STATE LAW/REGULATIONS

MEDICAID PROGRAM

Store and Forward Reimbursement

No reference found.

Potential conflicting information exists in the Medicaid provider manual.

The manual cites the use of GQ (the store and forward) modifier for rehabilitative services but not in the physician section. However, services are considered to be telemedicine services only if delivered via an interactive audio and video communication system.

Note: There is no other reference to this modifier in the

Medicaid provider manual.

Source: AL Medicaid Management Information System Provider

Manual, p. 717, (Oct. 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Please see “Comments” section below.

Email/Phone/FAX

No reimbursement for telephone.

No reference found for email or FAX.

Source: AL Admin Code r. 560-X-6-.14 (2011).

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: AL Medicaid Management Information System Provider

Manual, p. 474, (Oct. 2012).

Online Prescribing

Prescribing drugs to an individual the prescriber has not personally examined is usually inappropriate”. Before prescribing a drug, the physician should make an informed medical judgment. Ordinarily, this will require that the physician personally perform an appropriate history and physical exam, make a diagnosis, and formulate a therapeutic plan, which might include a prescription.

Source: AL Admin. Code r. 540-X-9-.11 (2011).

No reference found.

Consent

No reference found.

A written informed consent is required prior to an initial telemedicine service.

Source: AL Medicaid Management Information System Provider

Manual, p. 716, (Oct. 2012).

Location

No reference found.

Originating and distant sites must be located in

Alabama.

For rehabilitative services, the originating site must be:

• Physician’s office;

• Hospital;

• Critical Access Hospital;

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Rural Health Clinic;

• Federally Qualified Health Center;

• Community mental health center;

• Public health department.

Source: AL Medicaid Management Information System Provider

Manual, p. 715, (Oct. 2012).

Cross-State Licensing

“A special purpose license allowing practitioners licensed in other states to practice across state lines may be issued.”

Source: Code of AL Sec. 34-24-502 - 507 (2012).

Providers must have an Alabama license.

Source: AL Medicaid Management Information System Provider

Manual, p. 474, (Oct. 2012).

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reimbursement for originating site or transmission fees.

Source: AL Medicaid Management Information System Provider

Manual, p. 474, (Oct. 2012).

Miscellaneous

Effective for dates of service 1/16/2012 and thereafter, all physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In

order to participate in the telemedicine program:

• Physicians must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service)

• Physician must submit the telemedicine Service

Agreement/Certification form

• Physician must obtain prior consent from the recipient before services are rendered. This will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

Source: Alabama Medicaid Management Information System

Provider Manual, p. 474, (Oct. 2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data through audio, video, or data communications that are engaged in over two or more locations between providers who are physically separated from the patient or from each other.”

Source: AK Admin. Code, Title 7, 12.449 (2012).

“Telemedicine is identical to a “traditional” health-care visit except it uses a different mode of delivery; with telemedicine, the health-care provider and the patient are not in the same physical location. Instead, providers use telemedicine applications, such as video, audio, and/or digitized image transmissions, to link the patient and the provider.”

Source: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Ambulatory Surgical Care Facility, Early and Periodic Screening, Diagnosis, and Treatment, Hospice Care, Inpatient Psychiatric Services, Independent Laboratory Services, Appendices.

Live Video Reimbursement

(See Medicaid column)

Alaska’s Medicaid program will reimburse for services “provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis”

Source: AK Admin. Code, Title 7, 110.625(a) (2012).

Eligible services:

• Initial or follow up office visits;

• Consultation made to confirm diagnosis

• A diagnostic, therapeutic or interpretive service

• Psychiatric or substance abuse assessments;

• Individual psychotherapy or pharmacological management services.

Source: AK Admin. Code, Title 7, 110.625 (2012).

Source: AK Admin. Code, Title 7, 110.630 (2012).

No reimbursement for:

• Home and community-based waiver services;

• Pharmacy;

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Durable medical equipmen;

• Transportation;

• Accommodation services;

• End-stage renal disease;

• Direct-entry midwife;

• Private duty nursing;

• Personal care assistants;

• Visual care, dispensing or optician services;

• Technological equipment and systems associated with telemedicine application.

Source: AK Admin. Code, Title 7, 110.635 (2012).

Store and Forward Reimbursement

(See Medicaid column)

Alaska Medicaid will reimburse for services delivered through store-and-forward.

Source: AK Dept. of Health and Social Svcs., AK Medical Assistance Provider Billing Manuals, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, p. 24 (Jun. 7, 2012).

To be eligible for payment under store-and-forward the service must be “provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider.”

Source: AK Admin. Code, Title 7, 110.625(a) (2012).

Remote Patient Monitoring Reimbursement

(See Medicaid column)

Alaska Medicaid will reimburse for services delivered through self-monitoring.

Source: AK Dept of Health and Social Svcs., AK Medical Assistance Provider Billing Manuals, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, p. 24 (Jun. 7, 2012).

To be eligible for payment under self monitoring or testing, “the services must be provided by a telemedicine application based in the recipient’s home, with the provider only indirectly involved in the provision of the service.”

Source: AK Admin. Code, Title 7, 110.625(a) (2012).

Email/Phone/FAX

(see Medicaid column)

No reimbursement for telephone. No reimbursement for FAX.

Source: AK Dept. of Health and Social Svcs., AL Medical Assistance Provider Billing Manuals, Section1: Physician, Advance Nurse Practitioner, Physician Assistant: Services, Policies and Procedures, p. 24 (Jun. 7, 2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Reimbursement for phone, only if part of a dedicated audio conference system.

No reimbursement for FAX.

Source: AK Admin Code, Title 7, 110.625 (2012).

Online Prescribing

Physicians are prohibited from prescribing medications based solely on a patient-supplied history received by telephone, FAX, or electronic format.

Source: AK Admin. Code, Title 12, Sec. 40.967 (2012).

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

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

Source: AK Admin. Code, Title 7, 110.635(b) (2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

Under Arizona Statute, Public Health & Safety, "telemedicine means the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications

sent to a health care provider for diagnostic or treatment consultation.”

Source: AZ Revised Statute Sec. 36-3601 (2012).

Under State Administrative Code, Department of Insurance, Health Care Services Organizations Oversight, "telemedicine means diagnostic, consultation, and treatment services that occur in the physical presence of an enrollee on a real-time basis through interactive audio, video, or data communication.”

Source: AZ Admin. Code Sec. R20-6-1902 (2012).

Telemedicine is “the practice of health care delivery, diagnosis, consultation and treatment and the transfer

of medical data between the originating and distant sites through real time interactive audio, video or data communications that occur in the physical presence of the member.”

Source: AZ Health Care Cost Containment System .AHCCCS Medical Policy Manual for AHCCCS Covered Services, Ch. 300, p.

172, Apr. 2012.

Telehealth is “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.”

Source: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, p. 172. Apr. 2012.

Live Video Reimbursement

Health Care Service Organizations (HCSO) are allowed, but not mandated, to provide access to covered services through telemedicine, telephone, and email.

Source: AZ Admin. Code Sec. R20-6-1915 (2012)

AHCCCS will reimburse for medically necessary services provided via live video in their fee for service program.

Eligible services:

• Cardiology;

• Dermatology;

• Endocrinology;

• Hematology/oncology;

• Home Health

• Infectious diseases;

• Neurology;

• Obstetrics/gynecology;

• Oncology/radiation;

• Ophthalmology;

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Orthopedics;

• Pain clinic;

• Pathology;

• Pediatrics and pediatric sub-specialties;

• Radiology;

• Rheumatology;

• Surgery follow-up and consults;

Source: AZ Health Care Cost Containment System, AHCCCS Fee- For- Service Provider Manual, Ch. 10: Professional and Technical Services, p. 39 (Jan. 2013).

Behavioral health services are covered for AHCCS and

KidsCare patients.

Covered behavioral health services:

• Diagnostic consultation and evaluation;

• Psychotropic medication adjustment and monitoring;

• Individual and family counseling;

• Case management.

The patient’s primary care provider (PCP), attending physician, other medical professional employed by the PCP, or an attending physician who is familiar with the patient’s condition, must be present.

Other medical professionals:

• Registered nurses;

• Licensed practical nurses;

• Clinical nurse specialists;

• Registered nurse midwives;

• Registered nurse practitioners;

• Physician assistants;

• Physical, occupational, speech, and respiratory therapists;

• Trained telepresenter familiar with the recipient’s medical condition.

For behavioral health services, the patient’s physician, case manager, behavioral health professional, or tele- presenter must be present.

Source: AZ Health Care Cost Containment System, AHCCCS Fee- For- Service Provider Manual, Ch. 10: Professional and Technical Services, p. 40 (Jan. 2013).

Store and Forward Reimbursement

The definition of “telemedicine”, which describes telemedicine as occurring in the “physical presence” of the patient, would exclude store and forward.

Source: AZ Admin. Code Sec. R20-6-1902 (2012).

AHCCCS will reimburse for store-and-forward in their fee-for-service program. The same services are covered for store and forward, as for real time.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Real time telemedicine is the only type of

reimbursement available in the field of Behavioral Health

Services.

Source: AZ Health Care Cost Containment System, AHCCCS Fee- For- Service Provider Manual, Ch. 10: Professional and Technical Services, p. 40-1 (Jan. 2013).

In the Services with Special Circumstances program, AHCCCS only covers for store and forward the following:

• Dermatology

• Radiology

• Ophthalmology

• Pathology.

.

Source: Arizona Health Care Cost Containment System. AHCCCS Medical Policy Manual for AHCCCS Covered Services, Ch. 300, Policy 320 Services With Special Circumstances, p. 174 (Apr.

2012).

The following exceptions may be eligible for reimbursement by Services with Special Circumstances, but are not considered a “telemedicine service”:

• A provider in the role of tele-presenter may be providing a separately billable service, such as an electrocardiogram or an X-ray. The service is covered, but not the tele-presenting.

• A consulting distant-site provider may offer a service that does not require real-time patient interaction. Reimbursement only for dermatology, radiology, ophthalmology, and pathology. and is subject to review by AHCCCS Medical Management.

• When a patient in a rural area presents within three hours of onset of stroke symptoms, AHCCCS will reimburse the consulting neurologist if the consult is placed for assistance in determining appropriateness of thrombolytic therapy even when the patients’ condition is

such that real-time video interaction cannot be achieved.

Source: AZ Health Care Cost Containment System, AHCCS Medical Policy Manual, Medical Policy for AHCCCS Covered Services, Ch. 300, Policy 320: Services With Special Circumstances, page 181, (Apr. 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Home health is listed as a reimbursable service in fee for service, but no other reference was found or explanation of what is considered a “home health”

STATE LAW/REGULATIONS

MEDICAID PROGRAM

service

Source: AZ Health Care Cost Containment System, AHCCCS Fee- For- Service Provider Manual, Ch. 10: Professional and Technical Services, p. 39 (Jan. 2013).

AHCCCS Services With Special Circumstances program only reimburses for telemedicine delivered via real time, Home Health is not a covered service under this program.

Source: AZ Health Care Cost Containment System .AHCCCS Medical Policy Manual for AHCCCS Covered Services, Ch. 300, Policy 320 Services With Special Circumstances, p. 173-174 (Apr.

2012).

Email/Phone/FAX

Health Care Service Organizations are allowed, but not mandated, to provide covered services through telemedicine, telephone, and email.

Source: AZ Admin. Code Sec. R20-6-1915 (2012).

No reference found.

Online Prescribing

Physicians are prohibited from issuing a prescription to patients without having a previously established provider-patient relationship, or first conducting a physical exam.

Source: Arizona Revised Statute Sec. 32-1401 (2012).

No reference found.

Consent

Providers must obtain and document oral or written consent before delivery of services. Oral consent should be documented on the patient’s medical record.

Source: AZ Revised Statute Sec. 36-3602 (2012).

No reference found.

Location

No reference found.

