/FAX
No Email No Phone No Fax

Source: MS Code Sec. 83-9-351. No reimbursement for email.
No reimbursement for telephone. No reimbursement for facsimile.

Source: Code of MS Rules 23-225, Rule. 1.4(C).

Home and Community-Based Services & Hospice Services
MS Medicaid does not cover telephone consults.

Source: Mississippi Medicaid Provider Reference Guide, Home and Community-Based Services, Mar. 2013, pg. 1; Hospice Services, Jan. 2013, pg. 1; Family Planning Services, Jan. 2013, pg. 2. (Accessed. Jul. 2015).
Online Prescribing
A prescription for a controlled substance based solely on a consumer’s completion of an online medical questionnaire is not a valid prescription.

Source: MS Code Annotated Sec. 41-29-137 (2012).

A health care practitioner may prescribe medication after an appropriate examination through the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. An e-prescribed, telephoned or faxed prescription from the prescriber may be accepted when it is not in conflict with federal and state laws and regulations.

Source: MS. Code Ann.23-214, Rule 1.7 & Mississippi Medicaid Provider Reference Guide, Pharmacy Services, Jul. 2014, pg. 29. (Accessed. Jul. 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: MS Code Sec. 83-9-351.

Consent
The physician should obtain the patient’s informed consent before providing care.

Source: Code of MS Rules 50-013-2635 (2012). No reference found.
Location
No reference found. No reference found.
Cross-State Licensing
Physicians practicing telemedicine must have a Mississippi medical license.

However, a valid Mississippi license is not required where the evaluation, treatment and/or medicine given by a physician outside of Mississippi is requested by a physician duly licensed to practice medicine in Mississippi, and the physician who has requested such evaluation, treatment and/or medical opinion has already established a doctor/patient relationship with the patient to be evaluated and/or treated.

In order to practice telemedicine a valid “physician patient relationship” must be established. The elements of this valid relationship are:

1. verify that the person requesting the medical treatment is in fact who they claim to be;
2. conducting an appropriate examination of the patient that meets the applicable standard of care;
3. establishing a diagnosis through the use of accepted medical practices, i.e., a patient history, mental status exam, physical exam and appropriate diagnostic and laboratory testing;
4. discussing with the patient the diagnosis, risks and benefits of various treatment options to
obtain informed consent;
5. insuring the availability of appropriate follow-up care; and
6. maintaining a complete medical record available to patient and other treating health care providers.

Source: Code of MS Rules 50-013-2635 (2012). No reference found.
Private Payers
Health insurance plans must provide coverage for telemedicine services to the same extent as in-person consultations.

Source: MS Code Sec. 83-9-351.
No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Health insurance plans are also required to provide coverage for store-and-forward and remote patient monitoring services, in accordance with certain requirements (see above store and forward & remote patient monitoring sections).

Source: MS Source: MS Code Sec. 83-9-353.
Site/Transmission Fee
The originating site is eligible to receive a facility fee.

Source: MS Code Sec. 83-9-351 Source: MS Code Sec. 83-9-353. The Division of Medicaid reimburses the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission.

The following enrolled Medicaid providers are eligible to receive the originating site facility fee for telehealth services per transmission:

• Office of a physician or practitioner,
• Outpatient hospital, including a Critical Access Hospital (CAH),
• Rural Health Clinic (RHC),
• Federally Qualified Health Center (FQHC),
• Community Mental Health/Private Mental Health Center,
• Therapeutic Group Home,
• Indian Health Service Clinic, and
• School-based clinic.

The telepresenter must be one of the following and physically present at all times for the originating site to receive the originating site facility fee:
• Physician,
• Physician assistants,
• Nurse practitioners,
• Psychologists, and
• Licensed clinical social workers (LCSW).

Source: Code of MS Rules 23-225, Rule. 1.5(B).
Miscellaneous
To practice telemedicine, physicians must establish a valid physician-patient relationship by the following:

• Verifying the identity of the patient;
• Conducting an appropriate exam that meets the applicable standard of care. This exam need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face;
• Establishing a diagnosis;
• Discussing with the patient the diagnosis, and the risks and benefits of various treatment options, to obtain informed consent;

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Insuring the availability of appropriate follow-up care;
• Maintaining a complete medical record.

Source: Code of MS Rules 50-013-2635 (2012).

A health insurance plan may limit coverage to health care providers in a telemedicine network approved by the plan.

Source: MS Code Sec. 83-9-351.

Regional Telehealth Resource Center:
Great Plains Telehealth Resource and Assistance Center University of Minnesota/Institute for Health Informatics 330 Diehl Hall
505 Essex Street S.E.
Minneapolis, MN 55455
(888) 239-7092
www.gptrac.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care practitioner in the diagnosis or treatment of a patient. Telehealth includes services originating from a patient’s home or any other location where such patient is located, asynchronous services involving the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care practitioner at another site for medical evaluation, and telemonitoring.

Source: NE Rev. Statute, 71-8503. (LB 1076) & LB 257 (2015).

Telehealth consultation means any contact between a patient and a health care practitioner relating to the health care diagnosis or treatment of such patient through telehealth.

Source: NE Rev. Statute, 71-8503. (LB 1076) Telehealth is a Medicaid-covered service delivered by a health care practitioner that utilize an interactive audio and video telecommunications system that permits real- time communication between the health care practitioner at the distant site and the client at the originating site. Telehealth services do not include a telephone conversation, electronic mail message, facsimile transmission between a health care practitioner and a client, a consultation between two health care practitioners and asynchronous “store and forward” technology.

Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider Handbook, Manual Letter 63-2014
Live Video Reimbursement
(see Medicaid column)
For managed care plans who contract with the Department, in-person contact is not required for reimbursable services only to the extent that:

• Services delivered via telehealth are covered and reimbursed under the fee-for-service program and
• Managed care contracts are amended to add coverage of services delivered via telehealth

Telehealth services are not covered if a child has access to a comparable service within 30 miles of his/her place of residence.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Exceptions to this requirement:
• Children receiving behavioral health services. Reimbursement shall, at a minimum, be set at the same
rate as a comparable in-person consult and the rate must not depend on the distance between the health care practitioner and the patient.

NB Medicaid requires providers to be specifically enrolled as a telehealth site with Medicaid to bill for a telehealth services.

A safety plan must be developed for clients, (except children receiving behavioral health services).

Source (authorization and reimbursement): NE Revised Statutes Sec. 71-8506 (2012).
Source (exceptions to 30-mile rule): NE Admin. Code Title 471, Ch. 1.
Source: Physician Provider Handbook, Manual Letter 63-2014 Source (Children’s behavioral health): LB 556 (Recently passed,
effective Aug. 30, 2013).

Federally Qualified Health Centers & Rural Health Clinics
FQHC & RHC core services provided via telehealth are not covered under the encounter rate.

Source: NE FQHC Provider Handbook, Manual Letter 11-2010 Source: NE RHC Provider Handbook, Manual Letter 11-2010

Children’s Behavioral Health
A trained staff member must be immediately available to a child receiving telehealth behavioral health service. This requirement may be waived by a legal guardian.

Source: Revised Statutes of NE. Sec. 71-8506.

Assertive Community Treatment (ACT)

ACT Team Interventions may be provided via telehealth when provided according to certain regulations.

Source: NE Mental Health & Substance Abuse Provider Handbook, Ch. 32 Mental Health and Substance Abuse Treatment Services for Children and Adolescents, Manual Letter 89-2008
Store and Forward Reimbursement
(see Medicaid column) Nebraska Medicaid will reimburse for tele-radiology when it meets the American College of Radiology standards for tele-radiology. There is no other reference to reimbursing for other specialties.

Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider Handbook, Manual Letter 63-2014.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
(see Medicaid column) No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: NE Admin. Code Title 471, Ch. 1.
Online Prescribing
Prescribing drugs to individuals the physician has never met, based solely on answers to questions provided by the internet, telephone, or FAX, or without first establishing a proper physician-patient relationship, is prohibited.

Source: NE Admin. Code Title 172, Ch. 88.

(also see Medicaid column) Prescriptions over the Internet: Neither the prescribing health care practitioner service nor the pharmacy service is covered when the health care practitioner prescribing the medication has only reviewed an e-mail message or e-mail questionnaire about the client.

Source: NE Admin. Code Title 471, Ch. 1.
Consent
Written patient consent required prior to any service delivery.

Source: NE Revised Statutes Sec. 71-8505 (2012).

