Delaware

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: No

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: APRN, ASLP-IC, CC, EMS, IMLC, NLC, OTC, PSY, PTC
  • Consent Requirements: Yes

FQHCs

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

STATE RESOURCES

  1. Medicaid Program: Delaware Division of Medicaid & Medical Assistance (DMMA)
  2. Administrator: Delaware Health and Social Services Dept., Division of Medicaid & Medical Assistance
  3. Regional Telehealth Resource Center: Mid-Atlantic 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 08/24/2022

Audio Only Delivery

Medicaid:  Telehealth and COVID FAQs

STATUS: Active, until further notice.

Medicaid: Changes to Telehealth Policy

STATUS: Active, until further notice.

Medicaid: COVID-19 and Telehealth Fee Schedule

STATUS: Active, until further notice.

Medicaid 1915(c) Waiver: Appendix K DDDS Lifespan Waiver

STATUS: Expired January 26, 2021

HB 160: Permanent Private Payer Telehealth Expansions – Made audio-only flexibility permanent and removed in-person requirements in certain instances

STATUS: Enacted (Most provisions took effect July 1, 2021)

Last updated 08/16/2022

Cross State Licensing

STATUS: Active, set to expire September 19, 2022 unless renewed

Division of Professional Regulation: Telehealth Form for Behavioral Health Providers

STATUS: Active

HB 160: Telehealth Expansions

STATUS: Enacted (Most provisions took effect July 1, 2021)

Last updated 08/24/2022

Easing Prescribing Requirements

Medicaid:  Telehealth and COVID FAQs

STATUS: Active, until further notice.

Medicaid: Changes to Telehealth Policy

STATUS: Active, until further notice.

Division of Professional Regulation:  Letter to Pharmacists RE Telehealth

STATUS: Unclear if still active.

HB 160: Permanent Private Payer Telehealth Expansions – Made audio-only flexibility permanent and removed in-person requirements in certain instances

STATUS: Enacted (Most provisions took effect July 1, 2021)

Last updated 08/24/2022

Miscellaneous

No Reference Found

Last updated 08/24/2022

Originating Site

Medicaid: Changes to DMMA Telehealth Policies to Respond to COVID-19

STATUS: Active

Medicaid:  Telehealth and COVID FAQs

STATUS: Active, until further notice.

Last updated 08/24/2022

Private Payer

Insurance Commissioner: Bulletin to Insurance Carriers on Telehealth

STATUS: Active

Insurance Commissioner: Universally Applicable Bulletin No. 6 – Rescinding of COVID 19-Related Bulletins and Continuation of Certain Relevant Provisions

STATUS: Active

HB 160: Permanent Private Payer Telehealth Expansions – Made audio-only flexibility permanent and removed in-person requirements in certain instances

STATUS: Enacted (Most provisions took effect July 1, 2021)

Department of Insurance: Insurance Coverage for Telemedicine and Telehealth Final Order

STATUS: Permanent

Last updated 08/24/2022

Provider Type

Medicaid: Telehealth and COVID FAQs

STATUS: Active, until further notice.

Medicaid: Changes to Telehealth Policy

STATUS: Active, until further notice.

Last updated 08/24/2022

Service Expansion

Medicaid: Telehealth and COVID FAQs

STATUS: Active, until further notice.

Medicaid: Changes to Telehealth Policy

STATUS: Active, until further notice.

Medicaid: POS Telehealth and Codes

STATUS: Active, until further notice.

Medicaid: COVID-19 and Telehealth Fee Schedule

STATUS: Active, until further notice.

Office of the Governor: Declaration of a Public Health Emergency for the State of Delaware; First Revision; Sixth Extension

STATUS: Active, set to expire September 19, 2022 unless renewed.

HB 160: Permanent Private Payer Telehealth Expansions – Made audio-only flexibility permanent and removed in-person requirements in certain instances

STATUS: Enacted (Most provisions took effect July 1, 2021)

Last updated 08/24/2022

Definitions

Group and Blanket Insurance, & Health Insurance Contracts

“Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care provider consultation, patient and professional health-related education, public health, health administration, and other services as authorized in Chapter 60 of Title 24.

