Connecticut

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, PSYPACT
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: Medical Assistance Program
  2. Administrator: Connecticut Department of Social Services
  3. Regional Telehealth Resource Center: Northeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 08/10/2022

Audio Only Delivery

Medicaid:  FAQs About CMAP’s Response to COVID-19

STATUS: Active

Medicaid: Provider Message All COVID-19 Telehealth Policies Remain in Effect

STATUS: Active until further notice

STATUS: Active

Medicaid: Audio Only Behavioral Health Telephonic Services, Bulletin 20-44

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Additional Changes to Synchronous Telemedicine, Bulletin 20-38

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Telemedicine Coverage for Home Health Services and Hospice Services, Bulletin 20-28

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Remote Early Intervention Treatment Services, Bulletin 20-17

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Expanded Telemedicine and New Audio-Only (Telephonic) Services, Bulletin 20-14

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Clarifying Guidance for Expanded Use of Synchronized Telemedicine for Specified Behavioral Health Services, Bulletin 20-90

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Bulletin on Telemedicine Services, Bulletin 20-9

STATUS: Active

STATUS: Enacted

STATUS: Enacted

Last updated 08/10/2022

Cross State Licensing

Department of Public Health: Commissioner’s Order; Memo on Commissioner’s Order: Temporary Suspension of State Licensure Requirement for Selected Professions

Status: Expired April 15, 2022

Department of Public Health: Out-of-State Social Workers and Telehealth

STATUS: Active

HB 5596 (2021 Session): Extends Telehealth emergency orders until June 30, 2023

STATUS: Enacted

HB 5001 (2022 Session): Allows Out-of-State Social Workers to Provide In-State Telehealth Under Certain Circumstances

STATUS: Enacted; Out-of-state social worker provision effective until July 1, 2024

SB 2 (2022 Session): Extends Certain Telehealth Expansions until June 30, 2024, Includes Additional Licensure Provisions

STATUS: Enacted

Last updated 08/10/2022

Easing Prescribing Requirements

HB 5596 (2021 Session): Extends Telehealth emergency orders until June 30, 2023

STATUS: Enacted

SB 2 (2022 Session): Amends HB 5596; Extends Telehealth expansions until June 30, 2024

STATUS: Enacted

Last updated 08/10/2022

Miscellaneous

Governor Executive Order: Declaration of a Continued Public Health Emergency

STATUS: Effective June 28, 2022 – December 28, 2022 or until the Federal PHE ends, whichever is earlier

Office of the Attorney General: Telehealth Security Guidance

STATUS: Active

Last updated 08/10/2022

Originating Site

Medicaid: FAQs About CMAP’s Response to COVID-19

STATUS: Active

Medicaid: Important information for HUSKY Health Providers

STATUS: Active

Medicaid: Updated Telemedicine Guidance for Physical Therapy and Occupational Therapy Services, Bulletin 20-87

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Emergency Temporary Telemedicine Coverage for Physical Therapy, Occupational Therapy & Speech Therapy Services, Bulletin 20-23

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Telemedicine Coverage for Home Health Services and Hospice Services, Bulletin 20-28

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Updates to Telemedicine Coverage for Home Health/Access Agencies, Bulletin 20-85

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Emergency Temporary Telehealth Coverage for Specified Dental Services, Bulletin 20-21

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Clarifying Guidance for Speech and Language Pathology Telemedicine Services (clarifies allowed services for SLP), Bulletin 20-84

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Therapy Services Rendered at Rehabilitation Clinics, Bulletin 20-24

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Synchronized Telemedicine for Behavioral Health and Autism Spectrum Disorder, Bulletin 20-25

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid:  Updated Synchronized Telemedicine for Autism Spectrum Disorder Providers, Bulletin 20-47

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Bulletin on Emergency Temporary Telemedicine Coverage, Bulletin 20-10

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Telemedicine Guidance for Respiratory Care Services, Bulletin 21-12

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid:  Bulletin on Telemedicine Services, Bulletin 20-9

STATUS: Active

HB 5596 (2021 Session): Extends Telehealth emergency orders until June 30, 2023

STATUS: Enacted

STATUS: Enacted

Last updated 08/10/2022

Private Payer

HB 5596 (2021 Session): Extends Telehealth emergency orders until June 30, 2023

STATUS: Enacted

STATUS: Enacted

Last updated 08/10/2022

Provider Type

Medicaid: FAQs About CMAP’s Response to COVID-19

STATUS: Active

Medicaid: Important information for HUSKY Health Providers

STATUS: Active

Medicaid: Telemedicine Guidance for Respiratory Care Services, Bulletin 21-12

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Telemedicine Coverage for Home Health Services and Hospice Services, Bulletin 20-28

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid:  Provider Bulletin on Synchronized Telemedicine for Behavioral Health and Autism Spectrum Disorder, Bulletin 20-25

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid:  Updated Synchronized Telemedicine for Autism Spectrum Disorder Providers, Bulletin 20-47

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Bulletin on Telemedicine Services, Bulletin 20-9

STATUS: Active

Medicaid: Provider Bulletin on Therapy Services Rendered at Rehabilitation Clinics, Bulletin 20-24

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Updated Telemedicine Guidance for Physical Therapy and Occupational Therapy Services, Bulletin 20-87

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Emergency Temporary Telemedicine Coverage for Physical Therapy, Occupational Therapy & Speech Therapy Services, Bulletin 20-23

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

HB 5596 (2021 Session): Extends Telehealth emergency orders until June 30, 2023

STATUS: Enacted

STATUS: Enacted

Last updated 08/10/2022

Service Expansion

Medicaid: FAQs About CMAP’s Response to COVID-19

STATUS: Active

Medicaid: Provider Message All COVID-19 Telehealth Policies Remain in Effect

STATUS: Active until further notice

Medicaid: Important information for HUSKY Health Providers

STATUS: Active

Medicaid: Guidance for Respiratory Therapy, Bulletin 2021-12

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Wheelchair Assessments via Telemedicine, Bulletin 20-50

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Audio Only Behavioral Health Telephonic Services, Bulletin 20-44

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Updated Telemedicine Guidance for Physical Therapy and Occupational Therapy Services, Bulletin 20-87

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Updates to Telemedicine Coverage for Home Health/Access Agencies, Bulletin 20-85

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Emergency Temporary Telehealth Coverage for Specified Dental Services, Bulletin 20-21

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Clarifying Guidance for Speech and Language Pathology Telemedicine Services (clarifies allowed services for SLP), Bulletin 20-84

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Therapy Services Rendered at Rehabilitation Clinics, Bulletin 20-24

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Synchronized Telemedicine for Behavioral Health and Autism Spectrum Disorder, Bulletin 20-25

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Updated Synchronized Telemedicine for Autism Spectrum Disorder Providers, Bulletin 20-47

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Telemedicine Coverage for Home Health Services and Hospice Services, Bulletin 20-28

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Provider Bulletin on Additional Changes to Synchronous Telemedicine, Bulletin 20-38

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Bulletin on Emergency Temporary Telemedicine Coverage, Bulletin 20-10

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

Medicaid: Bulletin on Telemedicine Services, Bulletin 20-9

STATUS: Active

Medicaid: Clarifying Guidance for Expanded Use of Synchronized Telemedicine for Specified Behavioral Health Services Stated in PB 2020-14 and 2020-44, Bulletin 20-90

STATUS: Active until DSS has notified providers in writing that the state has deemed COVID-19 to no longer be a PHE

STATUS: Enacted

STATUS: Enacted

Last updated 08/10/2022

Definitions

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of an insured’s physical, oral and mental health, and includes interaction between the insured at the originating site and the telehealth provider at a distant site, synchronous interactions, asynchronous store and forward transfers or remote patient monitoring, but does not include interaction through (A) facsimile, texting or electronic mail, or (B) audio-only telephone if the policy uses a provider network and the telehealth provider is out-of-network.

SOURCE: HB 5596 (2021 Session)& SB 2 (2022 Session). (Accessed Aug. 2022).