Eligible hub or spoke sites for Indian Health Services or tribal providers:

• Indian Health Service clinic;

• Tribally-governed facility;

• Urban clinic for American Indians;

• Physician or other provider office;

• Hospital;

• Federally Qualified Health Center (FQHC).

Source: AHCCCS, HIS/638 AHCCCS Telehealth Training Manual, p. 8.

Fee for service manual definitions:

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Hub site – “the location of the telemedicine consulting provider, which is considered

the place of service.”

Spoke site – “the location where the recipient is receiving the telemedicine service.”

Source: AZ Health Care Cost Containment System, AHCCCS Fee- For- Service Provider Manual, Ch. 10: Professional and Technical Services, p. 40 (Jan. 2013).

Cross-State Licensing

An out-of-state doctor may engage in a single or infrequent consultation with an Arizona physician.

Source: AZ Revised Statute Sec. 32-1421 (2012).

A consultation by a non-Arizona licensed provider may occur if:

• It is to a specific patient in the AHCCCS

program;

• The provider is registered with AHCCCS;

• The provider is licensed in the state the consultation is being provided from, or the provider is employed by an Indian Health Services, Tribal or Urban Indian Health program, and appropriately licensed based on IHS and Tribal facility requirements.

Source: AZ Health Care Cost Containment System, AHCCS Medical Policy Manual, Medical Policy for AHCCCS Covered Services, Ch. 300, Policy 320: Services With Special Circumstances, page 182, (Apr. 2012).

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

Arizona explicitly prohibits the use of telemedicine to provide an abortion.

Source: AZ Revised Statute Sec. 36-3604 (2012).

There is reimbursement for non-emergency transportation to and from the telemedicine originating site.

Source: AZ Health Care Cost Containment System, AHCCS Medical Policy Manual, Medical Policy for AHCCCS Covered Services, Ch. 300, Policy 320: Services With Special Circumstances, page 175, (Mar. 1, 2011).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

There is reimbursement for live video for “Telepsych” services under the Rehabilitative Services for Persons with Mental Illness (RSPMI) program.

Note: These services are only available when, at a minimum, the Arkansas Telehealth Network (ATN) recommended audio video standards for real-time, two- way interactive audiovisual transmissions are met. Providers also must be able to link or connect to ATN, to ensure HIPAA compliance.

Source: AR Provider Manual, Section II: Rehabilitative Services for Persons with Mental Illnesses, p. 12.

Store and Forward Reimbursement

(See Medicaid column)

Arkansas Medicaid defines telemedicine as “Interactive electronic consultations are physician consultations, “face-to-face” in real time, via two-way electronic data exchange.” This would exclude store and forward.

Source: AR Provider Manual, Section II: Physician/Independent

Labe/CRNA/Radiation Therapy Center, p. 30.

However, Arkansas Medicaid policies indicate that electronic transactions office/ outpatient echography and echocardiography, X-rays, and other diagnostic procedures may qualify for Medicaid reimbursement when the transactions do not take place in real time.

Source: 016 06 Code of AR Rules and Regs. (CARR) 036 (2012) in “Internet Prescribing Language: State by State Overview,” Federation of State Medical Boards, January 26, 2012, p. 2-3.

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found.

No reference found.

Online Prescribing

Without a prior and proper patient-provider relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

Source: AR Code Annotated Sec. 17-92-1003 (2012).

No reference found.

Consent

No reference found.

No reference found.

Location

Patients must be in a physician’s office or a hospital.

Source: 016 06 Code of AR Rules and Regs. (CARR) 036 (2012).

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Cross-State Licensing

An out of state physician utilizing an electronic medium who performs an act that is part of a patient care service that was initiated in Arkansas, including interpretation of an X-ray, that would affect the diagnosis or treatment, is engaged in the practice of medicine and subject to regulation by the Arkansas State Medical Board.

Source: AR Code Revised 17-95-206 (2012)

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

without an appropriate prior examination and medical indication.

Source: CA Business & Professions Code Sec. 2242.1(a).

Consent

The originating site provider must obtain and document oral patient consent prior to service delivery.

CA Health & Safety Code Sec. 1374.13 (2012).

No reference found.

Location

Health plans cannot limit the settings where services are provided. Settings are still subject to contract terms and conditions.

Source: CA Health & Safety Code Sec. 1374.13 (2012).

An “originating site” is the location of an eligible recipient at the time service is furnished via telecommunications.

Originating sites:

• Physician or practitioner offices;

• Critical Access Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers.

A “distant site” is the location from where a physician or practitioner provides professional services via telecommunications.

Source: CA Dept. of Health Care Svcs. Medi-Cal Provider Manual, Medicine: Telemedicine, p. 2 (Oct. 2008).

Cross-State Licensing

No reference found.

No reference found.

Private Payers

Private payers cannot require that in-person contact occur before payment is made for covered telehealth services, subject to contract terms and conditions.

Source: CA Health & Safety Code Sec. 1374.13 (2012).

No reference found.

Site/Transmission Fee

No reference found.

Medi-Cal will reimburse the originating site a facility fees, and for live video transmission costs.

Source: CA Dept. of Health Care Svcs. Medi-Cal Provider Manual, Medicine: Telemedicine, p. 8 (Oct. 2008).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Store and Forward Reimbursement

No reimbursement based upon definition of “telemedicine” which describes telemedicine as “interactive” implying that it happens in real time.

Source: CO Revised Statutes 12-36-102.5 (2012).

The CO Medical Assistance Program will only reimburse for “live” telemedicine, excluding store and forward. Peripherals, such as transmission of a live ultrasound exam, may be reimbursed.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 5 (Dec. 2011).

Remote Patient Monitoring Reimbursement

(see Medicaid column)

The CO Medical Assistance Program will reimburse for Remote Patient Monitoring at a flat fee set by the state board when all these requirements are met:

• The patient is receiving services from a home health provider for at least one of the following: congestive heart failure, chronic obstructive pulmonary disease, asthma, or diabetes;

• The patient requires monitoring at least five

times weekly to manage the disease, as ordered by a physician or podiatrist;

• The patient has been hospitalized two or more times in the last 12 months for conditions related to the disease;

• The patient or caregiver misses no more than five monitoring events in a 30-day period;

• The patient’s home has space for all program equipment and full transmission capability.

Source: (Reimbursement): CO Revised Statutes 25.5-5-321 (2012). Source: (Requirements): 10 CO Code of Regulation 2505-10.

Additional restrictions apply. See Colorado Code of

Regulations for more information.

Medicaid Home Health will reimburse for services only if the patient has no other insurance.

Source: 10 CO Code of Regulation 2505-10.

Email/Phone/FAX

Private payers and the managed care system are not required to cover telephone or FAX services.

Source: CO Revised Statutes 10-16-123 and Colorado Revised

Statutes 25.5-5-414 (2012).

No reimbursement for telephone. No reimbursement for FAX.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 5 (Dec. 2011).

Online Prescribing

Pharmacists are prohibited from dispensing prescription drugs if they know, or should have known, that it was

on the basis of an internet-based questionnaire,

an Internet-based consult, or a telephone consultation, all without a valid pre-existing patient-practitioner relationship.

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: 3 CO Code of Regulation 719-1 (2012).

Consent

Providers shall give all first-time patients a written statement that includes the following:

• The patient may refuse telemedicine services at any time, without loss or withdrawal of

treatment;

• All applicable confidentiality protections shall apply to the services;

• The patient shall have access to all medical information from the services, under state law.

Source: CO Revised Statutes 25.5-5-320 (2012).

The Medicaid requirement for face-to-face contact between provider and client may be waived prior to treating the client through telemedicine for the first time. The rendering provider must furnish each client with all

of the following written statements which must be signed by the client or the client’s legal representative:

• The client retains the option to refuse the delivery of health care services via telemedicine at any time without affecting the client's right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the client would otherwise be entitled.

• All applicable confidentiality protections shall apply to the services.

• The client shall have access to all medical information resulting from the telemedicine services as provided by applicable law for client access to

his or her medical records.

These requirements do not apply in an emergency.

Source: CO Medical Assistance Program, Telemedicine Manual, p. 6 (Dec. 2011).

Location

No reference found.

No reference found.

Cross-State Licensure

No reference found.

No reference found.

Private Payers

Health plans for patients in counties with 150,000 or fewer residents cannot require face-to-face contact between a provider and a patient for services that could be appropriately provided through telemedicine.

These services are subject to all terms and conditions of the health plans.

Source: CO Revised Statutes 10-16-123 (2012).

No reference found.

Site/Transmission Fee

No reference found.

The CO Medical Assistance Program will reimburse for transmission costs, at a rate set by their state department.

Source: CO Revised Statutes 25.5-5-320 (2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: CT General Statutes Sec. 20-12 (2012).

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine is the use of telecommunication and information technologies to provide clinical health care at a distance”.

Source: DE Dept. of Health and Social Svcs., Press Release

DHSS-59-2012, (Jun. 27, 2012).

Live Video Reimbursement

No reference found.

The Delaware Medical Assistance Program will reimburse for “telemedicine-delivered services.”

Source: DE Dept. of Health and Social Svcs., Press Release

DHSS-59-2012, (Jun. 27, 2012).

Store and Forward Reimbursement

No reference found.

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found.

No reference found.

Online Prescribing

Pharmacists are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to

an Internet pharmacy through an Internet site.

Source: DE Code, Title 16 Sec. 4744 (2012).

No reference found.

Consent

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reference found.

No reference found.

Location

No reference found.

Eligible originating sites:

• Hospitals;

• Federally qualified health centers (FQHC);

• Public health clinics;

• Program for All-Inclusive Care for the Elderly

(PACE) centers.

Source: DE Dept. of Health and Social Svcs., Press Release

DHSS-59-2012, (Jun. 27, 2012).

Cross-State Licensing

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

The originating site will be reimbursed a facility fee for the telemedicine space and equipment.

Source: DE Dept. of Health and Social Svcs., Press Release

DHSS-59-2012, (Jun. 27, 2012).

Miscellaneous

STATE LAW

MEDICAID PROGRAM

including history and physical examination, to establish the diagnosis for which any drug is prescribed, and discuss treatment options with the patient.

These rules don’t apply in emergency situations.

Source: FL Admin. Code 64B8-9.014.

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

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Telemedicine Handbook, p. 2-3, (Nov. 2012).

Georgia Medicaid will reimburse for mental health services for residents in nursing homes via telemedicine (although not available in all areas of the state).

Source: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facilities, p. 206 (Oct. 1, 2012).

Store and Forward Reimbursement

No reference found.

Georgia Medicaid will not reimburse for store and forward because these services do not include direct, in-person patient contact.

Source: GA Dept. of Community Health, GA Medicaid

Telemedicine Handbook, p. 4, (Nov. 2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for FAX.

No reimbursement for telephone. No reimbursement for email.

Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012).

No reimbursement for FAX.

No reimbursement for telephone. No reimbursement for email.

Source: GA Dept. of Community Health, GA Medicaid

Telemedicine Handbook, p. 8, (Nov. 2012).

Online Prescribing

Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult.

Source: GA Rules & Regulations revised 360-3-.02 (2012).

No reference found.

Consent

No reference found in statute.

The referring provider must obtain prior written consent.

Source: GA Dept. of Community Health, GA Medicaid

Telemedicine Handbook, p. 5, (Nov. 2012).

Location

No reference found.

Eligible originating sites:

• Provider offices;

• Hospitals;

• Critical Access Hospitals (CAH);

• Rural Health Clinics (RHC);

• Federally Qualified Health Centers (FQHC);

• Skilled nursing facilities;

• Community mental health centers;

• GA public health clinics;

• School-based clinics.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Eligible distant sites:

• Provider offices;

• Hospitals;

• Critical Access Hospitals (CAH);

• Rural Health Clinics (RHC);

• Federally Qualified Health Centers (FQHC);

• Skilled nursing facilities;

• Community mental health centers;

• GA public health clinics.

Source: GA Dept. of Community Health, GA Medicaid

Telemedicine Handbook, p. 3, (Nov. 2012).

Cross-State Licensure

No reference found.

Providers must have a Georgia license.

