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                                                                                 Center for Connected Health Policy

           Georgia


           Medicaid Program:  Georgia Medicaid

           Program Administrator:  Georgia Dept. of Community Health

           Regional Telehealth Resource Center:
           Southeast Telehealth Resource Center
           PO Box 1408
           Waycross, GA 31501
           (888) 138-7210
           www.setrc.us


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telemedicine means the practice, by a duly licensed   “Telemedicine is the use of medical information
            physician or other health care provider acting within the   exchange from one site to another via electronic
            scope of such provider's practice, of health care   communications to improve patients’ health status. It is
            delivery, diagnosis, consultation, treatment, or transfer   the use of two-way, real time interactive communication
            of medical data by means of audio, video, or data   equipment to exchange the patient information from one
            communications which are used during a medical visit   site to another via an electronic communication system.
            with a patient or which are used to transfer medical data  This includes audio and video telecommunication
            obtained during a medical visit with a patient. Standard   equipment.”
            telephone, facsimile transmissions, unsecured e-mail, or
            a combination thereof do not constitute telemedicine   “Closely associated with telemedicine is the
            services.”                                         term ’telehealth,’ which is often used to encompass a
                                                               broader definition of remote healthcare that does not
            Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012).   always involve clinical services.  Telehealth is the use of
                                                               telecommunication technologies for clinical care
                                                               (telemedicine), patient teachings and home health,
                                                               health professional education (distance learning),
                                                               administrative and program planning, and other diverse
                                                               aspects of a health care delivery system.”

                                                               Source: GA Dept. of Community Health, GA Medicaid
                                                               Telemedicine Handbook, p. 2, (Nov. 2012).

            Live Video Reimbursement
            Georgia requires coverage of telemedicine services   Georgia Medicaid will reimburse for live video when the
            (which includes live video), subject to contract terms and  service is “medically necessary, the procedure is
            conditions. (See “Private Payers” section).        individualized, specific, consistent with symptoms or
                                                               confirmed diagnosis of an illness or injury under
            Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012).   treatment, and not in excess of the member’s needs.”

                                                               Eligible services:

                                                                   •   Office visits;
                                                                   •   Pharmacologic management;
                                                                   •   Limited office psychiatric services;
                                                                   •   Limited radiological services;
                                                                   •   A limited number of other physician fee
                                                                       schedule services.

                                                               Source: GA Dept. of Community Health, GA Medicaid

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Telemedicine Handbook, p. 2-3, (Nov. 2012).

                                                               Georgia Medicaid will reimburse for mental health
                                                               services for residents in nursing homes via telemedicine
                                                               (although not available in all areas of the state) for “dual
                                                               eligibles” (Medicaid and Medicare).

                                                               Nursing facilities and community behavioral health
                                                               rehabilitation (CBHRS) service providers can arrange for
                                                               the provision of specialized services to residents either
                                                               in nursing facilities, via telemedicine or at the CBHRS
                                                               location for residents in the Preadmission Screening and
                                                               Resident Review Serious Mental Illness and dually
                                                               diagnosed populations.

                                                               Source: GA Dept. of Community Health, Division of Medical
                                                               Assistance, Part II Policies and Procedures for Nursing Facilities,
                                                               p. 189 (Jan. 1, 2015) and Part II Policies and Procedures for
                                                               Community Behavioral Health Rehabilitation Services, p. 61 (Jan.
                                                               1, 2015).

            Store and Forward Reimbursement
            No reference found.                                 Georgia Medicaid will not reimburse for store and
                                                                forward because these services do not include direct,
                                                                in-person patient contact.

                                                                Source: GA Dept. of Community Health, GA Medicaid
                                                                Telemedicine Handbook, p. 4, (Nov. 2012).
            Remote Patient Monitoring Reimbursement

            No reference found.                                No reference found.
            Email/Phone/FAX
            No reimbursement for FAX.                          No reimbursement for FAX.
            No reimbursement for telephone.                    No reimbursement for telephone.
            No reimbursement for email.                        No reimbursement for email.


            Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012).   Source: GA Dept. of Community Health, GA Medicaid
                                                               Telemedicine Handbook, p. 8, (Nov. 2012).
            Online Prescribing
            Physicians are prohibited from prescribing controlled   No reference found.
            substances or dangerous drugs based solely on an
            electronic consult.

            Source: GA Rules & Regulations revised 360-3-.02 (2012).
            Consent

            No reference found in statute.                     The referring provider must obtain prior written consent.

                                                               Source: GA Dept. of Community Health, GA Medicaid
                                                               Telemedicine Handbook, p. 5, (Nov. 2012).
            Location
            No reference found.                                 Eligible originating sites:


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                                   •   Provider offices;
                                                                   •   Hospitals;
                                                                   •   Critical Access Hospitals (CAH);
                                                                   •   Rural Health Clinics (RHC);
                                                                   •   Federally Qualified Health Centers (FQHC);
                                                                   •   Skilled nursing facilities;
                                                                   •   Community mental health centers;
                                                                   •   GA public health clinics;
                                                                   •   School-based clinics.

                                                               Eligible distant sites:

                                                                   •   Provider offices;
                                                                   •   Hospitals;
                                                                   •   Critical Access Hospitals (CAH);
                                                                   •   Rural Health Clinics (RHC);
                                                                   •   Federally Qualified Health Centers (FQHC);
                                                                   •   Skilled nursing facilities;
                                                                   •   Community mental health centers;
                                                                   •   GA public health clinics.

                                                               Source: GA Dept. of Community Health, GA Medicaid
                                                               Telemedicine Handbook, p. 3, (Nov. 2012).
            Cross-State Licensure
            Must be a Georgia licensed practitioner.           Providers must have a Georgia license.

            Source:  GA Admin. Code Sec. 360-3-.07             Source: GA Dept. of Community Health, GA Medicaid
                                                               Telemedicine Handbook, p. 3, (Nov. 2012).
            Private Payers
            Requires coverage of telemedicine services, subject to   No reference found.
            contract terms and conditions.

            Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012).

            Site/Transmission Fee
            No reference found.                                Rural Health Clinics and FQHCs can collect a telehealth
                                                               origination site facility fee.

                                                               Source: GA Dept. of Community Health, CA Medicaid Rural Health
                                                               Clinic Services Handbook, p. 48 (Jan. 2015) and FQHC Handbook,
                                                               p. 42 (Jan. 2015).

            Miscellaneous


           Comments:    Patients who are eligible for both Medicare and Medicaid (known as dual eligibles), will receive
                         mental health care through Medicare, with Medicaid the payer of last resort.  Though not available in
                         all areas of the state, Medicare-funded mental health services are currently provided to nursing
                         home residents via telemedicine, face-to-face visits by providers in the nursing home, and nursing
                         home resident visits to psychiatric/mental health clinics or offices, for those individuals able to travel.



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                                                                                 Center for Connected Health Policy

                         GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing
                         Facilities, p. 202 (Jan. 1, 2014).

                         New Regulations Passed
                                    •   GA Composite Medical Board (Source:  GA Admin. Code Sec. 360-3-.07)














































































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