Permanent Statute

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store-and-forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, audio-only telephone, texting or electronic mail.

SOURCE: CT General Statute 19a, Sec. 906(a)(11). (Accessed Aug. 2022)

Last updated 08/11/2022

Parity

SERVICE PARITY

Coverage must be provided for telehealth if it would be covered in-person, subject to the terms and conditions of all other benefits under such policy.

SOURCE: CT General Statute 38a, Sec. 499a. & 38a, Sec. 526a. (Accessed Aug. 2022).


PAYMENT PARITY

Effective Now Until June 30, 2024

Until June 30, 2024, no health carrier shall reduce the amount of a reimbursement paid to a telehealth provider for covered health care or health services that the telehealth provider appropriately provided to an insured because the telehealth provider provided such health care or health services to the patient through telehealth and not in person.

SOURCE: HB 5596 p.18 (2021 Session) & SB 2 p. 47 (2022 Session). (Accessed Aug. 2022).

Last updated 08/10/2022

Requirements

Effective Now Until June 30, 2024

Insurers shall provide coverage for medical advice, diagnosis, care or treatment provided through telehealth, to the same extent coverage is provided for such advice, diagnosis, care or treatment when provided to the insured in person. The policy shall not, at any time during such period, exclude coverage for a service that is appropriately provided through telehealth because such service is provided through telehealth or a telehealth platform selected by an in-network telehealth provider.

No telehealth provider who receives a reimbursement for a covered service shall seek any payment for such service from the insured who received such service, except for any coinsurance, copayment, deductible or other out-of-pocket expense set forth in the insured’s policy. Such amount shall be deemed by the telehealth provider to be payment in full.

Notwithstanding any provision of the general statutes, no health carrier shall reduce the amount of a reimbursement paid to a telehealth provider for covered health care or health services that the telehealth provider appropriately provided to an insured through telehealth during the period beginning on May 10, 2021, and ending on June 30, 2024, because the telehealth provider provided such health care or health services to the patient through telehealth and not in person.

A telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191.

No telehealth provider shall charge a facility fee for a telehealth service provided during the period beginning on the effective date of this section and ending on June 30, 2024.

No telehealth provider shall provide health care or health services to a patient through telehealth unless the telehealth provider has determined whether or not the patient has health coverage for such health care or health services.

A telehealth provider who provides health care or health services to a patient through telehealth during the period beginning on the effective date of this section and ending on June 30, 2024, shall accept as full payment for such health care or health services:

  • An amount that is equal to the amount that Medicare reimburses for such health care or health services if the telehealth provider determines that the patient does not have health coverage for such health care or health services; or
  • The amount that the patient’s health coverage reimburses, and any coinsurance, copayment, deductible or other out-of-pocket expense imposed by the patient’s health coverage, for such health care or health services if the telehealth provider determines that the patient has health coverage for such health care or health services. If the patient’s health coverage uses a provider network, the amount of such reimbursement, and such coinsurance, copayment, deductible or other out-of-pocket expense, shall not exceed the in-network amount regardless of the network status of such telehealth provider.

If a telehealth provider determines that a patient is unable to pay for any health care or health services described in subdivisions (1) and (2) of this subsection, the provider shall offer to the patient financial assistance, if such provider is otherwise required to offer to the patient such financial assistance, under any applicable state or federal law.

SOURCE: HB 5596 (2021 Session) & SB 2 (2022 Session). (Accessed Aug. 2022).

Permanent Statute

Each individual health insurance policy and group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall provide coverage for medical advice, diagnosis, care or treatment provided via telehealth to the extent coverage is provided for such advice, diagnosis, care or treatment when provided through in-person consultation between the insured and a health care provider licensed in the state. Such coverage shall be subject to the same terms and conditions of the policy.

No such policy shall: (1) Exclude a service for coverage solely because such service is provided only through telehealth and not through in-person consultation between the insured and a health care provider licensed in the state, provided telehealth is appropriate for the provision of such service; or (2) be required to reimburse a treating or consulting health care provider for the technical fees or technical costs for the provision of telehealth services.

Nothing in this section shall prohibit or limit a health insurer, health care center, hospital service corporation, medical service corporation or other entity from conducting utilization review for telehealth services, provided such utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for an in-person consultation for the same service.

SOURCE: CT General Statute 38a, Sec. 499a. & 38a, Sec. 526a, as proposed to be amended by SB 2 (2022 Session).

Last updated 08/10/2022

Definitions

Effective Now Until June 30, 2024

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical, oral and mental health, and includes interaction between the patient at the originating site and the telehealth provider at a distant site, synchronous interactions, asynchronous store and forward transfers or remote patient monitoring, but does not include interaction through facsimile, texting or electronic mail.

SOURCE: SB 2 (2022 Session), Sec. 32.HB 5596 (2021 Session), Sec. 1. (Accessed Aug. 2022).

Permanent Statute

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, texting or electronic mail.

SOURCE: CT General Statute 19a, Sec. 906., as amended by HB 6470 (Accessed Aug. 2022).

Synchronized telemedicine is defined as an audio and video telecommunication system with real-time communication between the patient and practitioner.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Definition for Telemedicine Demonstration Program for FQHCs: “Telemedicine means the use of interactive audio, interactive video or interactive data communication in the delivery of medical advice, diagnosis, care or treatment and includes services described in subsection (d) of section 20-9 and 42 CFR 410.78(a)(3). Telemedicine does not include the use of facsimile or audio-only telephone.”

SOURCE: CT General Statute 17b, Sec. 245c. (Accessed Aug. 2022).

Last updated 08/10/2022

Email, Phone & Fax

Effective Now Until June 30, 2024

Notwithstanding the provisions of section 19a-906 of the general statutes, as amended by this act, and subdivision (1) of this subsection, a telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may, during the period beginning on May 10, 2021 and ending on June 30, 2024, use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time, or the rules and regulations adopted thereunder.

Telehealth does not include facsimile, texting or electronic mail. The Commissioner of Social Services may, in the commissioner’s discretion and to the extent permissible under federal law, provide coverage under the Connecticut medical assistance program for audio-only telehealth services until June 30, 2023. 

SOURCE: HB 5596 (2021 Session), Sec. 1, 6. & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Permanent Policy/Statute

The department shall not pay for information or services provided to a client over the telephone except for case management behavioral health services for patients aged 18 and under.

SOURCE: CT Provider Manual. Clinic. Sec. 17b-262-823. Jan. 31, 2018. Ch. 7, pg. 20Behavioral Health. Sec. 17b-262-918. Oct. 2020 Ch. 7, Pg. 6; CT Provider Manual. Physician and Psychiatrist. Sec. 17b-262-342 & 17b-262-456. Oct. 2020 Pg. 9 & 20; CT Provider Manual. Psychologist. Sec. 17b-262-472. Oct. 2020. Ch. 7, pg. 7; CT Provider Manual. Hospital Inpatient Services. Sec. 150.2(E)(III)(l). Oct. 2020. Ch. 7, pg. 44; CT Provider Manual. Chiropractic. Sec. 17b-262-540. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Dental. Sec. 17b-262-698. Oct. 2020. Ch. 7, Pg. 44; CT Provider Manual. Home Health. Sec. 17b-262-729. Oct. 2020. Ch. 7, pg. 12; CT Provider Manual. Naturopath. Sec. 17b-262-552. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Nurse Practitioner/Midwife. Sec. 17b-262-578. Oct. 2020. Ch. 7, pg. 7; CT Provider Manual. Podiatry. Sec. 17b-262-624. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Vision Care. Sec. 17b-262-564. Oct. 2020. Ch. 7, pg. 4. (Accessed Aug. 2022).

The price for any supply listed in the fee schedule published by the department shall include and the department shall pay the lowest: … information furnished by the provider to the client over the telephone.

SOURCE: CT Provider Manual. Medical Services, Sec. 17b-262-720, p. 7. (Accessed Aug. 2022).

Telephonic consultations are not reimbursable under CMAP.