Source: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Physician Services, Appendix R p. 139 (Oct. 1, 2012).

Private Payers

Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: GA Rules & Regulations. Sec. 33-24-56.4 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

includes live video), subject to contract terms and conditions.

Source: HI Revised Statutes § 431:10A-116.3 (2012).

(See Medicaid column & “Private Payers” Section)

“includes audio and video equipment, permitting real- time consultation among the patient, consulting practitioner and referring practitioner.”

Source: Code of HI Rules 17-1737 (2012).

Store and Forward Reimbursement

Based upon the definition of “telehealth” (which includes secure asynchronous information exchange) in the state insurance law, store and forward may be covered.

Source: HI Revised Statutes § 431:10A-116.3 (2012).

(also see Medicaid column)

Hawaii Quest requires the patient to be “present and participating in the telehealth visit” therefore excluding store and forward from reimbursement.

Source: Code of HI Rules 17-1737 (2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: HI Revised Statutes § 431:10A-116.3 (2012).

(also see Medicaid column)

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: Code of HI Rules 17-1737 (2012).

Online Prescribing

Prescribing providers must have a provider-patient relationship prior to e-prescribing. This includes:

• A face-to-face history and physical exam;

• A diagnosis and therapeutic plan;

• Discussion of diagnosis or treatment with the patient;

• Availability of appropriate follow-up care.

Source: HI Revised Statutes § 329-1 (2012).

Treatment recommendations made via telemedicine are appropriate for traditional physician-patient settings that do not include a face-to-face visit, but in which prescribing is appropriate, including on-call telephone encounters and encounters for which a follow-up visit is arranged.

Issuing a prescription based solely on an online questionnaire is prohibited.

Source: HI Revised Statutes § 453-1.3.

No reference found.

Consent

No reference found.

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Location

(see Medicaid column)

Eligible originating sites:

• Hospitals;

• Critical Access Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers;

• Federal telehealth demonstration project sites.

In addition, originating sites must be located in one of the following:

• A federally designated Rural Health

Professional Shortage Area;

• A county outside of a Metropolitan Statistical

Area;

• An entity that participates in a federal telemedicine demonstration project.

Source: Code of HI Rules 17-1737 (2012).

Cross-State Licensing

Out-of-state radiologists may provide services in Hawaii.

Source: HI Revised Statutes § 453-2(b)(6).

No reference found.

Private Payers

Hawaii requires coverage of telehealth services, subject to contract terms and conditions.

Source: HI Revised Statutes § 431:10A-116.3 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment.

Prescriptions based solely on online questionnaires or consults outside of an ongoing clinical relationship are prohibited.

Source: ID Code § 54-1733 (2012).

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

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

Reimbursement is made at a fixed rate for the facility fee for site transmission.

Source: ID MMIS Provider Handbook, Allopathic and Osteopathic

Physicians, p. 29 (Oct. 2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

telecommunication system;

• The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system. The system must also be capable of transmitting clearly audible heart tones and lung sounds, as well as clear video images of the patient and any diagnostic tools, such as radiographs.

An encounter clinic serving as the distant site shall be reimbursed as follows:

1. If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department. The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and

2. If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter. The originating site

provider will receive a facility fee.

Source: IL Admin. Code Title 89, 140.403.

Eligible originating site providers include:

• Physicians;

• Podiatrists;

• Local health departments;

• Community mental health centers;

• Outpatient hospitals;

• Encounter Rate Clinics

• Federally Qualified Health Centerse (FQHC);

• Rural Health Clinics (RHC)

Eligible distant site providers include:

• Physicians;

• Podiatrists;

• Advanced practice nurses;

• Encounter Rate Clinics

• Federally Qualified Health Centers (FQHC);

• Rural Health Clinics;

Source: IL Dept. of Healthcare and Family Svcs., Expansion of

Telehealth Services, Informational

Notice, http://www.hfs.illinois.gov/html/011210n2.html, (Jan. 12,

2010)

Distant Site providers may not seek reimbursement for their services when the Originating Site is an encounter clinic. The Originating Site encounter clinic is responsible for reimbursement to the Distant Site provider.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Nonenrolled providers rendering services as a Distant Site provider shall not be eligible for reimbursement from the department, but may be reimbursed by the Originating Site provider.

Under the department’s telehealth policy, providers will be paid as either an Originating Site or Distant Site.

Source: IL Dept. of Healthcare and Family Svcs., Expansion of

Telehealth Services, Informational

Notice, http://www.hfs.illinois.gov/html/011210n2.html, (Jan. 12,

2010)

Psychiatric Services

With the exception of group psychotherapy, tele-psychiatry is covered, if all of the conditions stated above are met.

Tele-psychiatry eligible originating site providers:

• Physician;

• Other licensed healthcare professional or other licensed clinician;

• Mental health professional;

• Qualified mental health professional

Source: IL Dept. of Healthcare and Family Svcs., Expansion of

Telehealth Services, Informational

Notice, http://www.hfs.illinois.gov/html/011210n2.html, (Jan. 12,

2010)

Store and Forward Reimbursement

(see Medicaid column)

Illinois Medicaid will reimburse a provider at a distant site when they “review the medical case without the patient being present.”

Source: IL Administrative Code, Title 89 ,140.403 (2012).

The Illinois Medicaid definition encompasses store and forward. “The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through “store and forward” applications.”

Source: IL Dept. of Healthcare and Family Svcs., Expansion of

Telehealth Services, Informational

Notice, http://www.hfs.illinois.gov/html/011210n2.html, (Jan. 12,

2010).

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.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: IL Dept. of Healthcare and Family Services, Handbook for Practitioners Rendering Medical Services, Chapter A-200, Policy and Procedures for Medical Services, p. 38 (August 2010) & Source: IL Administrative Code, Title 89 ,140.403 (2012).

Online Prescribing

No reference found.

No reference found.

Consent

No reference found.

No reference found.

Location

(see Medicaid column)

Eligible originating site:

• Physician office;

• Podiatrist office;

• Local health departments;

• Community mental health centers;

• Outpatient hospitals;

• Rural health clinics;

• Encounter Rate Clinics

• Federally Qualified Health Centers;

Source: IL Dept. of Healthcare and Family Svcs., Expansion of

Telehealth Services, Informational

Notice, http://www.hfs.illinois.gov/html/011210n2.html, (Jan. 12,

2010)

Cross-State Licensing

No reference found.

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

For psychiatric services, the provider rendering the service at the distant site must be a physician licensed by the State of Illinois, or by the state where the patient is located, who has completed an approved general psychiatry residency program or a child and adolescent psychiatry residency program.

Source: IL Handbook for Practitioners Rendering Medical Services, Chapter A-200, Policy and Procedures for Medical Services, p. 38 (August 2010).

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

There is reimbursement for originating site facility fees.

Eligible facilities include:

• Physician’s office;

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Podiatrist’s office;

• Local health departments;

• Community mental health centers;

• Outpatient hospitals.

Originating site providers who receive reimbursement for the patient’s room and board are not eligible for facility fees.

Source: IL Handbook for Practitioners Rendering Medical Services, Ch. A-200, Policy and Procedures for Medical Services, p. 38 (Aug. 2010).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Consultations

Office or other outpatient visit Individual psychotherapy Psychiatric diagnostic interview Pharmacologic management

End-stage renal disease (ESRD) services

Source: IN Health Coverage Programs Provider Manual, Chapter

8, Billing Instructions, p. 137 (May 8, 2012).

No reimbursement for the following:

• Ambulatory surgical centers;

• Outpatient surgical services;

• Home health agencies or services;

• Radiological services;

• Laboratory services;

• Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled;

• Anesthesia services or nurse anesthetist services;

• Audiological services;

• Chiropractic services;

• Care coordination services;

• Durable medical equipment, medical supplies, hearing aids, or oxygen;

• Optical or optometric services;

• Podiatric services;

• Services billed by school corporations;

• Physical or speech therapy services;

• Transportation services;

• Services provided under a Medicaid waiver.

Source: IN Admin. Code, Title 405, 5-38-4 (2012).

Store and Forward Reimbursement

(see Medicaid column)

Indiana Medicaid will not reimburse for store and forward services.

Source: IN Admin. Code, Title 405, 5-38-4 (2012).

However, there is reimbursement for store and forward technology to facilitate other reimbursable services. Separate reimbursement of the spoke-site payment is not provided for this technology.

Source: IN Health Coverage Programs Provider Manual, Chapter

8, Billing Instructions, p 136, (May 8, 2012).

Remote Patient Monitoring Reimbursement

(see Medicaid column)

Indiana Medicaid considers telemedicine as “not a telephone transmitter for transtelephonic monitoring.”

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: IN Admin. Code, Title 405, 5-38-1 (2012).

Email/Phone/FAX

No reference found for email.

No reimbursement for telephone. No reference found for FAX.

Source: IN Admin. Code, Title 405, 5-38-1 (2012).

No reference found for email.

No reimbursement for telephone. No reference found for FAX.

Source: IN Health Coverage Programs Provider Manual, Chapter

8, Billing Instructions, p. 136 (May 8, 2012).

Online Prescribing

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to issuing e-prescriptions.

Source: IN Admin. Code, Title 844, 5-3-2 (2012).

No reference found.

Consent

No reference found.

The spoke site must obtain patient consent. The consent must be maintained at the hub and spoke sites.

Source: IN Health Coverage Programs Provider Manual, Chapter

8, Billing Instructions, p. 138 (May 8, 2012).

Location

The patient must be physically present at the spoke site and participate in the visit.

Source: IN Admin. Code, Title 405, 5-38-4 (2012).

There is reimbursement for telemedicine services only when the hub and spoke sites are greater than 20 miles apart.

Source: IN Health Coverage Programs Provider Manual, Chapter

8, Billing Instructions, p. 138 (May 8, 2012).

Cross-State Licensing

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The hub physician should coordinate with the patient’s primary care physician.

Source: IN Health Coverage Programs Provider Manual, Chapter

8, Billing Instructions, p. 138 (May 8, 2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reference found.

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

“Home telehealth uses real-time, interactive, audio/video telecommunication equipment to monitor patients in the home setting, as opposed to a nurse visiting the home.

This technology may be used to monitor the patient for significant changes in health status, provide timely assessment of chronic conditions, and provide other skilled nursing services.

Services must be provided by a registered nurse or licensed practical nurse. Agencies may bill skilled nursing services on the same date of service as telehealth services.”

Source: Dept. of Health and Environment, Kansas Medical

Assistance Program, Provider Manual, Home Health Agency, p.

33 (Nov. 2012).

Providers are eligible for reimbursement of home telehealth services that meet the following criteria:

• Prescribed by a physician;

• Considered medically necessary;

• Signed beneficiary consent for telehealth services;

• Skilled nursing service;

• Does not exceed two visits per week for non- Home and Community Based Services patients.

Source: KS Dept. of Health and Environment, Kansas Medical

Assistance Program, Provider Manual, Home Health Agency, p.

67 (Nov. 2012).

Email/Phone/FAX

No reference found.

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 38 (Feb. 2012).

Online Prescribing

Physicians must have a pre-existing patient-prescriber relationship. Physicians are prohibited from prescribing drugs on the basis of an internet-based questionnaire or consult, or telephone consult.

Source: KS Admin. Regs., Sec. 68-2-20 (2012).

No reference found.

Consent

No reference found.

Written consent for telehealth home services is required.

Source: KS Dept. of Health and Environment, Kansas Medical

Assistance Program, Provider Manual, Home Health Agency, p.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

67 (Jun. 2012).

Location

No reference found.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Medicaid does not cover other forms of store and forward, as a thelehealth consultation requires a two- way interactive video.

Source: KY Admin. Regs., Title, 907, 3:170, Sec. 3, 3(a) (2011).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: KY Revised Statutes § 304.17A-138 (2012).

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: KY Revised Statutes § 205.559 (2012).

