STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

There is no explicit definition of “telemedicine” given in

state Medicaid policy. However, the provider manual

states, “Services must be administered via an interactive

audio and video telecommunications system which

permits two-way communication between the distant site

physician and the origination site where the recipient is

located (this does not include a telephone conversation,

electronic mail message, or facsimile transmission

between the physician, recipient, or a consultation

between two physicians).”

Source: AL Medicaid Management Information System Provider

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

Live Video Reimbursement

No reference found.

Alabama Medicaid reimburses for live video for the

following services:

• Consults;

• Office or other outpatient visits;

• Individual psychotherapy;

• Psychiatric diagnostic services;

• Neurobehavioral status exams.

However, for some specialties, special conditions or

circumstances must be present for reimbursement to

occur.

For all telemedicine services, an appropriately trained

staff member or employee familiar with the patient or the

treatment plan must be immediately available in person

to the patient.

Source: AL Medicaid Management Information System Provider

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

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

Center for Connected Health Policy

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 reimbursement for email.

No reference found for email or FAX.

No reimbursement for telephone.

No reimbursement for FAX.

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

Source: AL Medicaid Management Information System Provider

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

Online Prescribing

Prescribing drugs to an individual the prescriber has not

No reference found.

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).

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;

Center for Connected Health Policy

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

Providers must have an Alabama license.

licensed in other states to practice across state lines

may be issued.”

Source: AL Medicaid Management Information System Provider

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

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

Private Payers

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).

COMMENTS: Alabama’s “Patient 1st” program is a primary care case management (PCCM) program operated by

the Alabama Medicaid Agency. Patient 1^st participants with the chronic conditions of Diabetes,

Hypertension, and Congestive Heart Failure may monitor their conditions at home by transmitting

readings of their blood pressure, pulse, glucose (blood sugar) and/or weight by a telephone call into

a secure centralized database.

Source: Alabama Medicaid Agency, Patient 1^st.

http://medicaid.alabama.gov/CONTENT/4.0_Programs/4.4.0_Medical_Services/4.4.10_Patient_1st.asp > (Accessed

February 5, 2013).

Center for Connected Health Policy

Alaska

Medicaid Program: Alaska Medicaid

Program Administrator: Alaska Dept. of Health and Social Services, Division of Public Assistance

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W

Billings, MT 59101

(888) 662-5601

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the practice of health care

“Telemedicine is identical to a “traditional” health-care

delivery, evaluation, diagnosis, consultation, or

visit except it uses a different mode of delivery; with

treatment, using the transfer of medical data through

telemedicine, the health-care provider and the patient

audio, video, or data communications that are engaged

are not in the same physical location. Instead, providers

in over two or more locations between providers who

use telemedicine applications, such as video, audio,

are physically separated from the patient or from each

and/or digitized image transmissions, to link the patient

other.”

and the provider.”

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

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;

Center for Connected Health Policy

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).

Center for Connected Health Policy

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

No reference found.

based solely on a patient-supplied history received by

telephone, FAX, or electronic format.

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

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

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

Comments: Alaska and Hawaii are the only two states with Medicare coverage of store and forward services.

Center for Connected Health Policy

Arizona

Medicaid Program: Arizona Health Care Cost Containment System (AHCCCS)

Program Administrator: Arizona Health Care Cost Containment System Administration

Regional Telehealth Resource Center

Southwest Telehealth Resource Center

PO Box 245105

Tucson, AZ 85724

(520) 626-4498

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

Under Arizona Statute, Public Health & Safety,

Telemedicine is “the practice of health care delivery,

"telemedicine means the practice of health care delivery,

diagnosis, consultation and treatment and the transfer

diagnosis, consultation and treatment and the transfer of

of medical data between the originating and distant sites

medical data through interactive audio, video or data

through real time interactive audio, video or data

communications that occur in the physical presence of

the patient, including audio or video communications

the member.”

sent to a health care provider for diagnostic or treatment

consultation.”

Source: AZ Health Care Cost Containment System .AHCCCS

Medical Policy Manual for AHCCCS Covered Services, Ch. 300, p.

172, Apr. 2012.

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

Telehealth is “the use of telecommunications and

Under State Administrative Code, Department of

information technology to provide access to health

Insurance, Health Care Services Organizations

assessment, diagnosis, intervention, consultation,

Oversight, "telemedicine means diagnostic, consultation,

supervision and information across distance.”

and treatment services that occur in the physical

presence of an enrollee on a real-time basis through

Source: AZ Health Care Cost Containment System, AHCCCS

interactive audio, video, or data communication.”

Medical Policy for AHCCCS Covered Services, p. 172. Apr. 2012.

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

Live Video Reimbursement

Health Care Service Organizations (HCSO) are allowed,

AHCCCS will reimburse for medically necessary

but not mandated, to provide access to covered services

services provided via live video in their fee for service

through telemedicine, telephone, and email.

program.

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

Eligible services:

• Cardiology;

• Dermatology;

• Endocrinology;

• Hematology/oncology;

• Home Health

• Infectious diseases;

• Neurology;

• Obstetrics/gynecology;

• Oncology/radiation;

• Ophthalmology;

Center for Connected Health Policy

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

AHCCCS will reimburse for store-and-forward in their

telemedicine as occurring in the “physical presence” of

fee-for-service program. The same services are

the patient, would exclude store and forward.

covered for store and forward, as for real time.

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

Center for Connected Health Policy

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”

Center for Connected Health Policy

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

No reference found.

mandated, to provide covered services through

telemedicine, telephone, and email.

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

Online Prescribing

Physicians are prohibited from issuing a prescription to

No reference found.

patients without having a previously established

provider-patient relationship, or first conducting a

physical exam.

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

Consent

Providers must obtain and document oral or written

No reference found.

consent before delivery of services. Oral consent

should be documented on the patient’s medical record.

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

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:

Center for Connected Health Policy

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

A consultation by a non-Arizona licensed provider may

infrequent consultation with an Arizona physician.

occur if:

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

• 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.

Site/Transmission Fee

No reference found.

Miscellaneous

Arizona explicitly prohibits the use of telemedicine to

There is reimbursement for non-emergency

provide an abortion.

transportation to and from the telemedicine originating

site.

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

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).

Center for Connected Health Policy

Arkansas

Medicaid Program: Arkansas Medicaid

Program Administrator: Arkansas Department of Human Services

Regional Telehealth Resource Center

South Central Telehealth Resource Center

4301 W. Markham St. #519

Little Rock, AR 72205

(855) 664-3450

learntelehealth.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means an interactive telecommunications

Arkansas Medicaid defines telemedicine services as

system that: Utilizes information technology, audio,

“medical services performed as electronic transactions

video and other appropriate elements, and is compatible

in real time. In order for a telemedicine encounter to be

with other telemedicine networks; and is used for the

covered by Medicaid, the practitioner and the patient

purpose of enhancing the delivery of medical information

must be able to see and hear each other in real time.”

and health care to medical facilities in rural and urban

areas throughout Arkansas.”

Source: 016 06 06 Code of AR Rules and Regs. (CARR) 024

(2012).

Source: AR Code Annotated Sec. 10-3-1702 (2012)

The Medicaid manual describes telemedicine as,

“Interactive electronic consultations are physician

consultations, “face-to-face” in real time, via two-way

electronic data exchange.”

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

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

Live Video Reimbursement

No reference found.

Arkansas Medicaid will reimburse for up to two visits per

patient, per year. A benefit extension request may be

approved if it is medically necessary.

Covered visits:

• Consults;

• Fetal echography and echocardiography;

• Non-emergency visits in a physician’s office, a

clinic or a hospital outpatient department;

• Inpatient hospital visits;

• Federally Qualified Health Centers (FQHC)

encounters.

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

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

Source (FQHC only): AR Provider Manual, Section II: Federally

Qualified Health Center, p. 10.

Center for Connected Health Policy

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.

Email/Phone/FAX

No reference found.

Online Prescribing

Without a prior and proper patient-provider relationship,

No reference found.

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).

Consent

No reference found.

Location

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

No reference found.

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

Center for Connected Health Policy

California

Medicaid Program: Medi-Cal

Program Administrator: California Dept. of Health Care Services (DHCS)

Regional Telehealth Resource Center:

California Telehealth Resource Center (CTRC)

2001 P Street, Suite 100

Sacramento, CA 95811

(916) 341-3378 / (877) 590-8144

www.caltrc.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth means the mode of delivering health care

No reference found.

services and public health via information and

communication technologies to facilitate the diagnosis,

Note:

consultation, treatment, education, care management,

and self-management of a patient's health care while the

• In 2012, California implemented a

patient is at the originating site and the health care

comprehensive update to its telehealth law;

provider is at a distant site. Telehealth facilitates patient

• However, the State has not yet issued new

self-management and caregiver support for patients and

Medicaid guidelines;

includes synchronous interactions and asynchronous

• Guidelines expected in 2013;

store and forward transfers.”

• All Medi-Cal (CA Medicaid) program information

is from provider manuals based on the old laws.

Source: CA Business & Professions Code Sec. 2290.5 (2012).

Live Video Reimbursement

Private payers may reimburse for live video. (See

Medi-Cal will reimbursement for services provided

“Private Payers” section).

via live video.

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

Source: CA Welfare & Institutions Code Sec. 14132.72

(2012). & California Dept. of Health Care Svcs. Medi-Cal

Provider Manual, Medicine: Telemedicine, p. 1 (Oct. 2008).

(also see Medicaid column)

Store and Forward Reimbursement

Private payers may reimburse for store and forward.

Medi-Cal will reimbursement for store and forward

services for tele-dermatology and tele-ophthalmology.

Source: CA Business & Professions Code Sec. 2290.5 (2012).

Source: CA Dept. of Health Care Svcs. Medi-Cal Provider Manual,

(also see Medicaid column)

Medicine: Telemedicine, p. 8 (Oct. 2008) & CA Welfare &

Institutions Code Sec. 14132.725 (2012).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

Providers are prohibited from prescribing or dispensing

No reference found.

dangerous drugs or dangerous devices on the Internet

Center for Connected Health Policy

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

No reference found.

oral patient consent prior to service delivery.

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

Location

Health plans cannot limit the settings where services are

An “originating site” is the location of an eligible recipient

provided. Settings are still subject to contract terms and

at the time service is furnished via telecommunications.

conditions.

Originating sites:

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

• 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.

Private Payers

Private payers cannot require that in-person contact

No reference found.

occur before payment is made for covered telehealth

services, subject to contract terms and conditions.

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

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

Comments: The CA Board of Occupational Therapy proposed regulations in August 2012 that would require

occupational therapists providing telehealth services to have a California license, exercise the same

standard of care as with in-person services, obtain oral patient consent, and determine whether an

in-person evaluation or intervention is necessary.

Section 4172. Standards of Practice for Telehealth (proposed regulation).

Center for Connected Health Policy

Colorado

Medicaid Program: Colorado Medicaid

Program Administrator: Colorado Dept. of Health Care Policy and Financing

Regional Telehealth Resource Center:

Southwest Telehealth Resource Center

PO Box 245105

Tucson, AZ 85724

(520) 626-4498

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the delivery of medical services

No reference found.

and any diagnosis, consultation, or treatment using

interactive audio, interactive video, or interactive data

communication.”

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

Live Video Reimbursement

Health plans for patients in counties with 150,000 or

Colorado Medicaid will reimburse for medical and

fewer residents cannot require face-to-face contact

mental health services. Services shall be subject to

between a provider and a patient for services that could

reimbursement policies developed by the medical

be appropriately provided through telemedicine, subject

assistance program.

to the terms and conditions of the health benefit plan.

Reimbursement must be the same as in-person

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

services.

(also see Medicaid column & “Private Payers” section)

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

Colorado Medicaid does not pay for provider or patient

education when education is the only service provided

via telemedicine.

• No enrolled managed care organization may require

face-to-face contact between a provider and a client

for services appropriately provided through

telemedicine if: The client resides in a county with a

population of 150,000 or fewer residents and

• The county has the technology necessary to provide

telemedicine services.

The use of telemedicine is not required when in-person

care by a participating provider is available to an

enrolled client within a reasonable distance.

Source: CO Medical Assistance Program, Telemedicine Manual,

p. 5 (Dec. 2011).

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Store and Forward Reimbursement

No reimbursement based upon definition of

The CO Medical Assistance Program will only

“telemedicine” which describes telemedicine as

reimburse for “live” telemedicine, excluding store and

“interactive” implying that it happens in real time.

forward. Peripherals, such as transmission of a live

ultrasound exam, may be reimbursed.

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

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

No reimbursement for telephone.

required to cover telephone or FAX services.

No reimbursement for FAX.

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

Source: CO Medical Assistance Program, Telemedicine Manual,

Statutes 25.5-5-414 (2012).

p. 5 (Dec. 2011).

Online Prescribing

Pharmacists are prohibited from dispensing prescription

No reference found.

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.

Center for Connected Health Policy

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 Medicaid requirement for face-to-face contact

between provider and client may be waived prior to

• The patient may refuse telemedicine services at

treating the client through telemedicine for the first time.

any time, without loss or withdrawal of

The rendering provider must furnish each client with all

treatment;

of the following written statements which must be signed

• All applicable confidentiality protections shall

by the client or the client’s legal representative:

apply to the services;

• The client retains the option to refuse the delivery of

• The patient shall have access to all medical

health care services via telemedicine at any time

information from the services, under state law.

without affecting the client's right to future care or

treatment and without risking the loss or withdrawal

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

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.

