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                                                                                 Center for Connected Health Policy

           Oregon


           Medicaid Program:  Oregon Medicaid

           Medicaid Program Administrator:  Oregon Health Authority

           Regional Telehealth Resource Center:
           Northwest Regional Telehealth Resource Center
                  th
           2900 12  Ave. N., Ste. 30W
           Billings, MT 59101
           (888) 662-5601
           www.nrtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            “Telemedical means delivered through a two-way video   “Telemedicine is the use of medical information,
            communication that allows a health professional to   exchanged from one site to another, via telephonic or
            interact with a patient who is at an originating site.”   electronic communications, to improve a patient’s health
                                                               status.”
            Source: OR Revised Statutes Sec. 743A.058.
                                                               Source: OR Div. of Medical Assistance Program, Medical-Surgical
            “Telemedicine means the provision of health services to   Svcs. Rulebook, Div. 130, 410-130-0610, p. 65-6 (Jan. 1, 2015).
            patients by physicians and health care practitioners from
            a distance using electronic communications.”

            Source: OR Revised Statutes 442.015.
            Live Video Reimbursement
            Oregon statute requires coverage of telemedicine   Oregon Medicaid will reimburse for live video when
            services (which includes live video), subject to contract   billed services comply with their billing requirements.
            terms and conditions.
                                                               The referring provider is not required to be present with
            Source: OR Revised Statutes Sec. 743A.058.         the client for the consult.

            (See “Private Payers” section)                     The referring provider may bill for the patient visit only if
                                                               a separately identifiable visit is performed.

                                                               Source: OR Div. of Medical Assistance Program, Medical-Surgical
                                                               Svcs. Rulebook, Div. 130, 410-130-0610, p. 65-6 (Jan. 1, 2015).
            Store and Forward Reimbursement
            No reference found.                                No reference found.

            Remote Patient Monitoring Reimbursement
            Oregon requires out of state physicians to acquire active  No reference found.
            tele-monitoring status through the Oregon Medical
            Board before they can perform intraoperative tele-
            monitoring on patients during surgery.

            The Administrative Code defines “tele-monitoring” as the
            “intraoperative monitoring of data collected during
            surgery and electronically transmitted to a physician who
            practices in a location outside of Oregon. The monitoring
            physician is in communication with the operation team


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            through a technician in the operating room.”

            Requirements:

               •   The facility where the surgery is performed must
                   be a licensed hospital or ambulatory surgical
                   center;
               •   The facility must grant medical staff membership
                   and/or clinical privileges to the monitoring
                   physician;
               •   The monitoring physician must have OR active-
                   tele-monitoring status.

            Source: OR Admin. Rules. 847-008-0023.
            Email/Phone/FAX
            Yes for email.                                     Yes for email and telephone when used for patient
            Yes for telephone.                                 consulting and “when billed services comply with the
            No reference found for FAX.                        practice guidelines set forth by the Health Service
                                                               Commission (HSC), applicable HSC approved CPT
            Email and telephone consults must comply with Health   code requirements and delivered consistent with the
            Service Commission guidelines.                     HSC practice guideline.”

            Source: OR Admin. Rules 410-130-0610.              Email, telephone and fax may be used when
                                                               videoconferencing availability is limited.

                                                               Source: OR Div. of Medical Assistance Programs, Medical-
                                                               Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 65-6 (Jan. 1,
                                                               2015).
            Online Prescribing
            Practicing Across State Lines                      No reference found.
            A physician must first:

               •   Establish a physician-patient relationship;
               •   Make a judgment based on some type of
                   objective criteria upon which to diagnose, treat,
                   correct or prescribe;
               •   Act in the best interest of the patient.

            Writing prescriptions based only on an Internet sale or
            consults prohibited.

            Source: OR Admin. Rules, 847-025-0000.
            Consent
            No reference found.                                No reference found.
            Location

            Originating sites include but are not limited to:   No reference found.

               •   Hospitals;
               •   Rural Health Clinics;
               •   Federally Qualified Health Centers;
               •   Physician offices;


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

               •   Community mental health centers;
               •   Skilled nursing facilities;
               •   Renal dialysis centers;
               •   Sites where public health services are provided.

            Source: OR Revised Statutes Sec. 743A.058.
            Cross-State Licensing

                                                               The referring and evaluating practitioner must be
            Out-of-state physicians may receive a license to practice  licensed to practice medicine within the state of Oregon
            across state lines in Oregon, as long as they are fully   or within the contiguous area of Oregon and must be
            licensed in another state and meet certain requirements.  enrolled as a Division of Medical Assistance Programs
                                                               (Division) provider.
            Source: OR Revised Statutes Annotated Sec. 677.139.
                                                               Source: OR Administrative Regulation 410-130-0610(2)(a).
            (also see Medicaid column)

            Private Payers
            Oregon requires coverage of telemedicine services,   No reference found.
            subject to contract terms and conditions.

            Plans may not distinguish between originating sites that
            are rural and urban in providing coverage.

            Source: OR Revised Statutes Sec. 743A.058.

            A health benefit plan must provide coverage in
            connection with the treatment of diabetes if:

               •   If coverage is provided for in-person services
               •   The service is medically necessary;
               •   The service relates to a specific patient; and
               •   One of the participants in the telemedical health
                   service is a representative of an academic
                   health center.

            Source: OR Revised Statutes Sec. 743A.185.
            Site/Transmission Fee
            (see Medicaid column)                              Oregon Medicaid will provide transmission fees for
                                                               originating sites.

                                                               Source: OR Admin. Regulation 410-130-0610(5) & OR Div. of
                                                               Medical Assistance Programs, Medical-Surgical Svcs. Rulebook,
                                                               Div. 130, 410-130-0610, p. 65-6 (Jan. 1, 2015).
            Miscellaneous



           Comments:
                         OR New Regulations Passed
                             •   Occupational Therapy (Source: OR Admin. Code 339-010-0006)






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