SOURCE: CT Policy Transmittal 2019-12. Effective Jan. 1, 2019. Released Mar. 1, 2019. (Accessed Aug. 2022).

Notwithstanding the provisions of section 17b-245c, 17b-245e or 19a-906 of the general statutes, as amended by this act, or any other section of the general statutes, regulation, rule, policy or procedure governing the Connecticut medical assistance program, the Commissioner of Social Services shall, to the extent permissible under federal law, provide coverage under the Connecticut medical assistance program for audio-only telehealth services when (1) clinically appropriate, as determined by the commissioner, (2) it is not possible to provide comparable covered audiovisual telehealth services, and (3) provided to individuals who are unable to use or access comparable, covered audiovisual telehealth services.

SOURCE: CT Statute Sec. 17b-245g, as added by CT HB 6470 (2021 Session). (Accessed Aug. 2022).

Last updated 08/10/2022

Live Video

POLICY

Effective Now Until June 30, 2024

During the period beginning on May 10, 2021 and ending on June 30, 2024, a telehealth provider may only provide a telehealth service to a patient when the telehealth provider:

  • Is communicating through real-time, interactive, two-way communication technology or store and forward transfer technology;
  • Has determined whether the patient has health coverage that is fully insured, not fully insured or provided through the Connecticut medical assistance program, and whether the patient’s health coverage, if any, provides coverage for the telehealth service;
  • Has access to, or knowledge of, the patient’s medical history, as provided by the patient, and the patient’s health record, including the name and address of the patient’s primary care provider, if any;
  • Conforms to the standard of care applicable to the telehealth provider’s profession and expected for in-person care as appropriate to the patient’s age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient’s condition; and
  • Provides the patient with the telehealth provider’s license number, if any, and contact information

A telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may, during the period beginning on May 10, 2021 and ending on June 30, 2024, use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time, or the rules and regulations adopted thereunder.

No telehealth provider shall provide health care or health services to a patient through telehealth unless the telehealth provider has determined whether or not the patient has health coverage for such health care or health services.

A telehealth provider who provides health care or health services to a patient through telehealth during the period beginning on May 10, 2021 and ending on June 30, 2024, shall accept as full payment for such health care or health services:

  • An amount that is equal to the amount that Medicare reimburses for such health care or health services if the telehealth provider determines that the patient does not have health coverage for such health care or health services; or
  • The amount that the patient’s health coverage reimburses, and any coinsurance, copayment, deductible or other out-of-pocket expense imposed by the patient’s health coverage, for such health care or health services if the telehealth provider determines that the patient has health coverage for such health care or health services. If the patient’s health coverage uses a provider network, the amount of such reimbursement, and such coinsurance, copayment, deductible or other out-of-pocket expense, shall not exceed the in-network amount regardless of the network status of such telehealth provider.

If a telehealth provider determines that a patient is unable to pay for any health care or health services described in subdivisions (1) and (2) of this subsection, the provider shall offer to the patient financial assistance, if such provider is otherwise required to offer to the patient such financial assistance, under any applicable state or federal law.

A telehealth provider may provide telehealth services pursuant to the provisions of this section from any location.

The Commissioner of Social Services may, in the commissioner’s discretion and to the extent permissible under federal law, provide coverage under the Connecticut medical assistance program for audio-only telehealth services until June 30, 2023.

SOURCE: HB 5596 (2021 Session), Sec. 1, 6. & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Permanent Statute

CT Medicaid is required to provide coverage for telehealth services for categories of health care services that the commissioner determines are clinically appropriate to be provided through telehealth, cost effective for the state and likely to expand access to medically necessary services where there is a clinical need for those services to be provided by telehealth or for Medicaid recipients whom accessing healthcare poses an undue hardship.

The commissioner may provide coverage of telehealth services pursuant to this section notwithstanding any provision of the regulations of Connecticut state agencies that would otherwise prohibit coverage of telehealth services. The commissioner may implement policies and procedures as necessary to carry out the provisions of this section while in the process of adopting the policies and procedures as regulations.

SOURCE: CT General Statute 17b, Sec. 245e. (Accessed Aug. 2022).

In accordance with section 17b- 245e of the 2020 supplement to the Connecticut General Statutes, the Department of Social Services (DSS or Department) will implement full coverage of specified synchronized telemedicine, which is defined as an audio and video telecommunication system with real-time communication between the patient and practitioner. The coverage of specified synchronized telemedicine services will be covered under both Connecticut’s Medicaid Program and Children’s Health Insurance Program (CHIP) when they:

  • Are medically necessary, in accordance with the statutory definition of medical necessity
  • Are rendered via a HIPAA-compliant, real time audio and video communication system (but note that certain popular video chatting software programs are not HIPAA-compliant); and
  • Comply with all CMAP requirements that would otherwise apply to the same service performed face-to-face (in-person), including, but not limited to, enrollment, scope of practice, licensure, documentation, and other applicable requirements.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Connecticut’s Medical Assistance Program will not pay for information or services provided to a client by a provider electronically or over the telephone. However, there is an exception for case management behavioral health services for clients age eighteen and under.

SOURCE: CT Provider Manual. Physicians and Psychiatrists. Sec. 17b-262-342.  Pg. 9, Oct. 2020; CT Provider Manual. Psychologists. Sec. 17b-262-472. Oct. 2020. Pg. 7; & CT Provider Manual. Behavioral Health. Sec. 17b-262-918. Oct. 2020. Pg. 6. (Accessed Aug. 2022).

A telehealth provider shall only provide telehealth services to a patient when the telehealth provider: (A) Is communicating through real-time, interactive, two-way communication technology or store and forward technologies; (B) has access to, or knowledge of, the patient’s medical history, as provided by the patient, and the patient’s health record, including the name and address of the patient’s primary care provider, if any; (C) conforms to the standard of care applicable to the telehealth provider’s profession and expected for in-person care as appropriate to the patient’s age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient’s condition; and (D) provides the patient with the telehealth’s provider license number and contact information.

SOURCE: CA Gen. Statutes Sec. 19a-906(b)(1). (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

See bulletin for the behavioral health services that may be rendered via telemedicine.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Opioid Treatment Programs are required to perform a complete, fully documented physical evaluation prior to admission. The program physician may render the physical evaluation component of MAT services via telemedicine only when all of the following are met:

  • The CMAP member’s originating site is another CMAP-enrolled Opioid Treatment Program (Methadone Maintenance Clinic) that is part of the same billing entity as the originating site;
  • The originating site is providing all the other required components of MAT services including the intake and psychiatric evaluation;
  • As required by 42 CFR 8.12(f), an authorized healthcare professional under the supervision of a program physician is present with the member at the originating site; and
  • The distant site provider must be located at a different service location/address than the originating site.

Induction services must always be rendered face-to-face (in-person) and only after the physical and psychiatric evaluation has been performed. Once a CMAP member has been inducted, routine psychotherapy services may be rendered via telemedicine.

MAT services that may be rendered via telemedicine include medication management and psychotherapy services.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

CT does not pay for information or services furnished by a licensed behavioral health clinician to the client electronically or over the telephone, except for case management behavioral health services for clients age eighteen and under.

SOURCE: CT Provider Manual. Behavioral Health. Sec. 17b-262-918. Oct. 2020. Pg. 6. (Accessed Aug. 2022).


ELIGIBLE PROVIDERS

Effective Now Until June 30, 2024

A telehealth provider may provide telehealth services from any location.