Online Prescribing

Prior to prescribing in response to any communication transmitted or received by computer or other electronic means, physicians must establish a proper physician- patient relationship. This includes:

• Verification that the person requesting medication is in fact who the patient claims to be;

• Establishment of a documented diagnosis through the use of accepted medical practices;

• Maintenance of a current medical record.

An electronic, online, or telephone evaluation by questionnaire are inadequate for the initial or any follow- up evaluation.

Source: KY Revised Statutes § 311.597 (2012).

No reference found.

Consent

The provider who delivers or facilitates the telehealth service shall obtain the informed consent of the patient before services are provided.

Patient consent must be obtained by:

• Physicians;

• Chiropractors;

• Nurses;

• Dentists;

• Dieticians;

• Pharmacist;

• Psychologists;

• Occupational therapists;

• Behavioral analysts;

• Opthamologists;

• Physical therapists;

Before providing a telehealth consultation, providers must document written patient informed consent.

This includes:

• The patient may refuse the telehealth consultation at any time without affecting the right to future care or treatment, and without risking the loss or withdrawal of a benefit to which the patient is entitled;

• The recipient shall be informed of alternatives to the telehealth consult;

• The recipient shall have access to medical information resulting from the telehealth consult as provided by law;

• The dissemination, storage, or retention of an identifiable recipient image or other information

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Speech language pathologists or audiologists;

• Social workers;

• Marriage/family therapists.

Source: KY Revised Statutes § 311.5975 (2012).

(also see Medicaid column)

from the telehealth consult shall comply with all state and federal confidentiality laws and regulations;

• The patient shall have the right to be informed of the parties who will be present at the spoke site and the hub site during the telehealth consult, and shall have the right to exclude anyone from either site;

• The patient shall have the right to object to the videotaping of a telehealth consult.

Source: KY Admin. Regs., Title, 907, 3:170 (2011).

Location

No reference found.

No reference found.

Cross-State Licensure

A provider must be licensed in Kentucky with the exception of persons who, being nonresidents of Kentucky and lawfully licensed to practice medicine or osteopathy in their states of actual residence, infrequently engage in the practice of medicine or

osteopathy within this state, when called to see or attend particular patients in consultation and association with a Kentucky-licensed physician.

Source: KY Revised Statutes § 311.560 (2012).

No reference found.

Private Payers

Payers shall not exclude services solely because the service is provided through telehealth. A health benefit plan may provide coverage for a consultation at a site not within the telehealth network at the discretion of the insurer.

Source: KY Revised Statutes § 304.17A-138 (2012).

No reference found.

Site/Transmission Fee

(see Medicaid column)

No reimbursement for transmission fees.

Source: KY Admin. Regs., Title, 907, 3:170 (2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine is the practice of health care delivery, diagnosis, consultation, treatment, and transfer of medical data using interactive telecommunication technology that enables a health care practitioner and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously. Neither a telephone conversation nor an electronic mail message between a health care practitioner and patient, or a true consultation as may be defined by rules promulgated by the board pursuant to the Administrative Procedure Act, constitutes telemedicine.”

Source: LA Revised Statutes 37:1262 (2012).

“Telemedicine is the use of medical information exchanges from one site to another via electronic communications to improve a recipient’s health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two- way, real time interactive communication between the patient at the originating site, and the physician or practitioner at the distant site.”

Source: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.

152 (February 1, 2012).

Live Video Reimbursement

Louisiana law requires reimbursement to the originating site physician for a live video consultation if he/she is physically present during the exam and interacts with the distant-site physician. (See “Private Payers” section below)

Source: LA Revised Statutes 22:1821 (2012).

Louisiana Medicaid reimburses for “services provided via an interactive audio and video telecommunications system.”

Source: LA Register, Volume 31, 2032 (2012).

Louisiana Medicaid only reimburses the distant site provider.

Source: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.

152 (Feb. 1, 2012).

Store and Forward Reimbursement

There is no reimbursement requirement based upon the definition of “telemedicine” which describes telemedicine as an interaction “via two-way video and audio transmission” .

Source: LA Revised Statutes 37:1262 (2012).

Louisiana Medicaid will not provide reimbursement based upon the definition of “telemedicine” which describes telemedicine as including “audio and video equipment permitting two-way, real time interactive communication” therefore excluding store and forward.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.

152 (February 1, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone. No reference found for FAX.

Source: LA Revised Statutes 37:1262 (2012).

No reference found.

Online Prescribing

Only physicians certificated by a specialty board of the American Board of Medical Specialties or the American Osteopathic Association shall use telemedicine to prescribe amphetamines or narcotics.

Telemedicine, including the issuance of any prescription via electronic means, shall be held to the same prevailing and usually accepted standards of medical practice as those in traditional, face-to-face settings.

An online, electronic or written mail message, or a telephonic evaluation by questionnaire or otherwise, does not satisfy the standards of appropriate care.

Source (amphetamines and narcotics): LA Admin. Code

46:XLV.7513 (2012).

Source (prevailing standards): LA Admin. Code 46:XLV.7505 (2012).

No reference found.

Consent

Physicians must inform telemedicine patients of the relationship between the physician and patient, and the role of any other health care provider with respect to management of the patient. The patient may decline to receive telemedicine services and withdraw from such care at any time.

Source: LA Admin. Code 46:XLV.7511 (2012).

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

A telemedicine license may be issued to out-of-state physicians, as long as they hold a full and unrestricted license in another state or U.S. territory.

Out-of-state telemedicine providers cannot open an office, meet with patients or receive calls from patients

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

within Louisiana.

Source: LA Revised Statutes 37:1276.1 (2012).

Private Payers

Reimbursement must be made to the originating site physician if he/she is physically present during the exam and interact with the distant-site physician.

Originating-site physician fees shall be at least 75 percent of the normal fee for an intermediate office visit.

No reference found for distant-site physician reimbursement.

Source: LA Revised Statutes 22:1821 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

Louisiana law requires that a physician who uses telemedicine establish a proper physician-patient relationship.

Physicians must:

• Verify the identity of the patient;

• Conduct an appropriate exam;

• Establish a proper diagnosis;

• Establish a treatment plan;

• Create a written plan for follow up care.

Source: LA Admin. Code 46:XLV.7509 (2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine, as it pertains to the delivery of health care services, means the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. ‘Telemedicine’ does not include the use of audio-only telephone, facsimile machine or e-mail.”

Source: ME Revised Statutes Annotated. Title 24, Sec. 4316 (2012).

“Telehealth” is interactive, visual, real-time telecommunication, and must be a medically appropriate means of provider-patient interaction.

Source: MaineCare Benefits Manual, General Administrative

Policies and Procedures, 10-144 Ch. 101, p. 20 (Feb. 13, 2011).

Live Video Reimbursement

Maine law requires coverage for services provided through telemedicine, which includes live video.

Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).

(See Medicaid column & “Private Payers” section)

MaineCare will reimburse for live video when there is a compelling benefit for the patient in order for telehealth services to be appropriate and related to physical, social or geographic issues that make delivering the service in person difficult. This includes:

• For physical issues, a member's medical condition makes a face-to-face encounter that entails significant travel inadvisable or impossible;

• For social issues, the family or other support system does not support a member traveling a distance for a face-to-face encounter, or does not allow the member to take the time that travel will require;

• For geographic issues, there is a lack of medical/psychiatric/mental health expertise locally, limited transportation resources, or a long wait for such local care.

Source: Code of ME Rules. 10-144-101 (2012).

Providers must receive pre-authorization from the

Department for telehealth services.

Source: Code of ME Rules. 10-144-101 (2012).

Pre-authorization information must include:

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• The names, provider numbers and licensure level of individual providers who utilize telehealth to provide services;

• A list of the procedure codes to be used;

• A rationale for needing telehealth capabilities for the services being proposed;

• The specific criteria used in determining when telehealth services are more appropriate than face-to-face services;

• A plan for quality assurance activities specifically related to patient satisfaction and outcomes for telehealth services;

• Educational information that will be provided to the patient at the time of the member's visit.

Source: Code of ME Rules. 10-144-101 (2012).

Store and Forward Reimbursement

No reference found.

No reimbursement based upon definition of telehealth, which is described as occurring in “real-time”,.

Source: MaineCare Benefits Manual, General Administrative

Policies and Procedures, 10-144 Ch. 101, p. 20 (Feb. 13, 2011).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: Code of ME Rules. 10-144-101 (2012).

Online Prescribing

No reference found.

Tele-pharmacy is allowed.

Tele-pharmacy is a method of delivering prescriptions dispensed by a pharmacist to a remote site. Pharmacies using tele-pharmacy must follow all applicable State and Federal regulations, including use of staff qualified to deliver prescriptions through tele-pharmacy.

Source: MaineCare Benefits Manual, Ch. 2, Pharmacy Services,

10-144 Chapter 101, p. 5 (Oct. 1, 2012).

Providers may dispense prescriptions via tele- pharmacy; pre-authorization is required.

Source: MaineCare Benefits Manual, Ch. 2, Pharmacy Services, p.

33 (Oct. 1, 2012).

Consent

No reference found.

Providers must deliver written educational information to

STATE LAW/REGULATIONS

MEDICAID PROGRAM

patients at their visit.

This information should be written at a sixth-grade comprehension level, and include the following:

• Description of the telehealth equipment and what to expect;

• Explanation that the use of telehealth for this service is voluntary and that the same service is available in a face-to-face setting;

• Explanation that the member is able to stop the telehealth visit at any time and request a face- to-face service;

• Explanation that MaineCare will pay for transportation to a distant appointment if needed;

• HIPAA compliance information regarding the telehealth encounter.

Source: MaineCare Benefits Manual, General Administrative

Policies and Procedures, 10-144 Ch. 101, p. 22 (Feb. 13, 2011).

Location

No reference found.

No reference found.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to contract terms and conditions..

Source: ME Revised Statutes Annotated. Title 24 Sec. 4316 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reimbursement for site or transmission fees.

Source: MaineCare Benefits Manual, General Administrative

Policies and Procedures, 10-144 Ch. 101, p. 22 (Feb. 13, 2011).

Miscellaneous

MaineCare will pay for transportation to a distant appointment if needed.

Source: MaineCare Benefits Manual, General Administrative

Policies and Procedures, 10-144 Ch. 101, p. 22 (Feb. 13, 2011).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reimbursement for telephone. No reimbursement for FAX.

Source: MD Insurance Code Annotated Sec. 15-139 (2012).

Online Prescribing

No reference found.

No reference found.

Consent

Telehealth providers must inform patients and consultants of the following:

• The inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in-person service delivery;

• The knowledge, experiences, and qualifications of the consultant providing data and information to the provider of the telehealth services need not be completely known to and understood by the provider;

• The quality of transmitted data may affect the quality of services provided by the provider;

• That changes in the environment and test conditions could be impossible to make during delivery of telehealth services;

Telehealth services may not be provided by correspondence only.

Source: Code of MD Reg., 10.41.06.04 (2012).

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

MD has exceptions to its MD-only licensed physicians for physicians practicing in the adjoining states of Delaware, Virginia, West Virginia, and Pennsylvania.

Source: MD Health Occupations Code Annotated Sec. 14-302 (2012).

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: MD Insurance Code Annotated Sec. 15-139 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine as it pertains to the delivery of health care services, shall mean the use of interactive audio, video

or other electronic media for the purpose of diagnosis, consultation or treatment. ‘Telemedicine’ shall not include the use of audio-only telephone, facsimile machine or e-mail.”

Source: Annotated Laws of MA. Chapter 175, Sec. 47BB.

No reference found.

Live Video Reimbursement

Massachusetts law requires coverage of telemedicine services (subject to contract terms and conditions), which includes live video.

(See “Private Payers” section).

Source: MA Advanced Legislative Service. Chapter 224, S.B. 2400 (2012).

No reference found.

Store and Forward Reimbursement

No reference found.

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX ?

No Reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: MA Advanced Legislative Service. Chapter 224, S.B. 2400 (2012).

No reference found.

Online Prescribing

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Prior to any e-prescribing, there must be a physician- patient relationship that conforms to certain minimum norms and standards of care, which includes taking a medical history and conducting an appropriate exam.