Cross-State Licensure

No reference found.

Private Payers

Health plans for patients in counties with 150,000 or

No reference found.

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).

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

Center for Connected Health Policy

Connecticut

Medicaid Program: Medical Assistance Program

Program Administrator: Connecticut Dept. of Social Services

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the use of interactive audio,

No reference found.

interactive video or interactive data communication in

the delivery of medical advice, diagnosis, care or

treatment…Telemedicine does not include the use of

facsimile or audio-only telephone.”

Source: CT Public Act No. 12-109 (2012); HB 5483.

Live Video Reimbursement

No reference found.

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

There is no reimbursement for telephone or FAX.

No reference found.

Source: CT Public Act No. 12-109 (2012); HB 5483.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

Department of Public Health may establish a process of

No reference found.

accepting an applicant’s license from another state and

may issue that applicant a license to practice medicine

in the state without examination, if certain conditions are

met.

Center for Connected Health Policy

District of Columbia

Medicaid Program: District of Columbia Medicaid

Program Administrator: District of Columbia Dept. of Health Care Finance

Regional Telehealth Resource Center:

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

STATE LAW

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

Live Video Reimbursement

No reference found.

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

Delaware

Medicaid Program: Delaware Medical Assistance Program

Program Administrator: Delaware Health and Social Services Dept., Division of Social Services

Regional Telehealth Resource Center:

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

Recent Policy Developments:

In July 2012, the state Medicaid program began reimbursing for telemedicine services. This decision was made

administratively, with no change in state law.

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.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

Pharmacists are prohibited from dispensing prescription

No reference found.

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).

Consent

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

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.

Private Payers

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

Center for Connected Health Policy

Florida

Medicaid Program: Florida Medicaid

Program Administrator: Florida Dept. of Children and Families

Regional Telehealth Resource Center:

Southeast Telehealth Resource Center

PO Box 1408

Waycross, GA 31501

(888) 138-7210

STATE LAW

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine” is “the use of telecommunication and

information technology to provide clinical care to

individuals at a distance, and to transmit the information

needed to provide that care.”

Source: FL Dept. of Health, Child Protection Team Program,

Policy and Procedure Handbook, p.27 (Jun. 2009).

Live Video Reimbursement

No reference found.

Florida Medicaid will reimburse for live video only in

relation to the Child Protection Team Program (see

Comments), and for the following dental services:

• Oral prophylaxis;

• Topical fluoride application;

• Oral hygiene instructions.

All dental services must be delivered by a registered

dental hygienist, with a supervising dentist.

Source (Child Protection Team Program): FL Dept. of Health,

Child Protection Team Program, Policy and Procedure Handbook,

p.27 (Jun. 2009).

Source (dental services): FL Dental Services Coverages and

Limitations Handbook, p. 2-26, (November 2011).

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX Restrictions

No reference found.

Online Prescribing

Prior to e-prescribing, physicians and physician

No reference found.

assistants must document a patient evaluation,

Center for Connected Health Policy

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.

Location

No reference found.

Cross State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Comments: In 1998, the Child Protection Team (CPT) Program implemented a telemedicine network that links

CPT teams with remote or satellite CPT offices, or local facilities, such as hospital emergency rooms,

county health departments, or child advocacy centers, to facilitate telemedicine assessments for

abuse, abandonment, and neglect of children in remote or rural areas.

Only specially trained CPT physicians, advanced registered nurse practitioners or physician

assistants can perform these exams. And only specifically trained registered nurses at presenting

sites may participate in the exam.

Florida Department of Health, Child Protection Team Program, Policy and Procedure Handbook, p. 11 (Jun. 2009).

Center for Connected Health Policy

Georgia

Medicaid Program: Georgia Medicaid

Program Administrator: Georgia Dept. of Community Health

Regional Telehealth Resource Center:

Southeast Telehealth Resource Center

PO Box 1408

Waycross, GA 31501

(888) 138-7210

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the practice, by a duly licensed

“Telemedicine is the use of medical information

physician or other health care provider acting within the

exchange from one site to another via electronic

scope of such provider's practice, of health care

communications to improve patients’ health status. It is

delivery, diagnosis, consultation, treatment, or transfer

the use of two-way, real time interactive communication

of medical data by means of audio, video, or data

equipment to exchange the patient information from one

communications which are used during a medical visit

site to another via an electronic communication system.

with a patient or which are used to transfer medical data

This includes audio and video telecommunication

obtained during a medical visit with a patient. Standard

equipment.”

telephone, facsimile transmissions, unsecured e-mail, or

a combination thereof do not constitute telemedicine

“Closely associated with telemedicine is the

services.”

term ’telehealth,’ which is often used to encompass a

broader definition of remote healthcare that does not

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

always involve clinical services. Telehealth is the use of

telecommunication technologies for clinical care

(telemedicine), patient teachings and home health,

health professional education (distance learning),

administrative and program planning, and other diverse

aspects of a health care delivery system.”

Source: GA Dept. of Community Health, GA Medicaid

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

Live Video Reimbursement

Georgia requires coverage of telemedicine services

Georgia Medicaid will reimburse for live video when the

(which includes live video), subject to contract terms and

service is “medically necessary, the procedure is

conditions. (See “Private Payers” section).

individualized, specific, consistent with symptoms or

confirmed diagnosis of an illness or injury under

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

treatment, and not in excess of the member’s needs.”

Eligible services:

• Office visits;

• Pharmacologic management;

• Limited office psychiatric services;

• Limited radiological services;

• A limited number of other physician fee

schedule services.

Source: GA Dept. of Community Health, GA Medicaid

Center for Connected Health Policy

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.

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).

Source: GA Dept. of Community Health, GA Medicaid

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

Online Prescribing

Physicians are prohibited from prescribing controlled

No reference found.

substances or dangerous drugs based solely on an

electronic consult.

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

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.

Center for Connected Health Policy

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

No reference found.

contract terms and conditions.

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

Site/Transmission Fee

No reference found.

Miscellaneous

Comments: Patients who are eligible for both Medicare and Medicaid (known as dual eligibles), will receive

mental health care through Medicare, with Medicaid the payor of last resort. Though not available in

all areas of the state, Medicare-funded mental health services are currently provided to nursing

home residents via telemedicine, face-to-face visits by providers in the nursing home, and nursing

home resident visits to psychiatric/mental health clinics or offices, for those individuals able to travel.

GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing

Facilities, p. 206 (Oct. 1, 2012).

In July 2012, the Georgia Composite Medical Board proposed requiring a physical exam of a patient

before providing telemedicine treatment.

Georgia Medical Board Proposed Regulation. 360-3-.02 Unprofessional Conduct Defined.

Center for Connected Health Policy

Hawaii

Medicaid Program: Hawaii Quest

Program Administrator: Hawaii Dept. of Human Services

Regional Telehealth Resource Center:

Pacific Basin Telehealth Resource Center

Telehealth Research Institute, John A. Burns School of Medicine

651 Ilalo Street

Honolulu, HI 96813

(808) 692-1090

www.pbtrc.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

According to state insurance law, “Telehealth means the

No reference found.

use of telecommunications services, including but not

limited to, real-time video conferencing-based

communication, secure interactive and non-interactive

web-based communication, and secure asynchronous

information exchange, to transmit patient medical

information, including diagnostic-quality digital images

and laboratory results for medical interpretation and

diagnosis, for the purpose of delivering enhanced health

care services and information to parties separated by

distance. Standard telephone contacts, facsimile

transmissions, or email text, in combination or by itself,

does not constitute a telehealth service for the purposes

of this chapter.”

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

According to state business law, “Telehealth means the

use of electronic information and telecommunication

technologies to support long-distance clinical health

care, patient and professional health-related education,

public health and health administration, to the extent that

it relates to nursing.”

Source: HI Revised Statutes § 457-2 (2012).

According to state business law, “Telemedicine means

the use of telecommunications services, including real-

time video or web conferencing communication or

secure web-based communication to establish a

physician-patient relationship, to evaluate a patient, or to

treat a patient. ‘Telehealth’ as used in chapters 431,

432, and 432D, includes ‘telemedicine’ in its definition.”

Source: HI Revised Statutes § 453-1.3 (2012).

Live Video Reimbursement

Hawaii requires coverage of telehealth services (which

Hawaii Quest will reimburse for live video, as long as it

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

includes live video), subject to contract terms and

“includes audio and video equipment, permitting real-

conditions.

time consultation among the patient, consulting

practitioner and referring practitioner.”

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

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

(See Medicaid column & “Private Payers” Section)

Store and Forward Reimbursement

Based upon the definition of “telehealth” (which includes

Hawaii Quest requires the patient to be “present and

secure asynchronous information exchange) in the state

participating in the telehealth visit” therefore excluding

insurance law, store and forward may be covered.

store and forward from reimbursement.

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

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

(also see Medicaid column)

Remote Patient Monitoring Reimbursement

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).

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

(also see Medicaid column)

Online Prescribing

Prescribing providers must have a provider-patient

No reference found.

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.

Consent

No reference found.

Center for Connected Health Policy

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.

No reference found.

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

Private Payers

Hawaii requires coverage of telehealth services, subject

No reference found.

to contract terms and conditions.

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

Site/Transmission Fee

No reference found.

Miscellaneous

Comments: In July 2011, Hawaii began implementing a mobile medical van telehealth pilot project, staffed by

primary care providers, for consults with other health care providers,.

HI Revised Statutes, Div. 1, Title 20, Ch. 346 Note (2012).

Hawaii and Alaska are the only two states with Medicare coverage of store and forward services.

Center for Connected Health Policy

Idaho

Medicaid Program: Idaho Medicaid

Program Administrator: Idaho Dept. of Health and Welfare

Regional Telehealth Resource Center:

The Northwestern Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W, Billings, MT 59101

(888) 662-5601

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth is an electronic real-time synchronized

No reference found.

audio-visual contact between a consultant and

participant related to the treatment of the participant.

The consultant and participant interact as if they were

having a face-to-face service.”

Source: ID Administrative Code 16.03.10.681 (2012).

Live Video Reimbursement

(see Medicaid column)

Idaho Medicaid will reimburse for a limited number of

mental health services.

Source (authorization): ID MMIS Provider Handbook, Allopathic

and Osteopathic Physicians, p. 28 (Oct. 2012).

Through the Children’s Waiver Services, Idaho Medicaid

will reimburse for crisis intervention consults, or

individual consults by a therapeutic consultant via live

video.

Source (service type): ID Administrative Code 16.03.10.683 (2012).

Store and Forward Reimbursement

No reference found.

Idaho Medicaid will only reimburse for interactive audio

and video permitting “real-time communication”,

therefore excluding store and forward from coverage.

Source: ID MMIS Provider Handbook, Allopathic and Osteopathic

Physicians, p. 29 (Oct. 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

Prescribing physicians must have prescriber-patient

No reference found.

relationship, which includes a documented patient

Center for Connected Health Policy

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.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

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

Center for Connected Health Policy

Illinois

Medicaid Program: Illinois Medicaid

Program Administrator: Illinois Dept. of Healthcare and Family Services

Regional Telehealth Resource Center:

Upper Midwest Telehealth Resource Center

2901 Ohio Boulevard, Ste. 110

Terre Haute, IN 47803

(855) 283-3734 ext. 232

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

The Medical Practice Act of 1987 defines ‘telemedicine’

“Telemedicine” is the use of a telecommunication

as “the performance of diagnosing patients, prescribing

system to provide medical services for the purpose of

drugs, maintaining a medical office, etc., including but

evaluation and treatment when the patient is at one

not limited to rendering written or oral opinions

medical provider location and the rendering provider is

concerning diagnosis or treatment of a patient in Illinois

at another location.

by a person located outside the State of Illinois as a

result of transmission of individual patient data by

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

telephonic, electronic, or other means of communication

“Telehealth is defined as the use of a telecommunication

from within this State.”

system to provide medical services between places of

Source: IL Compiled Statutes, Chapter 225, 60/49.5 (2012).

lesser and greater medical capability and/or expertise,

for the purpose of evaluation and treatment. Medical

The Administrative Code for the Department of

data exchanged can take the form of multiple formats:

Healthcare and Family Services defines ‘telemedicine’

text, graphics, still images, audio and video. The

as “the use of a telecommunication system to provide

information or data exchanged can occur in real time

medical services for the purpose of evaluation and

(synchronous) through interactive video or multimedia

treatment when the patient is at one medical provider

collaborative environments or in near real time

location and the rendering provider is at another

(asynchronous) through “store and forward”

location.”

applications.”

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

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

Telehealth Services, Informational

(also see Medicaid column)

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

2010).

Live Video Reimbursement

(see Medicaid column)

Illinois Medicaid will reimburse for live video under the

following conditions:

• A physician or other licensed health care

professional must be present with the patient at all

times with the patient at the originating site;

• The distant site provider must be a physician,

physician assistant, podiatrist or advanced practice

nurse who is licensed by Illinois or the state where

the patient is located;

• The originating and distant site provider must not

be terminated, suspended or barred from the

Department’s medical programs;

• Medical data may be exchanged through a

Center for Connected Health Policy

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.