Telehealth providers include the following who are providing health care or other health services through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession:

  • Any physician licensed under chapter 370
  • Physical therapist or physical therapist assistant licensed under chapter 376
  • Chiropractor licensed under chapter 372
  • Naturopath licensed under chapter 373
  • Podiatrist licensed under chapter 375
  • Occupational therapist or occupational therapy assistant licensed under chapter 376a
  • Optometrist licensed under 380
  • Registered nurse or advanced practice registered nurse licensed under chapter 378
  • Physician assistant licensed under chapter 370
  • Psychologist licensed under chapter 383
  • Marital and family therapist licensed under chapter 383a
  • Clinical social worker or master social worker licensed under chapter 383b
  • Alcohol and drug counselor licensed under chapter 376b
  • Professional counselor licensed under chapter 383c
  • Dietitian-nutritionist licensed under chapter 384b
  • Speech and language pathologist licensed under chapter 399
  • Respiratory care practitioner licensed under chapter 381a
  • Audiologist licensed under chapter 397a
  • Pharmacist licensed under chapter 400j
  • Paramedic licensed under chapter 384d
  • Nurse-midwife licensed under chapter 377
  • Dentist licensed under chapter 379
  • Behavior analyst licensed under chapter 382a
  • Genetic counselor licensed under chapter 383d
  • Music therapist certified in the manner described in chapter 383f
  • Art therapist licensed in the manner described in chapter 383g
  • Athletic trainer licensed under chapter 375a

A telehealth provider may also be an appropriately licensed, certified or registered provider as listed below, that is in another state or territory of the United States or the District of Columbia and that provides telehealth services pursuant to his or her authority under any relevant order issued by the Commissioner of Public Health and maintains professional liability insurance, or other indemnity against liability for professional malpractice, in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers:

  • physician
  • physician assistant
  • physical therapist
  • physical therapist assistant
  • chiropractor
  • naturopath
  • podiatrist
  • occupational therapist
  • occupational therapy assistant
  • optometrist
  • registered nurse
  • advanced practice registered nurse
  • psychologist
  • marital and family therapist
  • clinical social worker
  • master social worker
  • alcohol and drug counselor
  • professional counselor
  • dietitian
  • nutritionist
  • speech and language pathologist
  • respiratory care practitioner
  • audiologist
  • pharmacist
  • paramedic
  • nurse-midwife
  • dentist
  • behavior analyst
  • genetic counselor
  • music therapist
  • art therapist
  • athletic trainer

SOURCE: HB 5596 (2021 Session), Sec. 1, & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Permanent Policy

Only the following categories of CMAP-enrolled providers may provide and bill for such psychotherapy services or psychiatric diagnostic evaluations within their scope of practice via telemedicine:

  • Physician
  • Physician Assistant
  • Advanced Practice Registered Nurses
  • Licensed Behavioral Health Clinicians (defined below and which includes only the following: Licensed Psychologists, Licensed Clinical Social Workers, Licensed Marital and Family Therapists, Licensed Professional Counselors, and Licensed Alcohol and Drug Counselors)
  • Behavioral Health Clinics – including Enhanced Care Clinics (ECCs)
  • Behavioral Health Federally Qualified Health Centers (FQHCs)
  • Medical Clinics – excluding School Based Health Centers (SBHCs)
  • Rehabilitation Clinics
  • Outpatient Hospital Behavioral Health (BH) Clinics
  • Outpatient Psychiatric Hospitals
  • Outpatient Chronic Disease Hospitals (CDHs)

Modifiers GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Medication Assisted Treatment

Eligible providers:

  • Physician
  • APRNs
  • PAs
  • Behavioral Health Clinics

Medication Management

Eligible Providers:

  • Physicians
  • PAs
  • APRNs
  • Medical Clinics – excluding SBHCs
  • Behavioral Health Clinics – including ECCs
  • Behavioral Health FQHCs
  • Outpatient Hospital BH Clinics
  • Outpatient Chronic Disease Hospitals

Eligible providers for out of state surgery and homebound patients include:

  • Physicians
  • PAs
  • APRNs
  • CNMs
  • Podiatrists

Eligible providers to determine if patient to be homebound and/or provide and bill for such service:

  • Physicians
  • PAs
  • APRNs
  • CNMs
  • Podiatrists

For homebound patients, provider must document the reason the member is being determined homebound.

Documentation must be maintained by both the originating site provider and the distant site provider to substantiate the services provided. Originating site documentation must indicate the member received or has been referred for telehealth services.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Telehealth providers includes the following who are providing health care or other health services through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession:

  • Any physician licensed under chapter 370
  • Physical therapist licensed under chapter 376
  • Chiropractor licensed under chapter 372
  • Naturopath licensed under chapter 373
  • Podiatrist licensed under chapter 375
  • Occupational therapist or licensed under chapter 376a
  • Optometrist licensed under 380
  • Registered nurse or advanced practice registered nurse licensed under chapter 378
  • Physician assistant licensed under chapter 370
  • Psychologist licensed under chapter 383
  • Marital and family therapist licensed under chapter 383a
  • Clinical social worker or master social worker licensed under chapter 383b
  • Alcohol and drug counselor licensed under chapter 376b
  • Professional counselor licensed under chapter 383c
  • Dietitian-nutritionist licensed under chapter 384b
  • Speech and language pathologist licensed under chapter 399
  • Respiratory care practitioner licensed under chapter 381a
  • Audiologist licensed under chapter 397a
  • Pharmacist licensed under chapter 400j
  • Paramedic licensed under chapter 384d
  • Nurse-Midwife licensed under chapter 377
  • Behavior Analyst licensed under chapter 382a

SOURCE: CT Gen. Statutes Sec. 19a-906(a)(12) as amended by CT HB 6470 (2021 Session). (Accessed Aug. 2022).

Medication Assisted Treatment – Opioid Treatment Program

The distant site provider cannot bill for the physical evaluation component rendered via telemedicine.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Medical and Behavioral Health Federally Qualified Health Centers (FQHCs) are eligible to bill their encounter rate when an approved, medically necessary telemedicine service is rendered.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Effective July 1, 2024

A telehealth provider also is to include an appropriately licensed, certified or registered provider as listed below in another state or territory of the United States or the District of Columbia, who (i) provides telehealth services under any relevant order issued pursuant to section 33 of this act, (ii) provides mental or behavioral health care through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession, and (iii) maintains professional liability insurance, or other indemnity against liability for professional malpractice, in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut mental or behavioral health care providers:

  • physician
  • naturopath
  • registered nurse
  • advanced practice registered nurse
  • physician assistant
  • psychologist
  • marital and family therapist
  • clinical social worker
  • master social worker
  • alcohol and drug counselor
  • professional counselor
  • dietitian-nutritionist
  • nurse-midwife
  • behavior analyst
  • music therapist
  • art therapist

SOURCE: SB 2 (2022 Session), Sec. 30. (Accessed Aug. 2022).


ELIGIBLE SITES

There is no limitation on the originating site for a member receiving individual therapy, family therapy or psychotherapy with medication management.

Psychiatric diagnostic evaluations may be rendered via telemedicine only if the member is located at a CMAP-enrolled originating site.

Modifiers GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

Documentation must be maintained by both the originating site provider and the distant site provider to substantiate the services provided. Originating site documentation must indicate the member received or has been referred for telehealth services.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020, (Accessed Aug. 2022).

Medication Assisted Treatment

Due to Opioid Treatment Programs (Methadone Maintenance Clinics) receiving a daily payment rate for all MAT services provided, the daily payment rate will continue to be paid to the originating site only. The distant site provider must be located at a different service location/address than the originating site.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Effective Now Until June 30, 2024

No telehealth provider shall charge a facility fee for a telehealth service provided during the period beginning on May 10, 2021 and ending on June 30, 2024.

SOURCE: HB 5596 (2021 Session), Sec. 1. & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Permanent Statute

No telehealth provider shall charge a facility fee for telehealth services.

SOURCE: CT Gen. Statutes Sec. 19a-906(h). (Accessed Aug. 2022).

No telehealth provider or hospital shall charge a facility fee for telehealth services. Such prohibition shall apply to hospital telehealth services whether provided on campus or otherwise. For purposes of this subsection, “hospital” has the same meaning as provided in section 19a490 and “campus” has the same meaning as provided in section 19a508c.

SOURCE: CT Gen. Statutes Sec. 19a-906(h), as proposed to be amended by SB 2 (2022 Session), Sec. 31. (Accessed Aug. 2022).

