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                                                                                 Center for Connected Health Policy

           Arizona


           Medicaid Program:  Arizona Health Care Cost Containment System (AHCCCS)

           Program Administrator: Arizona Health Care Cost Containment System Administration

           Regional Telehealth Resource Center
           Southwest Telehealth Resource Center
           PO Box 245105
           Tucson, AZ 85724
           (520) 626-4498
           www.southwesttrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            Under Arizona Statute, Public Health & Safety,      Telemedicine is “the practice of health care delivery,
            "telemedicine means the practice of health care delivery,  diagnosis, consultation and treatment and the transfer
            diagnosis, consultation and treatment and the transfer of  of medical data between the originating and distant sites
            medical data through interactive audio, video or data   through real time interactive audio, video or data
            communications that occur in the physical presence of   communications that occur in the physical presence of
            the patient, including audio or video communications   the member.”
            sent to a health care provider for diagnostic or treatment
            consultation.”                                      Source: AZ Health Care Cost Containment System .AHCCCS
                                                                Medical Policy Manual for AHCCCS Covered Services, Ch. 300, p.

            Source: AZ Revised Statute Sec. 36-3601 (2012).     176, Apr. 2012.

            Under State Administrative Code, Department of      Telehealth is “the use of telecommunications and
            Insurance, Health Care Services Organizations       information technology to provide access to health
            Oversight, "telemedicine means diagnostic, consultation,   assessment, diagnosis, intervention, consultation,
            and treatment services that occur in the physical   supervision and information across distance.”
            presence of an enrollee on a real-time basis through
            interactive audio, video, or data communication.”   Source: AZ Health Care Cost Containment System, AHCCCS
                                                                Medical Policy for AHCCCS Covered Services, Ch. 300, p. 176.
                                                                Apr. 2012.
            Source: AZ Admin. Code Sec. R20-6-1902 (2012).


            “Telemedicine means the interactive use of audio, video
            or other electronic media for the purpose of diagnosis,
            consultation or treatment.  Does not include the sole use
            of an audio-only telephone, a video-only system, a
            facsimile machine, instant messages or electronic mail.”

            Source: AZ SB 1353 (2013).


            Live Video Reimbursement
            Health Care Service Organizations (HCSO) are allowed,  Fee for Service
            but not mandated, to provide access to covered services  AHCCCS will reimburse for medically necessary
            through telemedicine, telephone, and email.        services provided via live video in their fee for service
                                                               program.
             Source: AZ Admin. Code Sec. R20-6-1915 (2012)
                                                               Eligible services:
            Private payers are required to provide coverage for live   •   Cardiology;
            video consultations when treating specific conditions   •   Dermatology;


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            and the originating site is located in a rural region.   •   Endocrinology;
            Allowed Conditions                                     •   Hematology/oncology;
               •   Trauma                                          •   Home Health
               •   Burn                                            •   Infectious diseases;
               •   Cardiology                                      •   Neurology;
               •   Infectious diseases                             •   Obstetrics/gynecology;
               •   Mental health disorders                         •   Oncology/radiation;
                                                                       Ophthalmology;
                                                                   •
               •   Neurologic diseases including strokes           •   Orthopedics;
               •   Dermatology                                     •   Pain clinic;
                                                                   •   Pathology;
            A rural region is defined as:                          •   Pediatrics and pediatric sub-specialties;
               •   An area that is located in a county with a      •   Radiology;
                   population of less than nine hundred thousand   •   Rheumatology;
                   persons; or                                     •   Surgery follow-up and consults;
               •   A city or town that is located in a county with a
                   population of nine hundred thousand persons or   Source: AZ Health Care Cost Containment System, AHCCCS Fee-
                                                               For-Service Provider Manual, Ch. 10: Professional and Technical
                   more and whose nearest boundary is more than  Services, p. 38 (Nov. 2014).
                   thirty miles from the boundary of a city that has
                   a population of five hundred thousand persons   Behavioral health services are covered for AHCCS and
                   or more.                                    KidsCare patients.

                                                               Covered behavioral health services:
            Source: AZ Statutes 20-841.09.
                                                                   •   Diagnostic consultation and evaluation;
                                                                   •   Psychotropic medication adjustment and
                                                                       monitoring;
                                                                   •   Individual and family counseling;
                                                                   •   Case management.

                                                               The patient’s primary care provider (PCP), attending
                                                               physician, other medical professional employed by the
                                                               PCP, or an attending physician who is familiar with the
                                                               patient’s condition, must be present.

