Arizona

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Arizona Health Care Cost Containment System (AHCCCS)

Administrator

Arizona Health Care Cost Containment System Administration

Regional Telehealth Resource Center

Southwest Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: Yes

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: PTC, PSY, NLC
Consent Requirements: Yes

Last updated 09/15/2021

Audio Only Delivery

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active, until end of COVID-19 emergency declaration

Medicaid: COVID-19 Telephonic Billing

STATUS: Active, until end of COVID-19 emergency

Medicaid 1915(c) Waiver: Appendix K 1115 Demonstration

STATUS: Expired Mar. 12, 2021

Last updated 09/20/2021

Cross State Licensing

Medicaid: Out of State Enrollment During COVID-19

STATUS: Active

Last updated 09/15/2021

Easing Prescribing Requirements

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active, until end of COVID-19 emergency declaration

Last updated 09/15/2021

Miscellaneous

Office of the Governor: Executive Order (EO) on Rescinding Telemedicine EOs due to Passage of Permanent Legislation

Status: Permanent

Last updated 09/15/2021

Originating Site

No Reference Found

Last updated 09/15/2021

Private Payer

Office of the Governor: Executive Order on Telemedicine Coverage

STATUS: Rescinded by EO 2021-13 due to passage of permanent legislation.

Office of the Governor: Executive Order on Telemedicine Coverage – Private Insurers

STATUS: Rescinded by EO 2021-13 due to passage of permanent legislation.

Office of the Governor: Executive Order on Telemedicine for Workers Compensation

STATUS: Rescinded due to passage of new legislation.

Office of the Secretary of State – Regulatory bulletin announcing enforcement of Governor’s executive orders

STATUS: Executive orders rescinded by EO 2021-13 due to passage of permanent legislation.

Last updated 09/15/2021

Provider Type

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active, until end of COVID-19 emergency declaration

Executive Order 2020-15: Expansion of Telemedicine

STATUS: Rescinded by EO 2021-13 due to passage of permanent legislation.

Last updated 09/15/2021

Service Expansion

Medicaid:  Telehealth Delivery and Billing FAQs

STATUS: Active, until end of COVID-19 emergency declaration

Office of the Governor: Executive Order on the Expansion of Telemedicine

STATUS: Active, until end of COVID-19 emergency declaration

Office of the Secretary of State – Regulatory bulletin announcing enforcement of Governor’s executive orders

STATUS: Active, until end of COVID-19 emergency declaration

Last updated 09/20/2021

Definition

Telehealth means services delivered via:

  • Asynchronous (store and forward);
  • Remote patient monitoring;
  • Teledentistry; or
  • Telemedicine (real-time interactive audio-video)

Teledentistry is “the acquisition and transmission of all necessary subjective and objective diagnostic data through interactive audio, video or data communications by an AHCCCS registered dental provider to a dentist at a distant site for triage, dental treatment planning, and referral.”

Telemedicine is “the practice of synchronous (real-time) health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/48), (07/12/2021) & IHS/Tribal Provider Billing Manual, (8/49), (7/12/2021). (Accessed Sept. 2021).

Teledentistry is “the acquisition and transmission of all necessary subjective and objective diagnostic data through interactive audio, video or data communications by an AHCCCS registered dental provider to a dentist at a distant site for triage, dental treatment planning, and referral.

Telemedicine is “the practice of synchronous (real-time) health care delivery, diagnosis, consultation, and treatment and the transfer of medical data through interactive audio and video communications that occur in the physical presence of the patient.”

Telehealth is “healthcare services delivered via asynchronous (store-and-forward), remote patient monitoring, teledentistry, or telemedicine (interactive audio and video).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 1-2). Oct. 2019. (Accessed Sept. 2021).

Telehealth is the use of digital technology, like computers, telephones, smartphones, and tablets, to access health care services remotely.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Sept. 2021).

Last updated 09/20/2021

Email, Phone & Fax

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Sept. 2021).

