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                                                                                 Center for Connected Health Policy

           New York


           Medicaid Program:  New York Medicaid

           Medicaid Program Administrator:  New York State Dept. of Health

           Regional Telehealth Resource Center
           Northeast Telehealth Resource Center
           11 Parkwood Drive
           Augusta, ME 04330
           (207) 622-7566 / (800) 379-2021
           www.netrc.org

           * Note:  Although Governor Cuomo signed SB 7852 (landmark legislation regarding coverage of certain
           telemedicine/telehealth services by private payers and the state’s Medicaid program) on December 29, 2014, it was
           accompanied by Approval Memo 35.  The Approval Memo made his approval contingent on a chapter amendment
           to address several concerns he had with the bill, including its effective date and that the bill’s language may obligate
           insurers to provide coverage for services via telehealth, even when those services are not covered under the
           patient’s existing contract or policies.

           The language currently existing in SB 7852, and signed into law under Chapter 550 of the NY Laws of 2014, will be
           superseded by the chapter amendment if and when it is signed into law retroactively.  In the meantime, the
           Department of Health will not enforce the provisions of SB 7852 due to the pending amendment.   AB 2552-A and
           SB 2405 were recently introduced into the 2015 legislative session to clarify SB 7852’s language and address the
           Governor’s concerns. CCHP will update its Medicaid manual in regards to the provisions in the new bill, once the
           required chapter amendment passes.

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth

            Related to Credentialing and Privileging health care   “Telemedicine is the use of interactive audio and video
            practitioners providing telemedicine               telecommunications technology to support "real time"
            “Telemedicine means the delivery of clinical health care  interactive patient care and consultations between
            services by means of real time two-way electronic audio- healthcare practitioners and patients at a distance. The
            visual communications which facilitate the assessment,   distant site or "hub" is where the medical specialist
            diagnosis, consultation, treatment, education, care   providing the consultation or service is located. The
            management and self management of a patient's health  originating site or "spoke" is where the referring health
            care, while such patient is at the originating site and the  professional and patient are located.”
            health care provider is at a distant site.”
                                                               Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume
            Source: NY Consolidated Law Service Public Health Sec. 2805-u.   27
                                                               <http://www.health.ny.gov/health_care/medicaid/program/update/
            New Definitions added by SB 7852 (currently not    2011/2011-09.htm> Accessed Aug. 28, 2014
            enforced)*

            The term “telehealth” means delivering health care
            services by means of information and communications
            technologies consisting of telephones, remote patient
            monitoring devices or other electronic means which
            facilitate the assessment, diagnosis, consultation,
            treatment, education, care management and self
            management of a patient’s health care while such
            patient is at the originating site and the health care
            provider is at a distant site.

            The term “telemedicine” means the delivery of clinical


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            health care services by means of real time two-way
            electronic audio visual communications, including the
            application of secure video conferencing or store and
            forward technology to provide or support healthcare
            delivery, which facilitate the assessment, diagnosis,
            consultation, delivery, which facilitate the assessment,
            diagnosis, consultation, treatment, education, care
            management and self management of a patient’s’ health
            care while such patient is at the originating site and the
            health provider is at a distant site.

            Source: NY SB 7852 (2014).
            Live Video Reimbursement
            New Reimbursement Policy added by SB 7852          New York Medicaid will reimburse for live video services
            (currently not enforced)*                          for medically necessary services provided to patients in:
            Medicaid shall not exclude from the payment of medical
            assistance funds the provision of medical care through   •   Hospitals (emergency room, outpatient
            telemedicine services.                                       department, Inpatient) established under
                                                                         Article 28 of the New York Public Health Law;
            Source: NY SB 7852 (2014).                               •   Diagnostic and Treatment Centers (D&TCs)
                                                                         established under Article 28 of the New York
                                                                         Public Health Law;
                                                                     •   FQHCs that have "opted into" NY Medicaid
                                                                         Ambulatory Patient Groups (APG);
                                                                     •   Non-FQHC School Based Health Centers
                                                                         (SBHCs).