SOURCE: Title 18, Ch. 33, Sec. 3370(4); Title 18, Ch. 35 Sec. 3571R & DE Administrative Code Title 18: 1409(2). (Accessed Aug. 2022)

“Telemedicine” is a subset of telehealth which is the delivery of clinical health-care services and other services, as authorized in Chapter 60 of Title 24, by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health-care provider legally allowed to practice in the state and practicing within the health-care provider’s scope of practice as would be practiced in-person with a patient, while such patient is at an originating site and the health-care provider is at a distant site.

SOURCE: Title 18, Ch. 33, Sec. 3370 (As amended by HB 160 (2021 Session) & DE Administrative Code Title 18: 1409(2). (Accessed Aug. 2022)

“Telemedicine” means a form of telehealth which is the delivery of clinical health-care services, and other services, as authorized in Chapter 60 of Title 24, by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health-care provider legally allowed to practice in the state and practicing within the health-care provider’s scope of practice as would be practiced in-person with a patient, while such patient is at an originating site and the health-care provider is at a distant site.

SOURCE: Title 18, Ch. 35, Sec. 3571R (As amended by HB 160 (2021 Session). (Accessed Aug. 2022)

Last updated 08/24/2022

Parity

SERVICE PARITY

A payer must reimburse the provider for the diagnosis, consultation, or treatment of the patient on the same basis as in-person services for telemedicine.

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Aug. 2022).


PAYMENT PARITY

An insurer, health service corporation, or health maintenance organization shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis and at least at the rate that the insurer, health service corporation, or health maintenance organization is responsible for coverage for the provision of the same service through in-person consultation or contact. Payment for telemedicine interactions shall include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health-care services.

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Aug. 2022).

Last updated 08/24/2022

Requirements

Private payers must provide coverage for the cost of health care services provided through telemedicine, and telehealth as directed through regulations by the Department.  Insurers must pay for telemedicine services at the same rate as in-person.  Payment for telemedicine must include reasonable compensation to the originating or distant site for the transmission cost.

Private payers may not impose an annual or lifetime dollar maximum on coverage for telemedicine services other than what would apply in the aggregate to all items and services covered under the policy. Additionally, no copayment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services may be imposed unless equally imposed on all terms and services under the policy.

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Aug. 2022).

No insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; health service corporation providing individual or group accident and sickness subscription contracts; or managed care organization or health maintenance organization providing a health care plan for health care services shall impose any limitation on the ability of an insured to seek medical care through the use of telehealth service solely because the health care service is being provided through telehealth. Such prohibited limitations shall include, but not be limited to, preauthorization, medical necessity, homebound requirements, or requiring the use of technology permitting visual communication.

SOURCE: 18 DE Administrative Code 1409 (Accessed Aug. 2022).

No insurer may, in issuing or renewing an insurance policy to a health-care professional or health-care organization, increase the premium on such policy or take other adverse action against any health-care professional or health-care organization who performs or assists in the provision of reproductive health services, as that term is defined in § 1702 of Title 24, that is legal in this State to an individual who is from out of the state. This section applies to a policy that covers any medical professional who prescribes medication for the termination of human pregnancy to an out-of-state patient by means of telehealth.

SOURCE: DE Code Title 18, Chap. 25, Sec. 2535 as amended by HB 455 (2022 Session). (Accessed Aug. 2022).

Last updated 08/24/2022

Definitions

Telemedicine is a cost-effective alternate to face-to-face encounters where access to care is compromised due to the lack of available service providers in the patient’s geographical location.  This definition is modeled on Medicare’s definition for telehealth services located at 42 CFR Sec. 410.78.  Note that the Federal Medicaid statute does not recognize telemedicine as a distinct service.

For purposes of DMAP, telemedicine is the use of medical or behavioral health information exchanged from one site to another site via an electronic interactive (two-way, real time) telecommunications system to improve a patient’s health.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16 Telemedicine, 16.1 & 16.2 (Accessed Aug. 2022).

“Telemedicine is the use of medical or behavioral health information exchanged from one site to another via an electronic interactive telecommunications system to improve a patient’s health. Telemedicine services are provided with specialized equipment at each site including real-time streaming via the use of:

  • Video Camera
  • Audio Equipment
  • Monitor
  • The telecommunications must permit real-time encryption of the interactive audio and video exchanges with the consulting provider.”

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 14, 2016.  Sec. 1.8. (Accessed Aug. 2022).