Last updated 08/10/2022

Miscellaneous

Effective Now Until June 30, 2024

A telehealth provider may only provide a telehealth service to a patient when the telehealth provider:

  • Is communicating through real-time, interactive, two-way communication technology or store and forward transfer technology;
  • Has determined whether the patient has health coverage that is fully insured, not fully insured or provided through Medicaid or the Children’s Health Insurance Program, and whether the patient’s health coverage, if any, provides coverage for the telehealth service;
  • Has access to, or knowledge of, the patient’s medical history, as provided by the patient, and the patient’s health record, including the name and address of the patient’s primary care provider, if any;
  • Conforms to the standard of care applicable to the telehealth provider’s profession and expected for in-person care as appropriate to the patient’s age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient’s condition; and
  • Provides the patient with the telehealth provider’s license number, if any, and contact information.

Nothing prevents a health care provider from:

  • Providing on-call coverage pursuant to an agreement with another health care provider or such health care provider’s professional entity or employer;
  • consulting with another health care provider concerning a patient’s care;
  • ordering care for hospital outpatients or inpatients; or
  • using telehealth for a hospital inpatient, including for the purpose of ordering medication or treatment for such patient in accordance with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time.

“Health care provider” means a person or entity licensed or certified pursuant to chapter 370, 372, 373, 375, 376 to 376b, inclusive, 378, 379, 380, 381a, 383 to 383c, inclusive, 384b, 397a, 399 or 400j of the general statutes or licensed or certified pursuant to chapter 368d or 384d of the general statutes.

A telehealth provider who provides health care or health services to a patient through telehealth until June 30, 2024, shall:

(A) Accept as full payment for such health care or health services:

(i) An amount that is equal to the amount that Medicare reimburses for such health care or health services if the telehealth provider determines that the patient does not have health coverage for such health care or health services; or

(ii) The amount that the patient’s health coverage reimburses, and any coinsurance, copayment, deductible or other out-of-pocket expense imposed by the patient’s health coverage, for such health care or health services if the telehealth provider determines that the patient has health coverage for such health care or health services. If the patient’s health coverage uses a provider network, the amount of such reimbursement, and such coinsurance, copayment, deductible or other out-of-pocket expense, shall not exceed the in-network amount regardless of the network status of such telehealth provider.

(3) If a telehealth provider determines that a patient is unable to pay for any health care or health services described in subdivisions (1) and (2) of this subsection, the provider shall offer to the patient financial assistance, if such provider is otherwise required to offer to the patient such financial assistance, under any applicable state or federal law.

SOURCE: HB 5596 (2021 Session) & SB 2 (2022 Session). (Accessed Aug. 2022).

Permanent Statute/Policy

The Commissioner is required to submit a report by Aug. 1, 2020 to the joint standing committees of the General Assembly on the categories of health care services in which the department is utilizing telehealth services, in what cities or regions of the state such services are being offered and any cost savings realized by the state by providing telehealth services.

SOURCE: CT General Statute 17b, Sec. 245e. (Accessed Aug. 2022).

Effective for dates of service January 1, 2021 and forward, telemedicine claims should no longer be billed with POS 02.

SOURCE: CT Department of Social Services, Medical Assistance Program, Provider Bulletin 2020-100, Dec. 2020. (Accessed Aug. 2022).

Audio-Only Telephone Remote Early Intervention Services is permissible only in accordance with the following:

  • Developmental Evaluations
  • Assessments
  • IFSP Planning
  • Early Intervention Treatment Services (EITS)

SOURCE: Medicaid Provider Bulletin on Remote Early Intervention Treatment Services, Provider Bulletin 2020-16, p. 3 (Accessed Aug. 2022).

The executive director of the Office of Health Strategy, established under section 19a-754a of the general statutes, shall conduct a study regarding the provision of, and coverage for, telehealth services in this state. Such study shall include, but need not be limited to, an examination of (1) the feasibility and impact of expanding access to telehealth services, telehealth providers and coverage for telehealth services in this state beginning on July 1, 2024, and (2) any means available to reduce or eliminate obstacles to patient access to telehealth services, telehealth providers and coverage for telehealth services in this state, including, but not limited to, any means available to reduce patient costs for telehealth services and coverage for telehealth services in this state. Not later than January 1, 2023, the executive director shall submit a report on the findings of such study, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and insurance.

SOURCE: SB 2 (2022 Session), sec. 41. (Accessed Aug. 2022).

Last updated 08/10/2022

Out of State Providers

Effective Now Until June 30, 2023

The following providers in another state or territory of the United States or the District of Columbia, that provide telehealth services pursuant to his or her authority under any relevant order issued by the Commissioner of Public Health, and maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers, are considered a telehealth provider:

  • Physician
  • Physician assistant
  • Physical therapist or physical therapist assistant
  • Chiropractor
  • Naturopath
  • Podiatrist
  • Occupational therapist or occupational therapy assistant
  • Optometrist
  • Registered nurse or advanced practice registered nurse
  • Psychologist
  • Marital and family therapist
  • Clinical social worker
  • Master social worker
  • Alcohol and drug counselor
  • Professional counselor
  • Dietitian-nutritionist
  • Speech and language pathologist
  • Respiratory care practitioner
  • Audiologist
  • Pharmacist
  • Paramedic
  • Nurse-midwife
  • Dentist
  • Behavior analyst
  • Genetic counselor
  • Music therapist
  • Art therapist
  • Athletic trainer

Effective Now Until June 30, 2024

Ending on June 30, 2024, any Connecticut entity, institution or health care provider that engages or contracts with a telehealth provider that is licensed, certified or registered in another state or territory of the United States or the District of Columbia to provide health care or other health services shall verify the credentials of such provider in the state in which he or she is licensed, certified or registered, ensure that such a provider is in good standing in such state, and confirm that such provider maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers.

Ending on June 30, 2024, the Commissioner of Public Health may temporarily waive, modify or suspend any regulatory requirements adopted by the Commissioner of Public Health or any boards or commissions as the Commissioner of Public Health deems necessary to reduce the spread of COVID-19 and to protect the public health for the purpose of providing residents of this state with telehealth services from out-of-state practitioners.

SOURCE: HB 5596 (2021 Session)SB 2 (2022 Session). (Accessed Aug. 2022).

*See COVID-19 Licensing Section in regard to any effective temporary orders.

Effective July 1, 2022

The Commissioner of Public Health may issue an order authorizing telehealth providers who are not licensed, certified or registered to practice in this state to provide telehealth services to patients in this state. Such order may be of limited duration and limited to one or more types of providers described in subdivision (13) of subsection (a) of section 1 of public act 21-9, as amended by this act, or subdivision (12) of subsection (a) of section 19a906 of the general statutes, as amended by this act. The commissioner may impose conditions including, but not limited to, a requirement that any telehealth provider providing telehealth services to patients in this state pursuant to such order shall submit an application for licensure, certification or registration, as applicable. The commissioner may suspend or revoke any authorization provided pursuant to this section to a telehealth provider who violates any condition imposed by the commissioner or applicable requirements for the provision of telehealth services under the law. Any such order issued pursuant to this section shall not constitute a regulation, as defined in section 4-166 of the general statutes.

SOURCE: SB 2 (2022 Session), Sec. 33 & Practitioner Licensing CDPH (Accessed Aug. 2022).

Out-of-State Surgery

Physicians rendering inpatient surgical services for a CMAP member must ensure the hospital has submitted and obtained an approved prior authorization for the inpatient surgery. Once the hospital has an approved authorization on file for the CMAP member, the member is eligible to receive their pre- and/or post-surgical consultations via telemedicine. Any telemedicine service related to the surgery must be rendered by the Out-of-State (OOS) provider who will be performing the surgery. All telemedicine services must be clinically appropriate and medically necessary. Pre/Post surgery instructions are not eligible for reimbursement via telemedicine.

SOURCE: CT Medical Assistance Program, Provider Bulletin 2020-09 (March 2020), p. 4. (Accessed Aug. 2022).