Source: “Internet Prescribing,” MA Board of Registration in Medicine. Dec. 17, 2003. http://www.mass.gov/eohhs/docs/borim/policies- guidelines/policy-03-06.pdf

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

Requires coverage of telemedicine services, subject to contract terms and conditions, and must be consistent with coverage for health care services provided through in-person consultations.

Source: MA Advanced Legislative Service. Chapter 224, S.B. 2400 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Physician’s assistant, (billed under the supervising physician);

• Psychologist;

• Social Worker.

Source: Dept. of Community Health, Medicaid Provider Manual, p.

1415 (Oct. 1, 2012).

Store and Forward Reimbursement

No reimbursement based upon definition of “telemedicine” which describes telemedicine as occurring in “real time.

Source: MI Compiled Law Svcs. Sec. 500.3476 (2012).

Michigan Medicaid does not reimburse for store and forward based upon the definition of telemedicine which describes telemedicine as occurring in “real time”,.

Source: Dept. of Community Health, Medicaid Provider Manual, p.

397(Oct. 1, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX Restrictions

No reference found.

No reference found.

Online Prescribing

Providers must have an existing physician-patient relationship.

Source: MI Compiled Laws Sec. 333.17751 (2012).

No reference found.

Consent

No reference found.

No reference found.

Location

No reference found.

The distant site and originating site must be at least 50 miles apart, except for Federal telemedicine demonstration projects funded or approved by the Secretary of Human Services as of Dec. 31, 2000.

Source: MI Dept. of Community Health, p. 1415.

Eligible originating sites:

• County mental health clinics or publicly funded mental health facilities;

• Federally Qualified Health Centers;

• Hospitals (inpatient, outpatient, or Critical

Access Hospitals);

• Physician or other providers’ offices, including medical clinics;

• Renal dialysis facilities;

• Rural Health Clinics;

• Skilled nursing facilities;

• Tribal Health Centers.

Source: MI Dept. of Community Health, p. 1415.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

In-state providers are to be used whenever possible for distant site services.

Source: MI Dept. of Community Health, p. 1415.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

Contracts shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health maintenance organization. Telemedicine services shall be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the contract.

Source: MI Compiled Law Services Sec. 500.3476 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

No reimbursement for remote access for surgical procedures, and use of robotics.

Source: Dept. of Community Health, Medicaid Provider Manual, p.

1414 (Oct. 1, 2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

present during the consult.

The patient record must include a written opinion from the consulting physician.

Source: MN Dept. of Human Services, Provider Manual, Physician and Professional

Svcs. www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNA MIC_CONVERSION&RevisionSelectionMethod=LatestReleased&d DocName=id_008926#P469_31519>, (Accessed Oct. 30, 2012).

Telemedicine consults shall be paid at the same rate as in-person services.

Minnesota Source: MN Statute Sec. 256B.0625

Store and Forward Reimbursement

(see Medicaid column)

Minnesota’s Medical Assistance program reimburses for services delivered through store and forward

technology.

Source: MN Dept. of Human Svcs., Provider Manual, Physician and Professional

Svcs. www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNA MIC_CONVERSION&RevisionSelectionMethod=LatestReleased&d DocName=id_008926#P469_31519>, (Accessed Oct. 30, 2012).

Store and forward technology includes telemedicine consults that do not occur in real time, and that do not require a face-to-face encounter with the patient for all or any part of the consult.

Source: MN Statute Sec. 256B.0625 (2012).

Remote Patient Monitoring Reimbursement

No reference found.

There is reimbursement for “telehomecare” under Elderly Waiver (EW) and Alternative Care (AC) programs.

Source: MN Dept. of Human Svcs., Provider Manual, Elderly Waiver (EW) and Alternative Care (AC) Program, < http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNA MIC_CONVERSION&RevisionSelectionMethod=LatestReleased& dDocName=id_056766> (Accessed Jan., 12, 2013).

Reimbursement is for skilled nurse visits only. Telehomecare is defined as the use of

telecommunications technology by a home health care professional to deliver home health care services within the professional’s scope of practice to a recipient located at a site other than the site where the practitioner is located.

Source: MN Dept. of Human Svcs., Provider Manual, Home Care

Svcs.,

< http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYN AMIC_CONVERSION&RevisionSelectionMethod=LatestReleased

&dDocName=id_008994> (Accessed Oct. 30, 2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Email/Phone/FAX

No reference found.

“A communication between two physicians that consists solely of a telephone conversation is not a telemedicine consultation.”

Source: MN Statute Sec. 256B.0625 (2012).

Online Prescribing

A prescription or drug order is not valid unless it can be established that the prescription or order was based on a documented patient evaluation, including an examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment.

This includes the referring provider performing an in- person examination and a consultant issuing the prescription when providing services by telemedicine.

Source: MN Statute Sec. 151.37(2012).

No reference found.

Consent

No reference found.

No reference found.

Location

No reference found.

Consults performed by providers who are not located in Minnesota and contiguous counties require prior authorization by the Medicaid program.

Source: MN Dept. of Human Svcs., Provider Manual, Physician and Professional Svcs.,

< http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNA MIC_CONVERSION&RevisionSelectionMethod=LatestReleased&d

DocName=id_008926#P469_31519>, (Accessed Oct. 30, 2012).

Cross-State Licensing

A physician licensed in another state can provide telemedicine services to a patient in Minnesota if their license has never been revoked or restricted in any state, they agree to not open an office in Minnesota and they register with the state’s board.

Source: MN Statute Sec. 147.032(1)

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

The physician should obtain the patient's informed consent before providing care.

Source: Code of MS Rules 50-013-2635 (2012).

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

Physicians practicing telemedicine must have a

Mississippi medical license.

However, a valid Mississippi license is not required where the evaluation, treatment and/or medicine given by a physician outside of Mississippi is requested by a physician duly licensed to practice medicine in Mississippi, and the physician who has requested such evaluation, treatment and/or medical opinion has

already established a doctor/patient relationship with the patient to be evaluated and/or treated.

In order to practice telemedicine a valid "physician patient relationship" must be established. The elements of this valid relationship are:

1. verify that the person requesting the medical treatment is in fact who they claim to be;

2. conducting an appropriate examination of the patient that meets the applicable standard of care;

3. establishing a diagnosis through the use of accepted medical practices, i.e., a patient

history, mental status exam, physical exam and

appropriate diagnostic and laboratory testing;

4. discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent;

5. insuring the availability of appropriate follow-up care; and

6. maintaining a complete medical record available to patient and other treating health care providers.

Source: Code of MS Rules 50-013-2635 (2012).

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

To practice telemedicine, physicians must establish a valid physician-patient relationship by the following:

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Verifying the identity of the patient;

• Conducting an appropriate exam that meets the applicable standard of care. This exam need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face;

• Establishing a diagnosis;

• Discussing with the patient the diagnosis, and the risks and benefits of various treatment options, to obtain informed consent;

• Insuring the availability of appropriate follow-up care;

• Maintaining a complete medical record.

Source: Code of MS Rules 50-013-2635 (2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source (reimbursement): MO Revised Statutes § 208.670 (2012).

Source (eligible providers): MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 66 (Oct 24, 2012).

Source (distant site reimbursement): MO Code of State

Regulation, Title 13, 70-3.190 (2010).

Store and Forward Reimbursement

No reference found.

HealthNet will not reimburse for store and forward.

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 65 (Oct 24, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found.

No reference found.

Online Prescribing

Prescribing or dispensing drugs without sufficient examination is prohibited.

Source: MO Revised Statutes § 334.100 (2012).

No reference found.

Consent

No reference found.

Providers must obtain written patient consent before delivery of telehealth services.

Source: MO Code of State Regulation, Title 13, 70-3.190 (2010).

Location

No reference found.

Originating sites must be one of the following:

• Physician or other health care provider office;

• Hospital;

• Critical Access Hospital;

• Rural Health Clinic;

• Federally Qualified Health Center;

• Nursing home;

• Dialysis center;

• Missouri state habilitation center or regional office;

• Community mental health center;

• Missouri state mental health facility;

• Missouri state facility;

• Missouri residential treatment facility;

• Comprehensive Substance Treatment and

Rehabilitation (CSTAR) program.

Source: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 66 (Oct 24, 2012).

Cross-State Licensing

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

Originating sites are eligible to receive a facility fee;

distant sites are not eligible.

Source: MO Code of State Regulations, Title 13, 70 3.190 (May 31,

2011).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found in statute.

No reference found.

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

Montana issues telemedicine licenses to out-of-state physicians that only allows the physician to practice telemedicine in the specialty the physician is board certified or meets the current requriements to take the examination to become board certified.

This license does not authorize the physician to practice medicine while physically present within the state.

Source: MT Code Annotated, 37-3-343.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reimbursement for network use charges.

Source: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., p 27 (Mar 2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• 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.

Reimbursement shall, at a minimum, be set at the same rate as a comparable in-person consult.

Source (authorization and reimbursement): NE Revised Statutes

Sec. 71-8506 (2012).

Source (exceptions to 30-mile rule): NE Admin. Code Title 471, Ch. 1.

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.

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.

Source: NE Admin. Code Title 471, Ch. 1.

Online Prescribing

Prescribing drugs to individuals the physician has never met, based solely on answers to questions provided by the internet, telephone, or FAX, or without first establishing a proper physician-patient relationship, is prohibited.

Source: NE Admin. Code Title 172, Ch. 88.

(also see Medicaid column)

Prescriptions over the Internet: Neither the prescribing health care practitioner service nor the pharmacy service is covered when the health care practitioner prescribing the medication has only reviewed an e-mail message or e-mail questionnaire about the client.

Source: NE Admin. Code Title 471, Ch. 1.

Consent

Written patient consent required prior to any service delivery.

Source: NE Revised Statutes Sec. 71-8505 (2012).

(also see Medicaid column)

Written consent required before initial service delivery. Must include this information:

• The patient may refuse the service at any time with no loss of future treatment or program benefits patient is otherwise entitled to;;

• A list of alternative care options, including in- person services;;

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• 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.

Location

No reference found.

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).

Telehealth services are not covered if the patient has access to a comparable service within 30 miles of his/her place of residence.

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.

Source (exceptions to 30-mile rule): NE Admin. Code Title 471, Ch. 1.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

(see Medicaid column)

Transmission costs may be covered, but not as a separate service.

The costs are included in the payment for inpatient

STATE LAW/REGULATIONS

MEDICAID PROGRAM

hospital services, or per diem or monthly payments for:

• Inpatient hospital services, including general hospital as well as psychiatric and rehabilitation hospital services;

• Nursing facility services;

• Intermediate care facility-mentally retarded services;

• Assisted living facility services;

• Residential treatment center services;

• Treatment group home services;

• Day treatment facility services;

• Treatment foster care services;

• Mental health/substance abuse crisis facility services;

• Psychiatric rehabilitative services.

Source: NE Admin. Code Title 471, Ch. 1.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Telemedicine means the practice of osteopathic medicine through the synchronous or asynchronous transfer of medical data or information using interactive audio, video or data communication, other than through a standard telephone, facsimile transmission or electronic mail message.”

Source: NV Revised Statutes Annotated Sec. 633.165 (2012).

“Telehealth is the use of a telecommunications system to substitute for an in-person encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services.”

Source: NV Dept. of Health and Human Svcs., Medicaid Services

Manual, Section 3400, p. 1 (Sept 12, 2012).

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 (Sept 12, 2012).

Eligible providers:

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Physician;

• Nurse practitioner;

• Physician assistant;

• Nurse midwife;

• Clinical psychologist;

• Clinical social worker.

Source: NV Dept. of Health and Human Svcs., Medicaid Services

Manual, Section 3403.3, p. 5 (Sept 12, 2012).

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. 6 (Sept 12, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: NV Revised Statutes Annotated Sec. 633.165 (2012).

No reference found for email.

No reimbursement for telephone, except psychiatric treatment in crisis intervention.

No reference found for FAX.