Two HCPCS codes used for a Virtual check-in with physicians via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Virtual check-ins are initiated by the patient and may be performed via multiple technology modalities including telephone, secure text messaging, email, or use of a patient portal. The two HCPCS codes are included in the 2020/2021 Fee Schedule.

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 425. (Accessed Sept. 2021).

Last updated 09/20/2021

Live Video

POLICY

Fee-for-Service Provider Manual

AHCCCS covers medically necessary, non-experimental and cost-effective services provided via telehealth. There are no geographic restrictions for telehealth; services delivered via telehealth are covered by AHCCCS in rural and metropolitan regions.

Telehealth may include healthcare services delivered via asynchronous (store and forward), remote patient monitoring, teledentistry, or telemedicine (interactive audio and video).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/46), (07/12/2021) & IHS/Tribal Provider Billing Manual, (8/48), (02/17/2021). (Accessed Sept. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Some of the services that can be covered via real-time telehealth include, but are not limited to:

  • Behavioral Health
  • Cardiology
  • Dentistry
  • Dermatology
  • Endocrinology
  • Hematology/Oncology
  • Home Health
  • Infectious Diseases
  • Inpatient Consultations
  • Medical Nutrition Therapy (MNT)
  • Neurology
  • Obstetrics/Gynecology
  • Oncology/Radiation
  • Ophthalmology
  • Orthopedics
  • Office Visits (adult and pediatric)
  • Outpatient Consultations
  • Pain Clinic
  • Pathology & Radiology
  • Pediatrics and Pediatric Subspecialties
  • Pharmacy Management
  • Rheumatology
  • Surgery Follow-Up and Consultations

Behavioral health services are covered for all Medicaid-eligible AHCCCS beneficiaries and KidsCare members.

Covered behavioral health services can include, but are not limited to:

  • Diagnostic consultation and evaluation,
  • Psychotropic medication adjustment and monitoring,
  • Individual and family counseling, and
  • Case management.

For a complete code set of services, along with their eligible place of service and modifiers, that can be billed as telehealth please visit the AHCCCS Medical Coding Resources webpage.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/46-49), (07/12/2021); IHS/Tribal Provider Billing Manual, Ch. 8 Individual Practitioner Services (8/48 & 50), (02/17/2021) (Accessed Sept. 2021).

Prolonged preventive services, beyond the typical service of the primary procedure, that require direct patient contact and occur in either the office or another outpatient setting are covered under telehealth. See manual for example codes.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10/49), (07/12/2021), (Accessed Sept 2021).

AHCCCS Policy Manual

AHCCCS covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS registered providers.

Synchronous (real-time) Telemedicine:

  • Shall not replace provider choice for healthcare delivery modality.
  • Shall not replace member choice for healthcare delivery modality.
  • Shall be AHCCCS-covered services that are medically necessary and cost effective.

AHCCCS covers Teledentistry for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) aged members when provided by an AHCCCS registered dental provider.  Teledentistry includes the provision of preventative and other approved therapeutic services by the AHCCCS registered Affiliated Practice Dental Hygienist, who provides dental hygiene services under an affiliated practice relationship with a dentist. Teledentistry does not replace the dental examination by the dentist, limited periodic and comprehensive examinations cannot be billed through the use of Teledentistry alone.

Non-emergency transportation (NEMT) is a covered benefit for member transport to and from the Originating Site where applicable.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2-3), Oct. 2019. (Accessed Sept. 2021)

Teledentistry services will be reimbursed for enrollees under the age of 21.

SOURCE: AZ Statute, Sec. 36-2907.13. (Accessed Sept. 2021).

Two HCPCS codes used for a Virtual check-in with physicians via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Virtual check-ins are initiated by the patient and may be performed via multiple technology modalities including telephone, secure text messaging, email, or use of a patient portal. The two HCPCS codes are included in the 2020/2021 Fee Schedule.

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 423. (Accessed Sept. 2021).


ELIGIBLE PROVIDERS

Fee-for-Service Provider Manual & IHS/Tribal Provider Billing Manual

Telehealth, including Teledentistry services, may be provided by AHCCCS registered providers, within their scope of practice.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-50), (02/17/2021)  & IHS/Tribal Provider Billing Manual (8/51), (02/17/2021). (Accessed Sept. 2021).

Telehealth and telemedicine may qualify as a FQHC/RHC visit if it meets the requirements as specified in AMPM Policy 320-I.

SOURCE: AZ Health Care Cost Containment System, AHCCCS. Provider Qualifications and Provider Requirements.  Ch. 600, (670 Pg. 3). Oct. 2015 (Accessed Sept. 2021) & AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (10-3), (7/26/2019) (Accessed Sept. 2021).


ELIGIBLE SITES

Fee-for-Service Provider Manual definitions:

Distant site means “the site at which the provider delivering the service is located at the time the service is provided via telehealth (formerly hub site).”

Originating site means “the location of the AHCCCS member at the service is being furnished via telehealth or where the asynchronous service originates (formerly spoke site). This is considered the place of service.”

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-48), (02/17/2021) & IHS/Tribal Provider Billing Manual, (8/49-50), (02/17/2021). (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth. Services delivered via telehealth are covered by AHCCCS in rural and urban regions.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019 ; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-46), & IHS/Tribal Provider Billing Manual, (8/48), (02/17/2021). (Accessed Sept. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 09/20/2021

Miscellaneous

Contractors shall promote the use of telehealth to support an adequate provider network.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019. (Accessed Sept. 2021).

Behavioral Health Medical Record Requirements include the requirement for members receiving services via telemedicine, to have copies of electronically recorded information of direct, consultative or collateral clinical interviews.

SOURCE: AZ Medical Policy for AHCCCS.  Ch. 940: Quality Management and Performance Improvement Program. Pg. 5 & 6.  (9/01/2020).  (Accessed Sept. 2021).

Last updated 09/20/2021

Out of State Providers

No Reference Found

Last updated 09/20/2021

Overview

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Sept. 2021).

Arizona Health Care Cost Containment System (AHCCCS) covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS-registered providers. There are no geographic restrictions for Telehealth; services delivered via Telehealth are covered by AHCCCS in rural and urban regions. They reimburse for store-and-forward for specific specialties and for remote patient monitoring, although restrictions apply. Arizona’s Medicaid program uses an integrated managed care model with a fee-for-service delivery system for Alaska Native/American Indian populations and limited emergency services.

All services provided via telehealth must be medically necessary, non-experimental and cost-effective services.  Services are billed by the individual provider (located at the distant site).  Tele-presenter services are not billable.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-46 & 48), (07/12/2021); AHCCCS Medical Policy Manual Section 320-I Telehealth (07/12/21). p. 2.;  IHS/Tribal Provider Billing Manual (8/48 & 50),  .; AHCCCS, AHCCCS Fact Sheet: What is AHCCCS Managed Care? (n.d.) (Accessed Sept. 2021)

Last updated 09/20/2021

Remote Patient Monitoring

POLICY

Service delivery via telehealth can be done via teledentistry, remote patient monitoring, telemedicine, or asynchronous (store and forward).

Remote Patient Monitoring is “personal health and medical data collection from a member in one location via electronic communication technologies, which is transmitted to a provider in a different location for use in providing improved chronic disease management, care, and related support. Such monitoring may be either synchronous (real-time) or asynchronous (store-and-forward).

AHCCCS will reimburse for remote patient monitoring in their fee-for-service program. Managed care organizations must abide by AHCCCS fee-for-service coverage policy.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 1-2). Oct. 2019; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/47-48), (07/12/2021) & IHS/Tribal Provider Billing Manual, (8/49), (07/12/2021). (Accessed Sept. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

Remote patient monitoring:

  1. Shall not replace provider choice for healthcare delivery modality.
  2. Shall not replace member choice for healthcare delivery modality.
  3. Shall be AHCCCS-covered services that are medically necessary and cost effective.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 3), Oct. 2019. (Accessed Sept. 2021).

Last updated 09/20/2021

Store and Forward

POLICY

Asynchronous (store-and-forward) is “transmission of recorded health history (e.g. pre-recorded videos, digital data, or digital images, such as x-rays and photos) through a secure electronic communications system between a practitioner, usually a specialist, and a member or other practitioner, in order to evaluate the case or to render consultative and/or therapeutic services outside of a synchronous (real-time) interaction. As compared to a real-time member care, synchronous care allows practitioners to assess, evaluate, consult, or treat conditions using secure digital transmission services, data storage services, and software solutions.”

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 1-2). Oct. 2019; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/47-48), (07/12/2021) & IHS/Tribal Provider Billing Manual, (8/49), (07/12/2021). (Accessed Sept. 2021).

AHCCCS will reimburse for store-and-forward in their fee-for-service program for certain services.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Professional and Technical Services, (10-46), (2/17/2021) & IHS/Tribal Provider Billing Manual, (8/48-49), (2/17/2021). (Accessed Sept. 2021).

Two HCPCS codes used for a Virtual check-in with physicians via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Virtual check-ins are initiated by the patient and may be performed via multiple technology modalities including telephone, secure text messaging, email, or use of a patient portal. The two HCPCS codes are included in the 2020/2021 Fee Schedule.

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 435. (Accessed Sept. 2021).


ELIGIBLE SERVICES/SPECIALTIES

The following services are covered via asynchronous telehealth (store-and-forward):

  • Behavioral Health
  • Cardiology
  • Dermatology
  • Infectious Disease
  • Neurology
  • Ophthalmology
  • Pathology
  • Radiology

Covered behavioral health services via asynchronous telehealth can include Naturalistic Observation Diagnostic Assessment (NODA).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Professional and Technical Services, (10-47 & 49), (2/17/2021) & IHS/Tribal Provider Billing Manual, (8/48-50), (2/17/2021). (Accessed Sept. 2021).

AHCCS Medical Policy Manual

  • AHCCCS only covers store-and-forward for the following:
  • Dermatology
  • Radiology
  • Ophthalmology
  • Pathology
  • Neurology
  • Cardiology
  • Behavioral Health
  • Infectious Disease
  • Allergy/Immunology

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019. (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth. Services delivered via telehealth are covered by AHCCCS in rural and urban regions.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019.; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-46) & IHS/Tribal Provider Billing Manual, (8/48), (2/17/2021). (Accessed Sept. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 09/20/2021

Parity

SERVICE PARITY

Recently Passed Legislation

All contracts issued, delivered or renewed in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encounter between the subscriber and a health care provider and provided to a subscriber receiving the service in this state.

A corporation may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth.

Before January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if that service is covered by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.

Certain other requirements apply.  See above ‘requirements’ section.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session).  (Accessed Sept. 2021)


PAYMENT PARITY

Recently Passed Legislation

A corporation shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. A corporation shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the corporation. A corporation may not require a health care provider to use a telehealth platform that is sponsored or provided by the corporation as a condition of network participation.

A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session).  (Accessed May 2021)

Last updated 05/17/2021

Private Payers

Newly Passed Legislation

[Telehealth] means the interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the purpose of diagnosis, consultation or treatment.  Includes:

  • The use of an audio-only telephone encounter between a subscriber who has an existing relationship with a health care provider or provider group if both of the following apply:
    • An audio-visual telehealth encounter is not reasonably available due to the subscriber’s functional status, the subscriber’s lack of technology or telecommunications infrastructure limits, as determined by the health care provider.
    • The telehealth encounter is initiated at the request of the subscriber or authorized by the subscriber before the telehealth encounter.
  • The use of an audio-only encounter between the subscriber and a health care provider, regardless of whether there is an existing relationship with the health care provider or provider group, if the telehealth encounter is for a behavioral health or substance use disorder service and both items of subdivision (a) of this paragraph apply.

Does not include the sole use of a fax machine, instant messages, voice mail or email.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session), (Accessed May 2021).

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

SOURCE: AZ Admin. Code Sec. R20-6-1902. Pg. 127 (Accessed May 2021).

Last updated 09/20/2021

Requirements

Recently Passed Legislation

All contracts issued, delivered or renewed in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encounter between the subscriber and a health care provider and provided to a subscriber receiving the service in this state. The following requirements apply to coverage of telehealth services:

  • A corporation may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth.
  • Except as otherwise provided in this paragraph, a corporation shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. A corporation shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the corporation. A corporation may not require a health care provider to use a telehealth platform that is sponsored or provided by the corporation as a condition of network participation.
  • Before January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if that service is covered by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.
  • A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media.
  • At the time of the telehealth encounter, the health care provider shall access clinical information and records, if available, that are appropriate to evaluate the patient’s condition. The health care provider shall inform the subscriber before the telehealth encounter if there is a charge for the encounter.
  • A corporation may establish reasonable requirements and parameters for telehealth services, including documentation, fraud prevention, identity verification and recordkeeping, but such requirements and parameters may not be more restrictive or less favorable to health care providers or subscribers than are required for health care services delivered in person.
  • Covered telehealth services may be provided regardless of where the subscriber is located or the type of site.
  • The contract may limit the coverage to those health care providers who are members of the corporation’s provider network.

This section does not relieve a corporation from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a corporation through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state.

Services provided through telehealth or resulting from a telehealth encounter are subject to all of this state’s laws and rules that govern prescribing, dispensing and administering prescription pharmaceuticals and devices and shall comply with Arizona licensure requirements and any practice guidelines of the telehealth advisory committee on telehealth best practices established by section 36-3607 or, if not addressed, the practice guidelines of a national association of medical professionals promoting access to medical care for consumers via telecommunications technology or other qualified medical professional societies to ensure quality of care.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session).  (Accessed Sept. 2021)

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

SOURCE: AZ Admin. Code Sec. R20-6-1915. Pg. 132 (Accessed Sept. 2021).

Last updated 05/17/2021

Cross State Licensing

Newly Adopted Legislation

A health care provider who is not licensed in Arizona may provide telehealth services to a person located in Arizona if the health care provider complies with all of the following:

  1. Registers with the state’s applicable health care provider regulatory board or agency that licenses comparable health care providers on an application prescribed by the board or agency that contains certain elements (see law text).
  2. Before prescribing a controlled substance to a patient, registers with the controlled substances prescription monitoring program.
  3. Pays the registration fee as determined by the applicable health care provider regulatory board or agency.
  4. Holds a current, valid and unrestricted license to practice in another state that is substantially similar to a license issued in Arizona to a comparable health care provider and is not subject to any past or pending disciplinary proceedings in any jurisdiction. The health care provider shall notify the applicable health care provider regulatory board or agency within five days after any restriction is placed on the health care provider’s license or any disciplinary action is initiated or imposed. The health care provider regulatory board or agency registering the health care provider may use the national practitioner databank to verify the information submitted.
  5. Acts in full compliance with all applicable laws and rules of this state, including scope of practice, laws and rules governing prescribing, dispensing and administering prescription drugs and devices, telehealth requirements and the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.
  6. Complies with all existing requirements of Arizona and any other state in which the health care provider is licensed regarding maintaining professional liability insurance, including coverage for telehealth services provided in Arizona.
  7. Consents to this state’s jurisdiction for any disciplinary action or legal proceeding related to the health care provider’s acts or omissions under this article.
  8. Follows Arizona’s standards of care for that particular licensed health profession.
  9. Annually updates the health care provider’s registration for accuracy and submits to the applicable health care provider regulatory board or agency a report with the number of patients the provider served in Arizona and the total number and type of encounters for the preceding year

A health care provider who is registered pursuant to this section may not:

  • Open an office in this state, except as part of a multistate provider group that includes at least one health care provider who is licensed in this state through the applicable health care provider regulatory board or agency.
  • Provide in-person health care services to persons located in this state without first obtaining a license through the applicable health care provider regulatory board or agency.

