North Carolina 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

North Carolina Medicaid

North Carolina
Medicaid Program: North Carolina Medicaid

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 “Telemedicine is the use of two-way real-time interactive
audio and video between places of lesser and greater audio and video between places of lesser and greater
medical capability or expertise to provide and support medical capability or expertise to provide and support
health care, when distance separates participants who health care, when distance separates participants who
are in different geographical locations.” are in different geographical locations.”
Source: NC General Statute 130A-125 Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 1, Oct. 1, 2015. (Accessed Oct. 2017).

Live Video Reimbursement

The Commission is required to address follow up North Carolina Medicaid and NC Health Choice will

protocols to ensure early treatment for newborn infants reimburse for live video medical services and tele-
diagnosed with congenital heart defects, to include psychiatry services. All of the following conditions must
telemedicine (live video). be met:
Source: NC General Statute 130A-125 The beneficiary must be present at the time of
consultation;
The medical examination must be under the
control of the consulting provider;
The distant site of the service must be of a
sufficient distance from the originating site to
provide services to a beneficiary who does not
have readily available access to such specialty
services; and
The consultation must take place by two-way
real-time interactive audio and video
telecommunications system.
Criteria for eligible beneficiaries:
Must be enrolled in the NC Medicaid program or
NC Health Choice
Providers must verify each Medicaid or NCHC
beneficiary’s eligibility each time a service is
rendered
The Medicaid beneficiary may have service
restrictions due to their eligibility category that
would make them ineligible
For the NCHC Program, Children must be
between the ages of 6-18 (one of many

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

restrictions in program)

Other Limitations:
Up to three different consulting providers may
be reimbursed for a separately identifiable
telemedicine or telepsychiatry service per date
of service
Only one facility fee is allowed per date of
service per beneficiary
There is no reimbursement to the referring
provider at the originating site on the same date
of service unless the referring provider is billing
for a separately identifiable billable service.
Health records must document that all the
components of the service being billed were
provided
These services are subject to the same
restrictions as face-to-face contacts.
Special provisions apply for the Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) program.
See manual.
Eligible medical providers:
Physicians;
Nurse practitioners;
Nurse midwives;
Physician’s assistants.
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.
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

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

convenience of the recipient, the recipient’s

caretaker, or the provider.
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;
Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 1-7, Oct. 1, 2015. (Accessed Oct. 2017).

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. 5, Oct. 1, 2015. (Accessed Oct. 2017).

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.
No reimbursement for video cell phone interaction.
Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 4-5, Oct. 1, 2015. (Accessed Oct. 2017).

Online Prescribing

No reference found. No reference found.

Consent

No reference found. No reference found.

Location

No reference found. “The distant site of the service must be of a sufficient
distance from the originating site to provide services to a
beneficiary who does not have readily available access
to such specialty services.”
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 does

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

not follow established criteria for the service

provided.
Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 1-7, Oct. 1, 2015. (Accessed Oct. 2017).

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.
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. 7, Oct. 1, 2015. (Accessed Oct. 2017).

Miscellaneous

Department of Health and Human Services required to study and recommend a telemedicine policy for consideration by the General Assembly & study the Psychology Interjurisdictional Compact.

Source: HB 283 (Session Law 2017-133).

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).

Providers must comply with the following in effect at the time the service was rendered:
All applicable agreements, federal, state and local laws and regulations including HIPAA and medical retention requirements.

All Medicaid’s clinical coverage policies, guidelines, policies, provider manuals, implementation updates and bulletins published by CMS, DHHS, its divisions or its fiscal agent.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 7, Oct. 1, 2015. (Accessed Oct. 2017).

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