                                                               Providers who may deliver telemedicine services
                                                               include:

                                                                     •   Physician specialists, including psychiatrists;
                                                                     •   Certified Diabetes Educators (CDEs);
                                                                     •   Certified Asthma Educators (CAEs or A-ECs).

                                                               Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume
                                                               27
                                                               <http://www.health.ny.gov/health_care/medicaid/program/update/
                                                               2011/2011-09.htm#ln2> Accessed Aug. 28, 2014.


            Store and Forward Reimbursement
            New Reimbursement Policy added by SB 7852          Store and forward is not reimbursed.
            (currently not enforced)*
            Telemedicine does include the use of store and forward   Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume
            technologies.                                      27
                                                               <http://www.health.ny.gov/health_care/medicaid/program/update/
                                                               2011/2011-09.htm#ln2> Accessed Aug. 28, 2014.
            Source: NY SB 7852 (2014).

            Remote Patient Monitoring Reimbursement
            New Reimbursement Policy added by SB 7852          See notes.
            (currently not enforced)*
            Medicaid will, at a minimum, provide payment for
            telehealth services as specified under Sec. 3614 of

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Public Health Law (related to demonstration rates – see
            below)

            Source: NY SB 7852 (2014).

            Demonstration rates of payment or fees shall be
            established for telehealth services provided by a
            certified home health agency, a long term home health
            care program or AIDS home care program, or for
            telehealth services by a licensed home care services
            agency under contract with such an agency or program,
            in order to ensure the availability of technology-based
            patient monitoring, communication and health
            management. Reimbursement is provided only in
            connection with Federal Food and Drug Administration-
            approved and interoperable devices that are
            incorporated as part of the patient’s plan of care.

            Source: NY Consolidated Law Service Public Health Sec. 3614.

            Email/Phone/FAX
            No reference found.                                 No payment for telephone.

                                                               Source: NY Medicaid Program. Physician Policy Guidelines.
                                                               Version 2008-2. Apr. 15, 2008. Pg. 18.
            Online Prescribing
            No reference found.                                No reference found.

            Consent
            No reference found.                                No reference found.

            Location
            No reference found.                                No reference found.
            Cross-State Licensing

            No reference found.                                No reference found.
            Private Payers

            New Private Payer Policy added by SB 7852          No reference found.
            (currently not enforced)*
            Insurance plans required to offer telemedicine coverage,
            and provide that coverage if telemedicine service is
            requested by policy holder. The service must meet the
            requirements of Medicare’s telehealth rules and
            regulations (with the exception of their originating site
            restrictions), limiting reimbursement to live video, and
            restricting the type of eligible providers and CPT codes.

            They may also provide coverage for telehealth services
            if they choose to do so.

            Source: NY SB 7852 (2014).



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Site/Transmission Fee
            No reference found.                                No reference found.

            Miscellaneous
                                                               New York hospitals acting as originating (spoke) sites
                                                               must ensure that all physicians at distant (hub) sites are
                                                               appropriately credentialed and privileged.

                                                               Originating sites may contract with an outside entity for
                                                               professional application and verification, but not for peer
                                                               review, quality assurance/quality improvement activities,
                                                               and granting medical staff membership or professional
                                                               privileges.

                                                               Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume
                                                               27
                                                               <http://www.health.ny.gov/health_care/medicaid/program/update/
                                                               2011/2011-09.htm#ln2> Accessed Aug. 28, 2014.


           Comments:
                         New York is in the process of updating its Medicaid reimbursement policies for telehealth.  We have
                         been informed by a source in the State Department of Health that the updated policy will expand the
                         settings and provider types for which live video services can be reimbursed.


                         Telemedicine/telehealth reimbursement in managed care is optional.
                         A review of Web resources of 18 MMC Plans reveals policy statements of telemedicine coverage for
                         at least the following insurance providers:

                         •     Amerigroup New York
                         •     BlueCross Blue Shield of Western New York
                         •     MVP Health Plan
                         •     United Healthcare
                         •     Univera Community Health
                         •     WellCare of New York

                         Source: Northeast Telehealth Resource Center.

























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