Arizona State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Arizona

Medicaid Program: Arizona Health Care Cost Containment System (AHCCCS)

Program Administrator: Arizona Health Care Cost Containment System Administration

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

Under Arizona Statute, Public Health & Safety, “telemedicine means the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications sent to a health care provider for diagnostic or treatment consultation.”

Source: AZ Revised Statute Sec. 36-3601 (2012).

Under State Administrative Code, Department of Insurance, Health Care Services Organizations Oversight, “telemedicine means diagnostic, consultation, and treatment services that occur in the physical presence of an enrollee on a real-time basis through interactive audio, video, or data communication.”

Source: AZ Admin. Code Sec. R20-6-1902 (2012).

“Telemedicine means the interactive use of audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. Does not include the sole use of an audio-only telephone, a video-only system, a facsimile machine, instant messages or electronic mail.”

Source: AZ Statute 20-841.09.

Under the Board of Behavioral health, “telepractice” means providing behavioral health services through interactive audio, video or electronic communication that occurs between the behavioral health professional and the client, including any electronic communication for evaluation, diagnosis and treatment, including distance counseling, in a secure platform, and that meets the requirements of telemedicine pursuant to section 36-3602.

Service delivery via telemedicine can be in one of two models: Real time means the interactive, two-way transfer of information and medical data, which occurs at two sites simultaneously: the hub site and spoke site

… Diagnostic, consultation and treatment services are delivered through interactive, audio, video and/or communication. Store-and-forward means transferring medical data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation.

Source: AZ Health Care Cost Containment System, AHCCCS Fee-

For-Service Provider Manual, Ch. 10: Professional and Technical Services, (10-38), (10/5/2016) & IHS/Tribal Provider Billing Manual, (8/42), (10/5/2016). (Accessed Oct. 2017).

Telemedicine is “the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the member, including audio or video communications sent to a health care provider for diagnostic or treatment consultation.”

Telehealth (or telemonitoring) is “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance. Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote member monitoring devices, which are used to collect and transmit member data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered telemedicine, they may nevertheless be covered service”.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

NOTE: Rules regarding the use of telepractice will be Source: AZ Health Care Cost Containment System, AHCCCS
adopted beginning Nov. 1, 2015. Medical Policy for AHCCCS Covered Services, Ch. 300, (320-21).
Oct. 2016. (Accessed Oct. 2017).
Source: AZ Revised Statute Sec. 32-3251(15) (2015). Telemedicine means the practice of health care delivery,
diagnosis, consultation, and treatment and the transfer
of medical data through interactive audio, video, and
data communications that occur in the physical
presence of the patient.
Source: AZ Health Care Cost Containment System Telehealth
Policy. Mar. 2015. (Accessed Oct. 2017).

Live Video Reimbursement

Health Care Service Organizations (HCSO) are allowed, Fee for Service Provider Manual
but not mandated, to provide access to covered services AHCCCS will reimburse for medically necessary
through telemedicine, telephone, and email. services provided via live video in their fee for service
Source: AZ Admin. Code Sec. R20-6-1915 (2012) program.

Private payers are required to provide coverage for live Eligible services:
Cardiology;
video consultations when treating specific conditions
Dermatology;
and the originating site is located in a rural region.
Endocrinology;
Allowed Conditions
Hematology/oncology;
Trauma
Home Health
Burn
Infectious diseases;
Cardiology
Neurology;
Infectious diseases
Obstetrics/gynecology;
Mental health disorders Oncology/radiation;
Neurologic diseases including strokes Ophthalmology;
Dermatology Orthopedics;
Pulmonology (Eff. Jan. 2018) Pain clinic;
Pathology;

A rural region is defined as: Pediatrics and pediatric sub-specialties;
Radiology;
An area that is located in a county with a
Rheumatology;
population of less than nine hundred thousand
Surgery follow-up and consults;
persons; or

A city or town that is located in a county with a Source: AZ Health Care Cost Containment System, AHCCCS Fee-
population of nine hundred thousand persons or For-Service Provider Manual, Ch. 10: Professional and Technical
more and whose nearest boundary is more than Services, (10/5/2016) & IHS/Tribal Provider Billing Manual, (8/42),
(10/5/2016). (Accessed Oct. 2017).
thirty miles from the boundary of a city that has Additional Covered Services (Located in AHCCCS
a population of five hundred thousand persons
or more. Policy Manual)
Behavioral Health