Source: NV Dept. of Health and Human Svcs., Medicaid Services

Manual, Section 600, p. 4 (Jul. 10, 2010).

Online Prescribing

No reference found.

No reference found.

Consent

For osteopaths, oral and written consent. Must include 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.

The originating site must be located in a rural Health Professional Shortage Area (HPSA), or a county that is not included in a Metropolitan Statistical Area (MSA).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: NV Dept. of Health and Human Svcs., Medicaid Services

Manual, Section 3403.1, p. 4 (Sept 12.2012).

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 (Sept 12.2012).

Cross-State Licensing

Nevada issues special-purpose licenses to out-of-state 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).

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

Before an osteopathic physician may use telemedicine:

• A bona fide relationship between the osteopathic physician and the patient must exist which must include, without limitation, a history and physical examination or consultation which occurred in person and which was sufficient to establish a diagnosis and identify any underlying medical conditions of the patient.

Telehealth services do not require prior authorization. However, individual services may require prior authorization, whether delivered in person or by telehealth.

Nevada Dept. of Health and Human Svcs., Medicaid Services

Manual, Section 3403.8, p. 9 (Sept. 12, 2012).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• 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).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• A patient of another provider for whom the prescriber is taking call;

• A prescription for a patient who has been examined by a physician assistant, nurse practitioner, or other licensed practitioner;

• Medication on a short-term basis for a new patient prior to the patient's first appointment;

• When providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics.

Source: NH Revised Statutes Annotated, Sec. 329:1-c.

Consent

No reference found.

No reference found.

Location

No reference found in statute.

No reference found.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

Insurers may not deny coverage for services provided through telemedicine, if the services are covered through in-person consults.

Source: NH Revised Statutes Annotated, 415-J:3 (2012).

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the practice of medicine across state lines.”

Source: NM Administrative Code, 16.10.2.7 (2012).

“The practice of medicine across state lines means the rendering of a written or otherwise documented medical opinion concerning diagnosis or treatment of a patient within this state, by a physician located outside this state, as a result of transmission of individual patient

data by electronic, telephonic or other means from within this state, to the physician or the physician’s agent, OR the rendering of treatment to a patient within this state,

by a physician located outside this state, as a result of transmission of individual patient data by electronic, telephonic or other means from within this state to the physician or the physician’s agent.”

Source: NM Statutes Annotated, 1978 Sec. 61-6-6 (2012).

"Telehealth means the use of electronic information, imaging and communication technologies, including interactive audio, video and data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education.”

Source: NM Statutes Annotated Sec. 24-1G-3 (2012).

No reference found.

Live Video Reimbursement

New Mexico statute encourages the use and reimbursement of telehealth, which includes live video.

Source: NM Statutes Annotated, Sec. 24-25-5 (2012).

(also see Medicaid column)

New Mexico Medicaid will reimburse for live video for the following covered services:

• Consultations;

• Evaluation and management services;

• Individual psychotherapy;

• Pharmacologic management;

• Psychiatric diagnostic interview examinations;

• End-stage renal disease related services;

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Individual medical nutrition services.

Source: See 8.310.2 NMAC, Medical Services Providers, 8.310.8

NMAC, Mental Health Professional Services, MAD-758 [8.324.9

NMAC], Nutrition Services and 8.325.2 NMAC, Dialysis Services.

Approved providers:

• Physicians and osteopaths;

• Podiatrists;

• Community mental health centers;

• Core service agencies;

• Hospitals;

• Rural Health Clinics;

• School-based health centers;

• Federally Qualified Health Centers;

• Nurse practitioners and registered nurses (in collaboration with physician or as an independent provider within their scope of practice);

• Physician assistants;

• Nurse midwives;

• Pharmacist clinicians;

• Clinical nurse specialists (in collaboration with physician or as an independent provider within their scope fo practice);

• Psychologists (Ph.D., Psy.D. or Ed.D.);

• Licensed independent social workers;

• Licensed professional clinical counselors

• Licensed family and marriage therapists

• Registered dietitians or nutrition professionals;

• Indian Health Service and tribal facilities;

• Physical therapists;

• Occupational therapists;

• Speech pathologists.

Source: NM Human Svcs. Dept., Medical Assistance Division, Program Policy Manual, Section 8.310.13.10 (Aug. 1, 2007).

Reimbursement for services at the originating site and the distant site are equivalent to in-person services.

Source: NM Admin Code 8.310.13.9 (2012).

Store and Forward Reimbursement

New Mexico Statute defines telehealth as encompassing

Store and Forward.

Source: NM Statutes Annotated Sec. 24-1G-3 (2012).

New Mexico Medicaid states that a telehealth communication system must occur in ‘real-time’.

Source: NM Human Svcs. Dept., Medical Assistance Division, Program Policy Manual, Section 8.310.13.12(A) (Aug. 1, 2007).

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX Restrictions

No reference found.

No reference found.

Online Prescribing

Physicians are prohibited from prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship.

This includes prescribing over the Internet, or via other electronic means, based solely on an online questionnaire.

Physicians may prescribe online during a live video exam. The prescribing physician must:

• Obtain a medical history;

• Obtain informed consent;

• Generate a medical record;

• A physical exam is recorded as appropriate by the telehealth practitioner or a practitioner such as a physician, advance practice nurse, or physician or anesthesiologist assistant; or the exam is waived when a physical exam would not normally be part of a typical physical face- to-face encounter with the patient for the services being provided.

Source: NM Statutes Annotated, 1978 Sec. 61-6-20(B).

No reference found.

Consent

No reference found.

No reference found.

Location

No reference found.

An interactive telehealth communication system must include both interactive audio and video, and be delivered on a real-time basis at both the originating and distant sites.

Source: See 8.310.2 NMAC, Medical Services Providers, 8.310.8

NMAC, Mental Health Professional Services, MAD-758 [8.324.9

NMAC], Nutrition Services and 8.325.2 NMAC, Dialysis Services.

Eligible originating sites:

• Practitioner office or clinic;

• Hospital;

• Critical Access Hospital;

• Rural Health Clinic;

• Federally Qualified Health Center;

• Community mental health center or core service

STATE LAW/REGULATIONS

MEDICAID PROGRAM

agency;

• School-based health center;

• Indian Health Services and tribal facilities;

• Ambulatory surgical or treatment center;

• Skilled nursing facility;

• Residential treatment center;

• Home health agency;

• Diagnostic laboratory or imaging center;

• Rehabilitation or other therapeutic health setting;

• Eligible recipient's residence.

Source: NM Admin Code, 8.310.13.12 (2012).

Cross-State Licensing

NM issues telemedicine licenses to providers who hold a full, unrestricted license in another state.

Source: NM Statutes Annotated, 1978 Sec. 61-6-11.1.

When the originating site is in New Mexico and the distant site is outside New Mexico, the distant-site provider at the distant site must be licensed in New Mexico for telehealth, or meet federal requirements for Indian Health Service or tribal contract facilities.

Source: NM Human Svcs. Dept., Medical Assistance Division, Program Policy Manual, Section 8.310.13.10 (Aug. 1, 2007).

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

A telehealth originating-site fee is covered if:

• The eligible recipient was present at and participated in the telehealth visit at the an originating-site located in a health professional shortage area (HPSA);

• A county not classified as a metropolitan statistical area (MSA);

• A primary medical care health professional shortage area for physicians, nurse practitioners, and physician assistants;

• Primary behavioral health care professional shortage area for psychiatrists and clinical psychologists;

• A medical specialist shortage area for non- primary care medical specialties;

• An IHS or tribal facility, a Federally Qualified Health Center or Rural Health Clinic, or a federal or state telemedicine demonstration project area.

Source: NM Human Svcs. Dept., Medical Assistance Division, Program Policy Manual, Section 8.310.13.12(C) (Aug. 1, 2007).

Reimbursement is made to the originating site for an interactive telehealth system fee at the lesser of the following:

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Provider's billed charge;

• Maximum allowed by MAD for the specific service or procedure.

Source: NM Admin Code 8.310.13.15 (2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Store and Forward Reimbursement

New York’s definition of “telemedicine” which describes telemedicine as “real time two-way electronic audio- visual communications”, excludes store and forward.

Source: NY Consolidated Law Service Public Health Sec. 2805-u.

Store and forward is not reimbursed.

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 Nov. 1, 2012.

Remote Patient Monitoring Reimbursement

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.

Please see “Comments” section.

Email/Phone/FAX

No reference found.

No reference found.

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

No reference found.

No reference found.

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

STATE LAW/REGULATIONS

MEDICAID PROGRAM

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 Nov. 1, 2012.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine is the use of two-way real-time interactive audio and video between places of lesser and greater medical capability or expertise to provide and support health care, when distance separates participants who are in different geographical locations.”

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 2, July 1, 2012.

Live Video Reimbursement

No reference found.

North Carolina Medicaid will reimburse for live video medical services and tele-psychiatry services.

Eligible medical providers:

• Physicians;

• Nurse practitioners;

• Nurse midwives;

• Physician’s assistants.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 7, July 1, 2012.

Eligible tele-psychiatry providers:

• Physicians;

• Advanced practice psychiatric nurse practitioners;

• Advanced practice psychiatric clinical nurse specialists;

• Licensed psychologists Ph.D level;

• Licensed clinical social workers (LCSW);

• Community diagnostic assessment agencies.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 7, July 1, 2012.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

All services must be:

• Medically necessary;

• The procedure, product, or service is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs;

• The procedure, product, or service can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide;

• The procedure, product, or service is furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 4, July 1, 2012.

Providers must obtain prior approval from NC Medicaid for all services delivered via telemedicine and tele- psychiatry. Providers must submit:

• Prior approval request;

• All health records and any other records to document that the patient has met the specific criteria for telemedicine services;

• If the patient is under age 21, information supporting that all Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) criteria are met, and evidence-based literature supporting the request, if available.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 4-5, July 1, 2012.

Store and Forward Reimbursement

No reference found.

North Carolina Medicaid will not reimburse for Store and

Forward.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 4, July 1, 2012.

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX Restrictions

No reference found.

No reimbursement for email.

No reimbursement for telephone. No reimbursement FAX.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 4, July 1, 2012.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Online Prescribing

No reference found.

No reference found.

Consent

No reference found.

No reference found.

Location

No reference found.

No reimbursement if:

• The recipient is located in a jail, detention center, or prison;

• The consulting provider is not a Medicaid-enrolled provider;

• The consulting provider is not located in North

Carolina or within the 40 miles radius.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 5, July 1, 2012.

Cross-State Licensing

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

Originating-site provider facility fees paid to:

• Physicians;

• Nurse practitioners;

• Nurse midwives;

• Advanced practice psychiatric nurse practitioners;

• Advanced practice psychiatric clinical nurse specialists;

• Licensed psychologists (Ph.D. level);

• Licensed clinical social workers (LCSW);

• Physician’s assistants;

• Hospitals (inpatient or outpatient)

• Federally Qualified Health Centers;

• Rural Health Clinics;

• Local health departments;

• Local Management Entities.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 7, July 1, 2012.

No facility fees for distant-site providers.

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 4, July 1, 2012.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Store and Forward Reimbursement

No reference found.

North Dakota Medicaid does not reimburse for store and forward.

Source: ND Dept. of Human Svcs., General Information For

Providers, Medicaid and Other Medical Assistance Programs, p.

129 (April 2012).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found.

No reference found for email.

No reimbursement for telephone. No reference found for FAX.

Source: ND Dept. of Human Svcs., General Information For

Providers, Medicaid and Other Medical Assistance Programs, p.

126 (April 2012).

Online Prescribing

A valid prescription via e-prescribing means a prescription has been issued for a legitimate medical purpose, in the usual course of professional practice, by a practitioner who has first conducted an in-person medical evaluation of the patient.

Source: ND Centennial Code, Sec. 19-02.1-15.1.

No reference found.

Consent

No reference found.

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

The ND Medical Board may engage in reciprocal licensing agreements with out-of-state licensing agencies, but is not required to do so.

