New York 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

New York Medicaid

New York
Medicaid Program: New York Medicaid

Medicaid Program Administrator: New York State Dept. of Health

Regional Telehealth Resource Center

Northeast Telehealth Resource Center
11 Parkwood Drive
Augusta, ME 04330

(800) 379-2021
www.netrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

Related to Credentialing and Privileging health care practitioners providing telemedicine
“Telemedicine means the delivery of clinical health care services by means of real time two-way electronic audio-visual communications which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care, while such patient is at the originating site and the health care provider is at a distant site.”

Source: NY Consolidated Law Service Public Health Sec. 2805-u.

The term “telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth shall not include delivery of health care services by means of audio-only telephone communication, facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology or remote patient monitoring.

Source: NY Public Health Law Article 29 – G Section 2999-cc

Telemedicine means the use of synchronous, two-way electronic audio visual communications to deliver clinical health care services, which shall include the assessment, diagnosis, and treatment of a patient, while such a patient is at the originating site and a telehealth provider is at a distant site.

Source: NY Public Health Law Article 29 – G Section 2999-cc

“Telemedicine is the use of interactive audio and video telecommunications technology to support “real time” interactive patient care and consultations between healthcare practitioners and patients at a distance. The distant site or “hub” is where the medical specialist providing the consultation or service is located. The originating site or “spoke” is where the referring health professional and patient are located.”

Source: NY Dept. of Health, Medicaid Update, Vol. 31, Number 3, March 2015, p. 18. (Accessed Mar. 2017).

For the home telehealth program, term “telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth shall not include delivery of health care services by means of audio-only telephone communication, facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology or remote patient monitoring.

Source: NY Public Health Law Article 29 – G Section 2999-cc.

Live Video Reimbursement

A health plan shall not exclude from coverage services that are provided via telehealth if they would otherwise

Reimbursement policy applies to fee-for-service. Managed care plans may cover telemedicine at their

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

be covered under a policy. Telehealth means the use of own option and establish their own payment guidelines
electronic information and communications technologies and structure.
by a health care provider to deliver health services to an
insured individual while such individual is located at a New York Medicaid will reimburse for live video services
site that is different from the site where the health care for medically necessary services provided to patients in:
provider is located. Hospitals (emergency room, outpatient
Source: NY Insurance Law Article 32 Section 3217-h & Article 43
department, Inpatient) established under
Section 4306-g. Article 28 of the New York Public Health Law;
Medicaid: Subject to federal financial participation and Diagnostic and Treatment Centers (D&TCs)
established under Article 28 of the New York

the approval of the director of the budget, the
Public Health Law;
commissioner shall not exclude from the payment of
FQHCs that have “opted into” NY Medicaid
medical assistance funds the delivery of health care
Ambulatory Patient Groups (APG);
services through telehealth, as defined in subdivision
Non-FQHC School Based Health Centers
four of section two thousand nine hundred ninety-nine-
(SBHCs)
cc of the public health law.
Practitioner offices;

Source: Social Services Law Article 367-u. Article 28 facilities providing dental services;
Providers who may deliver telemedicine services
include:
Physician specialists, including psychiatrists;
Certified Diabetes Educators (CDEs);
Certified Asthma Educators (CAEs or A-ECs)
Clinical Psychologists;
Dentists;
Psychiatric Nurse Practitioners;
Genetic Counselors;
Licensed Clinical Social Workers (LCSW) and
Licensed Master Social Workers (LMSW) only
when employed by an Article 28 clinic.
LCSWs and LMSW can only provide services
to Medicaid enrollees under age 21 and
pregnant women up to 60 days post-partum.
Source: NY Dept. of Health, Medicaid Update, Vol. 31, Number 3,
March 2015, p. 18-19. (Accessed. Mar. 2017).
Medicaid will cover genetic counseling services via
telemedicine.
Source: NY Dept. of Health, Medicaid Update, Vol. 31, Number 8,
July 2015, p. 15. (Accessed. Mar. 2017).
Telepsychiatric services must meet certain conditions to
be eligible for Medicaid reimbursement.
Source: NY Regulations Title 14 NYCRR Section 599.17.
For the Home Telehealth program, a telehealth provider
is:
Licensed physician
Licensed physician assistant
Licensed dentist
Licensed nurse practitioner