Rural requirement is eliminated beginning in Jan. 2018. Diagnostic consultation and Evaluation
1. Psychotropic medication adjustment and
Source: AZ Statutes 20-841.09. monitoring
2. Individual and family counseling
3. Case management
(Home health not listed as a covered service in this
manual)
Source: AZ Health Care Cost Containment System, AHCCCS
Medical Policy for AHCCCS Covered Services, Ch. 300, (320-21).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Oct. 2016. (Accessed Oct. 2017).
Additional Covered Services (listed in Telehealth Policy)
Behavioral Health
Inpatient consultation
Medical Nutrition Therapy (MTN)
Office, outpatient, and surgery follow-up-
consultations
Pain management
Pharmacy management
Telehealth policy lists covered codes.
Source: AZ Health Care Cost Containment System Telehealth
Policy. Mar. 2015. (Accessed Oct. 2017).
Eligible Providers
Physician
Registered nurse practitioner
Physician assistant
Certified nurse midwife
Clinical psychologist
Licensed clinical social worker
Licensed marriage and family therapist
Licensed professional counselor
Out-of-state providers may provide and bill for spoke
and/or hub telehealth services.
Source: AZ Health Care Cost Containment System Telehealth
Policy. Mar. 2015. (Accessed Oct. 2017).
Behavioral health services are covered for AHCCS and
KidsCare patients.
Covered behavioral health services:
Diagnostic consultation and evaluation;
Psychotropic medication adjustment and
monitoring;
Individual and family counseling;
Case management.
The patient’s primary care provider (PCP), attending
physician, other medical professional employed by the
PCP, or an attending physician who is familiar with the
patient’s condition may be present.
Other medical professionals:
Registered nurses;
Licensed practical nurses;
Clinical nurse specialists;
Registered nurse midwives;
Registered nurse practitioners;
Physician assistants;

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Physical, occupational, speech, and respiratory

therapists;

Trained telepresenter familiar with the

recipient’s medical condition.

All services provided via telemedicine must be

reasonable, cost effective and medically appropriate.
Services are billed by the consulting provider. Tele-
presenter services are not billable.

Source: AZ Health Care Cost Containment System, AHCCCS Fee-
For- Service Provider Manual, Ch. 10: Professional and Technical

Services, (10-39), (10/5/2016) & IHS/Tribal Provider Billing Manual

(8/42), (10/5/2016). (Accessed Oct. 2017).

AHCCCS Policy Manual

AHCCCS covers real-time teledentistry for Early and
Periodic Screening, Diagnostic and Treatment (EPSDT)
aged members when provided by a registered dental
providers.

Source: AZ Health Care Cost Containment System, AHCCCS
Medical Policy for AHCCCS Covered Services, Ch. 300, (320-21).

Oct. 2016. (Accessed Oct. 2017).

Teledentistry services will be reimbursed for enrollees

under the age of 21.

Source: AZ Statute, Sec. 36.1.

Store and Forward Reimbursement

The definition of “telemedicine”, which describes telemedicine as occurring in the “physical presence” of the patient, would exclude store and forward.

Source: AZ Admin. Code Sec. R20-6-1902 (2012).

Fee for Service Provider Manual

AHCCCS will reimburse for store-and-forward in their fee-for-service program. The same services are covered for store and forward, as for real time.

Real time telemedicine is the only type of reimbursement available in the field of Behavioral Health Services.

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Manual, Ch. 10: Professional and Technical Services, (10-38), (10/5/2016) & IHS/Tribal Provider Billing Manual, (8/42), (10/5/2016). (Accessed Oct. 2017).

AHCCCS Policy Manual

AHCCCS only covers for store and forward (and is subject for review) the following:

Dermatology

Radiology

Ophthalmology

Pathology

AHCCCS does not consider asynchronous or “store and forward” applications to be telemedicine, but it may be utilized to deliver services.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: Arizona Health Care Cost Containment System. AHCCCS
Medical Policy Manual for AHCCCS Covered Services, Ch. 300,
Policy 320 Services With Special Circumstances, (320-21). Oct.
2016. (Accessed Oct. 2017).
The following exceptions may be eligible for
reimbursement, but are not considered a “telemedicine
service”:
A provider in the role of tele-presenter may be
providing a separately billable service, such as
an electrocardiogram or an X-ray. The service is
covered, but not the tele-presenting.
A consulting distant-site provider may offer a
service that does not require real-time patient
interaction. Reimbursement only for
dermatology, radiology, ophthalmology, and
pathology. It is subject to review by AHCCCS
Medical Management.
When a patient in a rural area presents within
three hours of onset of stroke symptoms,
AHCCCS will reimburse the consulting
neurologist if the consult is placed for assistance
in determining appropriateness of thrombolytic
therapy even when the patients’ condition is
such that real-time video interaction cannot be
achieved.
Additional exceptions for Behavioral Services
apply.
Source: AZ Health Care Cost Containment System, AHCCS
Medical Policy Manual, Medical Policy for AHCCCS Covered
Services, Ch. 300, Policy 320: Services With Special
Circumstances, (320-23). Oct. 2016. (Accessed Oct. 2017).

Remote Patient Monitoring Reimbursement

No reference found. Telemonitoring is considered necessary for members
with Congestive Heart Failure (CHF) when the following
conditions are met:
1. Observation/inpatient admission with primary or
secondary discharge diagnosis of CHF within
the past two months, or readmission within the
past six months; AND
2. A symptom level at the New York Heart
Association class II or greater; CHF is identified
by one of the specified ICD-10 diagnostic codes
(see manual).
Other limitations apply. See manual.
Source: AZ Health Care Cost Containment System .AHCCCS
Medical Policy Manual for AHCCCS Covered Services, Ch. 300,
Policy 320 Services With Special Circumstances, (320-23). Oct.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

2016. (Accessed Oct. 2017).

