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                                                                                 Center for Connected Health Policy

           Nebraska


           Medicaid Program:  Nebraska Medicaid

           Program Administrator:  NE Dept. of Health and Human Services

           Regional Telehealth Resource Center:
           Great Plains Telehealth Resource and Assistance Center
           University of Minnesota/Institute for Health Informatics
           330 Diehl Hall
           505 Essex Street S.E.
           Minneapolis, MN 55455
           (888) 239-7092
           www.gptrac.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth

            Telehealth means the use of medical information    Telehealth is a Medicaid-covered service delivered by a
            electronically exchanged from one site to another,   health care practitioner that utilize an interactive audio
            whether synchronously or asynchronously, to aid a   and video telecommunications system that permits real-
            health care practitioner in the diagnosis or treatment of a  time communication between the health care practitioner
            patient.  Telehealth includes services originating from a   at the distant site and the client at the originating site.
            patient’s home or any other location where such patient   Telehealth services do not include a telephone
            is located, asynchronous services involving the    conversation, electronic mail message, facsimile
            acquisition and storage of medical information at one   transmission between a health care practitioner and a
            site that is then forwarded to or retrieved by a health   client, a consultation between two health care
            care practitioner at another site for medical evaluation,   practitioners and asynchronous “store and forward”
            and telemonitoring.                                technology.

            Telehealth consultation means any contact between a   Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider
            patient and a health care practitioner relating to the   Handbook, Manual Letter 63-2014, pg. 17-19.
            health care diagnosis or treatment of such patient
            through telehealth.

            Source: NE Rev. Statute, 71-8503. (LB 1076)
            Live Video Reimbursement

            (see Medicaid column)                              Nebraska Medicaid stipulates in-person contact is not
                                                               required for reimbursable services under the Medicaid
                                                               program, subject to reimbursement policies developed.

                                                               This policy also applies to managed care plans who
                                                               contract with the Department only to the extent that:

                                                                   •   Services delivered via telehealth are covered
                                                                       and reimbursed under the fee-for-service
                                                                       program and
                                                                   •   Managed care contracts are amended to add
                                                                       coverage of services delivered via telehealth

                                                               Telehealth services are not covered if a child has access
                                                               to a comparable service within 30 miles of his/her place
                                                               of residence.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                Exceptions to this requirement:

                                                                   •   Children receiving behavioral health services.

                                                               Reimbursement shall, at a minimum, be set at the same
                                                               rate as a comparable in-person consult and the rate
                                                               must not depend on the distance between the health
                                                               care practitioner and the patient.

                                                               NB Medicaid requires providers to be specifically
                                                               enrolled as a telehealth site with Medicaid to bill for a
                                                               telehealth services.

                                                               A safety plan must be developed for clients, (except
                                                               children receiving behavioral health services).

                                                               Source (authorization and reimbursement): NE Revised Statutes
                                                               Sec. 71-8506 (2012).
                                                               Source (exceptions to 30-mile rule): NE Admin. Code Title 471,
                                                               Ch. 1.
                                                               Source: Physician Provider Handbook, Manual Letter 63-2014, pg.
                                                               17-19.
                                                               Source (Children’s behavioral health): LB 556 (Recently passed,
                                                               effective Aug. 30, 2013).

                                                               Federally Qualified Health Centers & Rural Health
                                                               Clinics
                                                               FQHC & RHC core services provided via telehealth are
                                                               not covered under the encounter rate.

                                                               Source: NE FQHC Provider Handbook, Manual Letter 11-2010, pg.
                                                               5.

                                                               Children’s Behavioral Health
                                                               A trained staff member must be immediately available to
                                                               a child receiving telehealth behavioral health service.
                                                               This requirement may be waived by a legal guardian.

                                                               Source: Revised Statutes of NE. Sec. 71-8506.
            Store and Forward Reimbursement

            (see Medicaid column)                              Nebraska Medicaid will reimburse for tele-radiology
                                                               when it meets the American College of Radiology
                                                               standards for tele-radiology.  There is no other reference
                                                               to reimbursing for other specialties.

                                                               Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider
                                                               Handbook, Manual Letter 63-2014, pg. 17-19.
            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.

            Email/Phone/FAX
            (see Medicaid column)                              No reimbursement for email.
                                                               No reimbursement for telephone.
                                                               No reimbursement for FAX.