(also see Medicaid column) Written or email consent required before initial service delivery. Must include this information:

• The patient may refuse the service at any time with no loss of future treatment or program benefits patient is otherwise entitled to;;
• A list of alternative care options, including in- person services;
• Confidentiality protections;
• Patient access to all medical information from the consult;
• Prior consent for dissemination of any client- identifiable images or information from the consult;
• Patient shall be informed of all parties present at both ends of the consult, and the patient may exclude anyone from either site;
• The patient may see an appropriately trained staff or employee in person immediately after the consult, or be informed ahead of time that this is not available.

Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider Handbook, Manual Letter 63-2014
Location
Telehealth Site means either a health care facility enrolled with Medicaid and licensed under Neb. Rev. Stat. Section 71-2017 to 71-2029, and effective January 1, 2001, licensed under the Health Care Facility Act or a health care practitioner facility whose practitioners are

STATE LAW/REGULATIONS MEDICAID PROGRAM
enrolled with Medicaid and credentialed under the Uniform Licensing Law.

Source: NE Dept. of Health and Human Svcs., Title 471 NE Medical Assistance Svcs., p. 18 (July 11, 2009) & Physician Provider Handbook, Manual Letter 63-2014.

Telehealth services are not covered if the patient has access to a comparable service within 30 miles of his/her place of residence.

Exceptions to this requirement:

• Emergency or urgent medical situations;
• When accessing in-person services at less than 30 miles poses a significant hardship on the patient, due to a medical condition or disability;
• Nursing facility patients who require transportation via ambulance.
• Recently Passed Legislation: Children receiving behavioral health services.

Source (exceptions to 30-mile rule): NE Admin. Code Title 471, Ch. 1.
Source (Children’s behavioral health): LB 556 (Recently passed, effective Aug. 30, 2013)

Out-of State Telehealth Services are covered:

• When the distant site is located in another state and the originating site is located in Nebraska if requirements are met.
• When the Nebraska client is located at an originating site in another state, whether or not the provider’s distant site is located in or out of Nebraska if certain requirements are met.

Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider Handbook, Manual Letter 63-2014
Cross-State Licensing
No reference found. Health care practitioners must be appropriately licensed, certified or registered by Nebraska.

Source: Physician Provider Handbook, Manual Letter 63-2014
Private Payers
Recently Passed Legislation (Effective Aug. 29, 2015)
Private payers and self-funded employee benefit plans must provide, upon request, a description of the telehealth and telemonitoring services covered under the relevant policy. The description must include:
• Description of services in telehealth and telemonitoring;
• Exclusions or limitations (including limitation on No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
transmission costs);
• Requirements for licensing status;
• Requirements for signed written consent.

Source: LB 257 (2015).
Site/Transmission Fee
(see Medicaid column) Medicaid coverage of transmission costs is available.

Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider Handbook, Manual Letter 63-2014.

Federally Qualified Health Centers & Rural Health Clinics
Telehealth transmission cost related to non-core services will be the lower of:
• The provider’s submitted charge; or
• The maximum allowable amount

Source: NE FQHC Provider Handbook, Manual Letter 11-2010 Source: NE RHC Provider Handbook, Manual Letter 11-2010

Managed Care
Telehealth transmission is covered as a part of the behavioral health benefits package.

Source: NE Admin. Code Title 482, 5-004.
Miscellaneous
The University of Nebraska Medical Center is required to create the Behavioral Health Screening and Referral Pilot Program which will include telehealth behavioral health consultations between university and three clinics.

Source: Revised Statutes of NE. Sec. 71-8506 (sunsets Aug. 30, 2015).

Program Administrator: Dept. of Health and Human Services

Regional Telehealth Resource Center: Northeast Telehealth Resource Center 11 Parkwood Drive
Augusta, ME 04330
(207) 622-7566 / (800) 379-2021
www.netrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine, as it pertains to the delivery of health care services, means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Telemedicine does not include the use of audio-only telephone or facsimile.”

Source: NH Revised Statutes Annotated, 415-J: 2 (2012). ”Telehealth services” and the term “telemedicine” shall comply with 42 C.F.R. section 410.78 and the Centers for Medicare and Medicaid Services requirements.

Source: NH Bill SB 112 (2015).
Live Video Reimbursement
New Hampshire statute states that insurers may not deny coverage for services provided through telemedicine, which includes live video.

Source: NH Revised Statutes Annotated, 415-J: 3 (2012).

(See “Private Payers” section). Limited reimbursement for some live video services. NH Medicaid follows the reimbursement policies of Medicare.

Providers who may receive reimbursement:
• Physician
• Nurse practitioner
• Clinical nurse specialist
• Nurse-midwife
• Clinical psychologist
• Clinical social worker
• Registered dietitian or specified nutrition professional

Source: NH Bill SB 112 (2015).
Store and Forward Reimbursement
No reference found. No reimbursement for store-and-forward.

Source: NH Bill SB 112 (2015).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found for email. No reimbursement for email.

STATE LAW/REGULATIONS MEDICAID PROGRAM
No reimbursement for telephone. No reimbursement for FAX.

Source: NH Revised Statutes Annotated, 415-J: 2 (2012). No reimbursement for telephone. No reimbursement for FAX.

Source: NH Bill SB 112 (2015).
Online Prescribing
A physician-patient relationship requires an in-person exam that may take place via a face-to-face 2-way real time interactive communication. Prescribing drugs to individuals without a physician-patient relationship is prohibited, except under the following conditions:

• Writing admission orders for a newly hospitalized patient;
• A patient of another provider for whom the prescriber is taking call;
• A prescription for a patient who has been examined by a physician assistant, nurse practitioner, or other licensed practitioner;
• Medication on a short-term basis for a new patient prior to the patient’s first appointment;
• When providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics.

It is unlawful to prescribe through telemedicine a controlled drug classified in schedule II through IV. A prescription of a non-opioid controlled drug classified in schedule II through IV via telemedicine shall be limited to certain practitioners and who are treating patients at a state designated community mental health center or a Substance Abuse and Mental Health Services Administration-certified state opioid treatment program, and shall require an initial in-person exam by a practitioner licensed to prescribe the drug.

Source: NH Revised Statutes Annotated, Sec. 329:1-c. Source: NH Bill SB 84 (2015). No reference found.
Consent
No reference found. No reference found.
Location
No reference found in statute. NH Medicaid follows Medicare telehealth reimbursement policies. Telehealth services may only be provided to NH Medicaid enrollees who are in a rural health professional shortage area or a county not in a Metropolitan Statistical Area.

Additionally, only certain health facilities may serve as an originating site:

Source: NH Bill SB 112 (2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM

Cross-State Licensing
No reference found. No reference found.
Private Payers
Insurers may not deny coverage for services provided through telemedicine, if the services are covered through in-person consults.

Source: NH Revised Statutes Annotated, 415-J: 3 (2012). No reference found.
Site/Transmission Fee
No reference found. No reference found.
Miscellaneous
A committee has been established to study and resolve barriers related to the use of telehealth technology in New Hampshire. The committee must report its findings by Nov. 1, 2014.

Source: NH Revised Statutes Annotated, 112:1 (HB 556).

Comments: As of December 1, 2013 New Hampshire Medicaid transitioned to a managed care model of administration, under three health plans. These plans each have their own telehealth coverage policy.

Source: Provider Quick Reference Guide. (Accessed Feb. 21, 2014).

Medicaid Program Administrator: New Mexico Human Services Dept., Medical Assistance Division (MAD)

Regional Telehealth Resource Center: Southwest Telehealth Resource Center PO Box 245105
Tucson, AZ 85724
(520) 626-4498
www.southwesttrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine means the practice of medicine across state lines.”

Source: NM Administrative Code, 16.10.2.7 (2012).

Telemedicine means the use of interactive simultaneous audio and video or store-and-forward technology using information and telecommunications technologies by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and- forward technology.

Source: NM Statute. 59A-22-49.3.

“The practice of medicine across state lines means the rendering of a written or otherwise documented medical opinion concerning diagnosis or treatment of a patient within this state, by a physician located outside this state, as a result of transmission of individual patient data by electronic, telephonic or other means from within this state, to the physician or the physician’s agent, OR the rendering of treatment to a patient within this state, by a physician located outside this state, as a result of transmission of individual patient data by electronic, telephonic or other means from within this state to the physician or the physician’s agent.”

Source: NM Statutes Annotated, 1978 Sec. 61-6-6 (2012).

“Telehealth means the use of electronic information, imaging and communication technologies, including interactive audio, video and data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education.”

Source: NM Statutes Annotated Sec. 24-1G-3 (2012). No reference found.