Source: ND Century Code Sec. 43-17-21 (2012).

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

Under the Worker’s Compensation Act, the originating sites may receive a facility fee, not to exceed $20.

Source: ND Admin. Code 92-01-02-34.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“The practice of telemedicine means the practice of medicine in this state through the use of any communication, including oral, written, or electronic communication, by a physician located outside this state.”

Source: OH Revised Code Annotated, 4731.296.

No reference found.

Live Video Reimbursement

No reference found.

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

No reference found.

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found.

No reference found.

Online Prescribing

A physician shall not prescribe, dispense, or provide any 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

No reference found.

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

No reference found.

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

Ohio issues telemedicine certificates that allow the 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).

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Physicians;

• Advanced registered nurse practitioners;

• Physician assistants;

• Genetic counselors;

• Licensed behavioral health professionals;

• Dieticians;

• An Indian Health Service facility, a Tribal health facility or an Urban Indian (I/T/U) clinic with specialty service providers as listed here.

Coverage of all telemedicine services is at the discretion of the Oklahoma Health Care Authority.

Source: OK Admin. Code Sec. 317:30-3-27.

Office and outpatient visits count toward benefit limits.

Source: OK Statute, Title 36 Sec. 6803.

Store and Forward Reimbursement

(see Medicaid column)

SoonerCare will reimburse for “conventional health care delivery”, the service does not require face-to-face contact between the patient and the provider.

Examples include:

• Tele-radiology;

• Tele-pathology;

• Fetal monitor strips;

• Physician interpretation of electrocardiogram and electroencephalogram readings.

SoonerCare does not consider these services telemedicine as defined by OHCA.

Source: OK Admin. Code Sec. 317:30-3-27(e).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reference found for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: OK Statute, Title 36 St. Sec. 6802.

(also see Medicaid column)

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: OK Admin. Code Sec. 317:30-3-27(d).

Online Prescribing

Prescribing or administering a drug or treatment without

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

sufficient examination and the establishment of a valid physician-patient relationship is prohibited.

Source: OK Statute, Title 59, Sec. 509.

A physician-patient relationship includes an in-person patient exam.

Source: OK Admin. Code Sec. 435:10-1-4.

Consent

Written patient consent is required prior to the delivery of any telemedicine services. The provider who is in physical contact with the patient shall obtain this

consent.

Source: OK Statute, Title 36 Sec. 6804.

(also see Medicaid column)

Written consent required.

Source: OK Admin. Code Sec. 317:30-3-27(f)(6).

Location

No reference found.

Coverage is limited to rural or geographic areas where there is a lack of local medical/psychiatric/mental health expertise.

Source: OK Admin. Code Sec. 317:30-3-27(c)(2).

Rural areas are defined as counties with fewer than

50,000 people.

Source: OK Admin. Code Sec. 317:30-3-27(b)(5).

Eligible originating sites:

• Practitioner offices;

• Hospitals;

• Schools;

• Outpatient behavioral health clinics;

• Critical Access Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers;

• Indian Health Service, tribal health,or Urban

Indian facility (I/T/U).

Source: OK Admin. Code Sec. 317:30-3-27(c)(5).

Cross-State Licensing

No reference found.

No reference found.

Private Payers

Requires coverage of telemedicine services by health care service plans, disability insurer programs, workers’ compensation programs, and state Medicaid managed care program contracts, subject to contract terms and conditions.

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: OK Statute, Title 36 Sec. 6803.

Site/Transmission Fee

(see Medicaid column)

Facility fee paid to originating site.

Source: OK Admin. Code Sec. 317:30-3-27.

No originating site fee for store and forward.

Source: OK Admin. Code Sec. 317:30-3-27(e).

Miscellaneous

OK provides, at no cost, one telecommunications line or wireless connection for telemedicine services to the following:

• Not-for-profit hospitals;

• County health departments;

• City-county health departments;

• Federally Qualified Health Centers.

Source: OK Statutes, Title 17 Sec. 139.109.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

practices in a location outside of Oregon. The monitoring physician is in communication with the operation team 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- telemonitoring status.

Source: OR Admin. Rules. 847-008-0023.

Email/Phone/FAX

Yes for email.

Yes for telephone.

No reference found for FAX.

Email and telephone consults must comply with Health

Service Commission guidelines.

Source: OR Admin. Rules 410-130-0610.

Yes for email and telephone when used for patient consulting and “when billed services comply with the practice guidelines set forth by the Health Service Commission (HSC), applicable HSC approved CPT code requirements and delivered consistent with the HSC practice guideline.”

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. 76 (Jan. 1,

2012).

Online Prescribing

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.

No reference found.

Consent

No reference found.

No reference found.

Location

Originating sites include but are not limited to:

• Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers;

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Physician offices;

• 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

Out-of-state physicians may receive a license to practice across state lines in Oregon, as long as they are fully licensed in another state and meet certain requirements.

Source: OR Revised Statutes Annotated Sec. 677.139.

(also see Medicaid column)

The referring and evaluating practitioner must be licensed to practice medicine within the state of Oregon or within the contiguous area of Oregon and must be enrolled as a Division of Medical Assistance Programs (Division) provider.

Source: OR Administrative Regulation 410-130-0610(2)(a).

Private Payers

Oregon requires coverage of telemedicine services, 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.

No reference found.

Site/Transmission Fee

(see Medicaid column)

Oregon Medicaid will provide transmission fees for originating sites.

Source: OR Admin. Regulation 410-130-0610(5).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

near the Pennsylvania boundary, and whose practice extends into Pennsylvania to practice in Pennsylvania.

Pennsylvania bases its granting of this license on the availability of medical care in the area involved, and whether the adjoining state extends similar privileges to Pennsylvania physicians.

Source: PA Statutes Annotated, Title 63 Sec. 422.34(a) and (c)(2).

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

South Carolina law addresses telemedicine under veterinary services, stating, “telemedicine is an audio, video, or data communication of medical information.”

Source: SC Code Annotated Sec. 40-69-20.

“Telemedicine is the use of medical information about a patient that is exchanged from one site to another via electronic communications to provide medical care to a patient in circumstances in which face-to-face contact is not necessary.

In this instance, a physician or other qualified medical professional has determined that medical care can be provided via electronic communication with no loss in the quality or efficacy of the care.

Electronic communication means the use of interactive telecommunication equipment that typically includes audio and video equipment permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the referring site. Telemedicine includes consultation, diagnostic, and treatment services.”

Source: SC Health and Human Svcs. Dept., Physicians Provider

Manual, p. 130 (Nov. 1, 2012).

Live Video Reimbursement

No reference found.

South Carolina Medicaid will reimburse for live telemedicine and tele-psychiatry.

Eligible services:

• Office or other outpatient visits;

• Inpatient consultation;

• Individual psychotherapy;

• Pharmacologic management;

• Psychiatric diagnostic interview examination;

• Neurobehavioral status examination;

• Electrocardiogram interpretation and report only;

• Echocardiography.

Eligible services must meet these requirements:

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• The medical care is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under

treatment, and not in excess of the beneficiary’s need;

• The medical care can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide.

Source: SC Health and Human Svcs. Dept. Physicians Provider

Manual, p. 132 (Nov. 1, 2012).

These community mental health services are ineligible:

• Injectables;

• Crisis intervention (if there is no other MH staff with the client);

• Group therapy and psychological testing which require “hands-on” encounters.

Source: SC Health and Human Svcs. Dept. Community Mental

Health Services Provider Manual, p. 95 (Apr. 1, 2012).

Distant site eligible, reimbursed providers:

• Physicians;

• Nurse practitioners.

Source: SC Health and Human Svcs. Dept. Physicians Provider

Manual, p. 131 (Nov. 1, 2012).

Store and Forward Reimbursement

No reference found.

South Carolina Medicaid will not reimburse for store and forward.

Source: SC Health and Human Svcs. Dept. Physicians Provider

Manual, p. 130 (Nov. 1, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Please see “Comments” section below.

Email/Phone/FAX

No reference found.

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

Source: SC Health and Human Svcs. Dept. Physicians Provider

Manual, p. 130 (Nov. 1, 2012).

Online Prescribing

Prior to prescribing drugs to a patient, physicians first must establish a proper physician-patient relationship. Requirements are:

• Personally performing and documenting an

No reference found.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

appropriate history and physical examination, making a diagnosis, and formulating a therapeutic plan;

• Discussing with the patient the diagnosis and the evidence for it, and the risks and benefits of various treatment options;

• Ensuring the availability of the physician or other coverage for the patient for appropriate follow-

up care.

Exceptions for prescribing for a patient whom the physician has not personally examined include, but are not limited to:

• Admission orders for a newly hospitalized patient;

• Prescribing for a patient of another physician for whom the prescriber is taking call;

• Prescribing for a patient examined by a licensed advanced practice registered nurse, a physician assistant or other authorized provider;

• Continuing medication on a short-term basis for a new patient prior to the patient's first appointment.

Prescribing drugs to individuals the physician has never met based solely on answers to a set of questions, as is common in Internet or toll-free telephone prescribing, is prohibited.

Source: SC Admin. Regulations Annotated Sec. 81-28.

Consent

No reference found.

No reference found.

Location

No reference found.

Eligible originating (referring) sites:

• Practitioner offices;

• Hospitals (inpatient and outpatient);

• Rural Health Clinics;

• Federally Qualified Health Centers;

• Community mental health centers.

Source: SC Health and Human Svcs. Dept., Physicians Provider

Manual, p. 130-31 (Nov. 1, 2012).

Distant (consultant) sites must be located in the SC Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

Source: SC Health and Human Svcs. Dept., Physicians Provider

Manual, p. 130 (Nov. 1, 2012).

Cross-State Licensing

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reference found.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

The referring site is eligible to receive a facility fee.

Source: SC Health and Human Svcs. Dept., Physicians Provider

Manual, p. 134 (Nov. 1, 2012).

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

forward.

Source: SD Medical Assistance Program, Professional Svcs. Manual, p. 21 (Sept. 20, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Please see “Comments” section below.

Email/Phone/FAX

No reference found.

No reference found.

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

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Perform an appropriate history and physical examination;

• Make a diagnosis, consistent with good medical care;

• Formulate a therapeutic plan and discuss it with the patient;

• Ensure the availability for appropriate follow-up care.

Source: TN Composite Rules & Regulations 0880-02-.14.

Consent

No reference found.

The patient must be informed and given an opportunity to request an in-person assessment before receiving a telehealth assessment.

This consent must be documented in the patient’s record.

Source: TN Dept. of Mental Health and Substance Abuse Svcs., p.

8, (July 2012).

Location

No reference found.

No reference found.

Cross-State Licensing

Tennessee may issue telemedicine licenses to board- certified physicians from out of state.

Source: TN Code Annotated Sec. 63-6-209(b).

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telemedicine is “the use of health care information exchanged from one site to another via electronic communications for the health and education of the individual or provider, and for the purpose of improving patient care, treatment, and services.”

Source: TX Admin. Code, Title 25 Sec. 412.303.

Speech-Language Pathology and Audiology Telehealth is “the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of speech- language pathology or audiology services to an

individual from a provider through hardwire or internet connection.”

Source: TX Admin. Code, Title 22 Sec. 741.1.

“Telemedicine is defined as the practice of health-care delivery by a provider who is located at a site other than the site where the client is located. Telemedicine requires the use of advanced telecommunications technology and is used for the purposes of evaluation, diagnosis, consultation, or treatment.”

Source: TX Medicaid Provider Procedures Manual, p. 1475 (Jan.

2013).

"Telehealth service" means a health service, other than a telemedicine medical service, that is delivered by a licensed or certified health professional acting within the scope of the health professional's license or certification who does not perform a telemedicine medical service and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

• Compressed digital interactive video, audio, or data transmission;

• Clinical data transmission using computer imaging by way of still-image capture and store and forward; and

• Other technology that facilitates access to health care services or medical specialty expertise.

