Idaho State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

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Connected Health Policy 2019: http://cchpca.org

Idaho Medicaid

Idaho
Medicaid Program: Idaho Medicaid

Program Administrator: Idaho Dept. of Health and Welfare

Regional Telehealth Resource Center:

The Northwestern Regional Telehealth Resource Center
101 Wasatch Drive

Salt Lake City, UT 84112
(833) 747-0643
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

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 synchronous interaction telehealth encounters, delivered as defined in Title 54, Chapter 57, Idaho Code.

Source: ID Administrative Code 16.03.09 Sec. 502.

Telehealth is health care services provided by a provider to a participant through the use of electronic communications, information technology, synchronous interaction between a provider at a distant site and a patient at an originating site.

Source: Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct.

2017).

Live Video Reimbursement

Telehealth services that are properly identified in Idaho Medicaid reimburses for specific services under

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STATE LAW/REGULATIONS MEDICAID PROGRAM

accordance with billing requirements are covered under mental health, developmental disabilities, primary care,

Medicaid for physicians, within limitations defined by the therapy services and interpretation services and
Department in the Idaho Medicaid Provider Handbook. technical specifications.
Subject to primary care provider communication Providers must develop and document evaluation
requirements.
Telehealth services are covered for advanced practice processes and participant outcomes.

registered nurses enrolled as Healthy Connections The following services are allowed through telehealth
providers, within the limitations defined in the Idaho when provided by a physician or non-physician
Medicaid Provider Handbook. practitioner:
Source: ID Administrative Code 16.03.09 Sec. 210, 502 & 565. Primary care services
Specialty services
Psychotherapy with evaluation and
management
Psychotherapy diagnostic interview
Pharmacological management
Therapeutic consultation and crisis intervention
Reimbursement limited to specific CPT codes.
Must be referred by a primary care provider.
Source: Medicaid Telehealth Policy. Rev. 1/1/2017 & Idaho MMIS
Provider Handbook: allopathic and Osteopathic Physicians. Sept.
2017, p. 32. (Accessed Oct. 2017).
Telehealth services can be provided as an encounter by
an Indian Health Service facility, federally qualified
health clinic and rural health clinic,
Source: Idaho MMIS Provider Handbook: Ambulatory Health Care
Facility. Apr. 2017, p. 8, 11 & 18 (Accessed Oct. 2017).
Occupational therapists, physical therapists and speech
language pathologists may provide services through
telehealth. Covered telehealth services include speech
therapy provided by licensed speech language
pathologists as well as therapeutic procedures and
activities provided by licensed occupational therapists
and licensed physical therapists. Evaluations must be
performed with an in-person visit to the participant and is
not covered through telehealth.
The physician order must specifically allow the services
to be provided via telehealth.
Source: Medicaid Telehealth Policy. Rev. 1/1/2017 & ID MMIS
Provider Handbook. Speech, Language and Hearing Service
Providers. Jan. 1, 2017, Occupational and Physical Therapy
Services 7/1/2017, (Accessed Oct. 2017).
Through the Children’s Waiver Services, Idaho Medicaid
will reimburse for crisis intervention consults, or
individual consults by a therapeutic consultant via live
video.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source (service type): ID Administrative Code 16.03.10.683 (2012).
Community Based Rehabilitation Services (CBRS)
supervision is included in the CBRS reimbursement rate.
It is not separately reimbursable.
Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct. 2017).

Store and Forward Reimbursement

No reference found. Idaho Medicaid will only reimburse for “two-way live
video services”.
Source: Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct.
2017).

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX

Reimbursement not available in fee-for-service for No reimbursement for telephone, email or fax.
telephone, email or fax between a physician and
participant. Source: Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct.
2017).
Source: ID Administrative Code 16.03.09 Sec. 502.

Online Prescribing

Prescribing physicians must have prescriber-patient No reference found.
relationship, which includes a documented patient
evaluation adequate to establish diagnoses and identify
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).
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).
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. Participant written informed consent is required.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: ID Code Sec. 54-5608 & IDAPA 22.01.15). Source: Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct.
2017).

Location

No reference found. No reference found.

Cross-State Licensing

Idaho adopted the Federation of State Medical Board Providers of telehealth services must be licensed by the
(FSMB)’s model language for an interstate medical Idaho Board of Medicine.
licensure compact. Source: Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct.

Source: ID House Bill 150. ID Code Title 54, Ch. 18. 2017).

Private Payers

No reference found. No reference found.

Site/Transmission Fee

No reference found. No originating site fee.
Source: Medicaid Telehealth Policy. Rev. 1/1/2017. (Accessed Oct.
2017).

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. Idaho Telehealth Alliance. (Accessed Oct. 2018)

Professional Board Telehealth-Specific Regulations

ID Board of Medicine (Source: IDAPA 22.01.15) https://adminrules.idaho.gov/rules/current/22/0115.pdf

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