Live Video Reimbursement
New Mexico statute encourages the use and reimbursement of telehealth, which includes live video.

Source: NM Statutes Annotated, Sec. 24-25-5 (2012).

Private payers are required to provide coverage for services delivered through live video, equivalent to in- person coverage.

Source: NM Statute. 59A-22-49.3.

(also see Medicaid column) New Mexico Medicaid will reimburse for live video at the same rate as when the services are furnished without the use of a telecommunication system.

Source: NM Administrative Code 8.310.2.

Telemedicine is also covered by NM Managed Care.

Source: NM Medical Assistance Division Managed Care Policy Manual. Aug. 15, 2014.

Alternative Benefits Program & Managed Care Program

The benefits package includes telemedicine services.

Source: NM Admin Code Sec. 8.309.4.16 & 8.308.9.18.

School-based services provided via telemedicine are covered.

Source: NM Administrative Code 8.320.6.13(H).
Store and Forward Reimbursement
New Mexico Statute defines telehealth as encompassing Store and Forward.

Source: NM Statutes Annotated Sec. 24-1G-3 (2012).

Private payers are required to provide coverage for services delivered through store and forward, equivalent to in-person coverage.

Source: NM Statute. 59A-22-49.3. New Mexico Medicaid does reimburse for store and forward. To be eligible, the service must be provided through the transfer of digital images, sounds, or previously recorded video from one location to another. It does not need to occur in real time.

Source: NM Administrative Code 8.310.2.
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX Restrictions
No reference found. No reference found.
Online Prescribing
Physicians are prohibited from prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship.

This includes prescribing over the Internet, or via other electronic means, based solely on an online questionnaire.

Physicians may prescribe online during a live video exam. The prescribing physician must:

• Obtain a medical history;
• Obtain informed consent; No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Generate a medical record;
• A physical exam is recorded as appropriate by the telehealth practitioner or a practitioner such as a physician, advance practice nurse, or physician or anesthesiologist assistant; or the exam is waived when a physical exam would not normally be part of a typical physical face- to-face encounter with the patient for the services being provided.

Source: NM Statutes Annotated, 1978 Sec. 61-6-20(B).
Consent
No reference found. No reference found.
Location
No reference found. An interactive telehealth communication system must include both interactive audio and video, and be delivered on a real-time basis at both the originating and distant sites.

The originating site can be any medically warranted site.

Source: NM Administrative Code 8.310.2.
Cross-State Licensing
NM issues telemedicine licenses to providers who hold a full, unrestricted license in another state and has good moral character.

Source: NM Statutes Annotated, 1978 Sec. 61-6-11.1 (Sunset date of July 1, 2016) and 16.10.2.11. When the originating site is in New Mexico and the distant site is outside New Mexico, the distant-site provider at the distant site must be licensed in New Mexico for telemedicine, or meet federal requirements for Indian Health Service or tribal contract facilities.

Source: NM Administrative Code 8.310.2.
Private Payers
Private payers are required to provide coverage for services delivered through telemedicine, consistent with in-person coverage.

Source: NM Statute. 59A-22-49.3. No reference found.
Site/Transmission Fee
Indian Health Services
A telemedicine facility fee is paid. Both the originating and distant sites may be IHS or tribal facilities with two different locations, or a distant site can be under contract to the IHS or tribal facility.

Source: NM Administrative Code 8.310.12.12. Reimbursement is made to the originating site for an interactive telehealth system fee at the lesser of the following:

• Provider’s billed charge;
• Maximum allowed by MAD for the specific service or procedure.
• A telemedicine originating-site communication fee is also covered if the eligible recipient was present at and participated in the telemedicine visit at the originating site.

Source: NM Administrative Code 8.310.2.

STATE LAW/REGULATIONS MEDICAID PROGRAM

An originating site facility fee is not payable if telemedicine is used to connect an employee or staff member of a facility to the eligible recipient being seen at the same facility.

Source: NM Register. Volume XXV, No. 20. Oct. 30, 2014.
Miscellaneous

Comment: New Mexico offers out of state providers a “telemedicine license” to practice within its borders.

New Mexico is also the home of Project ECHO. The project’s mission is to develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas, and to monitor outcomes of this treatment utilizing technology.

Medicaid Program Administrator: Dept. of Health and Human Services, Division of Medical Assistance

Regional Telehealth Resource Center: Mid-Atlantic Telehealth Resource Center PO Box 800711
Charlottesville, VA 22908-0711
(434) 906-4960 / (855) MATRC4U
www.matrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine is the use of two-way real-time interactive audio and video between places of lesser and greater medical capability or expertise to provide and support health care, when distance separates participants who are in different geographical locations.”

Source: NC General Statute 130A-125 “Telemedicine is the use of two-way real-time interactive audio and video between places of lesser and greater medical capability or expertise to provide and support health care, when distance separates participants who are in different geographical locations.”

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 3, Nov. 15, 2013.
Live Video Reimbursement
The Commission is required to address follow up protocols to ensure early treatment for newborn infants diagnosed with congenital heart defects, to include telemedicine (live video).

Source: NC General Statute 130A-125 North Carolina Medicaid will reimburse for live video medical services and tele-psychiatry services.

Eligible medical providers:

• Physicians;
• Nurse practitioners;
• Nurse midwives;
• Physician’s assistants.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 6, Nov. 15, 2013.

Eligible tele-psychiatry providers:

• Physicians;
• Advanced practice psychiatric nurse practitioners;
• Advanced practice psychiatric clinical nurse specialists;
• Licensed psychologists Ph.D. level;
• Licensed clinical social workers (LCSW);
• Community diagnostic assessment agencies.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 6, Nov. 15, 2013.

STATE LAW/REGULATIONS MEDICAID PROGRAM
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.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 3, Nov. 15, 2013.

Providers must obtain prior approval from NC Medicaid for all services delivered via telemedicine and tele- psychiatry. Providers must submit:

• Prior approval request;
• All health records and any other records to document that the patient has met the specific criteria for telemedicine services;
• If the patient is under age 21, information supporting that all Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) criteria are met, and evidence-based literature supporting the request, if available.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 5, Nov. 15, 2013.

Store and Forward Reimbursement
No reference found. North Carolina Medicaid will not reimburse for Store and Forward.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 7, Nov. 15, 2013.

Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX Restrictions
No reference found. No reimbursement for email.
No reimbursement for telephone. No reimbursement FAX.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 7, Nov. 15, 2013.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Online Prescribing
No reference found. No reference found.
Consent
No reference found. No reference found.
Location
No reference found. No reimbursement if:

• The recipient is located in a jail, detention center, or prison;
• The consulting provider is not a Medicaid-enrolled provider;
• The consulting provider is not located in North Carolina or within the 40 miles radius.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 7, Nov. 15, 2013.

Cross-State Licensing
No reference found. No reference found.
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. Originating-site provider facility fees paid to:

• Physicians;
• Nurse practitioners;
• Nurse midwives;
• Advanced practice psychiatric nurse practitioners;
• Advanced practice psychiatric clinical nurse specialists;
• Licensed psychologists (Ph.D. level);
• Licensed clinical social workers (LCSW);
• Physician’s assistants;
• Hospitals (inpatient or outpatient)
• Federally Qualified Health Centers;
• Rural Health Clinics;
• Local health departments;
• Local Management Entities.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 9, Nov. 15, 2013.

No facility fees for distant-site providers.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 4, Nov. 15, 2013.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Miscellaneous
The Office of Rural Health and Community Care shall oversee and monitor the establishment of a statewide telepsychiatry program.

Source: NC General Statutes Article 3, Ch. 143B, Sect. 12A.2B.(b)

Medicaid Program Administrator: Ohio Department of Job and Family Services

Regional Telehealth Resource Center: Upper Midwest Telehealth Resource Center 2901 Ohio Boulevard, Ste. 110
Terre Haute, IN 47803 (855) 283-3734 ext. 232
www.umtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“The practice of telemedicine means the practice of medicine in this state through the use of any communication, including oral, written, or electronic communication, by a physician located outside this state.”

Source: OH Revised Code Annotated, 4731.296.

“Telehealth means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including, but not limited to physical therapy related information and services, over large and small distances.”

Source: OH Admin. Code 4755-27-01.

Telehealth service means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

Source: OH Revised Code, Sec. 5164.94.

Speech Language Pathology
Telehealth means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiology or speech-language pathology services to an individual from a provider through hardwire or internet connection.

Source: OH Admin. Code 4753-2-01 Telemedicine is the direct delivery of evaluation and management (E&M) or psychiatric services to a Medicaid eligible patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements.

