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                                                                                 Center for Connected Health Policy

           Nevada


           Medicaid Program:  Nevada Medicaid

           Program Administrator:  Division of Health Care Financing and Policy (DHCFP)

           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 practice of osteopathic    “Telehealth is the use of a telecommunications system
            medicine by using equipment that transfers information   to substitute for an in-person encounter for professional
            concerning the medical condition of a patient      consultations, office visits, office psychiatry services,
            electronically, telephonically or by fiber optics.”   and a limited number of other medical services.”

            Source: NV Revised Statutes Annotated Sec. 633.165.   Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 3400, p. 1 (Nov. 14, 2014).
                                                               http://www.dhcfp.state.nv.us/MSM/CH3400/MSM%20Ch%203400%
                                                               20Packet%2011-13-14.pdf
            Live Video Reimbursement
            No reference found.                                Nevada Medicaid will reimburse for live video.

                                                               Eligible services:

                                                                   •   Consultations;
                                                                   •   Follow-up inpatient consults;
                                                                   •   Office of other outpatient visits;
                                                                   •   Subsequent hospital care services;
                                                                   •   Subsequent nursing facility care services;
                                                                   •   Individual psychotherapy;
                                                                   •   Pharmacologic management;
                                                                   •   Psychiatric diagnostic interview examination;
                                                                   •   End-stage renal disease services
                                                                   •   Neurobehavioral status exam;
                                                                   •   Individual health and behavior assessment and
                                                                       interventions;
                                                                   •   Individual and group diabetes self-management
                                                                       training services;
                                                                   •   Smoking cessation counseling, for pregnant
                                                                       women only.

                                                               Reimbursement should be at the same amount as in-
                                                               person services.

                                                               Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 3403.4, p. 6 (Nov. 14, 2014).

                                                               Eligible providers:


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                                   •   Physician;
                                                                   •   Nurse practitioner;
                                                                   •   Advanced Practitioner of Nursing
                                                                   •   Physician assistant;
                                                                   •   Nurse midwife;
                                                                   •   Licensed Clinical Psychologist
                                                                   •   Licensed Clinical Social Worker
                                                                   •   Clinical staff employed and determined by a
                                                                       state mental health agency to meet established
                                                                       class specification qualifications of a Mental
                                                                       Health Counselor, Clinical Social Worker or
                                                                       Psychological Assistant.

                                                               Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 3403.3, p. 5-6 (Nov. 14, 2014).
                                                                 Subsequent hospital care is limited to one telehealth
                                                               visit every three calendar days.

                                                               Subsequent nursing facility care is limited to one
                                                               telehealth visit every 30 calendar days.

                                                               Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 3403.3, p. 6 (Nov. 14, 2014).
            Store and Forward Reimbursement

            No reference found.                                Nevada Medicaid will not reimburse for store and
                                                               forward.

                                                               Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 3403.4, p. 9 (Nov. 14, 2014).
            Remote Patient Monitoring Reimbursement

            No reference found.                                No reference found.
            Email/Phone/FAX

            No reimbursement for email.                        No reference found for email.
            No reimbursement for telephone.                    No reimbursement for telephone, except psychiatric
            No reimbursement for FAX.                          treatment in crisis intervention.
                                                               No reference found for FAX.
            Source: NV Revised Statutes Annotated Sec. 633.165 (2012).
                                                               Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 600, p. 10 (July 10, 2014).
            Online Prescribing

            Osteopathic Medicine                               No reference found.
            A bona fide relationship between a patient and
            osteopathic physician (needed for a prescription) can be
            established via telemedicine.

            Source: NV Revised Statutes Annotated Sec. 633.165
            Consent
            For osteopaths, oral and written consent. Must include


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            this information:

               •   The patient or legal representative may
                   withdraw consent at any time;
               •   Potential risks, consequences and benefits of
                   telemedicine;
               •   Whether the osteopath has a financial interest in
                   the web site used to engage in telemedicine, or
                   in the products or services provided ;
               •   Patient privacy and security;
               •   The osteopath will not release any confidential
                   medical information without written consent.

            Source: NV Revised Statutes Annotated Sec. 633.165 (2012).
            Location

            No reference found.                                Eligible originating sites include:

                                                                •  Office of a physician, physician assistant, nurse
                                                                  practitioner, or nurse, midwife;
                                                                •  Critical Access Hospital (CAH);
                                                                •  Rural Health Clinic (RHC);
                                                                •  Federally Qualified Health Center (FQHC);
                                                                •  Hospital;
                                                                •  Hospital-based or CAH-based renal dialysis center
                                                                  (including satellites);
                                                                •  Skilled nursing facility;
                                                                •  Office of clinical psychologist;
                                                                •  Office of clinical social worker;
                                                                •  Community mental health centers;
                                                                •  Indian Health Services, tribal organization, or urban
                                                                  Indian organization health programs.

                                                               Source: NV Dept. of Health and Human Svcs., Medicaid Services
                                                               Manual, Section 3403.3, p. 4-5 (Nov. 14, 2014).
            Cross-State Licensing
            Nevada issues special-purpose licenses to out-of-state   No reference found.
            physicians for telemedicine services.

            Physicians must:

               •   Hold a full, unrestricted license in another state;
               •   Not have any disciplinary or other action taken
                   by any state or jurisdiction;
               •   Be certified by the American Board of Medical
                   Specialties.

            Source: NV Revised Statutes Sec. 630.261(e).

            Private Payers
            No reference found.                                No reference found.
            Site/Transmission Fee



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            No reference found.                                No reference found.
            Miscellaneous

            Before an osteopathic physician may use telemedicine:   Telehealth services do not require prior authorization.
                                                               However, individual services may require prior
             •  A bona fide relationship between the osteopathic   authorization, whether delivered in person or by
               physician and the patient must exist which must   telehealth.
               include, without limitation, a history and physical
               examination or consultation which occurred in person   Nevada Dept. of Health and Human Svcs., Medicaid Services
               and which was sufficient to establish a diagnosis and   Manual, Section 3403.8, p. 9 (Nov. 14, 2014).
               identify any underlying medical conditions of the
               patient.
             •  The osteopathic physician must obtain informed,
               written consent from the patient or the legal
               representative of the patient to engage in
               telemedicine with the patient. The osteopathic
               physician shall maintain the consent form as part of
               the permanent medical record of the patient.

            Source: NV Revised Statutes Annotated Sec. 633.165 (2012).

           Comments:    In 2011, the Nevada Legislature defined telemedicine and established practice requirements.

                         New Regulation Passed:
                             •   Board of Occupational Therapy (Source: LCB File No. R017-14 & Ch. 640A of NE Admin. Code)













































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