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Licensed registered professional nurse

Licensed podiatrist

Licensed optometrist

Licensed psychologist

Licensed social worker

Licensed speech language pathologist or

audiologist

Licensed midwife

Certified diabetes educator

Certified asthma educator

Certified genetic counselor

Hospital

Home care services agency

Hospice

Or any other provider as determined by the

Commissioner.

Source: NY Public Health Law Article 29 – G Section 2999-cc.

Mental Health

Telepsychiatry services may be authorized by the office
for assessment and treatment services provided by
physicians or nurse practitioners, where the patient is
physically located at an originating/spoke site licensed
by the Office of Mental Health, and the physician or
nurse practitioner is physically located at a distant/hub
site that participates in the New York State Medicaid
program.

A provider of service must obtain prior written

authorization. See regulation for requirements.

A notation must be made in the clinical record that

indicates that the service was provided via
telepsychiatry and which specifies the time the service
was started and the time it ended.

A provider of services approved to utilize telepsychiatry

services must have written protocols and procedures
that address informed consent, confidentiality, security
of electronic transmission, psychiatric emergencies,
prescribing medications via telepsychiatry, procedures
for first evaluations for involuntary commitments, patient
rights, quality of care, and a contingency plan. See

regulation for further details.

Notice of contracts or agreements between

originating/spoke sites shall be provided by the
distant/hub provider of services within 30 days after
execution of such contract to the Field Office serving the
area where such provider of services is located.

Telepsychiatry shall not be utilized in Personalized

Recovery Oriented Services program or Assertive
Community Treatment programs.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: NY Code of Rules and Regs. Title 14, Sec. 596.

Store and Forward Reimbursement

Private payers may, but are not mandated to, reimburse Store and forward is not reimbursed.
for store-and forward delivered services. Source: NY Dept. of Health, Medicaid Update, Vol. 31, Number 3,

March 2015, p. 19. (Accessed Mar. 2017).
Source: NY Insurance Law Article 32 Section 3217-h & NY
Insurance Law Article 43 Section 4306-g. For the home telehealth program, store and forward

Medicaid: services may be reimbursed.

Store and forward included within definition of Source: NY Public Health Law Article 29 – G Section 2999-dd
“telehealth” in statute requiring Medicaid not exclude

from payment the delivery of services through The patient must be present for telepsychiatry services.
telehealth.
Telepsychiatry is also defined as “live” and “real time”.

Source: Social Services Law Article 367- Source: NY Code of Rules and Regs. Title 14, Sec. 596.
u. http://public.leginfo.state.ny.us/lawssrch.cgi?NVLWO:

NY Department of Health is encouraging Medicaid
* NY submitted a state plan amendment (SPA) to
Managed Care (MMC) plans to allow for telehealth
reimburse for store and forward diabetic retinopathy
services. They are allowing MMC plans to request
screening and teledermatology. However, the SPA is
reimbursement of additional cost effective alternative
being revised and regulations are still in development to
telehealth services.
implement the store and forward requirement in law.

Source: NY Department of Health Memorandum, Telehealth
Innovation in Medicaid Managed Care, Sept. 18, 2017. Accessed
Oct. 2017.

