Georgia 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

Georgia Medicaid

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 Telemedicine is the use of medical information
physician or other health care provider acting within the exchange from one site to another via electronic
scope of such provider’s practice, of health care communications to improve patient’s health status. It is
delivery, diagnosis, consultation, treatment, or transfer the use of two-way, real time interactive communication
of medical data by means of audio, video, or data equipment to exchange the patient information from one
communications which are used during a medical visit site to another via an electronic communication system.
with a patient or which are used to transfer medical data This includes audio and video communications
obtained during a medical visit with a patient. Standard equipment.
telephone, facsimile transmissions, unsecured e-mail, or Closely associated with telemedicine is the term
a combination thereof do not constitute telemedicine
services.” “telehealth,” which is often used to encompass a
broader definition of remote healthcare that does not
Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). always involve clinical services. Telehealth is the use of
telecommunications 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. 2017). (Accessed Oct. 2017).

Live Video Reimbursement

Georgia requires coverage of telemedicine services Georgia Medicaid reimbursement for telehealth is
(which includes live video), subject to contract terms and specific to clinical services rendered via telemedicine.
conditions. (See “Private Payers” section). The service must be medically necessary, and the
procedure individualized, specific, and consistent with
Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012). 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.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Eligible distant practitioners:

Physicians

Nurse practitioner

Physician assistant

Nurse-midwives

Clinical nurse specialists

Certified registered nurse anesthetists

Dentists and dental hygienists

Community mental health centers; community

behavioral health providers; Clinical
psychologists (CPs); and clinical social workers
(CSWs);

Speech language pathologists;

Registered dietitians or nutrition professionals.

See each program manual for associated telemedicine

guidelines.

Non-Covered Services:

1. Telephone conversations.
2. Electronic mail messages.
3. Facsimile.
4. Services rendered via a webcam or internet
based technologies (i.e., Skype, Tango, etc.)
that are not part of a secured network and do
not meet HIPAA encryption compliance.
5. Video cell phone interactions.
6. The cost of telemedicine equipment and
transmission.

7. Store and forward transactions
8. Failed or unsuccessful transmissions.

Source: GA Dept. of Community Health, GA Medicaid

Telemedicine Handbook, p. 2, (Apr. 2017). (Accessed Oct. 2017).

Local Education Agencies are allowed to enroll in the

Health Check Program to serve as telemedicine
originating sites only.

Source: GA Dept. of Community Health, Children’s Intervention

School Services (CISS). July 1, 2016. VI-4 (p. 9). (Accessed Mar.

2017).

GA Dept. of Community Health, Health Check EPSDT. Oct. 2017.

X-5. p. 58. (Accessed Oct. 2017).

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

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

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 Community
Behavioral Health Rehabilitation Services, p. 30 & 36 (Oct. 2017).
(Accessed Mar. 2017) & GA Dept. of Community Health, Division
of Medical Assistance, Part II Policies and Procedures for Nursing
Facilities, p. H-1 (p. 153). Oct. 2017. (Accessed Oct. 2017).

Store and Forward Reimbursement

No reference found. Georgia Medicaid will not reimburse for store and
forward because an interactive telecommunication
system is a condition of payment.
However, reimbursement for professional and technical
component can be made for store and forward
applications such as an MRI, X-rays or ultrasounds.
However no other reimbursement can be made.
Source: GA Dept. of Community Health, GA Medicaid
Telemedicine Handbook, p. 4 & p. 8, (Jan. 2016). (Accessed Mar.
2017).

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX

No reimbursement for FAX. No reimbursement for FAX.
No reimbursement for telephone. No reimbursement for telephone.
No reimbursement for email. No reimbursement for email.
Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). Source: GA Dept. of Community Health, GA Medicaid
Telemedicine Handbook, p. 8, (Oct. 2017).

Online Prescribing

Physicians are prohibited from prescribing controlled No reference found.
substances or dangerous drugs based solely on an
electronic consult.
Source: GA Rules & Regulations revised 360-3-.02 (2012).

Consent

No reference found in statute. The referring provider must obtain prior written consent.
Source: GA Dept. of Community Health, GA Medicaid
Telemedicine Handbook, p. 5, (Oct. 2017).

Location

No reference found. Eligible originating sites:
Provider offices;
Hospitals;
Rural Health Clinics (RHC);

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Federally Qualified Health Centers (FQHC);
Hospital based or CAH based renal Dialysis
Centers
Skilled nursing facilities;
Local Education Authorities and School Based
Clinics
County Boards of Health
Emergency Medical Services Ambulances; and
Pharmacies
Source: GA Dept. of Community Health, GA Medicaid
Telemedicine Handbook, p. 3-4, (Jan. 2016). (Accessed Mar.
2017).
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, Policies and Procedures
for Federally Qualified Health Services and Rural Health Clinic
Services, p. 22, (Oct. 2017), (accessed Oct. 2017).
Local Education Agencies are allowed to enroll in the
Health Check Program to serve as telemedicine
originating sites only.
Source: GA Dept. of Community Health, Children’s Intervention
School Services (CISS). Jan. 1, 2017. (p. 12) & GA Dept. of
Community Health, Health Check EPSDT. Oct. 2017, 2017. X-5. p.
59. (Accessed Oct. 2017).

Cross-State Licensure

Must be a Georgia licensed practitioner. Providers must have a Georgia license.
Source: GA Admin. Code Sec. 360-3-.07 Source: GA Dept. of Community Health, GA Medicaid
Telemedicine Handbook, p. 3, (Oct. 2017).

Private Payers

Requires coverage of telemedicine services, subject to No reference found.
contract terms and conditions.
Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012).

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, Policies and Procedures
for Federally Qualified Health Services and Rural Health Clinic
Services, p. 22, (Oct. 2017), (accessed Oct. 2017).
Eligible 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

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Telemedicine Handbook, p. 3 & 8, (Jan. 2016). (Accessed Mar.
2017).

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. 7, (Oct. 2017).

Comments:

Professional Board Telehealth-Specific Regulations

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

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