The Commissioner of Public Health, in consultation with the Commissioner of Early Childhood, shall develop and implement a plan to establish licensure by reciprocity or endorsement of a person who (1) is (A) a speech and language pathologist licensed or certified to provide speech and language pathology services, or entitled to provide speech and language pathology services under a different designation, in another state having requirements for practicing in such capacity that are substantially similar to or higher than the requirements in force in this state, or (B) an occupational therapist licensed or certified to provide occupational therapy services, or entitled to provide occupational therapy services under a different designation, in another state having requirements for practicing in such capacity that are substantially similar to or higher than the requirements in force in this state, (2) has no disciplinary action or unresolved complaint pending against such person, and (3) intends to provide early intervention services under the employment of an early intervention service program participating in the birth-to-three program established pursuant to section 17a-248b of the general statutes.

When developing and implementing such plan, the Commissioner of Public Health shall consider eliminating barriers to the expedient licensure of such persons in order to immediately address the needs of children receiving early intervention services under the birthto-three program. The provisions of any interstate licensure compact regarding a speech and language pathologist or occupational therapist adopted by the state shall supersede any program of licensure by reciprocity or endorsement implemented under this section for such speech and language pathologist or occupational therapist.

On or before January 1, 2023, the Commissioner of Public Health shall (1) implement the plan to establish licensure by reciprocity or endorsement, and (2) report, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and children regarding such plan and recommendations for any necessary legislative changes related to such plan.

SOURCE: SB 2 (2022 Session), Sec. 26. (Accessed Aug. 2022).

Effective July 1, 2024

A telehealth provider also is to include an appropriately licensed, certified or registered provider as listed below in another state or territory of the United States or the District of Columbia, who (i) provides telehealth services under any relevant order issued pursuant to section 33 of this act, (ii) provides mental or behavioral health care through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession, and (iii) maintains professional liability insurance, or other indemnity against liability for professional malpractice, in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut mental or behavioral health care providers:

  • physician
  • naturopath
  • registered nurse
  • advanced practice registered nurse
  • physician assistant
  • psychologist
  • marital and family therapist
  • clinical social worker
  • master social worker
  • alcohol and drug counselor
  • professional counselor
  • dietitian-nutritionist
  • nurse-midwife
  • behavior analyst
  • music therapist
  • art therapist

SOURCE: SB 2 (2022 Session), Sec. 30. (Accessed Aug. 2022).

Last updated 08/10/2022

Overview

CT has enacted temporary laws relative to telehealth, active until June 30, 2024, that require reimbursement of synchronous interactions, asynchronous store and forward transfers or remote patient monitoring.  After the law expires the law will revert back to what is CT’s ‘permanent statute’ section, unless new legislation is passed before that time that further amends the law.

Based on a previous law and permanent statute, Connecticut Medicaid is also required to cover telemedicine services for categories of health care that the commissioner determines are appropriate, cost effective and likely to expand access to medically necessary services where there is a clinical need for those services to be provided by telehealth or for Medicaid recipients for whom accessing appropriate health care services poses an undue hardship.  The CT Medicaid Program manuals do not mention reimbursement for telemedicine though provider bulletins do indicate coverage and reimbursement for some services. For audio-only services, while permanent policy does not provide reimbursement for behavioral health services provided electronically or over the phone, there is an exception for case management behavioral health services for clients age eighteen and under.  There is no reference to remote patient monitoring.

SOURCE:  HB 5596 (2021 Session) & SB 2 (2022 Session)CT Statute 17b-245e, (Accessed Aug. 2022).

An additional new law requires reimbursement of audio-only telehealth under certain circumstances and reimbursement for services provided by means of telehealth to the same extent as if the service was provided in person.

SOURCE: CT HB 6470 (2021 Session). (Accessed Aug. 2022).

Last updated 08/10/2022

Remote Patient Monitoring

POLICY

Effective Now Until June 30, 2024

Notwithstanding the provisions of section 19a-906 of the general statutes and subdivision (1) of this subsection, a telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may, during the period beginning on May 10, 2021 and ending on June 30, 2024, use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time, or the rules and regulations adopted thereunder.

SOURCE: HB 5596 (2021 Session), Sec. 1 & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

“Remote patient monitoring” means the personal health and medical data collection from a patient in one location via electronic communication technologies that is then transmitted to a telehealth provider located at a distant site for the purpose of health care monitoring to assist the effective management of the patient’s treatment, care and related support.

SOURCE: CT Statute 19a-906(a)(8). (Accessed Aug. 2022).


TRANSMISSION FEE

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 08/10/2022

Store and Forward

POLICY

Effective Now Until June 30, 2024

Notwithstanding the provisions of section 19a-906 of the general statutes, as amended by this act, and subdivision (1) of this subsection, a telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may, during the period beginning on May 10, 2021 and ending on June 30, 2024, use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time, or the rules and regulations adopted thereunder.

SOURCE: HB 5596 (2021 Session), Sec. 1 & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Permanent Policy

Although CT Medicaid previously covered electronic consultations, as of January 1, 2020 and forward, the codes used to bill for electronic consultations are no longer payable under the CT Medical Assistance Program.  This is due to guidance received by the Centers for Medicare and Medicaid Services (CMS), that reimbursement for electronic consultations does not meet the federal requirements.

SOURCE: CT Policy – Provider Bulletin 2019-75. Dec. 2019, (Accessed Aug. 2022).

“Asynchronous” means any transmission to another site for review at a later time that uses a camera or other technology to capture images or data to be recorded.

SOURCE: CT Statute Sec. 19a-906(a)(1). (Accessed Aug. 2022).

“Store and forward transfer” means the asynchronous transmission of a patient’s medical information from an originating site to the telehealth provider at a distant site.

SOURCE: CT Statute Sec. 19a-906(a)(9). (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/10/2022

Cross State Licensing

Effective Now Until June 30, 2023

Until June 30, 2023, the following providers in another state or territory of the United States or the District of Columbia, that provide telehealth services pursuant to his or her authority under any relevant order issued by the Commissioner of Public Health, and maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers, are considered a telehealth provider:

  • Physician
  • Physician assistant
  • Physical therapist or physical therapist assistant
  • Chiropractor
  • Naturopath
  • Podiatrist
  • Occupational therapist or occupational therapy assistant
  • Optometrist
  • Registered nurse or advanced practice registered nurse
  • Psychologist
  • Marital and family therapist
  • Clinical social worker
  • Master social worker
  • Alcohol and drug counselor
  • Professional counselor
  • Dietitian-nutritionist
  • Speech and language pathologist
  • Respiratory care practitioner
  • Audiologist
  • Pharmacist
  • Paramedic
  • Nurse-midwife
  • Dentist
  • Behavior analyst
  • Genetic counselor
  • Music therapist
  • Art therapist
  • Athletic trainer

Effective Now Until June 30, 2024

Ending on June 30, 2024, any Connecticut entity, institution or health care provider that engages or contracts with a telehealth provider that is licensed, certified or registered in another state or territory of the United States or the District of Columbia to provide health care or other health services shall verify the credentials of such provider in the state in which he or she is licensed, certified or registered, ensure that such a provider is in good standing in such state, and confirm that such provider maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers.

Ending on June 30, 2024, the Commissioner of Public Health may temporarily waive, modify or suspend any regulatory requirements adopted by the Commissioner of Public Health or any boards or commissions as the Commissioner of Public Health deems necessary to reduce the spread of COVID-19 and to protect the public health for the purpose of providing residents of this state with telehealth services from out-of-state practitioners.

See COVID-19 Licensing Section in regard to any effective temporary orders.

SOURCE: HB 5596 (2021 Session) & SB 2 (2022 Session) & Practitioner Licensing CDPH (Accessed Aug. 2022).