Source: OH Medicaid Handbook Transmittal Letter No. 3334-15- 01. Jan. 2, 2015, pg. 6 & OH Admin. Code 5160-1.
Live Video Reimbursement
The department of Medicaid is required to establish standards for Medicaid payment for health care services the department determines are appropriate to be covered when provided as telehealth services.

Source: OH Revised Code, Sec. 5164.95. Ohio Medicaid covers live video telemedicine.

Eligible Distant Site Providers
• Physicians (MD, DO)
• Psychologists
• Federally Qualified Health Center (medical and

STATE LAW/REGULATIONS MEDICAID PROGRAM
Speech Language Pathology Telehealth may be delivered through live video.

Source: OH Admin. Code 4753-2-01 mental health)

Only resident modifiers will be accepted.

Providers are not eligible for payment when a Q3014 (facility fee) and a CPT code with a GQ modifier is submitted for the same patient, same date of service, and same provider.

See transmittal letter for list of eligible CPT codes.

Source: OH Medicaid Handbook Transmittal Letter No. 3334-15- 01, pg. 6-7. Jan. 2, 2015 & OH Admin Code 5160-1.

Ohio Medicaid will reimburse for live video for speech therapy services in the Medicaid School Program (MSP) when provided by speech-language pathologists.

Source: OH Dept. of Job and Family Svcs., Long Term Care Services and Supports Transmittal Letter (LTCSSTL) No. 11-15, (Oct. 19, 2011).
Store and Forward Reimbursement
Speech Language Pathology
Telehealth may be delivered through store and forward.

Source: OH Admin. Code 4753-2-01 Telemedicine is defined as being “synchronous, interactive, real-time”, excluding the use of store and forward technology.

Source: OH Medicaid Handbook Transmittal Letter No. 3334-15- 01. Jan. 2, 2015, pg. 6-7.
Remote Patient Monitoring Reimbursement
No reference found. The home is not an acceptable place of service for either an originating or distant site.

Source: OH Medicaid Handbook Transmittal Letter No. 3334-15- 01. Jan. 2, 2015, pg. 6-7.
Email/Phone/FAX
No reference found. Electronic mail, telephone and facsimile transmission are not telemedicine.

Source: OH Admin. Code 5160-1.
Online Prescribing
A physician shall not prescribe, dispense, or provide any dangerous drug, which is not a controlled substance, to a person who the physician has never personally physically examined and diagnosed.

Eligible exceptions:

• The physician is providing care in consultation with another physician, who has an ongoing professional relationship with the patient, and No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
who has agreed to supervise the patient’s use of the drug or drugs to be provided, and the physician’s care of the patient meets all applicable standards of care;
• In institutional settings;
• On-call situations;
• Cross-coverage situations;
• Situations involving new patients;
• Protocol situations;
• Situations involving nurses practicing in accordance with standard care arrangements.

Source: OH Admin. Code 4731-11-09.
Consent
Speech Language Pathology
A provider is required to inform the patient of specific telehealth limitations.

Source: OH Admin. Code 4753-2-01 The originating site is responsible for obtaining informed consent.

Source: OH Admin. Code 5160-1.
Location
No reference found. When the originating site is located within a five mile radius from the distant site, providers are not eligible for reimbursement.

Provider types eligible as an originating site, either using a Q3014 HCPCS code or a GQ modifier:
• Primary Care Clinic
• Outpatient Hospital
• Rural Health Clinic (Medical)
• Federally Qualified Health Clinic (Medical)
• Physician
• Professional Medical Group
• Podiatrist
• Optometrist
See transmittal letter for additional billing rules. Additional place of service restrictions:
• Inpatient hospital
• Nursing facility
• Inpatient psychiatric hospitals

Source: OH Medicaid Handbook Transmittal Letter No. 3334-15- 01. Jan. 2, 2015, pg. 6-7.
Cross-State Licensing
Ohio issues telemedicine certificates that allow the holder to engage in the practice of telemedicine in the state.

Providers with telemedicine certificates cannot practice in OH without a special activity certificate. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: OH Revised Code Annotated, Sec. 4731.296(C).

Physical Therapy
Physical therapists and physical therapist assistants must hold a valid OH physical therapy license to treat a patient located in Ohio via telehealth.

Source: OH Admin. Code 4755-27-01.
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. Originating site eligible for a facility fee using HCPCS code Q3014.

See transmittal letter for additional billing rules.

Source: OH Medicaid Handbook Transmittal Letter No. 3334-15- 01, pg. 5-6. Jan. 2, 2015 & OH Admin Code 5160-1.
Miscellaneous

Medicaid Program Administrator: Oregon Health Authority

Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center 2900 12th Ave. N., Ste. 30W
Billings, MT 59101
(888) 662-5601
www.nrtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth

“Telemedicine means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications.”

Source: OR Revised Statutes 442.015. “Telemedicine is the use of medical information, exchanged from one site to another, via telephonic or electronic communications, to improve a patient’s health status.”

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 68 (Mar. 10, 2015).
Live Video Reimbursement
(See “Private Payers” section) Oregon Medicaid will reimburse for live video when billed services comply with their billing requirements.

The referring provider is not required to be present with the client for the consult.

The referring provider may bill for the patient visit only if a separately identifiable visit is performed.

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 68-69 (Mar. 10, 2015).
Store and Forward Reimbursement
No reference found. No reference found.
Remote Patient Monitoring Reimbursement
Oregon requires out of state physicians to acquire active tele-monitoring status through the Oregon Medical Board before they can perform intraoperative tele- monitoring on patients during surgery.

The Administrative Code defines “tele-monitoring” as the “intraoperative monitoring of data collected during surgery and electronically transmitted to a physician who practices in a location outside of Oregon. The monitoring physician is in communication with the operation team through a technician in the operating room.”

Requirements: No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM

• The facility where the surgery is performed must be a licensed hospital or ambulatory surgical center;
• The facility must grant medical staff membership and/or clinical privileges to the monitoring physician;
• The monitoring physician must have OR active- tele-monitoring status.

Source: OR Admin. Rules. 847-008-0023.
Email/Phone/FAX
Yes for email.
Yes for telephone.
No reference found for FAX.

Email and telephone consults must comply with Health Service Commission guidelines.

Source: OR Admin. Rules 410-130-0610. Yes for email and telephone when used for patient consulting and “when billed services comply with the practice guidelines set forth by the Health Service Commission (HSC), applicable HSC approved CPT code requirements and delivered consistent with the HSC practice guideline.”

Email, telephone and fax may be used when videoconferencing availability is limited.

Source: OR Div. of Medical Assistance Programs, Medical- Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 69 (Mar 10,
2015).
Online Prescribing
Practicing Across State Lines
A physician must first:

• Establish a physician-patient relationship;
• Make a judgment based on some type of objective criteria upon which to diagnose, treat, correct or prescribe;
• Act in the best interest of the patient.

Writing prescriptions based only on an Internet sale or consults prohibited.

Source: OR Admin. Rules, 847-025-0000. No reference found.
Consent
No reference found. No reference found.
Location
Plans may not distinguish between originating sites that are rural and urban in providing coverage.

Source: OR Senate Bill 144 (2015); & Revised Statutes Sec. 743A.058. No reference found.
Cross-State Licensing
Out-of-state physicians may receive a license to practice across state lines in Oregon, as long as they are fully The referring and evaluating practitioner must be licensed to practice medicine within the state of Oregon

STATE LAW/REGULATIONS MEDICAID PROGRAM
licensed in another state and meet certain requirements.

Source: OR Revised Statutes Annotated Sec. 677.139.

(also see Medicaid column) or within the contiguous area of Oregon and must be enrolled as a Division of Medical Assistance Programs (Division) provider.

Source: OR Administrative Regulation 410-130-0610(2)(a) & Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 68 (Mar. 10, 2015).
Private Payers
Recently Passed Legislation (Effective Jan. 1, 2016)

Oregon requires coverage by health benefit plans and self insured health plans offered through the Public Employees’ Benefit Board or the Oregon Educators Benefit Board of health services that is provided using synchronous two-way interactive video conferencing, subject to contract terms and conditions.

Plans may not distinguish between originating sites that are rural and urban in providing coverage.

Source: OR Senate Bill 144 (2015); & Revised Statutes Sec. 743A.058.
A health benefit plan must provide coverage in connection with the treatment of diabetes if:

• If coverage is provided for in-person services
• The service is medically necessary;
• The service relates to a specific patient; and
• One of the participants in the telemedical health service is a representative of an academic health center.