Last updated 08/24/2022

Email, Phone & Fax

Telephone, chart review, electronic mail messages, facsimile transmissions or internet services for online medical evaluations are not considered telemedicine.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.8.1, Telemedicine, pg. 76, (Accessed Aug. 2022). 

Adult Behavioral Health

Telephone calls, internet services for online medical evaluations, electronic mail messages or facsimile transmissions between a health care practitioner and a patient or a consultation between two health care practitioners are non-covered services.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement Provider Specific Policy Manual (12/1/16), 1.8, p. 14. (Accessed Aug. 2022).

Last updated 08/24/2022

Live Video

POLICY

DE Medicaid reimburses for live video telemedicine services for up to three different consulting providers for separately identifiable telemedicine services provided to a member per date of service.

SOURCE: DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/22. Ch. 16 Telemedicine, Sec. 16..8.2, pg. 76 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 14. (Accessed Aug. 2022).

The GT modifier (which indicates the service occurred via interactive audio and video telecommunication system) can be used for Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program in  Group Physical Therapy treatment utilizing code 97150 + the GT modifier.

SOURCE: DE School Based Health Services Specific Policy Manual, pg. 53 & 57 (4/1/16). (Accessed Aug. 2022).

The referring provider is not required to be present at the originating site, however the recipient of the services must be present. The Distant Site provider must be located within the continental United States.

Reimbursement to the referring provider will only occur when providing a separately identifiable covered service.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.6.1.1, 16.2.6.1.2,& 16.5.1 Telemedicine, pg. 75. & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 12. (Accessed Aug. 2022).

The recipient:

  • must be able to verbally communicate, either directly or through a representative, with the originating and distant site providers,
  • must be able to receive services via telemedicine, and
  • must have provided consent for the use of telemedicine.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.5.5 Telemedicine, pg. 75 (Accessed Aug, 2022).


ELIGIBLE SERVICES/SPECIALTIES

The service must be medically necessary, written in the patient’s treatment plan and, follow generally accepted standards of care. The service provided by the distant provider must be a service covered by DMAP.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16 Telemedicine, Sec. 16.5.2, pg. 75 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 12. (Accessed Aug. 2022).

Interactive audio and video telecommunications can be used for group physical therapy in the Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program for group physical therapy treatment.

SOURCE: DE School Based Health Services Specific Policy Manual, pg. 53 & 57 (4/1/16). (Accessed Aug. 2022).

Tele-Dentistry

Synchronous real-time tele-dentistry services must be provided in accordance with the recommendations provided by the American Dental Association.  The evaluation is limited to a specific oral health problem or complaint.

SOURCE: DE Medical Assistance Program. Adult Dental Program Services Provider Specific Manual. Nov. 19, 2021. Sec. 4.2. p. 8 (Accessed Aug. 2022).

Adult Behavioral Health Service

Rate Methodologies for the CPT codes under the telemedicine section of the State Plan for Adult Behavioral Health Services are paid at a lower rate and provided in the manual.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 14 (Accessed Aug. 2022).

Durable Medical Equipment

The face-to-face encounter may occur through telehealth; as implemented by DMAP. In addition, the face-to-face encounter occurred through telehealth may be performed by any of the practitioners described above with the exception of certified nurse-midwives.

SOURCE: DE Medical Assistance Program, Durable Medical Equipment Provider Specific Manual, 3.1.5, p. 19 (Mar. 9, 2022). (Accessed Aug. 2022).


ELIGIBLE PROVIDERS

To receive payment for services delivered through telemedicine technology from DMAP or MCOs, healthcare practitioners must:

  • Act within their scope of practice;
  • Be licensed (in Delaware, or the State in which the provider is located if exempted under Delaware State law to provide telemedicine services without a Delaware (license) for the service for which they bill DMAP;
  • Be enrolled with DMAP/MCOs;
  • Be located within the continental United States;
  • Be credentialed by DMMA-contracted MCOs, when needed;
  • Submit a DMMA Disclosure Form.

SOURCE: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 11 (Accessed Aug. 2022).

Eligible distant site providers include:

  • Inpatient/outpatient hospitals (including ER)
  • Physicians (or PAs under the physician’s supervision)
  • Certified Nurse Practitioners
  • Nurse Midwives
  • Licensed Psychologists
  • Licensed Clinical Social Workers
  • Licensed Professional Counselors of Mental Health
  • Speech Language Therapists
  • Audiologists
  • Other providers as approved by the DMAP

SOURCE: DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.4.3 Telemedicine, pg. 72-73, & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 12 (Accessed Aug. 2022).