Center for Connected Health Policy

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.

Center for Connected Health Policy

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.

Consent

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.

Site/Transmission Fee

No reference found.

There is reimbursement for originating site facility fees.

Eligible facilities include:

• Physician’s office;

Center for Connected Health Policy

Indiana

Medicaid Program: Indiana Medicaid

Program Administrator: Indiana Family and Social Services Administration

Regional Telehealth Resource Center:

Upper Midwest Telehealth Resource Center

2901 Ohio Boulevard, Ste. 110

Terre Haute, IN 47803

(855) 283-3734 ext. 232

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine services refer to a specific method of

No reference found.

delivery of certain services, including medical exams

and consultations, which are already reimbursed by

Medicaid. Telemedicine uses videoconferencing

equipment allowing a medical provider to render an

exam or other service to a patient at a distant location.”

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

Live Video Reimbursement

(see Medicaid column)

Indiana Medicaid will reimburse for live video, as long as

certain conditions are met.

The hub site provider must determine if it is medically

necessary for a medical professional to be at the spoke

site.

For a medical professional to receive reimbursement for

professional services in addition to payment for spoke

services, medical necessity must be documented. If it is

medically necessary for a medical professional to be

with the member at the spoke site, the spoke site is

permitted to bill an evaluation and management code in

addition to the fee for spoke services. There must be

documentation in the patient's medical record to support

the need for the provider's presence at the spoke site.

The documentation is subject to post-payment review.

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

Source (hub-spoke provider reimbursement): IN Admin. Code,

Title 405, 5-38-4 (2012) & IN Health Coverage Programs Provider

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

Reimbursement for the following:

Center for Connected Health Policy

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.”

Center for Connected Health Policy

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).

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

No reference found.

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).

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

There is reimbursement for telemedicine services only

and participate in the visit.

when the hub and spoke sites are greater than 20 miles

apart.

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

Source: IN Health Coverage Programs Provider Manual, Chapter

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

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

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).

Center for Connected Health Policy

Iowa

Medicaid Program: Iowa Medicaid Enterprise (IME)

Program Administrator: IA Dept. of Human Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center

University of Minnesota/Institute for Health Informatics

330 Diehl Hall

505 Essex Street S.E.

Minneapolis, MN 55455

(888) 239-7092

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means use of a telecommunications

No reference found.

system for diagnostic, clinical, consultative, data, and

educational services for the delivery of health care

services or related health care activities by licensed

health care professionals, licensed medical

professionals, and staff who function under the direction

of a physician, a licensed health care professional, or

hospital, for the purpose of developing a

comprehensive, statewide telemedicine network or

education.”

Source: IA Admin. Code, 751 7.1(8D) (2012).

Live Video Reimbursement

No reference found.

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

Pharmacists are prohibited from dispensing prescription

No reference found.

drugs if the pharmacist knows or should have known

that the prescription was issued solely on the basis of

an Internet-based questionnaire, an Internet-based

consult, or a telephone consult, and was completed

without a pre-existing patient-provider relationship.

Source: IA Admin. Code, 657 8.19(124,126,155A) (2012).

Consent

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Comments: Iowa conducted a pilot program in 1997-2000 to study the cost-effectiveness of providing telehealth

services to Medicaid patients. Few providers participated in the program, and the study found that it

was not cost effective.

Office for the Advancement of Telehealth, Telemedicine Reimbursement

Report, ftp://ftp.hrsa.gov/telehealth/licen.pdf, p. 34 (Oct. 2003).

Center for Connected Health Policy

Kansas

Medicaid Program: Kansas Medicaid

Program Administrator: Kansas Dept. of Health and Environment

Regional Telehealth Resource Center:

Heartland Telehealth Resource Center

3901 Rainbow Blvd MS 1048

Kansas City, KS 66160

(877) 643-4872

heartlandtrc.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine is the use of communication equipment to

link health care practitioners and patients in different

locations. This technology is used by health care

providers for many reasons, including increased cost

efficiency, reduced transportation expenses, improved

patient access to specialists and mental health

providers, improved quality of care, and better

communication among providers.”

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

Assistance Program, Provider Manual, General Benefits, p. 38

(Feb. 2012).

Live Video Reimbursement

No reference found.

Kansas Medicaid will reimburse for live video, for the

following services:

• Office visits;

• Individual psychotherapy;

• Pharmacological management services.

The patient must be present at the originating site.

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

Assistance Program, Provider Manual, General Benefits, p. 38

(Feb. 2012).

Store and Forward Reimbursement

No reference found.

Kansas Medicaid requires the patient to be present at

the originating site indicating store and forward will not

be reimbursed.

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

Assistance Program, Provider Manual, General Benefits, p. 38

(Feb. 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Kansas Medicaid will reimburse for home telehealth.

The policy states:

Center for Connected Health Policy

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

No reference found.

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).

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.

Center for Connected Health Policy

Kentucky

Medicaid Program: Kentucky Medicaid

Program Administrator: KY Dept. for Medicaid Services

Regional Telehealth Resource Center:

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Telehealth means the use of interactive audio, video, or

"Telehealth consultation means a medical or health

other electronic media to deliver health care. It includes

consultation, for purposes of patient diagnosis or

the use of electronic media for diagnosis, consultation,

treatment, that requires the use of advanced

treatment, transfer of health or medical data, and

telecommunications technology, including, but not

continuing education.”

limited to: (a) compressed digital interactive video,

audio, or data transmission; (b) clinical data

Source: KY Revised Statutes § 310.200 (2012).

transmission via computer imaging for tele-radiology or

tele-pathology; and (c) other technology that facilitates

(also see Medicaid column)

access to health care services or medical specialty

expertise.”

Source: KY Revised Statutes § 205.510 (2012).

Live Video Reimbursement

Kentucky law states that insurers may not deny

Kentucky Medicaid will reimburse for a “telehealth

coverage because it is “provided thorugh telehealth and

consultation”, which includes live video.

not provided through face-to-face consultation” therefore

requiring reimbursement for live video.

Source: KY Revised Statutes 205.559 (2012).

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

Reimbursement shall not be denied solely because an

in-person consultation between a provider and a patient

(See Medicaid column and “Private Payers” section)

did not occur.

Source: KY Revised Statutes § 205.559 (2012).

Except for a telehealth consultation provided by an

Advanced Registered Nurse Practitioner or Community

Mental Health Clinic, an amount equal to the amount

paid for a comparable in-person service.

Source: KY Admin. Regs., Title, 907, 3:170, Sec. 4(a) (2011).

Store and Forward Reimbursement

(see Medicaid column)

Kentucky reimburses for tele-radiology but there is no

other reference to reimbursing for other specialties.

Source: KY Provider Billing Instructions for Physician’s Services

Provider Type - 64, 65, Version 5.6, p.41 (Sept. 26, 2012).

Center for Connected Health Policy

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.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

Source: KY Revised Statutes § 205.559 (2012).

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

Online Prescribing

Prior to prescribing in response to any communication

No reference found.

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).

Consent

The provider who delivers or facilitates the telehealth

Before providing a telehealth consultation, providers

service shall obtain the informed consent of the patient

must document written patient informed consent.

before services are provided.

This includes:

Patient consent must be obtained by:

• The patient may refuse the telehealth

• Physicians;

consultation at any time without affecting the

• Chiropractors;

right to future care or treatment, and without

• Nurses;

risking the loss or withdrawal of a benefit to

• Dentists;

which the patient is entitled;

• Dieticians;

• The recipient shall be informed of alternatives to

the telehealth consult;

• Pharmacist;

• The recipient shall have access to medical

• Psychologists;

information resulting from the telehealth consult

• Occupational therapists;

as provided by law;

• Behavioral analysts;

• The dissemination, storage, or retention of an

• Opthamologists;

identifiable recipient image or other information

• Physical therapists;

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Speech language pathologists or audiologists;

from the telehealth consult shall comply with all

• Social workers;

state and federal confidentiality laws and

• Marriage/family therapists.

regulations;

• The patient shall have the right to be informed of

Source: KY Revised Statutes § 311.5975 (2012).

the parties who will be present at the spoke site

and the hub site during the telehealth consult,

(also see Medicaid column)

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.

Cross-State Licensure

A provider must be licensed in Kentucky with the

No reference found.

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).

Private Payers

Payers shall not exclude services solely because the

No reference found.

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).

Site/Transmission Fee

(see Medicaid column)

No reimbursement for transmission fees.

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

Miscellaneous

Comments: Kentucky created its e-Health Network in 2005, to develop a secure electronic network. The

network oversees development of ways to use health information technology to improve the health

and lives of state residents.

The network is providing decision support on security of protected information, electronic data

interchange, and clinical practice software packages. This includes the feasibility of developing a

software purchasing alliance to decrease the cost of software, and tax incentives to encourage

network members purchase software that meets state standards.

Center for Connected Health Policy

Louisiana

Medicaid Program: Louisiana Medicaid

Program Administrator: LA Dept. of Health and Hospitals

Regional Telehealth Resource Center:

TexLa Telehealth Resource Center

3601 4^th Street, Ste. 2B440

Lubbock, TX 79430

(806) 743-4440

http://www.texlatrc.org

Recent Policy Developments: Louisiana is currently exploring expanding the use of telemedicine in the

state. There is discussion of potential legislation.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine is the practice of health care delivery,

“Telemedicine is the use of medical information

diagnosis, consultation, treatment, and transfer of

exchanges from one site to another via electronic

medical data using interactive telecommunication

communications to improve a recipient’s health.

technology that enables a health care practitioner and a

Electronic communication means the use of interactive

patient at two locations separated by distance to interact

telecommunications equipment that includes, at a

via two-way video and audio transmissions

minimum, audio and video equipment permitting two-

simultaneously. Neither a telephone conversation nor an

way, real time interactive communication between the

electronic mail message between a health care

patient at the originating site, and the physician or

practitioner and patient, or a true consultation as may be

practitioner at the distant site.”

defined by rules promulgated by the board pursuant to

the Administrative Procedure Act, constitutes

Source: LA Dept. of Health and Hospitals, Professional Svcs.

Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p.

telemedicine.”

152 (February 1, 2012).

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

Live Video Reimbursement

Louisiana law requires reimbursement to the originating

Louisiana Medicaid reimburses for “services provided

site physician for a live video consultation if he/she is

via an interactive audio and video telecommunications

physically present during the exam and interacts with

system.”

the distant-site physician. (See “Private Payers” section

below)

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

Louisiana Medicaid only reimburses the distant site

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

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

Louisiana Medicaid will not provide reimbursement

definition of “telemedicine” which describes telemedicine

based upon the definition of “telemedicine” which

as an interaction “via two-way video and audio

describes telemedicine as including “audio and video

transmission” .

equipment permitting two-way, real time interactive

communication” therefore excluding store and forward.

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

Center for Connected Health Policy

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.

Email/Phone/FAX

No reimbursement for email.

No reference found.

No reimbursement for telephone.

No reference found for FAX.

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

Online Prescribing

Only physicians certificated by a specialty board of the

No reference found.

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).

Consent

Physicians must inform telemedicine patients of the

No reference found.

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).

Location

No reference found.

Cross-State Licensing

A telemedicine license may be issued to out-of-state

No reference found.

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

Center for Connected Health Policy

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

No reference found.

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).

Site/Transmission Fee

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).

Center for Connected Health Policy

Maine

Medicaid Program: MaineCare

Medicaid Program Administrator: Maine Dept. of Health and Human Services

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine, as it pertains to the delivery of health

“Telehealth” is interactive, visual, real-time

care services, means the use of interactive audio, video

telecommunication, and must be a medically appropriate

or other electronic media for the purpose of diagnosis,

means of provider-patient interaction.

consultation or treatment. ‘Telemedicine’ does not

include the use of audio-only telephone, facsimile

Source: MaineCare Benefits Manual, General Administrative

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

machine or e-mail.”

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

(2012).

Live Video Reimbursement

Maine law requires coverage for services provided

MaineCare will reimburse for live video when there is a

through telemedicine, which includes live video.

compelling benefit for the patient in order for telehealth

services to be appropriate and related to physical, social

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

or geographic issues that make delivering the service in

person difficult. This includes:

(See Medicaid column & “Private Payers” section)

• 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:

Center for Connected Health Policy

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.

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).

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

Center for Connected Health Policy

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.

Cross-State Licensing

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to

No reference found.

contract terms and conditions..

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

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).

Center for Connected Health Policy

Maryland

Medicaid Program: MD Medical Assistance Program

Program Administrator: MD Dept. of Social Services

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth means the use of telecommunications and

No reference found.

information technologies for the exchange of information

from one site to another, for the provision of health care

to an individual from a provider through hardwire or

Internet connection.”

Source: MD Health Occupations Annotated Sec. 2-101 (2012).

”Telemedicine means, as it relates to the delivery of

health care services, the use of interactive audio, video,

or other telecommunications or electronic technology by

a licensed health care provider to deliver a health care

services at a site other than the site at which the patient

is located.”

