Oregon State Telehealth Laws and Reimbursement Policies

[gview file=”https://mtelehealth.com/wp-content/uploads/2020/05/State-Telehealth-Laws-and-Reimbursement-Policies-Oregon.pdf”]
AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Oregon Medicaid

Oregon
Medicaid Program: Oregon Medicaid

Medicaid Program Administrator: Oregon Health Authority

Regional Telehealth Resource Center:

Northwest 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

“Telemedicine means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications.”

Source: OR Revised Statutes 442.015.

Recently Passed Legislation (Now Effective)

Telehealth means a variety of methods, through the use of electronic and telecommunications technologies, for the distance delivery of health care services, including dental care services and clinical information designed to improve a patient’s health status and to enhance delivery of the health care services and clinical information.

Source: SB 786 (2017).
https://olis.leg.state.or.us/liz/2017R1/Downloads/MeasureDocume

nt/SB0786/Enrolled

Telehealth means a technological solution that provides two-way, video-like communication on a secure line.

Source: ORS 309-032-0860.

Physical Therapy:

“Telehealth service means a physical therapy intervention, including assessment or consultation that can be safely and effectively provided using synchronous two-way interactive video conferencing, or asynchronous video communication, in accordance with generally accepted healthcare practices and standards. For purposes of these rules, ‘telehealth service’ also means, or may be referred to, as ‘telepractice, teletherapy, or telerehab’.”

Source: OR Administrative Rule, Sec. 848-040-1080.

“Telemedicine is the use of medical information, exchanged from one site to another, via telephonic or electronic communications, to improve a patient’s health status.”

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. (Accessed Oct. 2017).

Live Video Reimbursement

(See “Private Payers” section) Oregon Medicaid will reimburse for live video when
billed services comply with their billing requirements.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

The referring provider is not required to be present with
the client for the consult.
The referring provider may bill for the patient visit only if
a separately identifiable visit is performed.
Behavioral health services identified as allowable for
telephonic delivery are listed in the fee schedule. The
authority must provide coverage for telemedicine
services to the same extent that the service would be
covered if they were provided in person.
Source: OR Div. of Medical Assistance Program, Medical-Surgical
Svcs. Rulebook, Div. 130, 410-130-0610 & Behavior Health
Services Rules 410-172-0850. (Accessed Oct. 2017).

Store and Forward Reimbursement

No reference found. Behavioral Health Services Manual:
Unless specifically authorized by OAR 410-120-1200
other types of telecommunication are not covered such
as images transmitted via facsimile machines and
electronic mail when:
Those methods are not being used in lieu of
videoconferencing, due to limited video
conferencing equipment; or
Those methods and specific services are not
specifically allowed pursuant to the Oregon
Health Evidence Review Commission’s
Prioritized List of Health Services and Evidence
Based Guidelines.
Source: Behavior Health Services Rules 410-172-0850. (Accessed
Oct. 2017).

Remote Patient Monitoring Reimbursement

Oregon requires out of state physicians to acquire active No reference found.
tele-monitoring status through the Oregon Medical
Board before they can perform intraoperative tele-
monitoring on patients during surgery.
The Administrative Code defines “tele-monitoring” as the
“intraoperative monitoring of data collected during
surgery and electronically transmitted to a physician who
practices in a location outside of Oregon. The monitoring
physician is in communication with the operation team
through a technician in the operating room.”
Requirements:
The facility where the surgery is performed must
be a licensed hospital or ambulatory surgical
center;
The facility must grant medical staff membership
and/or clinical privileges to the monitoring
physician;

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

The monitoring physician must have OR active-

tele-monitoring status.

Source: OR Admin. Rules. 847-008-0023.

Email/Phone/FAX

Yes for email.

Yes for telephone.
No reference found for FAX.

Email and telephone consults must comply with Health Service Commission guidelines.

Source: OR Admin. Rules 410-130-0610.

Yes for email and telephone when used for patient consulting and “when billed services comply with the practice guidelines set forth by the Health Service Commission (HSC), applicable HSC approved CPT code requirements and delivered consistent with the HSC practice guideline.”

Email, telephone and fax may be used when videoconferencing availability is limited.

Source: OR Div. of Medical Assistance Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 69-70 (Jan. 1, 2016) & Behavior Health Services Rules 410-172-0850 (Accessed Oct. 2017).

Online Prescribing

Practicing Across State Lines No reference found.
A physician must first:
Establish a physician-patient relationship;
Make a judgment based on some type of
objective criteria upon which to diagnose, treat,
correct or prescribe;
Act in the best interest of the patient.
Writing prescriptions based only on an Internet sale or
consults prohibited.
Source: OR Admin. Rules, 847-025-0000.

Consent

No reference found. No reference found.

Location

Plans may not distinguish between originating sites that No reference found.
are rural and urban in providing coverage.
Source: OR Senate Bill 144 (2015); & Revised Statutes Sec.
743A.058.

Cross-State Licensing

Out-of- state physicians may receive a license to practice across state lines in Oregon, as long as they are fully licensed in another state and meet certain requirements.

Source: OR Revised Statutes Annotated Sec. 677.139.

(also see Medicaid column)

The referring and evaluating practitioner must be licensed to practice medicine within the state of Oregon or within the contiguous area of Oregon and must be enrolled as a Division of Medical Assistance Programs (Division) provider.

Source: OR Administrative Regulation 410-130-0610(2)(a) &
Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. (Accessed Oct. 2017).

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Private Payers

Oregon requires coverage by health benefit plans and No reference found.

self-insured health plans offered through the Public
Employees’ Benefit Board or the Oregon Educators
Benefit Board of health services that is provided using
synchronous two-way interactive video conferencing,
subject to contract terms and conditions.
Plans may not distinguish between originating sites that
are rural and urban in providing coverage.
Source: OR Senate Bill 144 (2015); & Revised Statutes Sec.
743A.058.
A health benefit plan must provide coverage in
connection with the treatment of diabetes if:
If coverage is provided for in-person services
The service is medically necessary;
The service relates to a specific patient; and
One of the participants in the telemedical health
service is a representative of an academic
health center.
Source: OR Revised Statutes Sec. 743A.185.

Site/Transmission Fee

(see Medicaid column) Oregon Medicaid will provide transmission fees for
originating sites.
Source: OR Admin. Regulation 410-130-0610(5) & OR Div. of
Medical Assistance Programs, Medical-Surgical Svcs. Rulebook,
Div. 130, 410-130-0610. (Accessed Oct. 2017).

Miscellaneous

Comments: Professional Board Telehealth-Specific Regulations

Dental Care Services (Source: SB 786 – 2017) https://olis.leg.state.or.us/liz/2017R1/Downloads/MeasureDocument/SB0786/Enrolled

Occupational Therapy (Source: OR Admin. Code 339-010-0006)

Physical Therapy (Source: OR Admin. Code 848-040-0180)

© 2020 mTelehealth, Inc. All rights reserved.