ELIGIBLE SITES

An originating site refers to the facility in which the Medicaid patient is located at the time the telemedicine service is being furnished. An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized.

Medical Facility Sites:

  • Outpatient Hospitals
  • Inpatient Hospitals
  • Federally Qualified Health Centers
  • Rural Health Centers
  • Renal Dialysis Centers
  • Skilled Nursing Facilities
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
  • Intermediate Care Facilities/Institutions for Mental Diseases (ICF/IMDs)
  • Outpatient Mental Health/Substance Abuse Centers/Clinics
  • Community Mental Health Centers/Clinics
  • Public Health Clinics
  • PACE Centers
  • Assisted Living Facilities
  • School-Based Wellness Centers
  • Patient’s Home (must comply with HIPAA, privacy, secure communications, etc., and does not warrant an originating site fee)
  • Other Sites as approved by the DMAP

Medical Professional Sites:

  • Physicians (or Physicians Assistants under the supervision of a physician)
  • Certified Nurse Practitioners
  • Medical and Behavioral Health Therapists

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.5.4.1 & 16.2.5.4.2 Telemedicine, pg. 73 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1. 8. pg. 11 & 12 (Accessed Aug. 2022).


GEOGRAPHIC LIMITS

There are no geographical limitations within Delaware regarding the location of an originating site provider.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 12. (Accessed Aug. 2022).


FACILITY/TRANSMISSION FEE

A facility fee is covered for originating sites.

Facility fees for the distant site are not covered.

Only one facility fee is permitted per date, per member.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/22. Ch. 16 Telemedicine, Sec. 16.2,4.2 16.2.5.3 & 16.8.3, pg. 72-76 & DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 11. (Accessed Aug. 2022).

Last updated 08/24/2022

Miscellaneous

The face-to-face encounter for home health services used to evaluate a patient’s condition and recertify services may take place via telehealth.

SOURCE: DE Medical Assistance Program. Home Health Provider Specific Manual, 2/15/20. Sec. 5.2.8, p. 18. (Accessed Aug. 2022).

Provider manual lays out three different models for prescribing:

  1. First Model:  The distant provider consults with the referring healthcare practitioner (if present during the telemedicine session or by other means) about appropriate medications. The referring provider then executes the prescription locally for the patient.
  2. Second Model:  The consulting provider works with a medical professional at the originating site to provide front line care, including writing prescriptions. This method is common at mental health centers. The medical professional must be available on site to write the prescription exactly as described by the consulting healthcare practitioner.
  3. Third Model:  The consulting healthcare practitioner directly prescribes and sends/calls-in the initial prescription or refill to the patient’s pharmacy.

For stimulants, narcotics and refills, hard copy prescriptions can be written and sent via delivery service to the referring site for the consumer to pick up a couple days after the appointment (see manual for more details).

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16 Telemedicine, Sec. 16.11 p. 76-77 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 13.  (Accessed Aug. 2022). 

Confidentiality, privacy and electronic security standards for telemedicine as well as a contingency plan required of telemedicine sites are listed in the DE Behavioral Health Service Certification and Reimbursement manual.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10 (Accessed Aug. 2022).

Last updated 08/24/2022

Out of State Providers

The Distant site provider must be located within the continental US and enrolled in the DE Medicaid program or in a DE Medicaid Managed Care Organization to be reimbursed for services.

SOURCE:  DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.4.1 & 16.5.7 Telemedicine pg. 72 & 75 & DE Adult Behavioral Health Service Certification and Reimbursement Provider Policy Manual (Dec. 14, 2016), p. 11.  (Accessed Aug. 2022).

Last updated 08/24/2022

Overview

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telemedicine services delivered via live video for certain providers and for patients at specific sites.  DMAP does not reimburse for store-and-forward and makes no reference to remote patent monitoring.

Last updated 08/24/2022

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 08/24/2022

Store and Forward

POLICY

Asynchronous or “store-and-forward” applications do not meet the DMAP definition of telemedicine.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.3.4.1 Telemedicine, pg. 74 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10 (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/24/2022

Cross State Licensing

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

  1. Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
  2. Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
  3. Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
  4. Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

SOURCE: Title 24, Ch. 60, Sec. 6005. (Accessed Aug. 2022).