                                                               Other medical professionals:

                                                                   •   Registered nurses;
                                                                   •   Licensed practical nurses;
                                                                   •   Clinical nurse specialists;
                                                                   •   Registered nurse midwives;
                                                                   •   Registered nurse practitioners;
                                                                   •   Physician assistants;
                                                                   •   Physical, occupational, speech, and respiratory
                                                                       therapists;
                                                                   •   Trained telepresenter familiar with the
                                                                       recipient’s medical condition.

                                                               For behavioral health services, the patient’s physician,
                                                               case manager, behavioral health professional, or tele-
                                                               presenter must be present.

                                                               Source: AZ Health Care Cost Containment System, AHCCCS Fee-
                                                               For- Service Provider Manual, Ch. 10: Professional and Technical


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Services, p. 39 (Nov. 2014).
            Store and Forward Reimbursement
            The definition of “telemedicine”, which describes   Fee for Service
            telemedicine as occurring in the “physical presence” of   AHCCCS will reimburse for store-and-forward in their
            the patient, would exclude store and forward.      fee-for-service program.  The same services are
                                                               covered for store and forward, as for real time.
            Source: AZ Admin. Code Sec. R20-6-1902 (2012).

                                                               Real time telemedicine is the only type of
                                                               reimbursement available in the field of Behavioral Health
                                                               Services.

                                                               Source: AZ Health Care Cost Containment System, AHCCCS Fee-
                                                               For- Service Provider Manual, Ch. 10: Professional and Technical
                                                               Services, p. 38 (Nov. 2014).

                                                               Fee for Service and Managed Care
                                                               In the Managed Care program, AHCCCS only covers for
                                                               store and forward (and is subject for review) the
                                                               following:

                                                                   •   Dermatology
                                                                   •   Radiology
                                                                   •   Ophthalmology
                                                                   •   Pathology

                                                               Source: Arizona Health Care Cost Containment System. AHCCCS
                                                               Medical Policy Manual for AHCCCS Covered Services, Ch. 300,
                                                               Policy 320 Services With Special Circumstances, p. 178 (Apr.
                                                               2012).

                                                               The following exceptions may be eligible for
                                                               reimbursement by managed care, but are not
                                                               considered a “telemedicine service”:

                                                                   •   A provider in the role of tele-presenter may be
                                                                       providing a separately billable service, such as
                                                                       an electrocardiogram or an X-ray. The service is
                                                                       covered, but not the tele-presenting.

                                                                   •   A consulting distant-site provider may offer a
                                                                       service that does not require real-time patient
                                                                       interaction. Reimbursement only for
                                                                       dermatology, radiology, ophthalmology, and
                                                                       pathology. It is subject to review by AHCCCS
                                                                       Medical Management.

                                                                   •   When a patient in a rural area presents within
                                                                       three hours of onset of stroke symptoms,
                                                                       AHCCCS will reimburse the consulting
                                                                       neurologist if the consult is placed for assistance
                                                                       in determining appropriateness of thrombolytic
                                                                       therapy even when the patients’ condition is
                                                                       such that real-time video interaction cannot be
                                                                       achieved.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Source: AZ Health Care Cost Containment System, AHCCS
                                                               Medical Policy Manual, Medical Policy for AHCCCS Covered
                                                               Services, Ch. 300, Policy 320: Services With Special
                                                               Circumstances, page 178, (Apr. 2012).
            Remote Patient Monitoring Reimbursement

            No reference found.                                Home health is listed as a reimbursable service in fee
                                                               for service, but no other reference was found or
                                                               explanation of what is considered a “home health”
                                                               service.

                                                               Source: AZ Health Care Cost Containment System, AHCCCS Fee-
                                                               For- Service Provider Manual, Ch. 10: Professional and Technical
                                                               Services, p. 38 (Nov. 2014).

                                                               Fee for Service and Managed Care
                                                               AHCCCS program only reimburses for telemedicine
                                                               delivered via real time, Home Health is not a covered
                                                               service under this program.

                                                               Source: AZ Health Care Cost Containment System .AHCCCS
                                                               Medical Policy Manual for AHCCCS Covered Services, Ch. 300,
                                                               Policy 320 Services With Special Circumstances, p. 178 (Apr.
                                                               2012).

            Email/Phone/FAX
            Health Care Service Organizations are allowed, but not   No reference found.
            mandated, to provide covered services through
            telemedicine, telephone, and email.

