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                                                                                 Center for Connected Health Policy

           Idaho


           Medicaid Program:  Idaho Medicaid

           Program Administrator:  Idaho Dept. of Health and Welfare

           Regional Telehealth Resource Center:
           The Northwestern Regional Telehealth Resource Center
                  th
           2900 12  Ave. N., Ste. 30W, Billings, MT 59101
           (888) 662-5601
           www.nrtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth

            “Telehealth is an electronic real-time synchronized   Telehealth is an electronic, real time, synchronized,
            audio-visual contact between a consultant and      audio-visual contact between a qualified provider and a
            participant related to the treatment of the participant.   participant using specialized equipment.
            The consultant and participant interact as if they were
            having a face-to-face service.”                    Source: Medicaid Telehealth Policy. Rev. 7/18/2014. (accessed
                                                               Jul. 2014).
            Source: ID Administrative Code 16.03.10.681 (2012).

            Psychiatric Telehealth is an electronic real time
            synchronous audio-visual contact between a physician
            and participant related to the treatment of the
            participant. The participant is in one (1) location, called
            the hub site, with specialized equipment including a
            video camera and monitor, and with the hosting
            provider. The physician is at another location, called the
            spoke site, with specialized equipment. The physician
            and participant interact as if they were having a face-to-
            face service.

            Source: ID Administrative Code 16.03.09 Sec. 502
            Live Video Reimbursement

            (see Medicaid column)                              Idaho Medicaid will reimburse for a limited number of
                                                               mental health and developmental disabilities (DD)
                                                               services.  They include:

                                                                   •   Psychotherapy with evaluation and
                                                                       management
                                                                   •   Psychiatric diagnostic interview
                                                                   •   Pharmacological management
                                                                   •   DD therapeutic consultation
                                                                   •   DD crisis intervention


                                                               Source: Medicaid Telehealth Policy. Rev. 7/18/2014.
                                                               http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medic
                                                               aid/TelehealthPolicy.pdf (accessed Jul. 2014)
                                                               Source: Idaho MMIS Provider Handbook: allopathic and
                                                               Osteopathic Physicians. Dec. 2014, p. 27.
                                                               https://www.idmedicaid.com/Provider%20Guidelines/Allopathic%
                                                               20and%20Osteopathic%20Physicians.pdf


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                               Psychiatric telehealth services not provided through
                                                               Idaho Behavioral Health Plan is limited to psychiatric
                                                               services for:
                                                                   •   Diagnostic assessment
                                                                   •   Pharmacological management
                                                                   •   Psychotherapy with evaluation and
                                                                       management services

                                                               Services are not reimbursed when provided through a
                                                               videophone or webcam.

                                                               Source: ID Administrative Code 16.03.09 Sec. 502

                                                               Through the Children’s Waiver Services, Idaho Medicaid
                                                               will reimburse for crisis intervention consults, or
                                                               individual consults by a therapeutic consultant via live
                                                               video.

                                                               Source (service type): ID Administrative Code 16.03.10.683 (2012).

            Store and Forward Reimbursement
            No reference found.                                 Idaho Medicaid will only reimburse for interactive audio
                                                                and video permitting “real-time communication”,
                                                                therefore excluding store and forward from coverage.

                                                               Source: Idaho MMIS Provider Handbook: allopathic and
                                                               Osteopathic Physicians. Jul. 2014, p. 25.

                                                               Source: Medicaid Telehealth Policy. Rev. 7/18/2014.
                                                               http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medic
                                                               aid/TelehealthPolicy.pdf (accessed Jul. 2014)
            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.

            Email/Phone/FAX
            No reference found.                                No reimbursement for telephone, email or fax.

                                                               Source: Medicaid Telehealth Policy. Rev. 7/18/2014.
                                                               http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medic
                                                               aid/TelehealthPolicy.pdf (accessed Jul. 2014)
            Online Prescribing

            Prescribing physicians must have prescriber-patient   No reference found.
            relationship, which includes a documented patient
            evaluation adequate to establish diagnoses and identify
            underlying conditions and/or contraindications to the
            treatment.

            Prescriptions based solely on online questionnaires or
            consults outside of an ongoing clinical relationship are
            prohibited.

            Source: ID Code § 54-1733 (2012).
            Consent


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            No reference found.                                Participant informed consent is required.

                                                               Source: Medicaid Telehealth Policy. Rev. 7/18/2014.
                                                               http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medic
                                                               aid/TelehealthPolicy.pdf (accessed Jul. 2014)
            Location

            No reference found.                                Telehealth services are only covered for participants
                                                               who live in a rural HPSA or MSA where there is a
                                                               shortage of qualified providers.  The provider must
                                                               document when there is no provider available to provide
                                                               the services in person.

                                                               Source: Medicaid Telehealth Policy. Rev. 7/18/2014.
                                                               http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medic
                                                               aid/TelehealthPolicy.pdf (accessed Jul. 2014)
            Cross-State Licensing

            No reference found.                                No reference found.
            Private Payers

            No reference found.                                No reference found.
            Site/Transmission Fee
            No reference found.                                ID Medicaid does reimburse for the transmission fee of
                                                               the originating and distant site for mental health
                                                               services.
                                                               Source: Idaho MMIS Provider Handbook: allopathic and
                                                               Osteopathic Physicians. Dec. 2014, p. 27.

                                                               Source: Medicaid Telehealth Policy. Rev. 7/18/2014.
                                                               http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medic
                                                               aid/TelehealthPolicy.pdf (accessed Jul. 2014)
            Miscellaneous


            Comments:
                         Idaho has a “Telehealth Council” that meets regularly to coordinate and develop a comprehensive set
                         of standards, policies, rules and procedures for the use of telehealth and telemedicine in Idaho.

                         Source: State of Idaho. Telehealth Council.  (accessed Jan. 7, 2015)
                         <http://telehealthcouncil.idaho.gov/Home/tabid/2823/Default.aspx>




















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