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

Live Video Reimbursement

Maryland law requires private insurers to provide

The Maryland Medical Assistance Program reimburses

coverage for telemedicine services (subject to terms and

for live video for tele-mental health services in 10 rural

conditions of contract), which includes live video.

counties, under a pilot program.

(See “Private Payers” section).

Source: MD Medicaid Advisory Committee Meeting Minutes, p. 6

(Jun. 28, 2012).

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

Store and Forward Reimbursement

No reimbursement based upon definition of

No reference found.

“telemedicine” which describes telemedicine as

“interactive”.

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

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reference found.

Center for Connected Health Policy

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.

Consent

Telehealth providers must inform patients and

No reference found.

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).

Location

No reference found.

Cross-State Licensing

MD has exceptions to its MD-only licensed physicians

No reference found.

for physicians practicing in the adjoining states of

Delaware, Virginia, West Virginia, and Pennsylvania.

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

(2012).

Private Payers

Requires coverage of telemedicine services, subject to

No reference found.

contract terms and conditions.

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

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

Massachusetts

Medicaid Program: MassHealth

Program Administrator: MA Dept. of Health and Human Services

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

http://www.mass.gov/eohhs/docs/borim/policies-

Recent Policy Developments:

Massachusetts passed SB 2400 in 2012, which requires the MA Division of Insurance and Board of Registration in

Medicine to review out-of-state physician issues and develop recommendations for legislation to permit use of out-

of-state physicians for telemedicine.

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine as it pertains to the delivery of health care

No reference found.

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.

Live Video Reimbursement

Massachusetts law requires coverage of telemedicine

No reference found.

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).

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX ?

No Reimbursement for email.

No reference found.

No reimbursement for telephone.

No reimbursement for FAX.

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

(2012).

Online Prescribing

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Prior to any e-prescribing, there must be a physician-

No reference found.

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.

guidelines/policy-03-06.pdf

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to

No reference found.

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).

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

Michigan

Medicaid Program: Michigan Medicaid

Program Administrator: Michigan Dept. of Community Health

Regional Telehealth Resource Center:

Upper Midwest Telehealth Resource Center

2901 Ohio Boulevard, Ste. 110

Terre Haute, IN 47803

(855) 283-3734 ext. 232

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

”Telemedicine means the use of an electronic media to

“Telemedicine (also known as telehealth) is the use of

link patients with health care professionals in different

an electronic media to link beneficiaries with health

locations. To be considered telemedicine, the health

professionals in different locations. The examination of

care professional must be able to examine the patient

the beneficiary is performed via a real time interactive

via a real-time, interactive audio or video, or both,

audio and video telecommunications system. This

telecommunications system, and the patient must be

means that the beneficiary must be able to see and

able to interact with the off-site health care professional

interact with the off-site practitioner at the time services

at the time the services are provided.”

are provided via telemedicine.”

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

Source: MI Dept. of Community Health, Medicaid Provider

Manual, p. 397(Oct. 1, 2012).

Live Video Reimbursement

Michigan law states that “contracts shall not require

Michigan Medicaid reimburses for the following services

face-to-face contact between a health care professional

via live video:

and a patient for services appropriately provided through

telemedicine”, which includes live video.

• Consults;

• Office visits;

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

• Individual psychotherapy;

• Pharmacological management;

(See “Private Payers” section).

• End stage renal disease (ESRD) related

services. However, there must be at least one

in-person visit per month, by a physician, nurse

practitioner, or physician’s assistant, to examine

the vascular site for ESRD services.

Where face-to-face visits are required, telemedicine

services may be used in addition to the required face-to-

face visit, but cannot be used as a substitute.

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

1414 (Oct. 1, 2012).

The following health professionals may provide

telemedicine services:

• Physician;

• Osteopath;

• Podiatrist;

• Nurse practitioner;

• Nurse midwife;

Center for Connected Health Policy

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

Michigan Medicaid does not reimburse for store and

“telemedicine” which describes telemedicine as

forward based upon the definition of telemedicine which

occurring in “real time.

describes telemedicine as occurring in “real time”,.

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

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

397(Oct. 1, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX Restrictions

No reference found.

Online Prescribing

Providers must have an existing physician-patient

No reference found.

relationship.

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

Consent

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.

Center for Connected Health Policy

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.

Private Payers

Contracts shall not require face-to-face contact between

No reference found.

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).

Site/Transmission Fee

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).

Center for Connected Health Policy

Minnesota

Medicaid Program: Medical Assistance (MA)

Program Administrator: MN Dept. of Human Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center

University of Minnesota/Institute for Health Informatics

330 Diehl Hall

505 Essex Street S.E.

Minneapolis, MN 55455

(888) 239-7092

<www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine” is “the use of telecommunications to

furnish medical information and services. Telemedicine

consultations must be made via two-way, interactive

video or store-and-forward technology.”

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

and Professional Services,

CONVERSION&RevisionSelectionMethod=LatestReleased&dDoc

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

Live Video Reimbursement

(see Medicaid column)

Minnesota’s Medical Assistance program reimburses

live video for fee-for-service programs.

Prepaid health plans may choose whether to cover

telemedicine services.

Eligible services:

• Mental health services;

• Children’s Therapeutic Services and Supports

services;

• Occupational therapy;

• Physical therapy;

• Speech-language pathology.

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

Individualized Education Program

Services, www.dhs.state.mn.us/main/idcplg?IdcService=GET_DY

NAMIC_CONVERSION&RevisionSelectionMethod=LatestRelease

d&dDocName=dhs16_151385> (Accessed Oct. 30, 2012).

Telemedicine consults are limited to three per calendar

week per patient.

Payment is made to both the consulting physician and

the referring physician if the referring physician is

Center for Connected Health Policy

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).

Center for Connected Health Policy

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

No reference found.

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).

Consent

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

No reference found.

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)

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

Mississippi

Medicaid Program: Mississippi Medicaid

Program Administrator: Mississippi Division of Medicaid

Regional Telehealth Resource Center:

South Central Telehealth Resource Center

4301 W. Markham St. #519

Little Rock, AR 72205

(855) 664-3450

learntelehealth.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine is the practice of medicine using

No reference found.

electronic communication, information technology or

other means between a physician in one location and a

patient in another location with or without an intervening

health care provider. This definition does not include the

practice of medicine through postal or courier services.”

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

Live Video Reimbursement

(see Medicaid column)

There is live video reimbursement for Medicaid mental

health medication evaluation and management.

Source: Code of MS Rules 13-000-206 (2012).

Store and Forward Reimbursement

No reference found.

There is reimbursement for tele-radiology services,

however there is no reference to reimbursing for other

specialties.

Source: MS Div. of Medicaid, Provider Policy Manual,

Teleradioloy, p. 1, (Jan. 1, 2010).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

A prescription for a controlled substance based solely

An e-prescribed, telephoned or faxed prescription from

on a consumer's completion of an online medical

the prescriber may be accepted when it is not in conflict

questionnaire is not a valid prescription.

with federal and state laws and regulations.

Source: MS Code Annotated Sec. 41-29-137 (2012).

Source: MS Div. of Medicaid, Provider Policy Manual, Pharmacy,

p. 3, (Apr. 1, 2009).

Consent

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

The physician should obtain the patient's informed

No reference found.

consent before providing care.

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

Location

No reference found.

Cross-State Licensing

Physicians practicing telemedicine must have a

No reference found.

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).

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

To practice telemedicine, physicians must establish a

valid physician-patient relationship by the following:

Center for Connected Health Policy

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).

Center for Connected Health Policy

Missouri

Medicaid Program: HealthNet

Program Administrator: Missouri Dept. of Social Services

Regional Telehealth Resource Center:

Heartland Telehealth Resource Center

3901 Rainbow Blvd MS 1048

Kansas City, KS 66160

(877) 643-4872

heartlandtrc.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth, the use of medical information exchanged

“Telehealth means the use of medical information

from one site to another via electronic communications

exchanged from one (1) site to another via electronic

to improve the health status of a patient.”

communications to improve the health status of a

patient. Telehealth means the practice of health care

Source: MO Revised Statutes § 208.670 (2012).

delivery, evaluation, diagnosis, consultation, or

treatment using the transfer of medical data, audio

(also see Medicaid column)

visual, or data communications that are performed over

two (2) or more locations between providers who are

physically separated from the patient or from each

other.”

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

Telehealth Services are medical services provided

through advanced telecommunications technology from

one location to another. Medical information is

exchanged in real-time communication from an

originating site, where the participant is located, to a

distant site, where the provider is located, allowing them

to interact as if they are having a face-to-face, hands-on

session.

Source: MO HealthNet, Provider Manual, Behavioral Services,

Section 13, p. 65 (Oct 24, 2012).

Live Video Reimbursement

(see Medicaid column)

HealthNet will reimburse for live video.

Eligible providers:

• Physicians;

• Advanced registered nurse practitioners,

including nurse practitioners with a mental

health specialty;

• Psychologists.

Reimbursement to the provider at the distant site is

made at the same amount as for an in-person service.

Center for Connected Health Policy

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.

Email/Phone/FAX

No reference found.

Online Prescribing

Prescribing or dispensing drugs without sufficient

No reference found.

examination is prohibited.

Source: MO Revised Statutes § 334.100 (2012).

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

Center for Connected Health Policy

Montana

Medicaid Program: Montana Medicaid

Program Administrator: MT Dept. of Public Health and Human Services

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W

Billings, MT 59101

(888) 662-5601

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the practice of medicine by a

No reference found in Medicaid Manual.

physician located outside the state, who performs an

evaluative or therapeutic act relating to the treatment or

correction of a patient's physical or mental condition,

ailment, disease, injury, or infirmity, and who transmits

that evaluative or therapeutic act into Montana through

any means, method, device, or instrumentality under the

following conditions:

• The information or opinion is provided directly to

a patient in Montana for compensation or with

the expectation of compensation;

• The physician does not limit the physician's

services to an occasional case;

• The physician has an established or regularly

used connection with the state, including but not

limited to: (i) an office or another place for the

reception of a transmission from the physician;

(ii) a contractual relationship with a person or

entity in Montana related to the physician's

practice of medicine; or (iii) privileges in a

Montana hospital or another Montana health

care facility.”

Source: MT Code Annotated, § 37-3-342 (2011).

Live Video Reimbursement

No reference found.

Montana Medicaid will reimburse for live video services

when the consulting provider is enrolled in Medicaid.

The requesting provider need not be enrolled in

Medicaid nor be present during the telemedicine consult.

Source: MT Dept. of Public Health and Human Svcs., Medicaid

and Medical Assistance Programs Manual, Physician Related

Svcs., p 27 (Mar 2012).

Store and Forward Reimbursement

No reference found.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found in statute.

No reference found.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

Montana issues telemedicine licenses to out-of-state

No reference found.

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.

Private Payers

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

Center for Connected Health Policy

Nebraska

Medicaid Program: Nebraska Medicaid

Program Administrator: NE Dept. of Health and Human Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center

University of Minnesota/Institute for Health Informatics

330 Diehl Hall

505 Essex Street S.E.

Minneapolis, MN 55455

(888) 239-7092

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telehealth means the use of telecommunications

technology by a health care practitioner to deliver health

care services within his or her scope of practice to a

patient located at a site other than the site where the

patient is located.

Telehealth service means any contact between a patient

and a health care practitioner relating to the health care

diagnosis or treatment of such patient through

telehealth, but does not include a telephone

conversation, electronic mail message, or facsimile

transmission between a health care practitioner and a

patient or a consultation between two health care

practitioners.”

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

Live Video Reimbursement

(see Medicaid column)

Nebraska Medicaid stipulates in-person contact is not

required for reimbursable services under the Medicaid

program, subject to reimbursement policies developed.

This policy also applies to managed care plans who

contract with the Department only to the extent that:

• Services delivered via telehealth are covered

and reimbursed under the fee-for-service

program and

• Managed care contracts are amended to add

coverage of services delivered via telehealth

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:

Center for Connected Health Policy

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.

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

Prescriptions over the Internet: Neither the prescribing

met, based solely on answers to questions provided by

health care practitioner service nor the pharmacy

the internet, telephone, or FAX, or without first

service is covered when the health care practitioner

establishing a proper physician-patient relationship, is

prescribing the medication has only reviewed an e-mail

prohibited.

message or e-mail questionnaire about the client.

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

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

(also see Medicaid column)

Consent

Written patient consent required prior to any service

Written consent required before initial service delivery.

delivery.

Must include this information:

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

• The patient may refuse the service at any time

with no loss of future treatment or program

(also see Medicaid column)

benefits patient is otherwise entitled to;;

• A list of alternative care options, including in-

person services;;

Center for Connected Health Policy

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.

Private Payers

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

Center for Connected Health Policy

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

Center for Connected Health Policy

Nevada

Medicaid Program: Nevada Medicaid

Program Administrator: Division of Health Care Financing and Policy (DHCFP)

Regional Telehealth Resource Center:

Southwest Telehealth Resource Center

PO Box 245105

Tucson, AZ 85724

(520) 626-4498

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Telemedicine means the practice of osteopathic

“Telehealth is the use of a telecommunications system

medicine through the synchronous or asynchronous

to substitute for an in-person encounter for professional

transfer of medical data or information using interactive

consultations, office visits, office psychiatry services,

audio, video or data communication, other than through

and a limited number of other medical services.”

a standard telephone, facsimile transmission or

electronic mail message.”