            Source: AZ Admin. Code Sec. R20-6-1915 (2012).

            No Phone
            No Email
            No Fax

            Source: AZ Statutes 20-841.09.
            Online Prescribing

            Physicians are prohibited from issuing a prescription to   No reference found.
            patients without having a physical or mental health
            status examination to establish a provider-patient
            relationship.

            The physical or mental health status examination can be
            conducting during a real-time telemedicine encounter.

            Source: Arizona Revised Statute Sec. 32-1401 (SB 1339).
            Consent

            Providers must obtain and document oral or written   No reference found.
            consent before delivery of services.  Oral consent
            should be documented on the patient’s medical record.

            Source: AZ Revised Statute Sec. 36-3602 (2012).

            Location


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Private payers are required to provide coverage when   Eligible hub or spoke sites for Indian Health Services or
            the originating site is located in a rural region, which is   tribal providers:
            defined as:
                •   An area that is located in a county with a     •   Indian Health Service clinic;
                   population of less than nine hundred thousand   •   Tribally-governed facility;
                   persons; or                                     •   Urban clinic for American Indians;
                •   A city or town that is located in a county with a   •   Physician or other provider office;
                   population of nine hundred thousand persons or   •   Hospital;
                   more and whose nearest boundary is more than      •   Federally Qualified Health Center (FQHC).
                   thirty miles from the boundary of a city that has   Source: AHCCCS, HIS/638 AHCCCS Telehealth Training Manual,
                   a population of five hundred thousand persons   p. 8 (Dec. 2014).
                   or more.                                      Fee for service manual definitions:
            Source: AZ Statutes 20-841.09.                       Hub site – “the location of the telemedicine consulting

                                                               provider, which is considered the place of service.”

                                                               Spoke site – “the location where the recipient is
                                                               receiving the telemedicine service.”

                                                               Source: AZ Health Care Cost Containment System, AHCCCS Fee-
                                                               For- Service Provider Manual, Ch. 10: Professional and Technical
                                                               Services, p. 38 (Nov. 2014).
            Cross-State Licensing
            An out-of-state doctor may engage in a single or   Fee for Service and Managed Care
            infrequent consultation with an Arizona physician.    A consultation by a non-Arizona licensed provider may
                                                               occur if:
            Source: AZ Revised Statute Sec. 32-1421 (2012).
                                                                   •   It is to a specific patient in the AHCCCS
                                                                       program;
                                                                   •   The provider is registered with AHCCCS;
                                                                   •   The provider is licensed in the state the
                                                                       consultation is being provided from, or the
                                                                       provider is employed by an Indian Health
                                                                       Services, Tribal or Urban Indian Health program
                                                                       and appropriately licensed based on IHS and
                                                                       Tribal facility requirements.

                                                               Source: AZ Health Care Cost Containment System, AHCCS
                                                               Medical Policy Manual, Medical Policy for AHCCCS Covered
                                                               Services, Ch. 300, Policy 320: Services With Special
                                                               Circumstances, page 179, (Apr. 2012).
            Private Payers

            Private payers are required to provide coverage for live   No reference found.
            video consultations when treating specific conditions
            and the originating site is located in a rural region.
            Allowed Conditions
               •   Trauma
               •   Burn
               •   Cardiology
               •   Infectious diseases
               •   Mental health disorders


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

               •   Neurologic diseases including strokes
               •   Dermatology
            A rural region is defined as:
               •   An area that is located in a county with a
                   population of less than nine hundred thousand
                   persons; or
               •   A city or town that is located in a county with a
                   population of nine hundred thousand persons or
                   more and whose nearest boundary is more than
                   thirty miles from the boundary of a city that has
                   a population of five hundred thousand persons
                   or more.


            Source: AZ Statutes 20-841.09.

            Site/Transmission Fee

            No reference found.                                No reference found.
            Miscellaneous
            Arizona explicitly prohibits the use of telemedicine to   Fee for Service and Managed Care
            provide an abortion.                               There is reimbursement for non-emergency
                                                               transportation to and from the telemedicine originating
            Source: AZ Revised Statute Sec. 36-3604 (2012).    site.

                                                               Source: AZ Health Care Cost Containment System, AHCCS
                                                               Medical Policy Manual, Medical Policy for AHCCCS Covered
                                                               Services, Ch. 300, Policy 320: Services With Special
                                                               Circumstances, page 179, (Apr. 1, 2012).


































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