Remote Patient Monitoring Reimbursement

Medicaid: For the home telehealth program, store and forward
services may be reimbursed.
RPM included within definition of “telehealth” in statute
requiring Medicaid not exclude from payment the
delivery of services through telehealth. Source: NY Public Health Law Article 29 – G Section 2999-dd.
(Accessed ).
See Comments section at the bottom of the document.
Source: Social Services Law Article 367-u.
Private payers may, but are not mandated to, reimburse
for remote patient monitoring services.
Source: NY Insurance Law Article 32 Section 3217-h & NY
Insurance Law Article 43 Section 4306-g.
Demonstration rates of payment or fees shall be
established for telehealth services provided by a
certified home health agency, a long term home health
care program or AIDS home care program, or for
telehealth services by a licensed home care services
agency under contract with such an agency or program,
in order to ensure the availability of technology-based
patient monitoring, communication and health
management. Reimbursement is provided only in
connection with Federal Food and Drug Administration-
approved and interoperable devices that are
incorporated as part of the patient’s plan of care.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: NY Consolidated Law Service Public Health Sec. 3614.

Email/Phone/FAX

Per the definition of telehealth, health care services by means of audio-only telephone communication, facsimile machines, or electronic messaging alone are not included in the definition of telehealth. The use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology or remote patient monitoring.

Source: NY Public Health Law Article 29 – G Section 2999-cc

No payment for telephone.

Source: NY Medicaid Program. Physician Policy Guidelines.

Version 2015-4. Oct. 15, 2015. P. 19. (Accessed. Mar. 2017Mar.

2017).

Telepsychiatry services does not include telephone, video cell phone, or e-mail.

Source: NY Code of Rules and Regs. Title 14, Sec. 596.

Online Prescribing

No reference found. No reference found.

Consent

No reference found. Mental Health
Part of obtaining approval for telepsychiatry services is
obtaining informed consent.
Source: NY Code of Rules and Regs. Title 14, Sec. 596.

Location

Originating sites are limited to: No reference found.
Licensed health facilities in Articles 28 (hospitals)
and 40 (hospice);
A facility as defined in Section 1.03, subdivision six
of the Mental Hygiene Law which includes and
place in which services for the mentally disabled
are provided and includes but is not limited to a
psychiatric center, development center, institute,
clinic, ward, institution or building;
Private physician’s or dentist’s offices located in
New York;
Public, private and charter elementary and
secondary schools, school age childcare programs
and child day care centers within the state of New
York;
Adult care facility licensed under title two of article
seven of the social services law;
When a patient is receiving health care services by
means of remote patient monitoring, the patient’s
place of residence located within the state of New
York or other temporary location located within or
outside the state of New York.
Source: NY Public Health Law Article 29 – G Section 2999-cc

Cross-State Licensing

No reference found. No reference found.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Private Payers

A health plan shall not exclude from coverage services No reference found.
that are provided via telehealth if they would otherwise
be covered under a policy. Telehealth means the use of
electronic information and communications technologies
by a health care provider to deliver health services to an
insured individual while such individual is located at a
site that is different from the site where the health care
provider is located.
Source: NY Insurance Law Article 32Section 3217-h & NY
Insurance Law Article 43 Section 4306-g.

Site/Transmission Fee

No reference found. Transmission fee may be billed under certain
circumstances.
Source: NY Dept. of Health, Medicaid Update, Vol. 31, Number 3,
March 2015, p. 21. (Accessed. Mar. 2017).
The originating site can bill for administrative expenses
only when a telepsychiatric connection is being provided
and a physician or NP is not present at the originating
site with the patient at the time of the encounter.
Source: NY Code of Rules and Regs. Title 14, Sec. 596.

Miscellaneous

New York hospitals acting as originating (spoke) sites
must ensure that all physicians at distant (hub) sites are
appropriately credentialed and privileged.
Source: NY Dept. of Health, Medicaid Update, Vol. 31, Number 3,
March 2015, p. 19. (Accessed Mar. 2017).

Comments:

CCHP has reviewed a copy of the state plan amendment NY Medicaid submitted and was approved authorizing them to cover store and forward and RPM.

Source: NY State Plan Amendment 16-0015 – https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NY/NY-16-0015.pdf

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