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

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

Source: NV Revised Statutes Annotated Sec. 633.165 (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:

Center for Connected Health Policy

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.

Email/Phone/FAX

No reimbursement for email.

No reference found for email.

No reimbursement for telephone.

No reimbursement for telephone, except psychiatric

No reimbursement for FAX.

treatment in crisis intervention.

No reference found for FAX.

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

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

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

Online Prescribing

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).

Center for Connected Health Policy

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

No reference found.

physicians for telemedicine services.

Physicians must:

• Hold a full, unrestricted license in another state;

• Not have any disciplinary or other action taken

by any state or jurisdiction;

• Be certified by the American Board of Medical

Specialties.

Source: NV Revised Statutes Sec. 630.261(e).

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Before an osteopathic physician may use telemedicine:

Telehealth services do not require prior authorization.

However, individual services may require prior

• A bona fide relationship between the osteopathic

authorization, whether delivered in person or by

physician and the patient must exist which must

telehealth.

include, without limitation, a history and physical

examination or consultation which occurred in person

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

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

and which was sufficient to establish a diagnosis and

identify any underlying medical conditions of the

patient.

Center for Connected Health Policy

New Hampshire

Medicaid Program: New Hampshire Medicaid

Program Administrator: Dept. of Health and Human Services

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Telemedicine, as it pertains to the delivery of health

No reference found.

care services, means the use of audio, video, or other

electronic media for the purpose of diagnosis,

consultation, or treatment. Telemedicine does not

include the use of audio-only telephone or facsimile.”

Source: NH Revised Statutes Annotated, 415-J:2 (2012).

Live Video Reimbursement

New Hampshire statute states that insurers may not

No reference found.

deny coverage for services provided through

telemedicine, which includes live video.

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

(See “Private Payers” section).

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found for email.

No reference found.

No reimbursement for telephone.

No reimbursement for FAX.

Source: NH Revised Statutes Annotated, 415-J:2 (2012).

Online Prescribing

A physician-patient relationship requires an in-person

No reference found.

exam. Prescribing drugs to individuals without a

physician-patient relationship is prohibited, except

under the following conditions:

• Writing admission orders for a newly

hospitalized patient;

Center for Connected Health Policy

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.

Location

No reference found in statute.

No reference found.

Cross-State Licensing

No reference found.

Private Payers

Insurers may not deny coverage for services provided

No reference found.

through telemedicine, if the services are covered

through in-person consults.

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

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

New Jersey

Medicaid Program: New Jersey Medicaid

Program Administrator: New Jersey Dept. of Human Services

Regional Telehealth Resource Center

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

Live Video Reimbursement

No reference found.

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

New Mexico

Medicaid Program: New Mexico Medicaid

Medicaid Program Administrator: New Mexico Human Services Dept., Medical Assistance Division (MAD)

Regional Telehealth Resource Center:

Southwest Telehealth Resource Center

PO Box 245105

Tucson, AZ 85724

(520) 626-4498

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the practice of medicine across

No reference found.

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).

Live Video Reimbursement

New Mexico statute encourages the use and

New Mexico Medicaid will reimburse for live video for

reimbursement of telehealth, which includes live video.

the following covered services:

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

• Consultations;

• Evaluation and management services;

(also see Medicaid column)

• Individual psychotherapy;

• Pharmacologic management;

• Psychiatric diagnostic interview examinations;

• End-stage renal disease related services;

Center for Connected Health Policy

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

New Mexico Medicaid states that a telehealth

Store and Forward.

communication system must occur in ‘real-time’.

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

Source: NM Human Svcs. Dept., Medical Assistance Division,

Program Policy Manual, Section 8.310.13.12(A) (Aug. 1, 2007).

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX Restrictions

No reference found.

Online Prescribing

Physicians are prohibited from prescribing, dispensing

No reference found.

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).

Consent

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

Center for Connected Health Policy

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

When the originating site is in New Mexico and the

full, unrestricted license in another state.

distant site is outside New Mexico, the distant-site

provider at the distant site must be licensed in New

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

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.

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:

Center for Connected Health Policy

New York

Medicaid Program: New York Medicaid

Mediaid Program Administrator: New York State Dept. of Health

Regional Telehealth Resource Center

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

<http://www.health.ny.gov/health_care/medicaid/program/update/

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the delivery of clinical health care

“Telemedicine is the use of interactive audio and video

services by means of real time two-way electronic audio-

telecommunications technology to support "real time"

visual communications which facilitate the assessment,

interactive patient care and consultations between

diagnosis, consultation, treatment, education, care

healthcare practitioners and patients at a distance. The

management and self management of a patient's health

distant site or "hub" is where the medical specialist

care, while such patient is at the originating site and the

providing the consultation or service is located. The

health care provider is at a distant site.”

originating site or "spoke" is where the referring health

professional and patient are located.”

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

Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume

2011/2011-09.htm#ln2> Accessed Nov. 1, 2012.

Live Video Reimbursement

No reference found.

New York Medicaid will reimburse for live video services

for medically necessary services provided to patients in:

• Hospitals (emergency room, outpatient department,

Inpatient) established under Article 28 of the New

York Public Health Law;

• Diagnostic and Treatment Centers (D&TCs)

established under Article 28 of the New York Public

Health Law;

• FQHCs that have "opted into" NY Medicaid

Ambulatory Patient Groups (APG);

• Non-FQHC School Based Health Centers (SBHCs).

Providers who may deliver telemedicine services

include:

• Physician specialists, including psychiatrists;

• Certified Diabetes Educators (CDEs);

• Certified Asthma Educators (CAEs or A-ECs).

Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume

<http://www.health.ny.gov/health_care/medicaid/program/update/

2011/2011-09.htm#ln2> Accessed Nov. 1, 2012.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Store and Forward Reimbursement

New York’s definition of “telemedicine” which describes

Store and forward is not reimbursed.

telemedicine as “real time two-way electronic audio-

visual communications”, excludes store and forward.

Source: NY Dept. of Health, 2011 DOH Medicaid Updates, Volume

<http://www.health.ny.gov/health_care/medicaid/program/update/

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

2011/2011-09.htm#ln2> Accessed Nov. 1, 2012.

Remote Patient Monitoring Reimbursement

Demonstration rates of payment or fees shall be

Please see “Comments” section.

established for telehealth services provided by a

certified home health agency, a long term home health

care program or AIDS home care program, or for

telehealth services by a licensed home care services

agency under contract with such an agency or program,

in order to ensure the availability of technology-based

patient monitoring, communication and health

management. Reimbursement is provided only in

connection with Federal Food and Drug Administration-

approved and interoperable devices that are

incorporated as part of the patient’s plan of care.

Source: NY Consolidated Law Service Public Health Sec. 3614.

Email/Phone/FAX

No reference found.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

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

Center for Connected Health Policy

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

<http://www.health.ny.gov/health_care/medicaid/program/update/

2011/2011-09.htm#ln2> Accessed Nov. 1, 2012.

Comments: New York is in the process of updating its Medicaid reimbursement policies for telehealth.

New York began implementation of a Home Health program to serve those with complex medical,

behavioral, and long term care needs. Health Home is a care management service model whereby

all of an individual's caregivers communicate with one another so that all of a patient's needs are

addressed in a comprehensive manner. This is done primarily through a "care manager" who

oversees and provides access to all of the services an individual needs to assure that they receive

everything necessary to stay healthy, out of the emergency room and out of the hospital. Health

records are shared (either electronically or paper) among providers so that services are not

duplicated or neglected. The health home services are provided through a network of organizations

- providers, health plans and community-based organizations. When all the services are considered

collectively they become a virtual "Health Home."

Source: NY Dept. of Health, Medicaid Health Homes <

http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/> Accessed February 3, 2013.

Telemedicine/telehealth reimbursement in managed care is optional. A review of Web resources of

18 MMC Plans reveals policy statements of telemedicine coverage for at least the following

insurance providers:

•

Amerigroup New York

•

BlueCross Blue Shield of Western New York

•

MVP Health Plan

•

United Healthcare

•

Univera Community Health

•

WellCare of New York

Source: Northeast Telehealth Resource Center.

Center for Connected Health Policy

North Carolina

Medicaid Program: North Carolina Medicaid

Medicaid Program Administrator: Dept. of Health and Human Services, Division of Medical Assistance

Regional Telehealth Resource Center:

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

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.

Center for Connected Health Policy

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.

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.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Online Prescribing

No reference found.

Consent

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.

Private Payers

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.

Center for Connected Health Policy

North Dakota

Medicaid Program: North Dakota Medicaid

Medicaid Program Administrator: North Dakota Dept. of Human Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center

University of Minnesota/Institute for Health Informatics

330 Diehl Hall

505 Essex Street S.E.

Minneapolis, MN 55455

(888) 239-7092

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

North Dakota uses federal definitions for "internet" and

No reference found.

"practice of telemedicine" set in the Ryan Haight Online

Pharmacy Consumer Protection Act of 2008.

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

“Telemedicine means the practice of medicine by a

practitioner, other than a pharmacist, who is at a location

remote from the patient, and is communicating with the

patient, or health care professional who is treating the

patient, using a telecommunications system.”

Source: Ryan Haight Online Pharmacy Consumer Protection Act

of 2008 [Pub. L. 110-425; 21 U.S.C. 802-803].

Live Video Reimbursement

North Dakota’s Worker Compensation Act provides

North Dakota Medicaid will reimburse for live video

reimbursement for live video.

services as long as the patient is present during the

service.

Eligible services:

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

Providers, Medicaid and Other Medical Assistance Programs, p.

• Office or other outpatient visits;

129 (Apr. 2012).

• New evaluation visits and established

management visits;

Both originating-site and distant-site physicians may bill

• Individual psychotherapy visits;

for services. There is no separate reimbursement for

• Pharmacologic management visits.

supplies.

The patient must be present and participate in the

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

appointment.

Providers, Medicaid and Other Medical Assistance Programs, p.

129 (April 2012).

The professional fee is equal to comparable in-person

There is reimbursement for long-distance charges

services.

required for out-of-network sites.

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

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

Providers, Medicaid and Other Medical Assistance Programs, p.

129 (April 2012).

Center for Connected Health Policy

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.

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

No reference found.

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.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

The ND Medical Board may engage in reciprocal

No reference found.

licensing agreements with out-of-state licensing

agencies, but is not required to do so.

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

Private Payers

No reference found.

Site/Transmission Fee

Under the Worker’s Compensation Act, the originating

No reference found.

sites may receive a facility fee, not to exceed $20.

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

Miscellaneous

Center for Connected Health Policy

Ohio

Medicaid Program: Ohio Medicaid

Medicaid Program Administrator: Ohio Department of Job and Family Services

Regional Telehealth Resource Center:

Upper Midwest Telehealth Resource Center

2901 Ohio Boulevard, Ste. 110

Terre Haute, IN 47803

(855) 283-3734 ext. 232

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“The practice of telemedicine means the practice of

No reference found.

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.

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.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

A physician shall not prescribe, dispense, or provide any

No reference found.

dangerous drug, which is not a controlled substance, to

a person who the physician has never personally

physically examined and diagnosed.

Eligible exceptions:

• The physician is providing care in consultation

with another physician, who has an ongoing

professional relationship with the patient, and

who has agreed to supervise the patient’s use of

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

the drug or drugs to be provided, and the

physician’s care of the patient meets all

applicable standards of care;

• In institutional settings;

• On-call situations;

• Cross-coverage situations;

• Situations involving new patients;

• Protocol situations;

• Situations involving nurses practicing in

accordance with standard care arrangements.

Source: OH Admin. Code 4731-11-09.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

Ohio issues telemedicine certificates that allow the

No reference found.

holder to engage in the practice of telemedicine in the

state.

Providers with telemedicine certificates cannot practice

in OH without a special activity certificate.

Source: OH Revised Code Annotated, Sec. 4731.296(C).

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

Oklahoma

Medicaid Program: SoonerCare

Medicaid Program Administrator: Oklahoma Health Care Authority

Regional Telehealth Resource Center:

Heartland Telehealth Resource Center

3901 Rainbow Blvd MS 1048

Kansas City, KS 66160

(877) 643-4872

heartlandtrc.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Telemedicine means the practice of health care

"Telehealth means the use of telecommunication

delivery, diagnosis, consultation, treatment, including but

technologies for clinical care (telemedicine), patient

not limited to, the treatment and prevention of strokes,

teaching and home health, health professional education

transfer of medical data, or exchange of medical

(distance learning), administrative and program

education information by means of audio, video, or data

planning, and other diverse aspects of a health care

communications. Telemedicine is not a consultation

delivery system.”

provided by telephone or facsimile machine.”

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

Source: OK Statutes, Title 36, Sec. 6802.

"Telemedicine means the practice of health care

(also see Medicaid column)

delivery, diagnosis, consultation and treatment and the

transfer of medical data through interactive audio, video

or data communications that occur in the real-time or

near real-time and in the physical presence of the

member.”

Source: OK Admin. Code Sec. 317:30-3-27 (b)(8).

