Ohio 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

Ohio Medicaid

Ohio
Medicaid Program: Ohio Medicaid

Medicaid Program Administrator: Ohio Department of Job and Family Services

Regional Telehealth Resource Center:

Upper Midwest Telehealth Resource Center
2901 Ohio Boulevard, Ste. 110

Terre Haute, IN 47803
(855) 283-3734 ext. 232 www.umtrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“The practice of telemedicine means the practice of medicine in this state through the use of any communication, including oral, written, or electronic communication, by a physician located outside this state.”

Source: OH Revised Code Annotated, 4731.296.

“Telehealth means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including, but not limited to physical therapy related information and services, over large and small distances.”

Source: OH Admin. Code 4755-27-01.

Telehealth service means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

Source: OH Revised Code, Sec. 5164.94.

Speech Language Pathology

Telehealth means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiology or speech-language pathology services to an individual from a provider through hardwire or internet connection.

Source: OH Admin. Code 4753-2-01

Telemedicine is the direct delivery of evaluation and management (E&M) or psychiatric services to a Medicaid eligible patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements.

Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016) & OH Admin. Code 5160-1. (Accessed Oct. 2017).

Live Video Reimbursement

The department of Medicaid is required to establish Ohio Medicaid covers live video telemedicine.

standards for Medicaid payment for health care services
the department determines are appropriate to be Eligible Distant Site Providers
covered when provided as telehealth services. Physicians (MD, DO)
Source: OH Revised Code, Sec. 5164.95. Psychologists

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Speech Language Pathology Telehealth may be Federally Qualified Health Center (medical and
delivered through live video. mental health)
Source: OH Admin. Code 4753-2-01 See fact sheet for list of eligible CPT codes.
Source: OH Fact Sheet: Telemedicine Billing Guidance (Dec.
2016) & OH Admin Code 5160-1. (Accessed Aug. 2016).

Store and Forward Reimbursement

Speech Language Pathology

Telehealth may be delivered through store and forward.

Source: OH Admin. Code 4753-2-01

Telemedicine is defined as being “synchronous, interactive, real-time”, excluding the use of store and forward technology.

Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016) (Accessed Oct. 2017).

Remote Patient Monitoring Reimbursement

No reference found. The home is not an acceptable place of service for
either an originating or distant site.
Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016)
(Accessed Oct. 2017).

Email/Phone/FAX

No reference found. Electronic mail, telephone and facsimile transmission
are not telemedicine.
Source: OH Admin. Code 5160-1.

Online Prescribing

A physician shall not prescribe, personally furnish or No reference found.
otherwise provide, or cause to be provided any
controlled substance or non-controlled substance to a
person on whom the physician has never conducted a
physical examination, with the exceptions listed below.
Non-Controlled Substances Exceptions
Prescribing is allowed when a patient is remote from the
physician by complying with the following:
Establish the patient’s identity and physical
location;
Obtain the patient’s informed consent;
Forward medical record to patient’s primary care
provider (upon consent);
Conduct an appropriate evaluation;
Establish or confirm a diagnosis and treatment
plan;
Document information in patient’s medical
record;
Provide appropriate follow-up care;
Make medical record of the visit available to
patient; and
Use appropriate technology sufficient to conduct
all steps.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Additional restrictions apply for controlled substances.

See regulation.

Source: OH Admin. Code 4731-11-09.

Consent

Informed consent is required (“patient’s agreement or signed authorization”). Must be documented in patient’s record.

Source: OH Admin. Code 4731-11-09.

Speech Language Pathology

A provider is required to inform the patient of specific telehealth limitations.

Source: OH Admin. Code 4753-2-01

The originating site is responsible for obtaining informed consent.

Source: OH Admin. Code 5160-1.

Location

No reference found. When the originating site is located within a five mile
radius from the distant site, providers are not eligible for
reimbursement.
Provider types eligible as an originating site, either using
a Q3014 HCPCS code or a GQ modifier:
Primary Care Clinic
Outpatient Hospital
Rural Health Clinic (Medical)
Federally Qualified Health Clinic (Medical)
Physician
Professional Medical Group
Podiatrist
Optometrist
See fact sheet for additional billing rules.
Additional place of service restrictions:
Home
Inpatient hospital
Nursing facility
Inpatient psychiatric hospitals
Other POS exclusions for E&M and psychiatric
codes
Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016),
(Accessed Oct. 2017).

Cross-State Licensing

Ohio issues telemedicine certificates that allow the No reference found.
holder to engage in the practice of telemedicine in the
state.

Providers with telemedicine certificates cannot practice

in OH without a special activity certificate.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: OH Revised Code Annotated, Sec. 4731.296(C).

Physical Therapy

Physical therapists and physical therapist assistants
must hold a valid OH physical therapy license to treat a
patient located in Ohio via telehealth.

Source: OH Admin. Code 4755-27-01.

Private Payers

No reference found. No reference found.

Site/Transmission Fee

No reference found. Originating site eligible for a facility fee using HCPCS
code Q3014.
See transmittal letter for additional billing rules.
Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016),
(Accessed Oct. 2017). & OH Admin Code 5160-1. (Accessed Aug.
2016).

Miscellaneous

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