Social Work Examiners Licensure Exemptions

General licensure requirements do not apply to an individual who meets any of the following criteria:

  • Is licensed in good standing to practice social work in another jurisdiction, provided that the individual has made prior written application to the Board to practice social work in this State and the Board has approved the application. An individual may practice social work, within the scope of practice designated by the individual’s license, in this State under this subsection for no more than 30 days per year. An individual who provides services under this subsection is deemed to have submitted to the Board’s jurisdiction and bound by the laws of this State.
  • Is certified or licensed in this State by any other law, and is engaged in and acting within the scope of the profession or occupation for which the individual is certified or licensed.
  • Is clergy of any denomination, when engaging in activities that are within the scope of the performance of that individual’s regular or specialized ministerial duties.
  • Performs assessments such as basic information collection, gathering of demographic data, and informal observations, screening, and referral to determine a client’s general eligibility for a program or service and a client’s functional status for the purpose of determining need for services unrelated to a behavioral health diagnosis or treatment plan.
  • Creates, develops, or implements a service plan unrelated to a behavioral health diagnosis or treatment plan. Service plans may include job training and employability, housing, general public assistance, in-home services and supports or home-delivered meals, de-escalation techniques, peer services, or skill development.
  • Participates as a member of a multi-disciplinary team to implement behavioral health services or a treatment plan in certain circumstances.
  • Individuals exempted under this paragraph (c)(1)f. do not engage in any of the following restricted practices:
    • Diagnosis of mental, emotional, behavioral, addictive, and developmental disorders and disabilities.
    • Client assessment and evaluation.
    • Provision of psychotherapeutic treatment.
    • Development and implementation of assessment-based treatment plans.

Nothing in this subsection may be construed as requiring a license for any particular activity or function solely because the activity or function is not listed in this subsection.

Social Worker Reciprocity

Upon payment of the required fee and submission and acceptance of a written application on forms that the Board provides, the Board shall grant a license to an applicant who has done all of the following:

  1. Presented proof of a current, active license in good standing and with no disciplinary action taken against the applicant in another jurisdiction whose standards the Board has determined are substantially similar to those of this State.
  2. Presented proof that, in any other jurisdiction in which the applicant is or was licensed, the applicant’s license is in good standing or the applicant is voluntarily no longer licensed.
  3. Successfully passed an examination that the Board designated under § 3906(a)(3) of this title.
  4. Provided the Board with a certified statement as to whether any outstanding or ongoing disciplinary actions or ethical violations are against the applicant, or whether the applicant has engaged in any of the acts or offenses that may be grounds for disciplinary action under this chapter. Applicants are deemed to consent to the release of information regarding disciplinary actions or ethical violations and waive all objections to the admissibility of the information as evidence at any hearing or other proceeding to which the applicant may be subject under this chapter.

An applicant who has a license in another jurisdiction that has less stringent requirements than those of this State may obtain a license under this section if the applicant can prove to the Board’s satisfaction that the applicant has worked in another jurisdiction in the field for which the applicant is seeking a license in this State for at least 5 years in the 7 years immediately preceding application in this State. The Board may determine whether the requirements of another jurisdiction are less stringent than those of this State.

SOURCE: Title 24, Chap. 39, Sec. 3903 & 3909. (Accessed Aug. 2022).

Last updated 08/24/2022

Definitions

Applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Mental Health, Chemical Dependency Professionals, Psychology, Dietetic and Nutrition Therapy, and Clinical Social Workers

“Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

“Telemedicine” means a form, or subset, of telehealth, which includes the delivery of clinical health-care services by means of real time 2-way audio (including audio-only conversations, if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection), visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health-care.

SOURCE: Title 24, Ch. 60, Sec. 6001(5) & (6). (Accessed Aug. 2022).

Applies to: Physical Therapy

“Telehealth, as set forth in the Board’s rules and regulations, means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including physical therapy and athletic training related information and services, over large and small distances.  Telehealth encompasses a variety of healthcare and health promotion activities, including education, advice, reminders, interventions, and monitoring of intervention.”

SOURCE: 24 DE Administrative Code 2602(13). (Accessed Aug. 2022).