Live Video Reimbursement

Oklahoma statute requires coverage of telemedicine

SoonerCare (Oklahoma’s Medicaid program)

services, which includes live video, by health care

reimburses for live video if the health care provider

service plans, disability insurer programs, workers’

determines the service to be appropriately provided via

compensation programs, and state Medicaid managed

telemedicine. This applies to health care service plans,

care program contracts, subject to contract terms and

disability insurer programs, workers’ compensation

conditions.

programs or state Medicaid managed care program

contracts.

Source: OK Statute, Title 36 Sec. 6803.

Eligible services:

(see Medicaid column & “Private Payers” section)

• Consultations;

• Office visits;

• Individual psychotherapy;

• Psychiatric diagnostic interview examinations

and testing;

• Mental health assessments;

• Pharmacologic management.

Eligible distant-site providers:

Center for Connected Health Policy

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.

Email/Phone/FAX

No reference found for email.

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

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

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

(also see Medicaid column)

Online Prescribing

Prescribing or administering a drug or treatment without

No reference found.

Center for Connected Health Policy

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

Written consent required.

any telemedicine services. The provider who is in

physical contact with the patient shall obtain this

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

consent.

Source: OK Statute, Title 36 Sec. 6804.

(also see Medicaid column)

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.

Private Payers

Requires coverage of telemedicine services by health

No reference found.

care service plans, disability insurer programs, workers’

compensation programs, and state Medicaid managed

care program contracts, subject to contract terms and

conditions.

Center for Connected Health Policy

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.

Comments: The OK Dept. of Health has begun to develop a statewide telemedicine network.

Oklahoma Statutes, Title 63 Sec. 1-2702.

Center for Connected Health Policy

Oregon

Medicaid Program: Oregon Medicaid

Medicaid Program Administrator: Oregon Health Authority

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W

Billings, MT 59101

(888) 662-5601

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

Oregon law requires insurers to cover telemedicine

“Telemedicine is the use of medical information,

services.

exchanged from one site to another, via telephonic or

electronic communications, to improve a patient’s health

“Telemedical means delivered through a two-way video

status.”

communication that allows a health professional to

interact with a patient who is at an originating site.”

Source: OR Div. of Medical Assistance Program, Medical-Surgical

Svcs. Rulebook, Div. 130, 410-130-0610, p. 75 (Jan. 1, 2012).

Source: OR Revised Statutes Sec. 743A.058.

Live Video Reimbursement

Oregon statute requires coverage of telemedicine

Oregon Medicaid will reimburse for live video when

services (which includes live video), subject to contract

billed services comply with their billing requirements.

terms and conditions.

The referring provider is not required to be present with

Source: OR Revised Statutes Sec. 743A.058.

the client for the consult.

(See “Private Payers” section)

The referring provider may bill for the patient visit only if

a separately identifiable visit is performed.

Source: OR Div. of Medical Assistance Program, Medical-Surgical

Svcs. Rulebook, Div. 130, 410-130-0610, p. 77 (Jan. 1, 2012).

Store and Forward Reimbursement

No reference found.

Oregon Medicaid does not reimburse for store and

forward.

Source: OR Dept. of Human Svcs., Div. of Medical Assistance

Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-

0610 (2)(a), p. 78 (Jul. 1, 2007).

Remote Patient Monitoring Reimbursement

Oregon requires out of state physicians to acquire active

No reference found.

tele-monitoring status through the Oregon Medical

Board before they can perform intraoperative

telemonitoring on patients during surgery.

The Administrative Code defines ”tele-monitoring” as the

“intraoperative monitoring of data collected during

surgery and electronically transmitted to a physician who

Center for Connected Health Policy

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 email and telephone when used for patient

Yes for telephone.

consulting and “when billed services comply with the

No reference found for FAX.

practice guidelines set forth by the Health Service

Commission (HSC), applicable HSC approved CPT

Email and telephone consults must comply with Health

code requirements and delivered consistent with the

Service Commission guidelines.

HSC practice guideline.”

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

Email, telephone and fax may be used when

videoconferencing availability is limited.

Source: OR Div. of Medical Assistance Programs, Medical-

Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 76 (Jan. 1,

2012).

Online Prescribing

A physician must first:

No reference found.

• Establish a physician-patient relationship;

• Make a judgment based on some type of

objective criteria upon which to diagnose, treat,

correct or prescribe;

• Act in the best interest of the patient.

Writing prescriptions based only on an Internet sale or

consults prohibited.

Source: OR Admin. Rules, 847-025-0000.

Consent

No reference found.

Location

Originating sites include but are not limited to:

No reference found.

• Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers;

Center for Connected Health Policy

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

The referring and evaluating practitioner must be

across state lines in Oregon, as long as they are fully

licensed to practice medicine within the state of Oregon

licensed in another state and meet certain requirements.

or within the contiguous area of Oregon and must be

enrolled as a Division of Medical Assistance Programs

Source: OR Revised Statutes Annotated Sec. 677.139.

(Division) provider.

(also see Medicaid column)

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

Private Payers

Oregon requires coverage of telemedicine services,

No reference found.

subject to contract terms and conditions.

Plans may not distinguish between originating sites that

are rural and urban in providing coverage.

Source: OR Revised Statutes Sec. 743A.058.

A health benefit plan must provide coverage in

connection with the treatment of diabetes if:

• If coverage is provided for in-person services

• The service is medically necessary;

• The service relates to a specific patient; and

• One of the participants in the telemedical health

service is a representative of an academic

health center.

Source: OR Revised Statutes Sec. 743A.185.

Site/Transmission Fee

(see Medicaid column)

Oregon Medicaid will provide transmission fees for

originating sites.

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

Miscellaneous

Center for Connected Health Policy

Pennsylvania

Medicaid Program: Pennsylvania Medical Assistance Program (MA)

Medicaid Program Administrator: Department of Public Welfare

Regional Telehealth Resource Center:

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

Live Video Reimbursement

No reference found.

Pennsylvania Medicaid will reimburse for live video for

specialty consultations.

Source: PA Ofc. of the Governor, Press Release, May 22, 2012.

Store and Forward Reimbursement

No reference found.

Pennsylvania Medicaid will not reimburse for store and

forward.

Source: PA Ofc. of the Governor, Press Release, May 22, 2012.

Remote Patient Monitoring Reimbursement

No reference found.

See “Comments” section below.

Email/Phone/FAX

No reference found.

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

Source: PA Ofc.fice of the Governor, Press Release, May 22,

2012.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

Pennsylvania issues extraterritorial licenses to

No reference found.

physicians residing or practicing in an adjoining state,

Center for Connected Health Policy

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.

Site/Transmission Fee

No reference found.

Miscellaneous

Comments: A new 2012 Medicaid regulation requires that telemedicine consults be a two-way, real time

interactive communication and use, at a minimum, interactive audio and video equipment to connect

the patient and the physician at the distant site. It bars telephones and asynchronous “store and

forward” technology, such as FAX machines, email systems or remote patient monitoring devices.

PA also removed Medicaid requirement that the referring provider be present for consults, and will

allow patients to access the consult at either the originating site of the referring provider or other

participating providers.

Pennsylvania Department of Aging , Office of Long Term Aging, offers “TeleCare” services under the

Aging and Waiver program. “TeleCare” is a model of service that uses technology with services that

allows people with chronic conditions to remain independent. In-home technology is used to provide

services. Health status measuring and monitoring; activity and sensor monitoring; and medication

dispensing and monitoring are used in the program.

Source: PA Dept. of Aging, Office of Long Term Aging, APD #09-01-05, Oct. 1, 2009.

Center for Connected Health Policy

Rhode Island

Medicaid Program: Rhode Island Medical Assistance Program

Medicaid Program Administrator: Rhode Island Dept. of Human Services

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

Live Video Reimbursement

No reference found.

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensure

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Center for Connected Health Policy

South Carolina

Medicaid Program: South Carolina Medicaid

Medicaid Program Administrator: South Carolina Health and Human Services Dept.

Regional Telehealth Resource Center:

Southeast Telehealth Resource Center

PO Box 1408

Waycross, GA 31501

(888) 138-7210

http://www1.scdhhs.gov/openpublic/insidedhhs/bureaus/BureauofLongTermCareServices/telemonitoring.asp >

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

South Carolina law addresses telemedicine under

“Telemedicine is the use of medical information about a

veterinary services, stating, “telemedicine is an audio,

patient that is exchanged from one site to another via

video, or data communication of medical information.”

electronic communications to provide medical care to a

patient in circumstances in which face-to-face contact is

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

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:

Center for Connected Health Policy

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

No reference found.

must establish a proper physician-patient relationship.

Requirements are:

• Personally performing and documenting an

Center for Connected Health Policy

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.

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

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reference found.

Private Payers

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

Comments: In 2011, a new state law, SCSB 588, established a statewide system of stroke care. It requires the

Department of Health and Environmental Control to distribute to emergency medical services

providers a list of primary stroke centers, telemedicine stroke centers, and other certified programs.

The Bureau of Long Term Care Services offers Telemonitoring. The objectives of the

Telemonitoring service are to maintain and promote the health status of Medicaid home and

community-based waiver participants through medical telemonitoring of body weight, blood pressure,

oxygen saturation, blood glucose levels, and basic heart rate information.

Source: SC Health and Human Svcs., Bureau of Long Term Care Services,

Accessed Feb. 3, 2013.

Center for Connected Health Policy

South Dakota

Medicaid Program: South Dakota Medicaid

Medicaid Program Administrator: South Dakota Dept. of Social Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center

University of Minnesota/Institute for Health Informatics

330 Diehl Hall

505 Essex Street S.E.

Minneapolis, MN 55455

(888) 239-7092

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine is the real time or near real time two-way

transfer of medical data and information between two

medical entities.

Medical data exchange can take the form of multiple

formats: text, graphics, still images, audio, and video.

The information/data exchange can occur in real time

(synchronous) through interactive video or multimedia

collaborative environments or in near real time

(ascynchronous) through so-called “store and forward”

applications such as email, fax, or phone-mail.”

Source: SD Medical Assistance Program, Professional Svcs.

Manual, p. 21 (Sept. 20, 2012).

Live Video Reimbursement

No reference found.

South Dakota Medicaid will reimburse for the following

services:

(also see Medicaid column)

• Consultation services;

• Follow-up office visits for established patients;

• Pharmacological management services by a

physician.

Coverage of telemedicine consults is treated like any

other consult service as defined in the Physician’s

Current Procedural Terminology (CPT).

Source (authorization and eligible services): SD Medical

Assistance Program, Professional Svcs. Manual, p. 21 (Sept. 20,

2012).

Source (pharmacological management): SD Administrative Rules

46:20:32:08.

Store and Forward Reimbursement

No reference found.

South Dakota Medicaid will reimburse for store and

Center for Connected Health Policy

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.

Online Prescribing

No reference found.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

COMMENTS: South Dakota’s Department of Health and Human Services, Adult Services and Aging offers

reimbursement for a home based monitoring system that monitors an individual's clinical data daily;

such as heart rate, blood pressure, oxygen saturation, temperature, weight and can be a medication

reminder depending on the unit available.

In addition to meeting other eligibility criteria, program specific eligibility for this service includes:

1. Either the individual’s inability to complete two activities of daily living without personal

assistance, standby assistance, supervision/cues and/or assistive devices;

2. Or the individual’s behavior poses a serious health or safety hazard to self and requires

substantial supervision due to a cognitive impairment; AND

3. The individual may have frequent hospitalizations or emergency room visits, difficulty getting to a

medical facility, medical condition(s) which requires frequent monitoring and those who may live

alone in a rural setting where it is difficult to receive prompt medical care.

Program eligibility and individual need must be determined utilizing the South Dakota Assessment

prior to the authorization of services. Staff determine if Telehealth can be accessed through other

resources, such as Medicare, and is not available through any other funding source.

Center for Connected Health Policy

Once eligibility and need have been determined, Telehealth may be authorized for an individual

subject to the following guidelines:

• Telehealth becomes a part of the $750 per month maximum care plan.

• The Monitoring Unit* required by individual

o Initial set up fee;

o BASIC or Advanced Unit*; *Discuss with the provider the type of unit available. Some

providers may include the oximeter as a part of the Basic unit. An Advanced Unit may

include a glucometer or other such monitoring devices.

o Nurse Visit -- if required by client as a result of Telehealth monitoring.

• Household’s resources may not exceed $40,000 for an individual and $45,000 for a married

couple.

• Individual will participate in the cost of the program through the cost share process whether

offered as a single service or provided in combination with other ASA services.

Appropriate Individual:

Individuals must be cognitively alert to manage the system and their ability to operate the system

should be required as a result of the monitoring device. Disease management and improving client

outcomes is the goal of the service.

Individuals with the following health conditions are the most appropriate for Telehealth:

• Congestive Heart Failure or other heart conditions

• Diabetes

• Hypo/Hypertension

• Chronic Obstructive Pulmonary Disease

• Other precarious health conditions that can be monitored safely through the system.

Cost Share:

If Telehealth is provided in combination with any other ASA services, the individual will be informed

of the total cost of the services and asked to cost share towards the total amount.

Services NOT available with Telehealth:

• Purchase price of the equipment.

• Equipment available through other state or federal programs.

• Liability for equipment damage while in individual’s home.