Email/Phone/FAX

Health Care Service Organizations are allowed, but not No reference found.
mandated, to provide covered services through
telemedicine, telephone, and email.
Source: AZ Admin. Code Sec. R20-6-1915 (2012).
No Phone
No Email
No Fax
Source: AZ Statutes 20-841.09.

Online Prescribing

Physicians are prohibited from issuing a prescription to No reference found.
patients without having a physical or mental health
status examination to establish a provider-patient
relationship.
The physical or mental health status examination can be
conducting during a real-time telemedicine encounter.
Source: Arizona Revised Statute Sec. 32-1401 (SB 1339).

Consent

Providers must obtain and document oral or written If there will be a recording of the interactive video
consent before delivery of services. Oral consent service, a separate consent must be obtained. See
should be documented on the patient’s medical record. manual for full requirements.
Source: AZ Revised Statute Sec. 36-3602 (2012). Source: AZ Health Care Cost Containment System .AHCCCS
Medical Policy Manual for AHCCCS Covered Services, Ch. 300,
Policy 320 Services With Special Circumstances, p. 180 (320-23).
Oct. 2016. (Accessed Oct. 2017).

Location

Private payers are required to provide coverage when Eligible hub or spoke sites for Indian Health Services or

the originating site is located in a rural region, which is tribal providers:
defined as:
An area that is located in a county with a Indian Health Service clinic;
population of less than nine hundred thousand Tribally-governed facility;
persons; or Urban clinic for American Indians;
A city or town that is located in a county with a Physician or other provider office;
Hospital;
population of nine hundred thousand persons or
Federally Qualified Health Center (FQHC).
more and whose nearest boundary is more than

thirty miles from the boundary of a city that has Source: AZ Health Care Cost Containment System Telehealth
a population of five hundred thousand persons Policy. Mar. 2015. (Accessed Oct. 2017).
or more. Fee for service manual definitions:

Rural requirement is eliminated beginning in Jan. 2018. Hub site – “the location of the telemedicine consulting

Source: AZ Statutes 20-841.09. provider, which is considered the place of service.”
Spoke site – “the location where the recipient is

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STATE LAW/REGULATIONS MEDICAID PROGRAM

receiving the telemedicine service.”
Source: AZ Health Care Cost Containment System, AHCCCS Fee-
For- Service Provider Manual, Ch. 10: Professional and Technical
Services, (10-38), (10/5/2016) & IHS/Tribal Provider Billing Manual,
(8/42), (10/5/2016). (Accessed Oct. 2017).

Cross-State Licensing

AZ enacted the Interstate Medical Licensure Compact.

Source: ARS Sec. 32-3241.

An out-of-state doctor may engage in a single or infrequent consultation with an Arizona physician.

Source: AZ Revised Statute Sec. 32-1421 (2012).

For teledentistry services: A consultation by a non-

Arizona licensed provider may occur if:

It is to a specific patient in the AHCCCS program;

The provider is registered with AHCCCS;

The provider is licensed in the state the consultation is being provided from, or the provider is employed by an Indian Health Services, Tribal or Urban Indian Health program and appropriately licensed based on IHS and Tribal facility requirements.

Source: AZ Health Care Cost Containment System, AHCCS Medical Policy Manual, Medical Policy for AHCCCS Covered Services, Ch. 300, Policy 320: Services With Special Circumstances, (320-23). Oct. 2016. (Accessed Oct. 2017).

Private Payers

Private payers are required to provide coverage for live No reference found.

video consultations when treating specific conditions
and the originating site is located in a rural region.
Allowed Conditions

Trauma

Burn

Cardiology

Infectious diseases

Mental health disorders

Neurologic diseases including strokes

Dermatology

Pulmonology (Eff. Jan. 2018)

A rural region is defined as:

An area that is located in a county with a

population of less than nine hundred thousand

persons; or

A city or town that is located in a county with a

population of nine hundred thousand persons or

more and whose nearest boundary is more than

thirty miles from the boundary of a city that has

a population of five hundred thousand persons

or more.

Rural requirement is eliminated beginning in Jan. 2018.

Source: AZ Statutes 20-841.09.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Site/Transmission Fee

No reference found. A facility fee is not an AHCCCS covered service.
Source: AZ Health Care Cost Containment System Telehealth
Policy. Mar. 2015. (Accessed Oct. 2017).

Miscellaneous

Arizona explicitly prohibits the use of telemedicine to

provide an abortion.
Source: AZ Revised Statute Sec. 36-3604 (2012).

Professional regulation with telehealth specific standards

Board of Psychologist Examiners (Source: AZ Reg. Sec. R4-26-109).

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