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                                                                                 Center for Connected Health Policy

           Ohio


           Medicaid Program:  Ohio Medicaid

           Medicaid Program Administrator:  Ohio Department of Job and Family Services

           Regional Telehealth Resource Center:
           Upper Midwest Telehealth Resource Center
           2901 Ohio Boulevard, Ste. 110
           Terre Haute, IN 47803
           (855) 283-3734 ext. 232
           www.umtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “The practice of telemedicine means the practice of   Telemedicine is the direct delivery of evaluation and
            medicine in this state through the use of any      management (E&M) or psychiatric services to a
            communication, including oral, written, or electronic   Medicaid eligible patient via synchronous, interactive,
            communication, by a physician located outside this   real-time electronic communication that comprises both
            state.”                                            audio and video elements.

            Source: OH Revised Code Annotated, 4731.296.       Source: OH Medicaid Handbook Transmittal Letter No. 3334-15-
                                                               01. Jan. 2, 2015, pg. 6 & OH Admin. Code 5160-1.
            “Telehealth means the use of electronic communications
            to provide and deliver a host of health-related
            information and healthcare services, including, but not
            limited to physical therapy related information and
            services, over large and small distances.”

            Source: OH Admin. Code 4755-27-01.

            Telehealth service means a health care service
            delivered to a patient through the use of interactive
            audio, video, or other telecommunications or electronic
            technology from a site other than the site where the
            patient is located.

            Source:  OH Revised Code, Sec. 5164.94.

            Speech Language Pathology
            Telehealth means the use of telecommunications and
            information technologies for the exchange of information
            from one site to another for the provision of audiology or
            speech-language pathology services to an individual
            from a provider through hardwire or internet connection.

            Source: OH Admin. Code 4753-2-01
            Live Video Reimbursement
            The department of Medicaid is required to establish   Ohio Medicaid covers live video telemedicine.
            standards for Medicaid payment for health care services
            the department determines are appropriate to be    Eligible Distant Site Providers
            covered when provided as telehealth services.          •   Physicians (MD, DO)
                                                                   •   Psychologists
            Source:  OH Revised Code, Sec. 5164.95.                •   Federally Qualified Health Center (medical and


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                       mental health)
            Speech Language Pathology Telehealth may be
            delivered through live video.                      Only resident modifiers will be accepted.

            Source: OH Admin. Code 4753-2-01                   Providers are not eligible for payment when a Q3014
                                                               (facility fee) and a CPT code with a GQ modifier is
                                                               submitted for the same patient, same date of service,
                                                               and same provider.

                                                               See transmittal letter for list of eligible CPT codes.

                                                               Source: OH Medicaid Handbook Transmittal Letter No. 3334-15-
                                                               01, pg. 6-7. Jan. 2, 2015 & OH Admin Code 5160-1.

                                                               Ohio Medicaid will reimburse for live video for speech
                                                               therapy services in the Medicaid School Program (MSP)
                                                               when provided by speech-language pathologists.

                                                               Source: OH Dept. of Job and Family Svcs., Long Term Care
                                                               Services and Supports Transmittal Letter (LTCSSTL) No. 11-15,
                                                               (Oct. 19, 2011).


            Store and Forward Reimbursement
            Speech Language Pathology                          Telemedicine is defined as being “synchronous,
            Telehealth may be delivered through store and forward.  interactive, real-time”, excluding the use of store and
                                                               forward technology.
            Source: OH Admin. Code 4753-2-01
                                                               Source: OH Medicaid Handbook Transmittal Letter No. 3334-15-
                                                               01. Jan. 2, 2015, pg. 6-7.
            Remote Patient Monitoring Reimbursement

            No reference found.                                The home is not an acceptable place of service for
                                                               either an originating or distant site.

                                                               Source: OH Medicaid Handbook Transmittal Letter No. 3334-15-
                                                               01.  Jan. 2, 2015, pg. 6-7.
            Email/Phone/FAX

            No reference found.                                Electronic mail, telephone and facsimile transmission
                                                               are not telemedicine.

                                                               Source: OH Admin. Code 5160-1.
            Online Prescribing
            A physician shall not prescribe, dispense, or provide any  No reference found.
            dangerous drug, which is not a controlled substance, to
            a person who the physician has never personally
            physically examined and diagnosed.

            Eligible exceptions:

               •   The physician is providing care in consultation
                   with another physician, who has an ongoing
                   professional relationship with the patient, and
                   who has agreed to supervise the patient’s use of

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                   the drug or drugs to be provided, and the
                   physician’s care of the patient meets all
                   applicable standards of care;
               •   In institutional settings;
               •   On-call situations;
               •   Cross-coverage situations;
               •   Situations involving new patients;
               •   Protocol situations;
               •   Situations involving nurses practicing in
                   accordance with standard care arrangements.

            Source: OH Admin. Code 4731-11-09.
            Consent
            Speech Language Pathology                          The originating site is responsible for obtaining informed
            A provider is required to inform the patient of specific   consent.
            telehealth limitations.
                                                               Source: OH Admin. Code 5160-1.
            Source: OH Admin. Code 4753-2-01
            Location
            No reference found.                                When the originating site is located within a five mile
                                                               radius from the distant site, providers are not eligible for
                                                               reimbursement.

                                                               Provider types eligible as an originating site, either using
                                                               a Q3014 HCPCS code or a GQ modifier:
                                                                   •   Primary Care Clinic
                                                                   •   Outpatient Hospital
                                                                   •   Rural Health Clinic (Medical)
                                                                   •   Federally Qualified Health Clinic (Medical)
                                                                   •   Physician
                                                                   •   Professional Medical Group
                                                                   •   Podiatrist
                                                                   •   Optometrist

                                                               See transmittal letter for additional billing rules.

                                                               Additional place of service restrictions:
                                                                   •   Inpatient hospital
                                                                   •   Nursing facility
                                                                   •   Inpatient psychiatric hospitals

                                                               Source: OH Medicaid Handbook Transmittal Letter No. 3334-15-
                                                               01.  Jan. 2, 2015, pg. 6-7..
            Cross-State Licensing

            Ohio issues telemedicine certificates that allow the   No reference found.
            holder to engage in the practice of telemedicine in the
            state.

            Providers with telemedicine certificates cannot practice
            in OH without a special activity certificate.

            Source: OH Revised Code Annotated, Sec. 4731.296(C).

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


            Physical Therapy
            Physical therapists and physical therapist assistants
            must hold a valid OH physical therapy license to treat a
            patient located in Ohio via telehealth.

            Source: OH Admin. Code 4755-27-01.
            Private Payers
            No reference found.                                No reference found.

            Site/Transmission Fee
            No reference found.                                Originating site eligible for a facility fee using HCPCS
                                                               code Q3014.

                                                               See transmittal letter for additional billing rules.

                                                               Source: OH Medicaid Handbook Transmittal Letter No. 3334-15-
                                                               01, pg. 5-6.  Jan. 2, 2015 & OH Admin Code 5160-1.

            Miscellaneous


















































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