Source: OR Revised Statutes Sec. 743A.185. No reference found.
Site/Transmission Fee
(see Medicaid column) Oregon Medicaid will provide transmission fees for originating sites.

Source: OR Admin. Regulation 410-130-0610(5) & OR Div. of Medical Assistance Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 69 (Mar. 10, 2015).
Miscellaneous

Comments: OR New Regulations Passed
Occupational Therapy (Source: OR Admin. Code 339-010-0006)

Medicaid Program Administrator: Rhode Island Dept. of Human Services

Regional Telehealth Resource Center: Northeast Telehealth Resource Center 11 Parkwood Drive
Augusta, ME 04330
(207) 622-7566 / (800) 379-2021
www.netrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
No reference found. No reference found.
Live Video Reimbursement
No reference found. No reference found.
Store and Forward Reimbursement
No reference found. No reference found.
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found. No reference found.
Online Prescribing
No reference found. No reference found.
Consent
No reference found. No reference found.
Location
No reference found. No reference found.
Cross-State Licensure
RI allows physicians who have a license in good standing in another state to consult with RI licensed physicians or provide teaching assistance.

Physicians not present in RI may not provide consultation to a patient without an established physician-patient relationship, unless that patient is in the physical presence of a physician licensed in RI.

Source: RI General Law, Sec. 5-37-14. No reference found.
Private Payers

STATE LAW/REGULATIONS MEDICAID PROGRAM
No reference found. No reference found.
Site/Transmission Fee
No reference found.

No reference found.

Miscellaneous

Medicaid Program Administrator: South Dakota Dept. of Social Services

Regional Telehealth Resource Center:
Great Plains Telehealth Resource and Assistance Center University of Minnesota/Institute for Health Informatics 330 Diehl Hall
505 Essex Street S.E.
Minneapolis, MN 55455
(888) 239-7092
www.gptrac.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telehealth services” is a home based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation.

Source: SD Regulation 67:40:18. “Telemedicine is the use of an interactive telecommunications system to provide two-way, real- time, interactive communication between a provider and a Medicaid recipient across a distance. The term telehealth and telemedicine are used interchangeably by South Dakota Medicaid.”

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 27 (July 2015).
Live Video Reimbursement
No reference found.

(also see Medicaid column) South Dakota Medicaid will reimburse for the following services at the same rate as in-person services:

• Patient office consultation
• Inpatient hospital consultation
• Pharmacologic management
• Office or other outpatient visit
• Diabetes outpatient self-management education services

All telemedicine services must comply with South Dakota Medicaid’s Out-Of-State Prior Authorization Requirements.

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 27-28 (Jul. 2015).

Source (pharmacological management): SD Administrative Rules 46:20:32:08.
Store and Forward Reimbursement
No reference found. South Dakota Medicaid defines telemedicine as occurring in “real time”, excluding store and forward applications.

Source: SD Medical Assistance Program, Professional Svcs.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Manual, p. 26 (Nov. 2014).
Remote Patient Monitoring Reimbursement

Office of Adult Service and Aging
In-home services, which is defined as including “telehealth services”, may be provided to an individual who demonstrates a need for long-term supports and services through an assessment and the following criteria:
• The individual is residing at home;
• The individual is age 60 or older or is age 18 or older with a disability; and
• The individual is not eligible for other programs which provide the same type of service.

Source: SD Regulation 67:40:19:04. Please see “Comments” section below.
Email/Phone/FAX
No reference found. No reimbursement for phone. No reimbursement for email. No reimbursement for facsimile.

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 27 (July 2015).
Online Prescribing
No reference found. No reference found.
Consent
No reference found. No reference found.
Location
No reference found. An originating site may not be located in the same community as the distant site. Originating sites approved for a facility fee include:

• Office of a physician or practitioner
• Outpatient hospital
• Critical Access Hospital
• Rural Health Clinic
• Federally Qualified Health Center
• Indian Health Services Clinic
• Community Mental Health Center

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 27 (July 2015).
Cross-State Licensing
An applicant who holds a valid medical license issued by another state can be licensed through reciprocity in South Dakota if:
• The applicant completed a residency program in the US or Canada; No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Has passed one of the listed licensure examinations. (Please see rule for list);
• Is in good standing with their state’s professional board; and
• Has completed a state and federal criminal background investigation.

Source: SD Regulation 20:78:03:12.

Recently Passed Legislation
South Dakota adopted the Federation of State Medical Board (FSMB)’s model language for an interstate medical licensure compact.

Source: SD Senate Bill 63 (2015).
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. Originating sites are eligible for a facility fee.

Originating sites include:
• Office of a physician or practitioner
• Outpatient hospital
• Critical Access Hospital
• Rural Health Clinic
• Federally Qualified Health Center
• Indian Health Services Clinic
• Community Mental Health Center

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 28 (Jul. 2015).
Miscellaneous

COMMENTS: South Dakota’s Department of Health and Human Services, Adult Services and Aging offers reimbursement for a home based monitoring system that monitors an individual’s clinical data daily; such as heart rate, blood pressure, oxygen saturation, temperature, weight and can be a medication reminder depending on the unit available.

Telehealth includes equipment rental and the set up and availability of a nurse’s time to monitor and provide feedback to the individual, their family, and/or consultation with the individual’s physician and the Adult Services and Aging Specialist.

Source: SD Dept. of Social Services, Dept. of Adult Services & Aging, Telehealth Technology (Accessed July 22, 2015).

Medicaid Program Administrator: Texas Health and Human Services Commission

Regional Telehealth Resource Center: TexLa Telehealth Resource Center 3601 4th Street, Ste. 2B440
Lubbock, TX 79430
(806) 743-4440/(877) 391-0487

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
Telemedicine is “the use of health care information exchanged from one site to another via electronic communications for the health and education of the individual or provider, and for the purpose of improving patient care, treatment, and services.”

Source: TX Admin. Code, Title 25 Sec. 412.303.

Speech-Language Pathology and Audiology Telehealth is “the use of telecommunications and
information technologies for the exchange of information from one site to another for the provision of speech- language pathology or audiology services to an individual from a provider through hardwire or internet connection.”

Source: TX Admin. Code, Title 22 Sec. 741.1.

“Telemedicine medical service–A health care service, initiated by a physician who is licensed to practice medicine in Texas under Title 3, Subtitle B of the Occupations Code or provided by a health professional acting under physician delegation and supervision, that is provided for purposes of patient assessment by a health professional, diagnosis or consultation by a physician, or treatment, or for the transfer of medical data, and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

• Compressed digital interactive video, audio, or data transmission;
• Clinical data transmission using computer imaging by way of still-image capture and store and forward; and
• Other technology that facilitates access to health care services or medical specialty expertise.”

Source: TX Admin. Code, Title 1 Sec. 354.1430 “Telehealth service” means a health service, other than a telemedicine medical service, that is delivered by a licensed or certified health professional acting within the scope of the health professional’s license or certification who does not perform a telemedicine medical service and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

• Compressed digital interactive video, audio, or data transmission;
• Clinical data transmission using computer imaging by way of still-image capture and store and forward; and
• Other technology that facilitates access to health care services or medical specialty expertise.

Source: TX Government Code, Sec. 531.001 & TX Admin. Code, Title 1 Sec. 354.1430 & TX Medicaid Telecommunication Services Handbook, pg. 6, (Jul. 2015).

Telemedicine is defined as a health-care service that is either initiated by a physician who is licensed to practice medicine in Texas or provided by a health professional who is acting under physician delegation and supervision. Telemedicine is provided for the purpose of the following:

• Client assessment by a health professional
• Diagnosis, consultation or treatment by a physician
• Transfer of medical data that requires the use of advanced telecommunications technology, other than telephone or facsimile, including the following: (1) Compressed digital interactive video, audio or data transmission, (2) clinical data transmission using computer imaging by way of still-image and store and forward; and (3) Other technology that facilitates access to health-care services or medical specialty expertise.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Source: TX Medicaid Telecommunication Services Handbook, pg. 5, (Jul. 2015).

“Telemedicine medical service” means a health care service that is initiated by a physician or provided by a health professional acting under physician delegation and supervision, that is provided for purposes of patient assessment by a health professional, diagnosis or consultation by a physician, or treatment, or for the transfer of medical data, and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

• Compressed digital interactive video, audio, or data transmission;
• Clinical data transmission using computer imaging by way of still-image capture and store and forward; and
• Other technology that facilitates access to health care services or medical specialty expertise.

Source: TX Government Code, Sec. 531.001.