NOTE: DE Professional Boards have different definitions of telehealth/telepractice/telemedicine.  See Professional Board Standards section for references.

Last updated 08/24/2022

Licensure Compacts

Member of Nurse Licensure (NLC) Compact.

SOURCE: Nurse Licensure Compact. Current NLC States. (Accessed Aug. 2022)

Member of the Advanced Practice Registered Nurse (APRN) Compact.

SOURCE: APRN Compact Map. (Accessed Aug. 2022).

Member of Physical Therapy Licensure Compact.

SOURCE: PT Compact. Member States. (Accessed Aug. 2022). 

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT. PSYPACT Map. (Accessed Aug. 2022).

Member of Interstate Medical Licensure Compact (IMLC)

SOURCE: IMLC. (Accessed Aug. 2022)

Member of Emergency Medical Services Compact.

SOURCE: Interstate Commission for EMS Personnel Practice, Member States, (Accessed Aug. 2022).

Enacted Occupational Therapy Licensure Compact.

SOURCE: OT Compact Map. (Accessed Aug. 2022).

Enacted Multistate Professional Counselor Licensure Compact.

SOURCE: Counseling Compact Map. (Accessed Aug. 2022).

Enacted Audiology and Speech-Language Pathology Interstate Compact.

SOURCE: ASLP Compact Map. (Accessed Aug. 2022).

 

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

Last updated 08/24/2022

Miscellaneous

No Reference Found

Last updated 08/24/2022

Online Prescribing

Health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include the following:

  • Thorough verification and authentication of the location and, to the extent possible, identity of the patient.
  • Disclosure and validation of the provider’s identity and credentials.
  • Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies as required by paragraph (a)(5) of this section.
  • Establishment of a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identification of underlying conditions or contra-indications, or both, for treatment recommended or provided.
  • Discussion with the patient of any diagnosis and supporting evidence as well as risks and benefits of various treatment options.
  • The availability of a distant site provider or other coverage of the patient for appropriate follow-up care.
  • A written visit summary provided to the patient.

Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology. Telehealth and telemedicine services may be used to establish a provider-patient relationship only if the provider determines that the provider is able to meet the same standard of care as if the health-care services were being provided in-person.

Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings. In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

  1. Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
  2. Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
  3. Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
  4. Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

SOURCE: Title 24, Ch. 60, Sec. 6003 & 6005. (Accessed Aug. 2022).

Pharmacists:

Pharmacists practicing within or outside of the state are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to an Internet pharmacy through an Internet site or that the prescription was issued by a practitioner who does not have a patient-practitioner relationship with the Delaware patient.

SOURCE: DE Code, Title 16, Chapter 47, Sec. 4744(d)(1)(a-b). (Accessed Aug. 2022).

Physicians:

A remote, audio-only examination is not an “appropriate in-person examination”.

No opioid prescribing is permitted via telemedicine with the exception of addiction treatment programs offering medication assisted treatment that have received a Division of Substance Abuse and Mental Health (DSAMH) waiver to use telemedicine through DSAMH’s licensure or renewal process. All other controlled substance prescribing utilizing telemedicine is held to the same standards of care and requisite practice as prescribing for in-person visits.

For formation of the physician-patient relationship using audio and visual communications, the audio and visual communications must be live, real-time communications.

SOURCE: DE Admin Code. Title 24 Sec. 1700.  Sec. 19. (Accessed Aug. 2022).

Delaware Board of Medical Licensure has specific requirements for electronic prescribing.

SOURCE: DE Admin Code, Title 24, Sec. 1713(a)(12) (Accessed Aug. 2022).

Last updated 08/24/2022

Professional Board Standards

Health-care providers licensed by the following professional boards are authorized to deliver health-care services by telehealth and telemedicine:

  • The Board of Podiatry created pursuant to Chapter 5 of this title.
  • The Board of Chiropractic created pursuant to Chapter 7 of this title.
  • The Board of Medical Practice created pursuant Chapter 17 of this title.
  • The State Board of Dentistry and Dental Hygiene created pursuant to Chapter 11 of this title.
  • The Delaware Board of Nursing created pursuant to Chapter 19 of this title.
  • The Board of Occupational Therapy Practice created pursuant to Chapter 20 of this title.
  • The Board of Examiners in Optometry created pursuant to Chapter 21 of this title.
  • The Board of Pharmacy created pursuant to Chapter 25 of this title.
  • The Board of Mental Health and Chemical Dependency Professionals created pursuant to Chapter 30 of this title.
  • The Board of Examiners of Psychologists created pursuant to Chapter 35 of this title.
  • The State Board of Dietetics/Nutrition created pursuant to Chapter 38 of this title.
  • The Board of Social Work Examiners created pursuant to Chapter 39 of this title.