A health care provider who is not licensed to provide health care services in Arizona but who holds an active license to provide health care services in another jurisdiction and who provides telehealth services to a person located in Aruziba is not subject to the registration requirements of this section if either of the following applies:

  • The services are provided under one of the following circumstances:
    • In response to an emergency medication condition.
    • In consultation with a health care provider who is licensed in Arizona and who has the ultimate authority over the patient’s diagnosis and treatment.
    • To provide after-care specifically related to a medical procedure that was delivered in person in another state.
    • To a person who is a resident of another state and the telehealth provider is the primary care provider or behavioral health provider located in the person’s state of residence.
  • The health care provider provides fewer than ten telehealth encounters in a calendar year.

SOURCE: AZ Revised Statute Sec. 36-3606 & House Bill 2454 (2021 Session), (Accessed May 2021).

An out-of-state doctor may engage in a single or infrequent consultation with an Arizona physician if the consultation regards a specific patient or patients.

SOURCE: AZ Revised Statute Sec. 32-1421. (Accessed May 2021).

Behavioral health providers delivering care via telepractice to Arizona patients must be licensed by the Arizona Board of Behavioral Health Examiners.

SOURCE: AZ Administrative Code, Title 4, Ch. 6, R4-6-1106. Telepractice. (Accessed May 2021)

Last updated 09/20/2021

Definitions

“Telehealth” means:

  • The interactive use of audio, video or other electronic media, including asynchronous store-and-forward technologies and remote patient monitoring technologies, for the practice of health care, assessment, diagnosis, consultation or treatment and the transfer of medical data.
  • Includes the use of an audio-only telephone encounter between the patient or client and health care provider if an audio-visual telehealth encounter is not reasonably available due to the patient’s functional status, the patient’s lack of technology or telecommunications infrastructure limits, as determined by the health care provider.
  • Does not include the use of a fax machine, instant messages, voice mail or email.

SOURCE: AZ Revised Statute Sec. 36-3601, as revised by House Bill 2454 (2021 Session), (Accessed Sept. 2021)

Board of Psychologist Examiners

“Telepractice” means providing psychological services through interactive audio, video or electronic communication that occurs between the psychologist and the patient or client, including any electronic communication for diagnostic, treatment or consultation purposes in a secure platform, and that meets the requirements of telehealth pursuant to section 36-3602. Telepractice includes supervision.

SOURCE: AZ Revised Statute Sec. 32-2061 as revised by House Bill 2454 (2021 Session), (Accessed Sept. 2021).

Last updated 09/20/2021

Licensure Compacts

Arizona has conditionally repealed and asked to withdraw from the Interstate Medical Licensure Compact.

SOURCE: AZ Revised Statute Sec. 32-3241. (Accessed Sept. 2021).

Member of the Interjurisdictional Compact of the Association of State and Provincial Psychology Boards (PSYPACT).

SOURCE: AZ Revised Statute Sec. 32-2087 & PSYPACT  (Accessed Sept. 2021).

Member of Nurse Licensure Compact.

SOURCE:  AZ Revised Statute Sec. 32-1660 &Nurse Licensure Compact (Accessed Sept. 2021).

Member of Physical Therapy Compact.

SOURCE:  AZ Revised Statute Sec. 32-2053 & Physical Therapy Compact (Accessed Sept. 2021). 

Last updated 09/20/2021

Miscellaneous

Arizona established a telehealth advisory committee on telehealth best practices in order to adopt telehealth best practice guidelines and recommendations regarding the health care services that may be appropriately provided through an audio-only telehealth format and make updates, when applicable.

Beginning October 1, 2021 and on or before the first of each month thereafter, each health care provider regulatory board or agency shall submit to the telehealth advisory committee on telehealth best practices established by section 36-3607 a report identifying the number and type of out-of-state health care providers who have applied for registration pursuant to section 36-3606 and the number and type of out-of-state health care providers whose registration pursuant to section 36-3606 has been approved.