Home telemonitoring is “a health service that requires scheduled remote monitoring of data related to patient’s health and transmission of the data to a licensed home health agency or a hospital”.

Source: TX Government Code, Sec. 531.001.
Live Video Reimbursement
(see Medicaid column) Texas Medicaid reimburses for live video for the following services:

• Consultations;
• Office or other outpatient visits;
• Psychiatric diagnostic interviews;
• Pharmacologic management;
• Psychotherapy
• Data transmission

Source: TX Admin. Code, Title 1, Sec. 354.1432 & TX Govt. Code Sec. 531.0216.

Telemedicine eligible distant site providers:
• Physician
• Certified Nutrition Specialist
• Nurse Practitioner
• Physician Assistant
• Certified Nurse Midwife

Source: TX Medicaid Telecommunication Services Handbook, pg. 5, (Jul. 2015).

Telehealth eligible distant site providers
• Licensed professional counselors
• Licensed marriage and family therapist

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Licensed clinical social worker
• Psychologist
• Licensed psychological associate
• Provisionally licensed psychologist
• Licensed dietician

Source: TX Medicaid Telecommunication Services Handbook, pg. 7, (Jul. 2015).

Eligible originating sites (Telecommunication):
• Established medical site
• State mental health facility
• State supported living center

Source: TX Medicaid Telecommunication Services Handbook. P. 5- 6-7 (Jul. 2015).

Telemedicine eligible originating (patient) site providers:

• Physicians;
• Physician assistants;
• Nurse practitioners;
• Clinical nurse specialists;
• Outpatient providers

Source: TX Admin Code. Title 1, Sec. 355.7001 and TX Medicaid Telecommunication Services Handbook, pg. 6 (Jul. 2015).

Telehealth eligible originating site presenter:
• An individual who is licensed or certified in Texas to perform health care services
• A qualified mental health professional

A telepresenter is required at the originating site for both telemedicine and telehealth, unless the services relate to mental health. In that situation a patient-site presenter does not have to be readily available unless the client is in a danger to himself/herself or others.

Source: TX Medicaid Telecommunication Services Handbook, pg. 8 (Jul. 2015).

More than one medically necessary telemedicine or telehealth service may be reimbursed for the same date and same place of service if the services are billed by providers of different specialties.

Source: TX Medicaid Telecommunication Services Handbook, pg. 4, (Jul. 2015).

There is distant-site physician reimbursement for assessment and evaluation office visit if:

• A health professional under the physician’s supervision is present with the patient for the visit;

STATE LAW/REGULATIONS MEDICAID PROGRAM
• The medical condition, illness, or injury for which the patient is receiving the service is not likely, within a reasonable degree of medical certainty, to undergo material deterioration within the 30- day period following the visit.

Source: TX Govt. Code Sec. 531.0217.

Provider reimbursement must be the same as in-person services.

Source: TX Admin. Code, Title 1 Sec. 355.7001.

Telemedicine services are not required if an in-person consultation with a physician is reasonably available where the patient resides or works.

Telemedicine providers must make a good-faith effort to identify and coordinate with existing providers, to preserve and protect existing health care systems and medical relationships in an area.

With patient consent, the primary care provider must be notified of the telemedicine medical service for the purpose of sharing medical information.

Source: TX Govt. Code Sec. 531.0217.

Before receiving a telehealth service, the patient must receive an in-person evaluation for the same diagnosis or condition, with the exception of mental health conditions.

For continued services through telehealth, a patient must receive an in-person evaluation at least once during the previous 12 months.

Source: TX Admin. Code, Title 1, Sec. 354.1432 & TX Medicaid Telecommunication Services Handbook, pg. 9 (Jan. 2015).
Store and Forward Reimbursement
(see Medicaid column) TX Medicaid Manual states that telemedicine and telehealth services only “involve direct face-to-face interactive video communication between the client and the distant-site provider.”

Source: TX Medicaid Telecommunication Services Handbook, pg. 4, (Jul. 2015).

TX Government Code includes a definition of “Telemedicine Medical Service” and “Telehealth Services” which encompasses Store and Forward, stating that it includes “clinical data transmission using computer imaging by way of still-image capture and store and forward”.

Source: TX Government Code, Sec. 531.001.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Remote Patient Monitoring Reimbursement
No reference found. Texas Medicaid will reimburse for home telemonitoring in the same manner as their other professional services provided by a home health agency.

Source: TX Admin Code, Title 1, Sec. 355.7001.

Online evaluation and management for home telemonitoring services is a benefit in the office or outpatient hospital setting when services are provided by a nurse practitioner, clinical nurse specialist, physician assistant or physician provider.

Data must be reviewed by a registered nurse, nurse practitioner, clinical nurse specialist, or physician assistant who is responsible for reporting data to the prescribing physician in the event of a measurement outside the established parameters.
The procedure code is limited to once per seven days. Scheduled periodic reporting of client data to the
physician is required.

Setup and daily monitoring is reimbursed when provided by a home health agency or outpatient hospital.

There must be prior authorization from TX Medicaid for home telemonitoring. Clients must be diagnosed with diabetes or hypertension and exhibit two or more risk factors (see regulations).

Source: TX Medicaid Telecommunication Services Handbook, pg. 8-9, (Jul. 2015).

Home Telemonitoring is available only to patients who:
• Are diagnosed with diabetes, hypertension; or
• When it is determined by Texas Health and Human Services Commission to be cost effective and feasible the following conditions are also included: pregnancy, heart disease, cancer, chronic obstructive pulmonary disease, congestive heart failure, mental illness, asthma, myocardial infarction or stroke.

Patients that meet the above criteria must exhibit two or more of the following risk factors:
• Two or more hospitalizations in the prior 12 month period
• Frequent or recurrent emergency room admissions
• A documented history of poor adherence to ordered medication regimens
• A documented history of falls in the prior six month period
• Limited or absent informal support system

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Living alone or being home alone for extended periods of time; and
• A documented history of care access challenges

Providers must be enrolled and approved as home telemonitoring services providers.

The home health agency must maintain extensive documentation in the patient’s medical record.

Source: TX Admin Code. Title 1, Sec. 354.1434 & TX Medicaid Telecommunication Services Handbook, pg. 9, (Jul. 2015).
Email/Phone/FAX
For speech-language pathology and audiology, no reimbursement for correspondence only, e.g., mail, email, or FAX, although they may be adjuncts to tele- practice.

Source: TX Admin. Code, Title 22, Sec. 741.214. No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.
No reimbursement for chart review.

Source: TX Medicaid Telecommunication Services Handbook, pg. 4, (Jul. 2015).
Online Prescribing
Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

Online or telephone evaluations solely by questionnaire are prohibited.

Source: TX Admin. Code, Title 22, Sec. 174.8.

Adopted Emergency Rule (Now Effective, Expires 5/20/15)
A physician-patient relationship (needed to prescribe any dangerous drug or controlled substance) requires either an in-person exam or the patient to be located at an Established Medical Site.

Source: TX Admin. Code, Title 22, Part 9, Ch. 190 (Injunction filed). No reference found.
Consent
Consent required prior to telemedicine or telehealth services.

Either originating or distant site health professionals shall obtain this consent.

Source: TX Occupational Code Sec. 111.002. No reference found.
Location
An established medical site may include the patient’s home, including a group or institutional setting, for the Telemedicine/Telehealth eligible originating (patient) sites:

STATE LAW/REGULATIONS MEDICAID PROGRAM
delivery of mental health services. If for other medical services other than mental health services, the patient’s home or group or institutional setting may be an established medical site if:

• A patient site presenter is present;
• There is a defined physician-patient relationship
• The patient site presenter has sufficient communication and remote medical diagnostic technology to allow the physician to carry out an adequate physical examination appropriate for the patient’s presenting condition while seeing and hearing the patient in real time.

Source: TX Administrative Code Sec. Title 22 Section 174.6.

• An established medical site
• A mental health facility
• State supported living centers.

Source: TX Medicaid Telecommunication Services Handbook, pg. 5 & 7, (Jul. 2015).

Services may take place in a school-based setting if:

• The physician is an authorized health care provider under Medicaid;
• The patient is a child who receives the service in A primary or secondary school-based setting;
• The parent or legal guardian of the patient provides consent before the service is provided; and
• A health professional is present with the patient during treatment.

Source TX Bill HB 1878(2015).
Cross-State Licensing
A telemedicine license may be issued for out of state providers.

Source: TX Admin. Code, Title 22, Sec. 172.12 & TX Occupation Code Section 151.056. No reference found.
Private Payers
Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: TX Insurance Code Sec. 1455.004. No reference found.
Site/Transmission Fee
(see Medicaid column) Telemedicine patient site locations are reimbursed a facility fee.