Effective July 1, 2022

The Commissioner of Public Health may issue an order authorizing telehealth providers who are not licensed, certified or registered to practice in this state to provide telehealth services to patients in this state. Such order may be of limited duration and limited to one or more types of providers described in subdivision (13) of subsection (a) of section 1 of public act 21-9, as amended by this act, or subdivision (12) of subsection (a) of section 19a906 of the general statutes, as amended by this act. The commissioner may impose conditions including, but not limited to, a requirement that any telehealth provider providing telehealth services to patients in this state pursuant to such order shall submit an application for licensure, certification or registration, as applicable. The commissioner may suspend or revoke any authorization provided pursuant to this section to a telehealth provider who violates any condition imposed by the commissioner or applicable requirements for the provision of telehealth services under the law. Any such order issued pursuant to this section shall not constitute a regulation, as defined in section 4-166 of the general statutes.

SOURCE: SB 2 (2022 Session), Sec. 33 & Practitioner Licensing CDPH (Accessed Aug. 2022).

Permanent Statute

Department of Public Health may establish a process of 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.

SOURCE: CT General Statutes 20, Sec. 12. (Accessed Aug. 2022). 

Effective Now Until July 1, 2024

Notwithstanding the provisions of section 1 of public act 21-9 and section 19a-906 of the general statutes, prior to July 1, 2024, a person who is appropriately licensed as a social worker in another state or territory of the United States or the District of Columbia may provide telehealth services to a resident of another state while such resident is in this state, provided the social worker (1) has a preexisting professional relationship with such resident, and (2) maintains professional liability insurance, or other indemnity against liability for professional malpractice, in an amount that is equal to or greater than that required for clinical or master social workers licensed pursuant to chapter 383b of the general statutes.

SOURCE: HB 5001 (2022 Session), Sec. 5. (Accessed Aug. 2022).

Effective July 1, 2024

A telehealth provider also is to include an appropriately licensed, certified or registered provider as listed below in another state or territory of the United States or the District of Columbia, who (i) provides telehealth services under any relevant order issued pursuant to section 33 of this act, (ii) provides mental or behavioral health care through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession, and (iii) maintains professional liability insurance, or other indemnity against liability for professional malpractice, in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut mental or behavioral health care providers:

  • physician
  • naturopath
  • registered nurse
  • advanced practice registered nurse
  • physician assistant
  • psychologist
  • marital and family therapist
  • clinical social worker
  • master social worker
  • alcohol and drug counselor
  • professional counselor
  • dietitian-nutritionist
  • nurse-midwife
  • behavior analyst
  • music therapist
  • art therapist

SOURCE: SB 2 (2022 Session), Sec. 30. (Accessed Aug. 2022).

Last updated 08/10/2022

Definitions

Effective Now Until June 30, 2024

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical, oral and mental health, and includes interaction between the patient at the originating site and the telehealth provider at a distant site, synchronous interactions, asynchronous store and forward transfers or remote patient monitoring, but does not include interaction through facsimile, texting or electronic mail.

Source: HB 5596 (2021 Session) sec. 1 & SB 2 (2022 Session) sec. 32. (Accessed Aug. 2022).

Permanent Statute

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store-and-forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, audio-only telephone, texting or electronic mail.

SOURCE: CT General Statute 19a, Sec. 906.  (Accessed Aug. 2022)

Last updated 08/10/2022

Licensure Compacts

Effective October 1, 2022

Enacted the Psychology Interjurisdictional Compact.

SOURCE: SB 2 (2022 Session), sec. 42. PSYPACT Map. (Accessed Aug. 2022).

Enacted the Interstate Medical Licensure Compact

SOURCE: SB 2 (2022 Session), sec. 43. IMLC Map. (Accessed Aug. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 08/10/2022

Miscellaneous

Effective Now Until June 30, 2024

A telehealth provider may only provide a telehealth service to a patient when the telehealth provider:

  • Is communicating through real-time, interactive, two-way communication technology or store and forward transfer technology;
  • Has determined whether the patient has health coverage that is fully insured, not fully insured or provided through the Connecticut medical assistance program, and whether the patient’s health coverage, if any, provides coverage for the telehealth service;
  • Has access to, or knowledge of, the patient’s medical history, as provided by the patient, and the patient’s health record, including the name and address of the patient’s primary care provider, if any;
  • Conforms to the standard of care applicable to the telehealth provider’s profession and expected for in-person care as appropriate to the patient’s age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient’s condition; and
  • Provides the patient with the telehealth provider’s license number, if any, and contact information.

The Commissioner of Public Health may temporarily waive, modify or suspend any regulatory requirements adopted by the Commissioner of Public Health or any boards or commissions under chapters 368a, 368d, 368v, 369 to 381a, inclusive, 382a, 383 to 388, inclusive, 397a, 398, 399, 400a, 400c, 400j and 474 of the general statutes as the Commissioner of Public Health deems necessary to reduce the spread of COVID-19 and to protect the public health for the purpose of providing residents of this state with telehealth services from out-of-state practitioners.

Nothing prohibits a health care provider from:

  • Providing on-call coverage pursuant to an agreement with another health care provider or such health care provider’s professional entity or employer;
  • consulting with another health care provider concerning a patient’s care;
  • ordering care for hospital outpatients or inpatients; or
  • using telehealth for a hospital inpatient, including for the purpose of ordering medication or treatment for such patient in accordance with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time.

“Health care provider” means a person or entity licensed or certified pursuant to chapter 370, 372, 373, 375, 376 to 376b, inclusive, 378, 379, 380, 381a, 383 to 383c, inclusive, 384b, 397a, 399 or 400j of the general statutes or licensed or certified pursuant to chapter 368d or 384d of the general statutes.

No telehealth provider shall provide health care or health services to a patient through telehealth unless the telehealth provider has determined whether or not the patient has health coverage for such health care or health services.

A telehealth provider who provides health care or health services to a patient through telehealth during the period beginning on May 10, 2021 and ending on June 30, 2024, shall accept as full payment for such health care or health services:

  • An amount that is equal to the amount that Medicare reimburses for such health care or health services if the telehealth provider determines that the patient does not have health coverage for such health care or health services; or
  • The amount that the patient’s health coverage reimburses, and any coinsurance, copayment, deductible or other out-of-pocket expense imposed by the patient’s health coverage, for such health care or health services if the telehealth provider determines that the patient has health coverage for such health care or health services. If the patient’s health coverage uses a provider network, the amount of such reimbursement, and such coinsurance, copayment, deductible or other out-of-pocket expense, shall not exceed the in-network amount regardless of the network status of such telehealth provider.

If a telehealth provider determines that a patient is unable to pay for any health care or health services described in subdivisions (1) and (2) of this subsection, the provider shall offer to the patient financial assistance, if such provider is otherwise required to offer to the patient such financial assistance, under any applicable state or federal law.

A telehealth provider may provide telehealth services from any location.

SOURCE: HB 5596 (2021 Session) & SB 2 (2022 Session). (Accessed Aug. 2022).

Last updated 08/10/2022

Online Prescribing

Effective Now Until June 30, 2024

Notwithstanding the provisions of this section or title 20 of the general statutes, no telehealth provider shall, during the period beginning on May 10, 2021 and ending on June 30, 2024, prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, as defined in section 20-14o of the general statutes, in a manner fully consistent with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time, for the treatment of a person with a psychiatric disability or a person with a substance use disorder, as defined in section 17a-458 of the general statutes, including, but not limited to, medication-assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically transmit the prescription pursuant to section 21a-249 of the general statutes, as amended by public act 21-9.

SOURCE: HB 5596 (2021 Session), Sec. 1 & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Effective Now Until June 30, 2023

Notwithstanding the provisions of sections 21a-408 to 21a-408n, inclusive, of the general statutes, as amended by this act, or any other section, regulation, rule, policy or procedure concerning the certification of medical marijuana patients, a physician, physician assistant, or advanced practice registered nurse may issue a written certification to a qualifying patient and provide any follow-up care using telehealth services during the period beginning on the effective date of this section and ending on June 30, 2023, provided all other requirements for issuing the written certification to the qualifying patient and all recordkeeping requirements are satisfied.

SOURCE: HB 5596 (2021 Session), Sec. 7 & HB 5329 (2022 Session), Sec. 20. (Accessed Aug. 2022).