Source: TX Government Code, Sec. 531.001.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

"Telemedicine medical service" means a health care service that is initiated by a physician or provided by a health professional acting under physician delegation and supervision, that is provided for purposes of patient assessment by a health professional, diagnosis or consultation by a physician, or treatment, or for the transfer of medical data, and that requires the use of advanced telecommunications technology, other than telephone or facsimile technology, including:

• Compressed digital interactive video, audio, or data transmission;

• Clinical data transmission using computer imaging by way of still-image capture and store and forward; and

• Other technology that facilitates access to health care services or medical specialty expertise.

Source: TX Government Code, Sec. 531.001.

Live Video Reimbursement

(see Medicaid column)

Texas Medicaid reimbuses for live video for the following services:

• Consultations;

• Office or other outpatient visits;

• Psychiatric diagnostic interviews;

• Pharmacologic management;

• Psychotherapy.

Source: TX Admin. Code, Title 1, Sec. 354.1432 & TX Govt. Code

Sec. 531.0216.

Eligible originating (patient) site providers:

• Physicians;

• Physician assistants;

• Nurse practitioners;

• Clinical nurse specialists;

• Outpatient hospitals.

Source: TX Medicaid Provider Procedures Manual, p. 1476 (Jan.

2013).

There is distant-site physician reimbursement for assessment and evaluation office visit if:

• A health professional under the physician’s supervision is present with the patient for the visit;

• The medical condition, illness, or injury for which the patient is receiving the service is not likely, within a reasonable degree of medical certainty, to undergo material deterioration within the 30- day period following the visit.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: TX Govt. Code Sec. 531.0217.

Provider reimbursement must be the same as in-person services.

Source: TX Admin. Code, Title 1 Sec. 355.7001.

Telemedicine services are not required if an in-person consultation with a physician is reasonably available where the patient resides or works.

Telemedicine providers must make a good-faith effort to identify and coordinate with existing providers, to preserve and protect existing health care systems and medical relationships in an area.

With patient consent, the primary care provider must be notified of the telemedicine medical service for the purpose of sharing medical information.

Source: TX Govt. Code Sec. 531.0217.

A telepresenter who meets one of the qualifications listed below must be at the patient site when the service is provided via telemedicine:

• An individual who is licensed or certified in Texas to perform health-care services and acting within the scope of the individual’s licensure or certification

• A qualified mental health professional (QMHP)

Source: TX Medicaid Provider Procedures Manual, p. 1476 (Jan.

2013).

Store and Forward Reimbursement

(see Medicaid column)

Texas Administrative Code states that services provided via telemedicine must be provided through direct “face- to-face” interactive video communications”.

Source: TX Admin. Code, Title 1 Sec. 354.1432.

No reference found in current Medical Manual (Jan.

2013). However, the TX Government Code includes a definition of “Telemedicine Medical Service” and “Telehealth Services” which encompasses Store and Forward, stating that it includes “clinical data transmission using computer imaging by way of still- image capture and store and forward”.

Source: TX Government Code, Sec. 531.001.

Remote Patient Monitoring Reimbursement

No reference found.

No reference found in current Medical Manual (Jan.

2013). However, TX Government Code includes a definition of Home telemonitoring service, stating that it is “a health service that requires scheduled remote monitoring of data related to patient’s health and

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MEDICAID PROGRAM

transmission of the data to a licensed home health agency or a hospital”.

Source: TX Government Code, Sec. 531.001.

Email/Phone/FAX

For speech-language pathology and audiology, no reimbursement for correspondence only, e.g., mail, email, or FAX, although they may be adjuncts to tele- practice.

Source: TX Admin. Code, Title 22, Sec. 741.214.

No reimbursement for email.

No reimbursement for telephone. No reimbursement for FAX.

No reimbursement for chart review.

Source: TX Medicaid Provider Procedures Manual, p. 1475 (Jan.

2013).

Online Prescribing

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

Online or telephone evaluations solely by questionnaire are prohibited.

Source: TX Admin. Code, Title 22, Sec. 174.8.

No reference found.

Consent

Consent required prior to telemedicine or telehealth services.

Either originating or distant site health professionals shall obtain this consent.

Source: TX Occupational Code Sec. 111.002.

No reference found.

Location

(see Medicaid column

Originating (patient) sites must be located in rural or underserved areas.

A rural area is defined as a county that is not included in a metropolitan statistical area as defined by the U.S. Office of Management and Budget, according to the most recent U.S. Census Bureau population estimates.

An underserved area is an area that meets the U.S. Department of Health and Human Service Index Primary Care Underservice criteria.

Source: TX Medicaid Provider Procedures Manual, p. 1476 (Jan.

2013).

Eligible originating (patient) sites:

• State hospitals;

• State supported living centers.

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Also eligible as an originating site if located in a rural or underserved area OR if not in a rural or underserved area, but the patient is under 21, receiving services from a distant-site provider who is Board eligible in a nationally recognized specialty or subspecialty, and who is not a primary care provider:

• Physician offices;

• Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers;

• Intermediate care facilities for persons with mental retardation (ICF/MR) that are not a state supported living center;

• Community centers;

• Outreach sites associated with a community centesr;

• Local health departments;

• Public health districts.

Source TX Admin. Code, Title 1, Sec. 354.1430.

Cross-State Licensing

A telemedicine license may be issued for out of state providers.

Source: TX Admin. Code, Title 22, Sec. 172.12 & TX Occupation

Code Section 151.056.

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: TX Insurance Code Sec. 1455.004.

No reference found.

Site/Transmission Fee

(see Medicaid column)

Telemedicine patient site locations are reimbursed a facility fee.

Source: TX Admin. Code, Title 1 Sec. 355.7001.

Miscellaneous

Children’s Health Insurance Program

Allows reimbursement for live video telemedicine and telehealth services to children with special health care needs.

Source: TX Govt. Code Sec. 531.02162.

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MEDICAID PROGRAM

Remote Patient Monitoring Reimbursement

(see Medicaid column)

There is reimbursement in the UT Medicaid Telehealth

Skilled Nurse Pilot Project for Patients in Rural Areas. Patient eligibility requirements:

• Reside in underserved rural areas;

• Would have to travel more than 50 paved road miles to obtain these services in person;

• Be eligible for Medicaid coverage;

• Require medical monitoring for diabetes;

• Be willing and able to use required technology. Home health agency service delivery requirements:

• The service is delivered through secure, HIPAA- compliant transmission lines, and takes place between the home health agency and the patient’s home;

• Patient and provider are able to see and hear each other in real time;

• An assessment at the patient’s home by a home health agency registered nurse finds that the patient is unable to leave the home; is suitable for participation in the program; and requires at least two skilled nursing home visits a week;

• Formulates a nursing care plan.

Source: UT Admin. Code R414-42-2.

Patients must need more than two home health agency visits per week. Telehealth home health services are limited to diabetic monitoring and education.

The agency must provide at least two in-person visits per week by a home health nurse, and may use telehealth home health services only as a supplement to the in-person visits.

Source: UT Admin. Code R414-42-3.

Email/Phone/FAX

No reference found.

No reference found.

Online Prescribing

Providers must first obtain information in the usual course of professional practice that is sufficient to establish a diagnosis, to identify conditions, and to identify potential risks to the proposed treatment.

Internet-based questionnaires or interactions on toll-free telephone numbers, when there exists no other bona

fide patient-practitioner relationship or bona fide referral by a practitioner involved in an existing patient- practitioner relationship, are prohibited.

No reference found.

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Source: UT Code Annotated Sec. 58-1-501.

Consent

No reference found.

No reference found.

Location

No reference found.

No reference found.

Cross-State Licensing

An out-of-state physician may practice without a Utah license if:

• The physician is licensed in another state, with no licensing action pending and at least 10 years of professional experience;

• The services are rendered as a public service and for a noncommercial purpose;

• No fee or other consideration of value is charged, expected or contemplated, beyond an amount necessary to cover the proportionate cost of malpractice insurance;

• The physician does not otherwise engage in unlawful or unprofessional conduct.

Source: UT Code Annotated Sec. 58-67-305.

No reference found.

Private Payers

No reference found.

No reference found.

Site/Transmission Fee

No reference found.

No reference found.

Miscellaneous

If a hospital participates in telemedicine, it shall develop and implement policies governing the practice of telemedicine in accordance with the scope and practice of the hospital.

These policies shall address security, access and retention of telemetric data, and define the privileging of all health professionals who participate in telemedicine.

Source: UT Code R432-100-32.

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Definition of telemedicine/telehealth

"Telemedicine means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that meets Health Insurance Portability and Accountability Act (HIPAA) requirements. Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.”

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).

Telemedicine is defined in Act 107 as “…the delivery of health care services…through the use of live interactive audio and video over a secure connection that complies with the requirements the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.”

Source: Dept. of VT Health Access, Provider Manual, p. 104 (Jan.

1, 2013).

Live Video Reimbursement

Private payers must reimburse for live video. Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). (See “Private Payers” section)

Live video is reimbursed.

Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person.

Source: Dept. of VT Health Access, Provider Manual, p. 104 (Jan.

1, 2013).

Store and Forward Reimbursement

Allows, but doesn’t require, reimbursement for tele- ophthalmology and tele-dermatology.

Allows payers to require the distant site provider to document the reason the services are being provided by store and forward.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).

No reimbursement for tele-ophthalmology or tele- dermatology; no reference to other store and forward technologies.

Source: Dept. of VT Health Access, Provider Manual, p. 104 (Jan.

1, 2013).

Remote Patient Monitoring Reimbursement

No reference found.

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for email.

No reimbursement for telephone.

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MEDICAID PROGRAM

No reimbursement for FAX.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).

No reimbursement for FAX.

Source: Dept. of VT Health Access, Provider Manual, p. 104 (Jan.

1, 2013).

Online Prescribing

Providers may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations if they first examine the patient in person, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.

Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider- patient settings.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2012).

No reference found.

Consent

Originating site providers must obtain consent for store and forward tele-ophthalmology or tele-dermatology.

Patients will be informed of the right to receive a consult with the distant-site provider, and will receive one, upon request, either at the time of the consult, or within a reasonable time after notification of the results of the initial consult.

Receiving tele-dermatology or tele-ophthalmology services by store and forward shall not preclude a patient from receiving real-time telemedicine, or face-to- face services with the distant site provider at a future date.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2012).

No reference found.

Location

No reference found.

Originating site provider locations are limited to:

• Physician or practitioner’s office

• Hospital

• Critical access hospital (CAH)

• Rural health clinic

• Federally qualified health center

• Community mental health center

• Skilled nursing facility

• Hospital-based or CAH-based renal dialysis center

Source: Dept. of VT Health Access, Provider Manual, p. 104-105

(Jan. 1, 2013).

Cross-State Licensing

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MEDICAID PROGRAM

No reference found.

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).

No reference found.

Site/Transmission Fee

No reference found.

Allowed, but not required, for originating site providers.

Dept. of VT Health Access, Provider Manual, p. 104 (Jan. 1, 2013).

Miscellaneous

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MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telemedicine services means the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment.

‘Telemedicine services’ do not include an audio-only telephone, electronic mail message, or facsimile transmission.”

Source: VA Code Annotated Sec. 38.2-3418.16 (2012).

“Telemedicine is the real-time or near real-time exchange of information for diagnosing and treating medical conditions. Telemedicine utilizes audio/video connections linking medical practitioners in one locality with medical practitioners in another locality.”

Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 19 (Apr. 2, 2012).

Live Video Reimbursement

Virginia statute requires coverage of telemedicine (which includes live video) by private insurers, subject to their terms and conditions.

Source: VA Code Annotated Sec. 38.2-3418.16 (2012).

Yes, for all Medicaid recipients irrespective of fee-for- service or managed care organization coverage.

Eligible services:

• Office visits;

• Individual psychotherapy;

• Psychiatric diagnostic interview examinations;

• Pharmacologic management;

• Colposcopy;

• Obstetric ultrasound;

• Fetal echocardiography:

• Cardiography interpretation and report only;

• Echocardiography;

• Speech therapy services. Eligible providers: