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                                                                                 Center for Connected Health Policy

           Colorado


           Medicaid Program:  Colorado Medicaid

           Program Administrator:  Colorado Dept. of Health Care Policy and Financing

           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
            “Telemedicine means the delivery of medical services   No reference found.
            and any diagnosis, consultation, or treatment using
            interactive audio, interactive video, or interactive data
            communication.”

            Source: CO Revised Statutes 12-36-102.5 (2012).
              Workers’ Compensation
            Telehealth is often used to encompass a broader
            definition of remote health care that does not always
            involve clinical services. Videoconferencing,
            transmission of still images, e-health including patient
            portals, remote monitoring of vital signs and continuing
            medical education are all considered part of
            telemedicine and telehealth.

            Source: 7 CO Regs. Rule 18.

            Live Video Reimbursement
            Health plans for patients in counties with 150,000 or   Colorado Medicaid will reimburse for medical and
            fewer residents cannot require face-to-face contact   mental health services.  Services shall be subject to
            between a provider and a patient for services that could  reimbursement policies developed by the medical
            be appropriately provided through telemedicine, subject  assistance program.
            to the terms and conditions of the health benefit plan.
                                                               Reimbursement must be the same as in-person
            Source: CO Revised Statutes 10-16-123 (2012).      services.

            (also see Medicaid column & “Private Payers” section)   Source: CO Revised Statutes 25.5-5-320 (2012).
                                                               Colorado Medicaid does not pay for provider or patient
                                                               education when education is the only service provided
                                                               via telemedicine.
                                                                  •  No enrolled managed care organization may require
                                                                   face-to-face contact between a provider and a client
                                                                   for services appropriately provided through
                                                                   telemedicine if: The client resides in a county with a
                                                                   population of 150,000 or fewer residents and
                                                                  •  The county has the technology necessary to provide
                                                                   telemedicine services.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               The use of telemedicine is not required when in-person
                                                               care by a participating provider is available to an
                                                               enrolled client within a reasonable distance.

                                                               Source: CO Medical Assistance Program, Telemedicine Manual,
                                                               p. 3-4 (Sept. 2013).
            Store and Forward Reimbursement

            No reimbursement based upon definition of           The CO Medical Assistance Program will only
            “telemedicine” which describes telemedicine as      reimburse for “live” telemedicine, excluding store and
            “interactive” implying that it happens in real time.   forward.  Peripherals, such as transmission of a live
                                                                ultrasound exam, may be reimbursed.
            Source: CO Revised Statutes 12-36-102.5 (2012).
                                                                Source: CO Medical Assistance Program, Telemedicine Manual,
                                                                p. 3 (Sept. 2013).
            Remote Patient Monitoring Reimbursement
            (see Medicaid column)                              The CO Medical Assistance Program will reimburse for
                                                               Remote Patient Monitoring at a flat fee set by the state
                                                               board when all these requirements are met:

                                                                   •   The patient is receiving services from a home
                                                                       health provider for at least one of the following:
                                                                       congestive heart failure, chronic obstructive
                                                                       pulmonary disease, asthma, or diabetes;
                                                                   •   The patient requires monitoring at least five
                                                                       times weekly to manage the disease, as ordered
                                                                       by a physician or podiatrist;
                                                                   •   The patient has been hospitalized two or more
                                                                       times in the last 12 months for conditions related
                                                                       to the disease;
                                                                   •   The patient or caregiver misses no more than
                                                                       five monitoring events in a 30-day period;
                                                                   •   The patient’s home has space for all program
                                                                       equipment and full transmission capability.

                                                               Source: (Reimbursement): CO Revised Statutes 25.5-5-321 (2012).
                                                               Source: (Requirements): 10 CO Code of Regulation 2505-10.

                                                               Additional restrictions apply.  See Colorado Code of
                                                               Regulations for more information.

                                                               Medicaid Home Health will reimburse for services only if
                                                               the patient has no other insurance.

                                                               Source: 10 CO Code of Regulation 2505-10.
            Email/Phone/FAX
            Private payers and the managed care system are not   No reimbursement for telephone.
            required to cover telephone or FAX services.       No reimbursement for FAX.

            Source: CO Revised Statutes 10-16-123 and Colorado Revised   Source: CO Medical Assistance Program, Telemedicine Manual,
            Statutes 25.5-5-414 (2012).                        p. 3 (Sept. 2013).
            Online Prescribing



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

             Pharmacists are prohibited from dispensing prescription  No reference found.
             drugs if they know, or should have known, that it was
             on the basis of an internet-based questionnaire, an
             Internet-based consult, or a telephone consultation, all
             without a valid pre-existing patient-practitioner
             relationship.

             Source: 3 CO Code of Regulation 719-1 (2012).

             Workers’ Compensation
             The physician-patient relationship/psychologist-patient
             relationship can be established through live audio/video
             services.

             Source: 7 CO Regs. Rule 18.

            Consent
            Providers  shall give all first-time patients a written
            statement that includes the following:             The Medicaid requirement for face-to-face contact
                                                               between provider and client may be waived prior to
               •   The patient may refuse telemedicine services at  treating the client through telemedicine for the first time.
                   any time, without loss or withdrawal of     The rendering provider must furnish each client with all
                   treatment;                                  of the following written statements which must be signed
               •   All applicable confidentiality protections shall   by the client or the client’s legal representative:
                   apply to the services;
               •   The patient shall have access to all medical   •  The client retains the option to refuse the delivery of
                                                                   health care services via telemedicine at any time
                   information from the services, under state law.   without affecting the client's right to future care or
                                                                   treatment and without risking the loss or withdrawal
            Source: CO Revised Statutes 25.5-5-320 (2012).
                                                                   of any program benefits to which the client would
            Workers’ Compensation                                  otherwise be entitled.
            The patient needs to give consent.                    •  All applicable confidentiality protections shall apply
                                                                   to the services.
            Source: 7 CO Regs. Rule 18.                           •  The client shall have access to all medical
                                                                   information resulting from the telemedicine services
                                                                   as provided by applicable law for client access to
                                                                   his or her medical records.

                                                               These requirements do not apply in an emergency.

                                                               Source: CO Medical Assistance Program, Telemedicine Manual,
                                                               p. 4 (Sept. 2013).
            Location

            Workers’ Compensation                              No reference found.
            Services provided via telecommunications technologies
            are not covered if the client has access to comparable
            service within 30 miles of his/her place of residence.

            Telehealth facilities can bill for the originating site fee if
            the site is in a:
               •   County outside of a Metropolitan Statistical Area
                   (MSA), or
               •   A Health Professional Shortage Area, either
                   located outside of an MSA or in a rural census
                   tract, as determined by the office of Rural Health

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                   Policy within the Health Resources and Services
                   Administration (HRSA)

            Authorized originating sites include:
               •   The office of a physician or practitioner
               •   A hospital
               •   A critical access hospital (CAH)
               •   A rural health clinic (RHC)
               •   A federally qualified health center (FQHC)
               •   A hospital based or critical access hospital
                   based renal dialysis center (including satellite)
               •   A skilled nursing facility (SNF)
               •   Community Mental Health Center

            Source: 7 CO Regs. Rule 18.
            Cross-State Licensure
             No reference found.                               No reference found.

            Private Payers
            Health plans for patients in counties with 150,000 or   No reference found.
            fewer residents cannot require face-to-face contact
            between a provider and a patient for services that could
            be appropriately provided through telemedicine.

            These services are subject to all terms and conditions of
            the health plans.

            Source: CO Revised Statutes 10-16-123 (2012).
            Site/Transmission Fee
            No reference found.                                The CO Medical Assistance Program will reimburse for
                                                               transmission costs, at a rate set by their state
                                                               department.

                                                               Source: CO Revised Statutes 25.5-5-320 (2012).

                                                               The originating site may bill for a facility fee.  Eligible
                                                               providers for a facility fee includes:
                                                                   •   Physician
                                                                   •   Clinic
                                                                   •   Osteopath
                                                                   •   FQHC
                                                                   •   Psychologist
                                                                   •   MA Psychologist
                                                                   •   Physician Assistant
                                                                   •   Nurse Practitioner
                                                                   •   Rural Health Clinic

                                                               Source: CO Medical Assistance Program, Telemedicine Manual,
                                                               p. 5 (Sept. 2013).

            Miscellaneous



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                                                                                 Center for Connected Health Policy

           Comments:    Colorado law includes in its definition of “health care services” the rendering of services via
                         telemedicine.

                         CO Revised Statutes 10-16-102 (2012).















































































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