Delaware State Telehealth Laws and Reimbursement Policies
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Delaware Medical Assistance Program
Delaware
Medicaid Program: Delaware Medical Assistance Program
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
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.
Group and Blanket Insurance, & Health Insurance Contracts
Also applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Physical Therapy, Mental Health, Psychology, Dietetic 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: 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.
Group and Blanket Insurance, & Health Insurance Contracts
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
Telemedicine is a cost-effective alternate to face-to-face encounters where access to care is compromised due to the lack of available service providers in the patient’s geographical location. This definition is modeled on Medicare’s definition for telehealth services located at 42 CFR Sec. 410.78. Note that the Federal Medicaid statute does not recognize telemedicine as a distinct service.
…
For purposes of DMAP, telemedicine is the use of medical or behavioral health information exchanged from one site to another site via an electronic interactive (two-way, real time) telecommunications system to improve a patient’s health.
Source: DE Medical Assistance Program. Practitioner Provider Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct. 2017).
https://medicaidpublications.dhss.delaware.gov/dotnetnuke/DesktopM odules/Bring2mind/DMX/Download.aspx?Command=Core_Download &EntryId=259&language=en-US&PortalId=0&TabId=94
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STATE LAW/REGULATIONS MEDICAID PROGRAM
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: Title 18, Sec. 3370; & Title 18, Sec. 3571R.
Applies to: Physicians, Podiatry, Optometry,
Chiropractic, Dentistry, Nursing, Occupational
Therapy, Physical Therapy, Mental Health,
Psychology, Dietetic 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 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.
Applies to: Mental Health Counseling, Chemical
Dependency Counseling, or Marriage and Family
Therapy
“Telehealth Services” means the practice of Mental
Health Counseling, Chemical Dependency Counseling,
or Marriage and Family Therapy (hereinafter referred to
as Behavioral Health Practice) by distance
communication technology such as but not necessarily
limited to telephone, email, Internet-based
communications, and videoconferencing.
Source: DE Admin. Code Title 24, Sec.
3000. http://regulations.delaware.gov/AdminCode/title24/3000.shtml
NOTE: DE Professional Boards each have a different
definition of telehealth/telepractice/telemedicine. See
“Comments” section for references.
Live Video Reimbursement
No reference found. DE Medicaid reimburses for live video telemedicine
services for up to three different consulting providers for
separately identifiable telemedicine services provided to
a member per date of service. Eligible distant site
providers include:
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STATE LAW/REGULATIONS MEDICAID PROGRAM
Inpatient/outpatient hospitals
Physicians (or PAs under the physician’s
supervision)
Certified Nurse Practitioners
Nurse Midwives
Licensed Psychologists
Licensed Clinical Social Workers
Licensed Professional Counselors of Mental
Health
Speech Language Therapists
Audiologists
Other providers as approved by the DMAP
Medical Professional Sites:
Physicians (or PAs under the supervision of a
physician
Certified Nurse Practitioner
Medical and Behavioral Health Therapists
Source: DE Medical Assistance Program. Practitioner Provider
Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct.
2017).
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 (Apr. 1, 2016). (Accessed Oct. 2017).
Store and Forward Reimbursement
No reference found. Asynchronous or “store and forward” applications do not
meet the DMAP definition of telemedicine.
Source: DE Medical Assistance Program. Practitioner Provider
Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct.
2017).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found. Telephone, chart review, electronic mail messages,
facsimile transmissions or internet services for online
medical evaluations are not considered telemedicine.
Source: DE Medical Assistance Program. Practitioner Provider
Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct.
2017).
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.
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STATE LAW/REGULATIONS MEDICAID PROGRAM
Source: Delaware FQHC Provider Specific Policy Manual, pg. 5.
(Accessed Oct. 2017).
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).
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: 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;
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.
After a relationship has been established, subsequent
Provider manual lays out three different models for prescribing:
First Model: Distant site provider consults with referring provider about appropriate medication. Referring provider executes prescription.
Second Model: Consulting provider works with medical professional at the originating site to provide front line care, including prescription writing.
Third Model: the consulting provider prescribes and sends/calls-in the initial prescription.
For stimulants, narcotics and refills, hard copy prescriptions can be written and sent via delivery service to the referring site for the consumer to pick up a couple days after the appointment (see manual for more details).
Source: DE Medical Assistance Program. Practitioner Provider Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct. 2017).
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STATE LAW/REGULATIONS MEDICAID PROGRAM
treatment of the same patient with the same physician
need not satisfy the limitations of this section.
This section shall not limit the practice of radiology or
pathology.
Source: Title 24, Sec. 1769D.
Consent
Informed consent must be obtained to establish a Recipient must provide consent to use telemedicine. It
physician-patient relationship over telehealth. must be obtained by either the referring, consulting, or
distant provider. An exception is made for involuntary
Source: Title 24, Sec. 1769D & DE Code Title 24, Sec. 1932. detention and commitment.
Applies to: Mental Health Counseling, Chemical Source: DE Medical Assistance Program. Practitioner Provider
Dependency Counseling, or Marriage and Family Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct.
Therapy 2017).
Informed consent required by Boards (see regulation
citations in “Comment” area).
Location
An approved originating site may include the DMAP An originating site can include the member’s place of
member’s place of residence. residence, day program or alternative location in which
the member is physically present and telemedicine can
Source: 19 DE Reg. 191. be effectively utilized.
The Distant site provider must be located within the
continental US.
Source: DE Medical Assistance Program. Practitioner Provider
Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct.
2017).
Cross-State Licensing
No reference found. No reference found.
Private Payers
Private payers must provide coverage for the cost of No reference found.
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: Title 18, Sec. 3370; & Title 18, Sec. 3571R.
Site/Transmission Fee
Private payers: Payment for telemedicine must include A facility fee for the following originating site providers is
reasonable compensation to the originating or distant covered:
site for the transmission cost. Outpatient hospitals
Source: Title 18, Sec. 3370; & Title 18, Sec. 3571R.
Inpatient Hospitals
FQHCs
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STATE LAW/REGULATIONS MEDICAID PROGRAM
RHCs
Renal Dialysis Centers
Skilled Nursing Facilities
Intermediate Care Facilities for Individuals with
Intellectual Disabilities (ICF/IID)
Intermediate Care Facilities/Institutions for
Mental Diseases (ICF/IMDs)
Outpatient Mental Health/Substance Abuse
Centers/Clinics
Community Mental Health Centers/Clinics
Public Health Clinics
PACE Centers
Assisted Living Facilities
School-based Wellness Centers
Other sites approved by DMAP
Patient’s home qualifies as originating site, but does not
warrant an originating site fee.
Source: DE Medical Assistance Program. Practitioner Provider
Specific Manual, 7/1/17. Ch. 16 Telemedicine (accessed Oct.
2017).
Miscellaneous
Comments:
Professional regulation with telehealth specific standards
Physical Therapists and Athletic Trainers (Source: DE Statute Title 24, Sec. 2602)
Board of Mental Health and Chemical Dependency Professionals (Source: DE Admin. Code Title 24, Sec. 3000)
Board of Clinical Social Work Examiners (Source: 24 DAC 3900)
Respiratory Care Practice Advisory Council (Source: 24 DAC 1770)Board of Examiners in
Optometry (Source: 24 DAC 2100)
Board of Occupational Therapy Practice (Source: 24 DAC 2000)