A professional board may promulgate or revise regulations and establish or revise rules applicable to health-care providers under the professional Board’s jurisdiction in order to facilitate the provision of telehealth and telemedicine services.

Practice requirements:

A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least one of the following:

  • Provide an appropriate examination in-person.
  • Require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis.
  • Make a diagnosis using audio or visual communication.
  • Meet the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

After a health-care provider-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient by the same health-care provider need not satisfy the limitations of this section.

A health-care provider treating a patient through telemedicine and telehealth must maintain complete records of the patient’s care and follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

Telehealth and telemedicine services shall include, if required by the applicable professional board listed, use of the Delaware Health Information Network (DHIN) in connection with the practice.

Nothing in this section shall be construed to limit the practice of radiology or pathology.

SOURCE: DE Statute Title 24, Chap. 60, Sec. 6002 & 6004. (Accessed Aug. 2022)

Physical Therapists and Athletic Trainers

SOURCE: DE Statute Title 24, Chapter 26, Sec. 2602. (Accessed Aug. 2022).

Board of Clinical Social Work Examiners

SOURCE: 24 DE Statute Title 24, Chapter 39, 3920. (Accessed Aug. 2022).

Board of Dentistry and Dental Hygiene

SOURCE: 24 DAC 1100 (Accessed Aug. 2022).

Pharmacy

SOURCE: 24 DAC 2500 (Accessed Aug. 2022).

Last updated 08/24/2022

Definition of Visit

A visit is a face-to-face encounter between a center patient and any health professional whose services are reimbursed under the State Plan.

Medical FQHC services shall be billed per “medical encounter”. “Encounter” is defined as a face-to-face visit between a FQHC patient and any health professional whose services are reimbursed under the State Plan for the purpose of diagnosis or treatment. Claims are limited to one all-inclusive “encounter” per day, to include all services received by an eligible recipient on a single day or relevant to the “encounter”. All subsequent services and follow-up care provided by other than a physician, nurse practitioner, or physician’s assistant, ordered as a result of an “encounter” are included in the related “encounter” rate, and are not billed separately.

SOURCE: DE FQHC Policy Manual, 10/1/21, p. 4, 9. (Accessed Aug. 2022).

Last updated 08/24/2022

Eligible Distant Site

FQHCs are not explicitly listed as eligible distant site providers, although the provider list states that other providers can be approved by DMAP. In addition, COVID-19 guidance implies that FQHCs should “continue” typical billing practices for telehealth services as distant site/rendering providers:

  • FQHC Rendering Providers billing for Interactive Telehealth Services or Telephonic Services should continue to bill their appropriate HCPCS (Healthcare Common Procedure Coding System) “G” visit payment code for each payable encounter visit, along with the appropriate code for the service provided and use Place of Service value 02 for all Telehealth Charges. For Telephonic Services, the same codes listed above should be used as appropriate.

SOURCE: DE Medical Assistance Program. Changes to DMMA Telehealth Policies to Respond to COVID-19. April 23, 2020. (Accessed Aug. 2022).

Generally, to receive payment for services delivered through telemedicine technology from DMAP or MCOs, healthcare practitioners must:

  • Act within their scope of practice;
  • Be licensed (in Delaware, or the State in which the provider is located if exempted under Delaware State law to provide telemedicine services without a Delaware (license) for the service for which they bill DMAP;
  • Be enrolled with DMAP/MCOs;
  • Be located within the continental United States;
  • Be credentialed by DMMA-contracted MCOs, when needed;
  • Submit a DMMA Disclosure Form.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 11. (Accessed Aug. 2022).