Telehealth Monitoring:

• Clinical data to be reviewed daily by a licensed nurse.

• Monitoring system set up in eligible individual’s home by provider or trained technician.

• Training video may be available for identified staff, ASA or Provider, on how to set up equipment

or check it during a home visit.

• Follow up calls to identified resources/professionals by provider.

• Home visits by provider to reprogram the device or change the settings of the monitor as required

by the individual’s health status.

• Optional Nurse assessment if monitoring warrants a visit. If a nurse assessment is warranted, the

provider will:

o Assess the individual’s health status and document findings as an official part of the case file;

o Make recommendations to the ASA Specialist regarding the individual’s ability to remain at

home and the need for services;

o Identify nursing problems and establish a tentative nursing plan of care;

Center for Connected Health Policy

o Assist in the development of the “Individual Care Plan” with the ASA Specialist and individual,

after the individual has been determined to be eligible;

o Review all prescription and over-the-counter medication (dosage, route, and frequency) taken

by the individual and any other nursing care needed by the client which can be verified by the

individual’s physician;

o Obtain a signed copy of the “Individual Care Plan” from the ASA Specialist;

o Complete documentation each time the client is provided nursing tasks;

o Provide nursing services in accordance with the individual’s needs and scope of nursing

license of the nurse providing care.

• Depending on Provider system used, there might be a website link that ASA Specialist and

authorized family and physician can access the clinical information.

• ASA Specialist may be provided with a monthly progress report of how the individual is doing.

Routinely an individual is not provided with a report unless there are clinical issues identified. The

Provider Nurse may be requested to call or send information in writing to the individual, or a family

member, on a routine schedule to provide an update. ASA Specialist should work closely with the

Telehealth provider to request this report as needed.

Source: SD Dept. of Social Services, Dept. of Adult Services & Aging, Telehealth Technology

http://dss.sd.gov/elderlyservices/services/telehealth.asp > (Accessed Feb. 3, 2013).

Center for Connected Health Policy

Tennessee

Medicaid Program: TennCare

Medicaid Program Administrator: Dept. of Human Services

Regional Telehealth Resource Center:

South Central Telehealth Resource Center

4301 W. Markham St. #519

Little Rock, AR 72205

(855) 664-3450

learntelehealth.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telehealth is the use of electronic information and

telecommunication technologies to support clinical care

between an individual with mental illness and/or

substance abuse issues and a healthcare practitioner.”

“Telehealth systems provide a live, interactive audio-

video communication or videoconferencing connection

between the individual in need of services and the crisis

service delivery system.”

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

4, (July 2012).

Live Video Reimbursement

No reference found.

TennCare will reimburse for live video for crisis-related

services.

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

4, (July 2012).

Store and Forward Reimbursement

No reference found.

TennCare will not reimburse for store and forward based

upon definition of “telehealth systems” which describes it

as “live interactive video”,.

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

4, (July 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

Online Prescribing

Prior to online or telephone prescribing, providers must

No reference found.

document and:

Center for Connected Health Policy

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.

Cross-State Licensing

Tennessee may issue telemedicine licenses to board-

No reference found.

certified physicians from out of state.

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

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Miscellaneous

Comment:

In 2011, Tennessee passed a Joint Resolution that encouraged the use and payment for telemedicine.

The resolution is not law and has no legal or binding power.

Tennessee 2011 Bill Text, House Joint Resolution 58.

Center for Connected Health Policy

Texas

Medicaid Program: Texas Medicaid

Medicaid Program Administrator: Texas Health and Human Services Commission

Regional Telehealth Resource Center:

TexLa Telehealth Resource Center

3601 4^th Street, Ste. 2B440

Lubbock, TX 79430

(806) 743-4440 / (877) 391-0487

http://www.texlatrc.org

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telemedicine is “the use of health care information

“Telemedicine is defined as the practice of health-care

exchanged from one site to another via electronic

delivery by a provider who is located at a site other than

communications for the health and education of the

the site where the client is located. Telemedicine

individual or provider, and for the purpose of improving

requires the use of advanced telecommunications

patient care, treatment, and services.”

technology and is used for the purposes of evaluation,

diagnosis, consultation, or treatment.”

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

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

Speech-Language Pathology and Audiology

2013).

Telehealth is “the use of telecommunications and

"Telehealth service" means a health service, other than

information technologies for the exchange of information

a telemedicine medical service, that is delivered by a

from one site to another for the provision of speech-

licensed or certified health professional acting within the

language pathology or audiology services to an

scope of the health professional's license or certification

individual from a provider through hardwire or internet

who does not perform a telemedicine medical service

connection.”

and that requires the use of advanced

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

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.

Center for Connected Health Policy

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.

Center for Connected Health Policy

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

Center for Connected Health Policy

STATE LAW/REGULATIONS

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

No reimbursement for email.

reimbursement for correspondence only, e.g., mail,

No reimbursement for telephone.

email, or FAX, although they may be adjuncts to tele-

No reimbursement for FAX.

practice.

No reimbursement for chart review.

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

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

2013).

Online Prescribing

Treatment and consultation recommendations made in

No reference found.

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.

Consent

Consent required prior to telemedicine or telehealth

No reference found.

services.

Either originating or distant site health professionals

shall obtain this consent.

Source: TX Occupational Code Sec. 111.002.

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.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

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

No reference found.

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.

Private Payers

Requires coverage of telemedicine services, subject to

No reference found.

contract terms and conditions.

Source: TX Insurance Code Sec. 1455.004.

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.

Center for Connected Health Policy

Utah

Medicaid Program: Utah Medicaid

Medicaid Program Administrator: Utah Dept. of Health

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W

Billings, MT 59101

(888) 662-5601

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Digital health service means the electronic transfer,

No reference found.

exchange, or management of related data for diagnosis,

treatment, consultation, educational, public health, or

other related purposes.”

Source: UT Code Annotated Sec. 26-9f-102.

Live Video Reimbursement

(see Medicaid column)

Utah’s Medical Assistance Program recognizes

“communication by telemedicine as face to face contact

between a health care provider and a patient.”

Reimbursement may be based on:

• A monthly reimbursement rate;

• A daily reimbursement rate; or

• An encounter rate.

Source: UT Code Annotated Sec. 26-18-13.

There is also live video reimbursement for psychiatry.

Eligible services:

• Live video evaluations of rural residents,

conducted by a qualified prescriber, to

determine need for medication prescription;

• Pharmacologic management services for rural

residents, where distance and travel time

create difficulty with access.

No reimbursement for originating site providers.

Source: UT Div. of Medicaid and Health Financing, Utah Medicaid

Provider Manual, Mental Health Centers/Prepaid Mental Health

Plans, p. 16 (Oct 2012).

Store and Forward Reimbursement

No reference found.

Center for Connected Health Policy

STATE LAW/REGULATIONS

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.

Online Prescribing

Providers must first obtain information in the usual

No reference found.

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.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

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

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

An out-of-state physician may practice without a Utah

No reference found.

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.

Private Payers

No reference found.

Site/Transmission Fee

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.

Center for Connected Health Policy

Vermont

Medicaid Program: Vermont Medicaid

Medicaid Program Administrator: State Dept. of Vermont Health Access, under the Agency of Human Services.

Regional Telehealth Resource Center:

Northeast Telehealth Resource Center

11 Parkwood Drive

Augusta, ME 04330

(207) 622-7566 / (800) 379-2021

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

"Telemedicine means the delivery of health care

Telemedicine is defined in Act 107 as “…the delivery of

services such as diagnosis, consultation, or treatment

health care services…through the use of live interactive

through the use of live interactive audio and video over a

audio and video over a secure connection that complies

secure connection that meets Health Insurance

with the requirements the Health Insurance Portability

Portability and Accountability Act (HIPAA) requirements.

and Accountability Act of 1996, Public Law 104-191.

Telemedicine does not include the use of audio-only

telephone, e-mail, or facsimile.”

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

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

1, 2013).

Live Video Reimbursement

Private payers must reimburse for live video.

Live video is reimbursed.

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

Originating site providers are required to document the

reason the service is being provided by telemedicine

(See “Private Payers” section)

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-

No reimbursement for tele-ophthalmology or tele-

ophthalmology and tele-dermatology.

dermatology; no reference to other store and forward

technologies.

Allows payers to require the distant site provider to

document the reason the services are being provided by

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

1, 2013).

store and forward.

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

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reimbursement for telephone.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

No reimbursement for FAX.

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

1, 2013).

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

Online Prescribing

Providers may prescribe, dispense, or administer drugs

No reference found.

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).

Consent

Originating site providers must obtain consent for store

No reference found.

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).

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

Center for Connected Health Policy

Virginia

Medicaid Program: Virginia Medicaid

Medicaid Program Administrator: State Dept. of Medical Assistance Services (DMAS)

Regional Telehealth Resource Center:

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telemedicine services means the use of interactive

“Telemedicine is the real-time or near real-time

audio, video, or other electronic media used for the

exchange of information for diagnosing and treating

purpose of diagnosis, consultation, or treatment.

medical conditions. Telemedicine utilizes audio/video

‘Telemedicine services’ do not include an audio-only

connections linking medical practitioners in one locality

telephone, electronic mail message, or facsimile

with medical practitioners in another locality.”

transmission.”

Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider

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

Manual, Physician/Practitioner Manual, Covered Svcs. and

Limitations, p. 19 (Apr. 2, 2012).

Live Video Reimbursement

Virginia statute requires coverage of telemedicine (which

Yes, for all Medicaid recipients irrespective of fee-for-

includes live video) by private insurers, subject to their

service or managed care organization coverage.

terms and conditions.

Eligible services:

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

• 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:

• Physicians;

• Nurse practitioners;

• Nurse midwives;

• Clinical nurse specialists;

• Clinical psychologists;

• Clinical social workers;

• Licensed professional counselors;

• Speech pathologists (speech therapy only).

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider

Manual, Physician/Practitioner Manual, Covered Svcs. and

Limitations, p. 19 (Apr. 2, 2012).

Speech therapy reimbursement for the speech-language

pathologist at the remote location and a qualified school

aide with the child during the tele-practice session.

Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider

Manual, Local Education Agency Provider Manual, Covered Svcs.

and Limitations, p. 13 (Oct. 24, 2012).

Store and Forward Reimbursement

No reference found.

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reimbursement for email.

No reference found.

No reimbursement for telephone.

No reimbursement for FAX.

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

Online Prescribing

Practitioners prescribing controlled substances must

No reference found.

have a “bona fide” relationship with the patient.

Requirements:

• Obtaining a medical or drug history;

• Informing the patient about the benefits and

risks of the drug;

• Conducting a patient exam, either physically or

by the use of instrumentation and diagnostic

equipment, through which images and medical

records may be transmitted electronically.

Source: VA Code Annotated Sec. 54.1-3303.

Consent

No reference found.

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

Requires coverage of telemedicine services, subject to

No reference found.

contract terms and conditions.

Center for Connected Health Policy

Washington

Medicaid Program: Washington Medicaid

Medicaid Program Administrator: Washington State Health Care Authority

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W

Billings, MT 59101

(888) 662-5601

http://www.doh.wa.gov/Portals/1/Documents/MD2002-

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telemedicine means the use of tele-monitoring to

“Telehealth is when a health care practitioner uses

enhance the delivery of certain home health skilled

interactive real-time audio and video

nursing services through:

telecommunications to deliver covered services that are

within his or her scope of practice to a client at a site

• The collection of clinical data and the

other than the site where the provider is located.”

transmission of such data between a patient at a

Source: WA State Health Care Authority, Medicaid Provider

distant location and the home health provider

Guide, Physician-Related Svcs./Health Care Professional Svcs., p.

through electronic processing technologies.

53 (Nov. 1, 2012).

Objective clinical data that may be transmitted

includes, but is not limited to, weight, blood

pressure, pulse, respirations, blood glucose,

and pulse oximetry;

• The provision of certain education related to

health care services using audio, video, or data

communication instead of a face-to-face visit.”

Source: WA Admin. Code Sec. 182-551-2010.

“Telehealth means providing physical therapy via

electronic communication where the physical therapist

or physical therapist assistant and the patient are not at

the same physical location.”

Source: WA Admin. Code Sec. 246-915-187.

Live Video Reimbursement

No reference found.

Yes, for patients with fee-for-service coverage.

Eligible services:

• Consultations;

• Office or other outpatient visits;

• Psychiatric intake and assessment;

• Individual psychotherapy;

• Pharmacologic management.

Source: WA State Health Care Authority, Medicaid Provider

Guide, Physician-Related Svcs./Health Care Professional Svcs., p.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

54 (Nov. 1, 2012).

Patients must be present and participate in the visit.

For patients with managed care plan coverage,

telehealth services will not be reimbursed separately. All

services must be arranged and provided by primary care

providers. It is not mandatory that the plan pay for

telehealth services.

Source: WA State Health Care Authority, Medicaid Provider

Guide, Physician-Related Svcs./Health Care Professional Svcs., p.

53 (Nov. 1, 2012).

Store and Forward Reimbursement

No reference found.

No reimbursement.

Source: WA State Health Care Authority, Medicaid Provider Guide,

Physician-Related Svcs./Health Care Professional Svcs., p. 53 (Nov.