Permanent Statute

No telehealth provider shall prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, in a manner consistent with federal law, for the treatment of a person with a psychiatric disability or substance use disorder, including but not limited to medication assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically submit the prescription pursuant to section 21a-249 of the general statutes, as amended by this act.

SOURCE: CT General Statute 19a, Sec. 906(c). (Accessed Aug. 2022).

A licensed practitioner shall not be required to electronically transmit a prescription when:

  • Electronic transmission is not available due to a temporary technological or electrical failure. In the event of a temporary technological or electrical failure, the practitioner shall, without undue delay, reasonably attempt to correct any cause for the failure that is within his or her control. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record as soon as practicable, but in no instance more than seventy-two hours following the end of the temporary technological or electrical failure that prevented the electronic transmittal of the prescription. For purposes of this subdivision, “temporary technological or electrical failure” means failure of a computer system, application or device or the loss of electrical power to such system, application or device, or any other service interruption to such system, application or device that reasonably prevents the practitioner from utilizing his or her certified application to electronically transmit the prescription in accordance with subsection (b) of this section;
  • The practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by an electronically transmitted prescription in a timely manner and that such delay would adversely impact the patient’s medical condition, provided if such prescription is for a controlled substance, the quantity of such controlled substance does not exceed a five-day supply for the patient, if the controlled substance was used in accordance with the directions for use. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record;
  • The prescription is to be dispensed by a pharmacy located outside this state. A practitioner who issues a prescription, but fails to electronically transmit the prescription, as permitted by this subsection, shall document the reason for the practitioner’s failure to electronically transmit the prescription in the patient’s medical record;
  • Use of an electronically transmitted prescription may negatively impact patient care, such as a prescription containing two or more products to be compounded by a pharmacist, a prescription for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, a prescription that contains long or complicated directions, a prescription that requires certain elements to be included by the federal Food and Drug and Administration, or an oral prescription communicated to a pharmacist by a health care practitioner for a patient in a chronic and convalescent nursing home, licensed pursuant to chapter 368v; or
  • The practitioner demonstrates, in a form and manner prescribed by the commissioner, that such practitioner does not have the technological capacity to issue an electronically transmitted prescription. For the purposes of this subsection, “technological capacity” means possession of a computer system, hardware or device that can be used to electronically transmit controlled substance prescriptions consistent with federal law. The provisions of this subdivision shall not apply to a practitioner when such practitioner is prescribing as a telehealth provider, as defined in section 19a-906, as amended by this act, section 1 of public act 20-2 of the July special session* or section 1 of public act 21-9*, as amended by this act, as applicable, pursuant to subsection (c) of section 19a-906, subsection (c) of section 1 of public act 20-2 of the July special session* or subsection (c) of section 1 of public act 21-9*, as amended by this act, as applicable. 

SOURCE: CT General Statute 21a-249 (c). As amended by HB 5596 (2021 Session)& proposed to be amended by SB 2 (2022 Session), sec. 34. (Accessed Aug. 2022).

Last updated 08/10/2022

Professional Board Standards

No Reference Found

Last updated 08/10/2022

Definition of Visit

“Encounter” means a face-to-face visit between a client and health professional or an allied health professional for medically necessary services and includes the client’s visit to the FQHC and all services and supplies incidental to the health professional’s services. Visits with more than one health professional or allied health professional or multiple visits with the same health professional or allied health professional that take place on the same day shall be considered one encounter, except under either of the following circumstances: (A) A client, subsequent to the first encounter, suffers an illness or injury requiring additional diagnosis or treatment; or (B) A client has different types of encounters (medical, behavioral health and dental) for different diagnoses on the same day;

SOURCE: CT FQHC Provider Manual, p. 4 (Oct. 1, 2020). (Accessed Aug. 2022).

Last updated 08/10/2022

Eligible Distant Site

FQHCs are listed as eligible providers for a variety of services via telehealth and guidance states that the modifier GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Last updated 08/10/2022

Eligible Originating Site

Medical and Behavioral Health FQHCs cannot bill their encounter rate when serving as an originating site only; meaning no other services were rendered to the member on that date of service outside of facilitating the telemedicine call by providing the space and technology.

SOURCE: CT Policy – Provider Bulletin 2020-09. P. 5, March 2020. (Accessed Aug. 2022).

Last updated 08/10/2022

Facility Fee

There is a general prohibition on providers charging a facility fee for telehealth services.

See: CT Medicaid Live Video Facility/Transmission Fee

Last updated 08/10/2022

Home Eligible

Billable services for FQHCs shall include core and noncore services identified in section 17b-262-997 of the Regulations of Connecticut State Agencies. Covered core and noncore services shall be billed on an encounter basis in accordance with section 17b-262-1002 and are subject to the following limitations:

Billable encounters shall include encounters that:

  1. Take place at a service site approved by HRSA as part of a FQHC; or
  2. Take place in a patient’s home for the purpose of providing services to FQHC patients; and
  3. Are documented in the patient health records.

The services of a registered nurse may be billed as a medical encounter unless provided incident to a medical encounter as described below. Encounters with more than one health professional for the same type of service (e.g., a nurse and a physician provide a medical encounter) and multiple interactions with the same health professional that take place on the same day constitute a single encounter except when the patient, after the first interaction, suffers illness or injury requiring additional diagnosis and treatment.

SOURCE: CT FQHC Provider Manual, p. 9 (Oct. 1, 2020) (Accessed Aug. 2022).

Guidance for eligible providers, including FQHCs, states that the modifier GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Aug. 2022).

Last updated 08/10/2022

Modalities Allowed

Live Video

CT Medicaid covers specified synchronized telemedicine, which is defined as an audio and video telecommunication system with real-time communication between the patient and practitioner.

See: CT Medicaid Live Video


Store and Forward

CT Medicaid doesn’t have explicit coverage of store-and-forward services.

See: CT Medicaid Store-and-forward


Remote Patient Monitoring

CT Medicaid doesn’t cover RPM.

See: CT Medicaid RPM


Audio-Only

No explicit reimbursement for telephone for FQHCs.

See: CT Medicaid Email, Phone, & Fax

Last updated 08/10/2022

Patient-Provider Relationship

No Reference Found.

For general information about prescribing see: CT Professional Requirements Online Prescribing

Last updated 08/10/2022

PPS Rate

All covered telehealth services provided by an FQHC are paid at the same encounter rate referenced in the state plan that would be paid to the FQHC for comparable in-person services.

SOURCE: CT Department of Social Services. FQHC Medicaid Reimbursement. (Accessed Aug. 2022).

Medical and Behavioral Health Federally Qualified Health Centers (FQHCs) are eligible to bill their encounter rate when an approved, medically necessary telemedicine service is rendered.

SOURCE: CT Policy – Provider Bulletin 2020-09. P. 5, March 2020. (Accessed Aug. 2022).

“Encounter rate” means the all-inclusive PPS rate that the Department reimburses a FQHC for an encounter pursuant to 42 USC 1396a (bb).

SOURCE: CT FQHC Provider Manual, p. 4 (Oct. 1, 2020). (Accessed Aug. 2022).

Last updated 08/10/2022

Same Day Encounters

Visits with more than one health professional or allied health professional or multiple visits with the same health professional or allied health professional that take place on the same day shall be considered one encounter, except under either of the following circumstances: (A) A client, subsequent to the first encounter, suffers an illness or injury requiring additional diagnosis or treatment; or (B) A client has different types of encounters (medical, behavioral health and dental) for different diagnoses on the same day.

SOURCE: CT FQHC Provider Manual, p. 4 (Oct. 1, 2020). (Accessed Aug. 2022).

Each FQHC shall bill for FQHC services per encounter. Claims are limited to one all-inclusive encounter per day to include all services received by a client on the same day unless the client suffers an illness or injury subsequent to the first encounter that requires additional diagnosis or treatment or if the client has different types of visits on the same day such as medical and dental or medical and behavioral health. Medicaid pays for one medical, one dental, and one behavioral health encounter per day.

SOURCE: CT FQHC Provider Manual, p. 14 (Oct. 1, 2020). (Accessed Aug. 2022).