Source: TX Admin. Code, Title 1 Sec. 355.7001 & TX Medicaid Telecommunication Services Handbook, pg. 6 (Jul. 2015).
Miscellaneous
Children’s Health Insurance Program
Allows reimbursement for live video telemedicine and telehealth services to children with special health care needs.

Source: TX Govt. Code Sec. 531.02162

Comments: New Regulations Passed
• TX Medical Board (Source: TX Admin. Code, Title 22, Part 9, Ch. 190)
• TX Board of Speech Pathology and Audiology (Source: TX Admin. Code, Title 22, Ch. 741)

New legislation establishes a pilot project to provide emergency medical services instruction and emergency prehospital care instruction through a telemedicine medical service provided by regional trauma resource centers to:
• Health care providers in rural area trauma facilities and
• Emergency medical services providers in rural areas.

(Source: TX Bill HB 479 (2015)).

Medicaid Program Administrator: State Dept. of Vermont Health Access, under the Agency of Human Services.

Regional Telehealth Resource Center: Northeast Telehealth Resource Center 11 Parkwood Drive
Augusta, ME 04330
(207) 622-7566 / (800) 379-2021
www.netrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telemedicine means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that meets Health Insurance Portability and Accountability Act (HIPAA) requirements. Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.”

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). Telemedicine is defined in Act 107 as “…the delivery of health care services…through the use of live interactive audio and video over a secure connection that complies with the requirements the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.”

Source: Dept. of VT Health Access, Provider Manual, p. 109 (Jul. 13, 2015).
Live Video Reimbursement
Private payers must reimburse for live video. Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). (See “Private Payers” section) Live video is reimbursed.

Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person.

Source: Dept. of VT Health Access, Provider Manual, p. 109 (Jul. 13, 2015).

This provision will go into effect Oct. 1, 2015.

Live video for the provision of primary care services outside of a health care facility will be reimbursed. Coverage shall comply with federal requirements imposed by the Center for Medicare and Medicaid Services which limits certain services and providers for reimbursement.

Source: VT Bill S. 139 (2015).
Store and Forward Reimbursement
Allows, but doesn’t require, reimbursement for tele- ophthalmology and tele-dermatology. No reimbursement for tele-ophthalmology or tele- dermatology; no reference to other store and forward technologies.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Allows payers to require the distant site provider to document the reason the services are being provided by store and forward.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).
Source: Dept. of VT Health Access, Provider Manual, p. 109 (Jul. 13, 2015).
Remote Patient Monitoring Reimbursement
VT Medicaid is required to cover home telemonitoring services performed by home health agencies or other qualified providers for beneficiaries who have serious or chronic medical conditions.

Source: VT Statutes Annotated Title 33 Sec. 1901k). Home telemonitoring is a Medicaid benefit.

Qualified providers are home health agencies enrolled with Vermont Medicaid.

The following healthcare professionals can review data:
• Registered nurse
• Nurse practitioner
• Clinical nurse specialist
• Licensed practice nurse under supervision of RN
• Physician assistant

Source: Code of VT Rules Sec. 13-170-770 & Dept. of VT Health Access, Provider Manual, p. 145 (Jul. 13, 2015).

Individuals receiving Medicaid telemonitoring must:
• Have Medicaid as primary insurance or be dually eligible with non-home bound status; and
• Have congestive heart failure; and
• Be clinically eligible for home health services; and
• Have a physician’s plan of care with an order for telemonitoring services

Source: Dept. of VT Health Access, Provider Manual, p. 145 (Jul. 13, 2015).
Email/Phone/FAX
No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: Dept. of VT Health Access, Provider Manual, p. 109 (Jul. 13, 2015).
Online Prescribing
Providers may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations if they first examine the patient in person or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.

Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider- No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
patient settings.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2012).
Consent
Originating site providers must obtain consent for store and forward tele-ophthalmology or tele-dermatology.

Patients will be informed of the right to receive a consult with the distant-site provider, and will receive one, upon request, either at the time of the consult, or within a reasonable time after notification of the results of the initial consult.

Receiving tele-dermatology or tele-ophthalmology services by store and forward shall not preclude a patient from receiving real-time telemedicine, or face-to- face services with the distant site provider at a future date.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2012). No reference found.
Location
No reference found. This provision will go into effect Oct. 1, 2015.

Certain primary care services may be provided outside of a health care facility.

Source: VT Bill S. 139 (2015).
Cross-State Licensing
No reference found. No reference found.
Private Payers
Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). No reference found.
Site/Transmission Fee
No reference found. Allowed, but not required, for originating site providers.

Dept. of VT Health Access, Provider Manual, p. 119 (Jan. 1, 2015).
Miscellaneous
The Department of Vermont Health Access and the Green Mountain Care Board is tasked with considering the implementation of pilot projects using telemedicine. Among other things, the pilot project should consider the scope of services that should be provided using telemedicine outside of a health care facility including possibly equipping home health agency nurses with tools needed to provide telemedicine during home health visits.

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: VT Act. No. 40 (S. 88).

Medicaid Program Administrator: Washington State Health Care Authority

Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center 2900 12th Ave. N., Ste. 30W
Billings, MT 59101
(888) 662-5601
www.nrtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
Recently Passed Legislation (Effective Jan. 1, 2017) “Telemedicine means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, ‘telemedicine’ does not include the use of audio-only telephone, facsimile, or email.”

Source: WA Senate Bill 5175 (2015). (Will be incorporated into Revised Code of WA Sec. 41.05, 48.43, 74.09, & 70.41.020).

“Telemedicine means the use of tele-monitoring to enhance the delivery of certain home health skilled nursing services through:

• The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry;
• The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit.”

Source: WA Admin. Code Sec. 182-551-2010.

“Telehealth means providing physical therapy via electronic communication where the physical therapist or physical therapist assistant and the patient are not at the same physical location.”

Source: WA Admin. Code Sec. 246-915-187.

Emergency Rule (Expires 4/22/15) “Telemedicine is when a health care practitioner uses interactive real-time audio and video telecommunications to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located.”

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 63 (Jul. 1, 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
Telemedicine is when a health care practitioner uses HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located. Using telemedicine enables the health care practitioner and the client to interact in real-time communication as if they were having a face-to-face session. Telemedicine allows clients, particularly those in medically underserved areas of the state, improved access to essential health care services that may not otherwise be available without traveling long distances.

Source: WA Admin. Code Sec. 182-531-1730.
Live Video Reimbursement
Recently Passed Legislation (Effective Jan. 1, 2017) Insurers (including employee health plans and Medicaid Managed Care) must reimburse for live video, with some limitations.

(See private payer section)

Source: WA Senate Bill 5175 (2015). (Will be incorporated into Revised Code of WA Sec. 41.05, 48.43, & 74.09).

Telemedicine is covered by the Department.

Source: WA Admin. Code Sec. 182-531-0100. Yes, for patients with fee-for-service coverage. Eligible services:
• Consultations;
• Office or other outpatient visits;
• Psychiatric intake and assessment;
• Individual psychotherapy;
• Visit for drug monitoring

Eligible Providers at the Distant Site are:

• Physicians (including Psychiatrists); and
• Advanced Registered Nurse Practitioners

Patients must be present and participate in the visit. For patients with managed care plan coverage,
telehealth services will not be reimbursed separately. All services must be arranged and provided by primary care providers. It is not mandatory that the plan pay for telehealth services.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 64-65 (Jul. 1, 2015).
Store and Forward Reimbursement
Recently Passed Legislation (Effective Jan. 1, 2017) Insurers (including employee health plans and Medicaid Managed Care) must reimburse for store-and forward, with some limitations.

(See private payer section)

Store and forward reimbursement is available only for No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
covered services specified in the negotiated agreement between the health plan and health care provider.

If the services are provided via store and forward, there must be an associated office visit between the patient and referring health care provider.

Source: WA Senate Bill 5175 (2015). (Will be incorporated into Revised Code of WA Sec. 41.05, 48.43, & 74.09).
Remote Patient Monitoring Reimbursement
(see Medicaid column) The Medicaid agency covers the delivery of home health services through telemedicine.

Services are provided for clients who have been diagnosed with an unstable condition, and who may be at risk for hospitalization or a more costly level of care.

Coverage is limited to one telemedicine interaction, per patient, per day, based on the ordering licensed practitioner’s care plan.