SOURCE: House Bill 2454 (2021 Session), (Accessed Sept. 2021).

Last updated 09/20/2021

Online Prescribing

Medical Board & Osteopathic Physicians and Surgeons

Unprofessional conduct includes prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person unless the licensee first conducts a physical or mental health status examination of that person or has previously established a doctor-patient relationship. The physical or mental health status examination may be conducted through telehealth with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

  • A physician who provides temporary patient supervision on behalf of the patient’s regular treating licensed health care professional or provides a consultation requested by the patient’s regular treating licensed health care professional.
  • Emergency medical situations as defined in section 41-1831.
  • Prescriptions written to prepare a patient for a medical examination.
  • Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, public health emergency, infectious disease outbreak or act of bioterrorism. For the purposes of this item, “bioterrorism” has the same meaning prescribed in section 36-781.
  • Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician.
  • Prescriptions written or prescription medications issued for administration of immunizations or vaccines listed in the United States centers for disease control and prevention’s recommended immunization schedule to a household member of a patient.
  • Prescriptions for epinephrine auto-injectors written or dispensed for a school district or charter school to be stocked for emergency use pursuant to section 15-157 or for an authorized entity to be stocked pursuant to section 36-2226.01.
  • Prescriptions written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Prescriptions for naloxone hydrochloride or any other opioid antagonist approved by the United States food and drug administration that are written or dispensed for use pursuant to section 36-2228 or 36-2266.

SOURCE: Arizona Revised Statute Sec. 32-1401 & Sec. 32-1854 as amended by House Bill 2454 (2021 Session)  (Accessed Sept. 2021).

For schedule II drugs, a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a health care provider who is licensed by that board or agency and who is authorized to write prescriptions or dispense or administer prescription drugs and devices to provide an in-person examination of the patient before issuing a prescription except as specifically prescribed by federal law. A physical or mental health status examination may be conducted during a telehealth encounter. Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law.

Services provided through telehealth are subject to this state’s laws and rules governing the health care provider’s scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.

SOURCE: Arizona Revised Statute Sec. 36-3602 as amended by House Bill 2454 (2021 Session)  (Accessed Sept. 2021).

Pharmacy

Unprofessional conduct includes knowingly dispensing a drug on a prescription order that was issued in the course of the conduct of business of dispensing drugs pursuant to diagnosis by mail or the internet, unless the order was any of the following: …

  • Written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center.
  • Written pursuant to a physical or mental health status examination that was conducted through telehealth as defined in section 36-3601 and consistent with federal law.

SOURCE: Arizona Revised Statute Sec. 1901.01.01 as amended by House Bill 2454 (2021 Session)  (Accessed Sept. 2021).

A health care provider shall not use telehealth to provide an abortion.

SOURCE: Arizona Revised Statute Sec. 36-3604 as amended by House Bill 2454 (2021 Session)  (Accessed Sept. 2021).

Last updated 09/20/2021

Professional Board Standards

Board of Psychologist Examiners

SOURCE: AZ Reg. Sec. R4-26-109. (Accessed Sept. 2021).

Board of Behavioral Health Examiners

SOURCE: AZ Reg. Sec. R4-6-1106. (Accessed May 2021).

Consistent with the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607, a health care provider shall make a good faith effort in determining both of the following:

Whether a health care service should be provided through telehealth instead of in person. The health care provider shall use the health care provider’s clinical judgment in considering whether the nature of the services necessitates physical interventions and close observation and the circumstances of the patient, including diagnosis, symptoms, history, age, physical location and access to telehealth.

The communication medium of telehealth and, whenever reasonably practicable, the telehealth communication medium that allows the health care provider to most effectively assess, diagnose and treat the patient. Factors the health care provider may consider in determining the communication medium include the patient’s lack of access to or inability to use technology or limits in telecommunication infrastructure necessary to support interactive telehealth encounters.

SOURCE: House Bill 2454 (2021 Session), (Accessed Sept. 2021).