1, 2012).

Remote Patient Monitoring Reimbursement

(see Medicaid column)

Yes for clients who have been diagnosed with an

unstable condition, and who may be at risk for

hospitalization or a more costly level of care.

Coverage is limited to one telemedicine interaction, per

patient, per day, based on the ordering licensed

practitioner's care plan.

Eligible services:

• Assessment and monitoring of clinical data

including, but not limited to, vital signs, pain

levels and other biometric measures specified in

the plan of care;

• Assessment of response to previous changes in

the plan of care;

• Detection of condition changes based on the

telemedicine encounter that may indicate the

need for a change in the plan of care.

• Implementation of a management plan

Source: WA Admin. Code Sec. 182-551-2125.

Ineligible services:

• Purchase, rental, repair, maintenance and

associated operating costs of telemedicine

equipment;

• Chronic long-term care skilled nursing visits or

specialized therapy visits for a medically stable

client when a long-term care skilled nursing plan

or specialized therapy plan is in place through

the Department of Social and Health Services,

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Aging and Disabilities Services Administration

(ADSA) or Division of Developmental Disabilities

(DDD);

•

Social work services;

•

Psychiatric skilled nursing services;

•

Pre- and post-natal skilled nursing services,

except those covered services mentioned

above;

•

Well-baby follow-up care;

•

Services performed in hospitals, correctional

facilities, skilled nursing facilities, or a residential

facility with skilled nursing available;

•

Home health aide services that are not provided

in conjunction with skilled nursing or specialized

therapy services;

•

Home health care for a medically stable client;

•

Skilled nursing visits for a client when a home

health agency cannot safely meet the medical

needs of that client within home health services

program limitations;

•

More than one of the same type of specialized

therapy and/or home health aide visit per day;

•

Any home health services covered by another

state agency;

•

Home health visits made without a written

physician order, unless the verbal order is

documented prior to the visit, and the document

is signed by the physician within 45 days of the

order being given.

Source: WA State Health Care Authority, Medicaid Provider

Guide, Home Health Svcs. (Acute Care Svcs.), p. 22 (Jan. 1, 2012).

Email/Phone/FAX

No reference found.

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

Source: WA State Health Care Authority, Medicaid Provider Guide,

Physician-Related Svcs./Health Care Professional Svcs., p. 53 (Nov.

1, 2012).

Online Prescribing

The WA Medical Quality Assurance Commission has

No reference found.

issued guidelines on the use of the Internet in medical

practices. A guideline does not have the force of law,

but can be considered by the Commission to be the

standard of practice in the state.

A documented patient evaluation, including history and

physical evaluation adequate to establish diagnoses and

identify underlying conditions and/or contra-indications

to the treatment recommended/provided, must be

obtained prior to providing treatment, including issuing

prescriptions, electronically or otherwise.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

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 in-person settings.

Treatment, including issuing a prescription, based solely

on an online questionnaire or consultation does not

constitute an acceptable standard of care.

Source: Washington Medical Quality Assurance Commission,

Guidelines for Appropriate Use of the Internet in Medical Practice,

04%20Appropriate%20Use%20of%20the%20Internet%20in%20Me

dical%20Practice.pdf)

Consent

No reference found.

Location

No reference found.

Eligible originating sites:

• Practitioner offices;

• Hospitals;

• Critical Access Hospitals;

• Rural Health Clinics;

• Federally Qualified Health Centers.

Source: WA State Health Care Authority, Medicaid Provider

Guide, Physician-Related Svcs./Health Care Professional vcs., p.

54 (Nov. 1, 2012).

Cross-State Licensing

Out-of-state, licensed practitioners may deliver

No reference found.

telemedicine or telehealth services, as long as they do

not open an office or appoint a place of meeting patients

or receive calls within the state.

Source: Revised Code of WA Sec. 18.71.030 (2012).

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Facility fees for originating sites.

Source: WA State Health Care Authority, Medicaid Provider

Guide, Physician-Related Svcs./Health Care Professional Svcs., p.

54 (Nov. 1, 2012).

Miscellaneous

Physical Therapy

Licensed physical therapists and physical therapist

assistants may provide physical therapy via telehealth.

The clinical record must indicate that the physical

therapy occurred via telehealth.

Center for Connected Health Policy

West Virginia

Medicaid Program: West Virginia Medicaid

Medicaid Program Administrator: Bureau for Medical Services, under the West Virginia Dept. of Health and

Human Resources

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

PO Box. 800711

Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

“The practice of telemedicine means the use of

“A tele-consultation is an interactive member encounter

electronic information and communication technologies

that meets specific criteria. This service requires the use

to provide health care when distance separates

of interactive telecommunications systems, defined as

participants. It includes one or both of the following:

multimedia communication equipment that involves at

least audio and video equipment, and which permits

1. The diagnosis of a patient within this state by a

two-way consultation among the member, consultant

physician located outside this state, as a result

and referring provider. Telephones, facsimile machines,

of the transmission of individual patient data,

and electronic mail systems do not qualify as interactive

specimens or other material by electronic or

telecommunication systems.”

other means from within this state to the

physician or his or her agent;

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter-519 Covered Svcs., Limitations, And Exclusions

For Practitioner Svcs. - Including Physicians, Physician

2. The rendering of treatment to a patient within

Assistants, And Advanced Registered Nurse Practitioners, p. 25

this state by a physician located outside this

(Jan. 16, 2012).

State as a result of transmission of individual

patient data, specimens or other material by

electronic or other means from within this State

to the physician or his or her agent.”

Source: WV Code Sec. 30-3-13.

Live Video Reimbursement

No reference found.

West Virginia Medicaid reimburses for live video

consultations for medical services and nutrition and

exercise services.

Requirements:

• The consult must involve real-time consultation

as appropriate for the member‘s medical needs,

and as needed to provide information to and at

the direction of the consulting physician;

• Coverage of consult is limited to members in

non-metropolitan statistical professional

shortage areas as defined by the Centers for

Medicare & Medicaid Services. The referring

provider must be located in the same non-

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

metropolitan area;

• The referring provider may bill for an office,

outpatient, or inpatient evaluation and

management (E&M) service that precedes the

consultation, and for other Medicaid-covered

services the consultant orders, or for services

unrelated to the medical problem for which the

consult was requested. However, the referring

provider may not bill for a second visit for

activities provided during the consult;

• The consultant must be in control of the

member‘s medical examination, with the

referring provider participating, as needed. The

patient must be present in real time, and

telecommunication technology must allow the

consultant to conduct a medical exam;

• The consultan must provide the referring

physician with a written report;

• Separate payment is not made for the review

and interpretation of medical records;

• Coverage is limited to professional consultations

that meet the criteria.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter-519 Covered Svcs., Limitations, And Exclusions

For Practitioner Svcs. - Including Physicians, Physician

Assistants, And Advanced Registered Nurse Practitioners, p. 25

(Jan. 16, 2012).

Exercise and nutrition services may be delivered

through a single site, or between two sites, with a formal

agreement between the two parties.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter 527: Mountain Health Choices, p. 37 (Jan. 3,

2009).

For facility-based fitness centers/certified trainer

services, rural clinics may partner with a single-site

provider to utilize their professional services. Scheduled

appointments are then set up and video

teleconferencing is used to deliver services to the

member with at minimum a nurse present with the

member during the consultation.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter 527: Mountain Health Choices, p. 40 (Jan. 3,

2009).

Store and Forward Reimbursement

No reference found.

No reimbursement, based upon definition of

teleconsultation, which describes it as using an

“interactive telecommunications system that allows a

“two-way consultation among the member, consultant

and referring provider”.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter-519 Covered Svcs., Limitations, And Exclusions

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

For Practitioner Svcs. - Including Physicians, Physician

Assistants, And Advanced Registered Nurse Practitioners, p. 25

(Jan. 16, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

No reimbursement for FAX.

No reimbursement for telephone.

No reimbursement for email.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter-519 Covered Svcs., Limitations, And Exclusions

For Practitioner Svcs. - Including Physicians, Physician

Assistants, And Advanced Registered Nurse Practitioners, p. 25

(Jan. 16, 2012).

Online Prescribing

Prohibits providers from issuing prescriptions, via

No reference found.

electronic or other means, for persons without

establishing an ongoing physician-patient relationship,

wherein the physician has obtained information

adequate to support the prescription.

Exceptions:

• Documented emergencies;

• On-call or cross-coverage situations;

• Where patient care is rendered in consultation

with another physician who has an ongoing

relationship with the patient, and who has

agreed to supervise the patient's treatment,

including use of any prescribed medications.

Source: WV Code Sec. 11-1A-12.

Consent

No reference found.

Location

No reference found.

Limited to members in CMS-defined non-metropolitan

statistical professional shortage areas. The referring

provider must be located in the non-metropolitan area.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider

Manual, Chapter-519 Covered Svcs., Limitations, And Exclusions

For Practitioner Svcs. - Including Physicians, Physician

Assistants, And Advanced Registered Nurse Practitioners, p. 25

(Jan. 16, 2012).

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Center for Connected Health Policy

Wisconsin

Medicaid Program: Forward Health

Medicaid Program Administrator: Wisconsin Dept. of Health Services

Regional Telehealth Resource Center:

Great Plains Telehealth Resource and Assistance Center

University of Minnesota/Institute for Health Informatics

330 Diehl Hall

505 Essex Street S.E.

Minneapolis, MN 55455

(888) 239-7092

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found.

“Telemedicine services (also known as "Telehealth") are

services provided from a remote location using a

combination of interactive video, audio, and externally

acquired images through a networking environment

between a member (i.e., the originating site) and a

Medicaid-enrolled provider at a remote location (i.e.,

distant site). The services must be of sufficient audio

and visual fidelity and clarity as to be functionally

equivalent to a face-to-face contact. Telemedicine

services do not include telephone conversations or

Internet-based communication between providers or

between providers and members.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.128 (Nov. 30, 2012).

Live Video Reimbursement

No reference found.

Forward Health will reimburse for medical and

mental/behavioral health services via live video.

Eligible services:

• Office or other outpatient services;

• Office or other outpatient consults;

• Initial inpatient consults;

• Outpatient mental health services;

• Health and behavior assessment/intervention;

• End stage renal disease-related services;

• Outpatient substance abuse services.

Eligible providers:

• Physicians and physician clinics;

• Rural Health Centers;

• Federally Qualified Health Center;

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

• Physician assistants;

• Nurse practitioners;

• Nurse midwives;

• Psychiatrists;

• Ph.D. psychologists.

Reimbursement is subject to the same restrictions as in-

person services.

Only one eligible provider may be reimbursed per

member per date of service (DOS), unless it is medically

necessary for the participation of more than one

provider.

Separate services provided by separate specialists for

the same patient at different times on the same date

may be reimbursed separately.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.128-129 (Nov. 30, 2012).

Providers may receive enhanced reimbursement for

pediatric services, for members 18 years old and under,

and for HPSA-eligible services.

HPSA-enhanced reimbursement is allowed when the

patient or the provider is located in a HPSA-designated

area.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.129-130 (Nov. 30, 2012).

Out-of-state providers, except border-status providers,

must obtain prior authorization (PA) before delivering

services to Wisconsin Medicaid members.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.129 (Nov. 30, 2012).

For mental/behavioral health services, BadgerCare Plus,

another plan under Forward Health, will reimburse

mental health and substance abuse services the same

way it reimburses for in-person.

BadgerCare Plus reimburses only one of the sites, not

both.

BadgerCare Plus will not accept claims from individual

professionals in private practice.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Adult Mental Health Day Treatment, p.239 (Nov. 30, 2012).

Please note: The same information is repeated in other

mental/behavioral health provider manuals.

Store and Forward Reimbursement

No reference found.

No reimbursement.

Center for Connected Health Policy

STATE LAW/REGULATIONS

MEDICAID PROGRAM

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.131 (Nov. 30, 2012).

Remote Patient Monitoring Reimbursement

No reference found.

Email/Phone/FAX

No reference found.

No reimbursement for email or Internet-based

communications.

No reimbursement for telephone.

No reference found for FAX.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.128 (Nov. 30, 2012).

Online Prescribing

No reference found.

Consent

No reference found.

Providers should develop their own methods of informed

consent.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Physician, p.129 (Nov. 30, 2012).

Location

No reference found.

Cross-State Licensing

No reference found.

Private Payers

No reference found.

Site/Transmission Fee

No reference found.

Reimbursement for originating site facility fees.

Eligible originating sites:

• Physician offices;

• Hospitals (inpatient or outpatient, excluding

emergency rooms);

• Any other appropriate place of service with

necessary equipment and staffing.

The originating site may not be an emergency room.

An originating site facility fee is not an RHC/FQHC

service, and may not be reported as an encounter on

cost reports. Any reimbursement for the originating site

facility fee must be reported as a deductive value.

Source: WI Forward Health, Wisconsin Medicaid Provider Manual,

Center for Connected Health Policy

Wyoming

Program Name: Wyoming Medicaid

Administrator: Office of Equality Care, under the Wyoming Dept. of Health.

Regional Telehealth Resource Center:

Northwest Regional Telehealth Resource Center

2900 12^th Ave. N., Ste. 30W

Billings, MT 59101

(888) 662-5601