Explicitly listed eligible distant site providers include:

  • Inpatient/outpatient hospitals (including ER)
  • Physicians (or PAs under the physician’s supervision)
  • Certified Nurse Practitioners
  • Nurse Midwives
  • Licensed Psychologists
  • Licensed Clinical Social Workers
  • Licensed Professional Counselors of Mental Health
  • Speech Language Therapists
  • Audiologists
  • Other providers as approved by the DMAP

SOURCE: DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.4.3 Telemedicine, pg. 72-73, Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 12. (Accessed Aug. 2022).

Last updated 08/24/2022

Eligible Originating Site

Yes, FQHCs are listed as eligible originating medical facility sites. An originating site refers to the facility in which the Medicaid patient is located at the time the telemedicine service is being furnished. An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.5.4.1 & 16.2.5.4.2 Telemedicine, pg. 73 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1. 8. pg. 11 & 12. (Accessed Aug. 2022).

Last updated 08/24/2022

Facility Fee

A facility fee is covered for originating sites. Facility fees for the distant site are not covered. Only one facility fee is permitted per date, per member.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16 Telemedicine, Sec. 16.2,4.2 16.2.5.3 & 16.8.3, pg. 72-76 DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 11. (Accessed Aug. 2022).

Last updated 08/24/2022

Home Eligible

Generally, an approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized. A patient’s home is an eligible originating site but must comply with HIPAA, privacy, secure communications, etc., and does not warrant an originating site fee.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.2.5.4.1 & 16.2.5.4.2 Telemedicine, pg. 73 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1. 8. pg. 11 & 12. (Accessed Aug. 2022).

Last updated 08/24/2022

Modalities Allowed

Live Video

Generally, DE Medicaid reimburses for live video telemedicine services.

See: DE Medicaid Live Video


Store and Forward

Generally, DE Medicaid does not cover store-and-forward.

See: DE Medicaid Store-and-Forward.


Remote Patient Monitoring

Generally, DE Medicaid does not cover RPM.

See: DE Medicaid RPM.


Audio-Only

Telephone Services – services by means of a telephone call between a physician and a patient (including those in which the physician provides advice or instructions to or on behalf of the patient) are covered services that are included in the payment made to the FQHC and should not be billed as an encounter.

SOURCE: DE FQHC Policy Manual, 10/1/21. (Accessed Aug. 2022).

Last updated 08/24/2022

Patient-Provider Relationship

No explicit FQHC reference found.

For general information about forming a patient-provider relationship see: DE Professional Requirements Online Prescribing

Last updated 08/24/2022

PPS Rate

There is no explicit language that the FQHC will be paid its PPS rate.

General instructions state that the FQHC must bill the DMAP using an FQHC HCPCS (Healthcare Common Procedure Coding System) “G” visit payment code for each payable encounter visit, along with a HCPCS code for each service provided. These codes are accepted for dates of service on or after 09/01/2017. Claims must be submitted with the correct Place of Service (POS).

The payment methodology for FQHCs will conform to the BIPA 2000 Requirements Prospective Payment System (PPS). Effective July 1, 2018, Delaware will reimburse each FQHC per-visit through one of the following two (2) methodologies, whichever nets the greater result: 1. A prospective payment system (PPS) rate, where 100 percent of the reasonable costs based upon an average of their fiscal years 1999 and 2000 audited cost reports are inflated annually by the Medicare Economic Index (MEI); or 2. The per-visit cost as reported by the FQHC in its most recent cost report, subject to an audit performed by a certified public accountant as to the reasonableness of the reported costs.

SOURCE: DE FQHC Policy Manual, 10/1/21, p. 9, 11. (Accessed Aug. 2022).

Last updated 08/24/2022

Same Day Encounters

Encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit except when the patient, after the first encounter, suffers illness or injury requiring additional diagnosis or treatment.

Claims are limited to one all-inclusive “encounter” per day, to include all services received by an eligible recipient on a single day or relevant to the “encounter”. All subsequent services and follow-up care provided by other than a physician, nurse practitioner, or physician’s assistant, ordered as a result of an “encounter” are included in the related “encounter” rate, and are not billed separately.

Exception is made for cases in which the patient, subsequent to the first “encounter” suffers illness or injury requiring additional diagnosis or treatment on the same day (42 CFR§405.2463). Exception is also made if the patient has a medical visit and another health visit for mental health services on the same day (42 CFR§405.2463(a)(3)(ii)).

SOURCE: DE FQHC Policy Manual, 10/1/21, p. 4, 9. (Accessed Aug. 2022).