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Source: NE Admin. Code Title 471, Ch. 1.
            Online Prescribing
            Prescribing drugs to individuals the physician has never   Prescriptions over the Internet: Neither the prescribing
            met, based solely on answers to questions provided by   health care practitioner service nor the pharmacy
            the internet, telephone, or FAX, or without first   service is covered when the health care practitioner
            establishing a proper physician-patient relationship, is   prescribing the medication has only reviewed an e-mail
            prohibited.                                         message or e-mail questionnaire about the client.

            Source: NE Admin. Code Title 172, Ch. 88.           Source: NE Admin. Code Title 471, Ch. 1.

            (also see Medicaid column)
            Consent
            Written patient consent required prior to any service   Written consent required before initial service delivery.
            delivery.                                          Must include this information:

            Source: NE Revised Statutes Sec. 71-8505 (2012).       •   The patient may refuse the service at any time
                                                                       with no loss of future treatment or program
            (also see Medicaid column)                                 benefits patient is otherwise entitled to;;
                                                                   •   A list of alternative care options, including in-
                                                                       person services;
                                                                   •   Confidentiality protections;
                                                                   •   Patient access to all medical information from
                                                                       the consult;
                                                                   •   Prior consent for dissemination of any client-
                                                                       identifiable images or information from the
                                                                       consult;
                                                                   •   Patient shall be informed of all parties present at
                                                                       both ends of the consult, and the patient may
                                                                       exclude anyone from either site;
                                                                   •   The patient may see an appropriately trained
                                                                       staff or employee in person immediately after
                                                                       the consult, or be informed ahead of time that
                                                                       this is not available.

                                                                Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider
                                                                Handbook, Manual Letter 63-2014, pg. 17-19.
            Location
                                                               Telehealth Site means either a health care facility
                                                               enrolled with Medicaid and licensed under Neb. Rev.
                                                               Stat. Section 71-2017 to 71-2029, and effective January
                                                               1, 2001, licensed under the Health Care Facility Act or a
                                                               health care practitioner facility whose practitioners are
                                                               enrolled with Medicaid and credentialed under the
                                                               Uniform Licensing Law.

                                                               Source: NE Dept. of Health and Human Svcs., Title 471 NE
                                                               Medical Assistance Svcs., p. 18 (July 11, 2009) & Physician
                                                               Provider Handbook, Manual Letter 63-2014, pg. 17-19.

                                                               Telehealth services are not covered if the patient has
                                                               access to a comparable service within 30 miles of
                                                               his/her place of residence.


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                Exceptions to this requirement:

                                                                   •   Emergency or urgent medical situations;
                                                                   •   When accessing in-person services at less than
                                                                       30 miles poses a significant hardship on the
                                                                       patient, due to a medical condition or disability;
                                                                   •   Nursing facility patients who require
                                                                       transportation via ambulance.
                                                                   •   Recently Passed Legislation:  Children receiving
                                                                       behavioral health services.

                                                               Source (exceptions to 30-mile rule): NE Admin. Code Title 471,
                                                               Ch. 1.
                                                               Source (Children’s behavioral health): LB 556 (Recently passed,
                                                               effective Aug. 30, 2013)

            Cross-State Licensing
            No reference found.                                Health care practitioners must be appropriately licensed,
                                                               certified or registered by Nebraska.

                                                               Source: Physician Provider Handbook, Manual Letter 63-2014, pg.
                                                               17-19.

            Private Payers
            No reference found.                                No reference found.
            Site/Transmission Fee

            (see Medicaid column)                              Medicaid coverage of transmission costs is available.

                                                               Source: NE Admin. Code Title 471, Ch. 1 & Physician Provider
                                                               Handbook, Manual Letter 63-2014, pg. 17-19.

                                                               Federally Qualified Health Centers & Rural Health
                                                               Clinics
                                                               Telehealth transmission cost related to non-core
                                                               services will be the lower of:
                                                                   •   The provider’s submitted charge; or
                                                                   •   The maximum allowable amount

                                                                Source: NE FQHC Provider Handbook, Manual Letter 11-2010,
                                                               pg. 5.

                                                               Managed Care
                                                               Telehealth transmission is covered as a part of the
                                                               behavioral health benefits package.

                                                               Source: NE Admin. Code Title 482, 5-004.
            Miscellaneous

                                                               The University of Nebraska Medical Center is required
                                                               to create the Behavioral Health Screening and Referral
                                                               Pilot Program which will include telehealth behavioral
                                                               health consultations between university and three
                                                               clinics.

                                                               Source: Revised Statutes of NE. Sec. 71-8506 (sunsets Aug. 30,
                                                               2015).

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