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                                                                                 Center for Connected Health Policy

           North Carolina


           Medicaid Program:  North Carolina Medicaid

           Medicaid Program Administrator:  Dept. of Health and Human Services, Division of Medical Assistance

           Regional Telehealth Resource Center:
           Mid-Atlantic Telehealth Resource Center
           PO Box. 800711
           Charlottesville, VA 22908-0711
           (434) 906-4960 / (855) MATRC4U
           www.matrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telemedicine is the use of two-way real-time interactive  “Telemedicine is the use of two-way real-time interactive
            audio and video between places of lesser and greater   audio and video between places of lesser and greater
            medical capability or expertise to provide and support   medical capability or expertise to provide and support
            health care, when distance separates participants who   health care, when distance separates participants who
            are in different geographical locations.”          are in different geographical locations.”

            Source: NC General Statute 130A-125                Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 3, Nov. 15, 2013.
            Live Video Reimbursement

            The Commission is required to address follow up    North Carolina Medicaid will reimburse for live video
            protocols to ensure early treatment for newborn infants   medical services and tele-psychiatry services.
            diagnosed with congenital heart defects, to include
            telemedicine (live video).                         Eligible medical providers:

            Source: NC General Statute 130A-125                    •   Physicians;
                                                                   •   Nurse practitioners;
                                                                   •   Nurse midwives;
                                                                   •   Physician’s assistants.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 6, Nov. 15, 2013.

                                                               Eligible tele-psychiatry providers:

                                                                   •   Physicians;
                                                                   •   Advanced practice psychiatric nurse
                                                                       practitioners;
                                                                   •   Advanced practice psychiatric clinical nurse
                                                                       specialists;
                                                                   •   Licensed psychologists Ph.D level;
                                                                   •   Licensed clinical social workers (LCSW);
                                                                   •   Community diagnostic assessment agencies.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 6, Nov. 15, 2013.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               All services must be:

                                                               •  Medically necessary;
                                                               •  The procedure, product, or service is individualized,
                                                                  specific, and consistent with symptoms or confirmed
                                                                  diagnosis of the illness or injury under treatment, and
                                                                  not in excess of the recipient’s needs;
                                                               •  The procedure, product, or service can be safely
                                                                  furnished, and no equally effective and more
                                                                  conservative or less costly treatment is available
                                                                  statewide;
                                                               •  The procedure, product, or service is furnished in a
                                                                  manner not primarily intended for the convenience of
                                                                  the recipient, the recipient’s caretaker, or the provider.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 3, Nov. 15, 2013.

                                                               Providers must obtain prior approval from NC Medicaid
                                                               for all services delivered via telemedicine and tele-
                                                               psychiatry. Providers must submit:

                                                                   •   Prior approval request;
                                                                   •   All health records and any other records to
                                                                       document that the patient has met the specific
                                                                       criteria for telemedicine services;
                                                                   •   If the patient is under age 21, information
                                                                       supporting that all Medicaid Early and Periodic
                                                                       Screening, Diagnosis, and Treatment (EPSDT)
                                                                       criteria are met, and evidence-based literature
                                                                       supporting the request, if available.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 5, Nov. 15, 2013.
            Store and Forward Reimbursement

            No reference found.                                North Carolina Medicaid will not reimburse for Store and
                                                               Forward.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 7, Nov. 15, 2013.
            Remote Patient Monitoring Reimbursement

            No reference found.                                No reference found.
            Email/Phone/FAX Restrictions

            No reference found.                                No reimbursement for email.
                                                               No reimbursement for telephone.
                                                               No reimbursement FAX.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 7, Nov. 15, 2013.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Online Prescribing
            No reference found.                                No reference found.

            Consent
            No reference found.                                No reference found.
            Location

            No reference found.                                No reimbursement if:

                                                                •  The recipient is located in a jail, detention center, or
                                                                  prison;
                                                                •  The consulting provider is not a Medicaid-enrolled
                                                                  provider;
                                                                •  The consulting provider is not located in North
                                                                  Carolina or within the 40 miles radius.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 7, Nov. 15, 2013.
            Cross-State Licensing

            No reference found.                                No reference found.
            Private Payers

            No reference found.                                No reference found.
            Site/Transmission Fee
            No reference found.                                Originating-site provider facility fees paid to:

                                                                   •   Physicians;
                                                                   •   Nurse practitioners;
                                                                   •   Nurse midwives;
                                                                   •   Advanced practice psychiatric nurse
                                                                       practitioners;
                                                                   •   Advanced practice psychiatric clinical nurse
                                                                       specialists;
                                                                   •   Licensed psychologists (Ph.D. level);
                                                                   •   Licensed clinical social workers (LCSW);
                                                                   •   Physician’s assistants;
                                                                   •   Hospitals (inpatient or outpatient)
                                                                   •   Federally Qualified Health Centers;
                                                                   •   Rural Health Clinics;
                                                                   •   Local health departments;
                                                                   •   Local Management Entities.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 9, Nov. 15, 2013.

                                                               No facility fees for distant-site providers.

                                                               Source: NC Div. of Medical Assistance, Medicaid and Health
                                                               Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
                                                               and Telepsychiatry, p. 4, Nov. 15, 2013.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Miscellaneous
                                                               The Office of Rural Health and Community Care shall
                                                               oversee and monitor the establishment of a statewide
                                                               telepsychiatry program.

                                                               Source: NC General Statutes Article 3, Ch. 143B, Sect. 12A.2B.(b)








































































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