Eligible services:

• Assessment and monitoring of clinical data including, but not limited to, vital signs, pain levels and other biometric measures specified in the plan of care;
• Assessment of response to previous changes in the plan of care;
• Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care.
• Implementation of a management plan

Must be provided by a Registered Nurse or Licensed Practical Nurse.

The Medicaid agency does not require prior authorization for the delivery of home health services through telemedicine.

Source: WA State Health Care Authority, Medicaid Provider Guide, Home Health Svcs. (Acute Care Svcs.), p. 22 (Jul. 1, 2014).
Email/Phone/FAX
No reference found. No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 63((Jul. 1,, 2015).

STATE LAW/REGULATIONS MEDICAID PROGRAM
Online Prescribing
The WA Medical Quality Assurance Commission has issued guidelines on the use of the Internet in medical practices. A guideline does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in in-person settings.

Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.

Source: Washington Medical Quality Assurance
Commission, Guidelines for Appropriate Use of the Internet in Medical Practice,
No reference found.
Consent
No reference found. No reference found.
Location
Recently Passed Legislation (Effective Jan. 1, 2017)

Eligible Originating Sites
• Hospital;
• Rural health clinic;
• Federally qualified health center;
• Physician’s or other health care provider’s office;
• Community mental health center;
• Skilled nursing facility; or
• Renal dialysis center

Originating sites may not distinguish between rural and urban originating sites.

Source: WA Senate Bill 5175 (2015). (Will be incorporated into Revised Code of WA Sec. 41.05, 48.43, & 74.09). Eligible originating sites:

• Practitioner offices;
• Hospitals;
• Critical Access Hospitals;
• Rural Health Clinics;
• Federally Qualified Health Centers.

Originating site provider responsible for determining and documenting that telemedicine is medically necessary.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional svcs., p. 64 (Jul. 1, 2015).
Cross-State Licensing
Out-of-state, licensed practitioners may deliver telemedicine or telehealth services, as long as they do not open an office or appoint a place of meeting patients No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
or receive calls within the state.

Source: Revised Code of WA Sec. 18.71.030 (2012).
Private Payers
Recently Passed Legislation (Effective Jan. 1, 2017) Insurers (including employee health plans and Medicaid Managed Care) must reimburse a provider for services delivered through telemedicine or store and forward if:
• The plan provides coverage when provided in- person;
• The health care service is medically necessary; and
• The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act.

Source: WA Senate Bill 5175 (2015). (Will be incorporated into Revised Code of WA Sec. 41.05, 48.43, & 74.09). No reference found.
Site/Transmission Fee
Recently Passed Legislation (Effective Jan. 1, 2017) An originating site can charge a facility fee, but it is subject to a negotiated agreement between the originating site and the health plan.

Source: WA Senate Bill 5175 (2015). (Will be incorporated into Revised Code of WA Sec. 41.05, 48.43, & 74.09). Facility fees for originating sites, except inpatient hospitals.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 64 (Jul. 1, 2015).
Miscellaneous
Physical Therapy
Licensed physical therapists and physical therapist assistants may provide physical therapy via telehealth. The clinical record must indicate that the physical therapy occurred via telehealth.

Source: WA Admin. Code Sec. 246-915-187.

Comment: WA State requires a provider directory to be updated monthly. For each health plan, the associated provider directory must include information about available telemedicine services and specifically described for each provider.

Source: WA Admin. Code Sec. 284-43-204.

Medicaid Program Administrator: Wisconsin Dept. of Health Services

Regional Telehealth Resource Center:
Great Plains Telehealth Resource and Assistance Center University of Minnesota/Institute for Health Informatics 330 Diehl Hall
505 Essex Street S.E.
Minneapolis, MN 55455
(888) 239-7092
www.gptrac.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telehealth” is a service provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between an individual at an originating site and a provider at a remote location with the service being of sufficient audio and visual fidelity and clarity as to be functionally equivalent to face-to-face contact. “Telehealth” does not include telephone conversations or Internet-based communications between providers or between providers and individuals.

Source: Wisconsin Statute 49.45 (29w). “Telemedicine services (also known as “Telehealth”) are services provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between a member (i.e., the originating site) and a Medicaid-enrolled provider at a remote location (i.e., distant site). The services must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face contact. Telemedicine services do not include telephone conversations or Internet-based communication between providers or between providers and members.

Source: WI Forward Health, Covered and non-covered services, Physician, (accessed Jul. 22, 2015).
Live Video Reimbursement
(see Medicaid column) Forward Health will reimburse for medical and mental/behavioral health services via live video.

Eligible services:

• Office or other outpatient services;
• Office or other outpatient consults;
• Initial inpatient consults;
• Outpatient mental health services;
• Health and behavior assessment/intervention;
• End stage renal disease-related services;
• Outpatient substance abuse services. Eligible providers:
• Physicians and physician clinics;
• Rural Health Centers;
• Federally Qualified Health Center;

STATE LAW/REGULATIONS MEDICAID PROGRAM
• Physician assistants;
• Nurse practitioners;
• Nurse midwives;
• Psychiatrists;
• Ph.D. psychologists.

Reimbursement is subject to the same restrictions as in- person services.

Only one eligible provider may be reimbursed per member per date of service (DOS), unless it is medically necessary for the participation of more than one provider.

Separate services provided by separate specialists for the same patient at different times on the same date may be reimbursed separately.

Providers may receive enhanced reimbursement for pediatric services, for members 18 years old and under, and for HPSA-eligible services.

HPSA-enhanced reimbursement is allowed when the patient or the provider is located in a HPSA-designated area.

Out-of-state providers, except border-status providers, must obtain prior authorization (PA) before delivering services to Wisconsin Medicaid members.

Source: WI Forward Health, Covered and non-covered services, Physician, (accessed Jul. 22, 2015).

Mental health services provided through telehealth are reimbursable by the Medical Assistance program if the provider of the service satisfies the following criteria:
• The provider is a certified provider of mental health services under the Medical Assistance program and is an agency that is certified by a mental health program. (Please see bill text for specific program list).
• The provider and the individual providing the service comply with all Medical assistance coverage policies and standards
• The provider is certified for telehealth by the department.
• The individual who is providing the service is licensed or registered and in good standing with the appropriate state board.
• The provider is located in the United States. The provider is not required to be located in the state.

Source: Wisconsin Statute 49.45 (29w) (2).

STATE LAW/REGULATIONS MEDICAID PROGRAM

Store and Forward Reimbursement
No reference found. No reimbursement.

Source: WI Forward Health, Covered and non-covered services, Physician, (accessed Jul. 22, 2015).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
“Telehealth” does not include telephone conversations or Internet-based communications between providers or between providers and individuals.

Source: Wisconsin Statute 94.45 (29w). No reimbursement for email or Internet-based communications.
No reimbursement for telephone. No reference found for FAX.

Source: WI Forward Health, Covered and non-covered services, Physician, (accessed Jul. 22, 2015).
Online Prescribing
No reference found. No reference found.
Consent
No reference found.
Location
No reference found. No reference found.
Cross-State Licensing
No reference found. No reference found.
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. Reimbursement for originating site facility fees. Eligible originating sites:

• Physician offices;
• Hospitals (inpatient or outpatient, excluding emergency rooms);
• Any other appropriate place of service with necessary equipment and staffing.

The originating site may not be an emergency room. An originating site facility fee is not an RHC/FQHC service, and may not be reported as an encounter on cost reports. Any reimbursement for the originating site facility fee must be reported as a deductive value.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Outpatient hospitals will receive only a facility fee. Wisconsin Medicaid will not separately reimburse the rate-per-visit for that member, unless the patient receives other covered services on the same date. Professional
services provided in the outpatient hospital are separately reimbursable.

Source: WI Forward Health, Covered and non-covered services, Physician, (accessed Jul. 22, 2015).
Miscellaneous
Information in the physician section of the WI Forward Health Covered and non-covered services manual is repeated in the following manuals as well:
• Adult Mental Health Day Treatment
• Ambulatory Surgery Centers
• Child/Adolescent Day Treatment
• Community Support Program
• Comprehensive Community Services
• Crisis Intervention
• End-Stage Renal Disease
• Family Planning
• Federally Qualified Health Centers
• Hospital, Inpatient
• Hospital, Outpatient
• In-Home Mental Health/Substance Abuse Services
• Nurse Midwife
• Nursing Home
• Outpatient Mental Health
• Outpatient Mental Health and Substance Abuse Services
• Outpatient Substance Abuse
• Rural Health Clinic
• Substance Abuse Day Treatment

Source: WI Forward Health Online Manuals. (Accessed Jul. 22, 2015).