Delaware

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Delaware Medical Assistance Program (DMAP)

Administrator

Delaware Health and Social Services Dept., Division of Social Services

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

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

Last updated 07/09/2021

Audio Only Delivery

Medicaid:  Telehealth and COVID FAQs

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid: Changes to Telehealth Policy

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid: COVID-19 and Telehealth Fee Schedule

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

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

STATUS: Expired January 26, 2021

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person, requirements, expand eligible providers and insurance coverage

STATUS: Enacted  (Expired July 1, 2021)

Last updated 07/03/2021

Cross State Licensing

Office of the Governor: Declaration of Public Health Emergency

STATUS: Expires July 13, 2021

Department of Health and Social Services: Joint Order on COVID-19

STATUS: Active, until further notice, or end of DE public health emergency or state of emergency

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person, requirements, expand eligible providers and insurance coverage

STATUS: Enacted  (Expired July 1, 2021)

Last updated 07/09/2021

Easing Prescribing Requirements

Medicaid:  Telehealth and COVID FAQs

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid: Changes to Telehealth Policy

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Division of Professional Regulation:  Letter to Pharmacists RE Telehealth

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Office of the Governor: Declaration of Public Health Emergency

STATUS: Expires July 13, 2021

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person requirements, expand eligible providers and insurance coverage

STATUS: Enacted  (Expired July 1, 2021)

Last updated 07/03/2021

Miscellaneous

No Reference Found

Last updated 07/09/2021

Originating Site

Medicaid:  Telehealth and COVID FAQs

STATUS: Active, until further notice. DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person, requirements, expand eligible providers and insurance coverage

STATUS: Enacted  (Expired July 1, 2021)

Last updated 07/09/2021

Private Payer

Insurance Commissioner: Bulletin to Insurance Carriers on Telehealth

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Insurance Commissioner: Bulletin Additional Guidance on Telehealth

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Insurance Commissioner: Bulletin, Passage of Telemedicine Statute

STATUS: Statute expired July 1, 2021

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person requirements, expand eligible providers and insurance coverage

STATUS: Enacted (Expired July 1, 2021)

Department of Insurance: Insurance Coverage for Telemedicine and Telehealth

STATUS: Expired July 1, 2021

Last updated 07/09/2021

Provider Type

Medicaid: Telehealth and COVID FAQs

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid: Changes to Telehealth Policy

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person requirements, expand eligible providers and insurance coverage

STATUS: Enacted  (Expired July 1, 2021)

Last updated 07/09/2021

Service Expansion

Medicaid:  Telehealth and COVID FAQs

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid: Changes to Telehealth Policy

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid:  POS Telehealth and Codes

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Medicaid: COVID-19 and Telehealth Fee Schedule

STATUS: DE State of Emergency to expire July 13, 2021. Unclear if this policy will be affected.

Office of the Governor: Declaration of Public Health Emergency

STATUS: Expires July 13, 2021

HB 348:  Extends Telehealth Emergency Expansions – Allow audio-only, waive in-person, requirements, expand eligible providers and insurance coverage

STATUS: Enacted  (Expired July 1, 2021)

Last updated 07/09/2021

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, 5/20/21. Ch. 16 Telemedicine, 16.1 & 16.2 (Accessed July 2021).

“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 July 2021).

Last updated 07/09/2021

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, 5/20/21. Ch. 16.8.1, Telemedicine, pg. 82, (Accessed July 2021). 

Last updated 07/09/2021

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, 5/20/21. Ch. 16 Telemedicine, Sec. 16..2, pg. 82 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8, p. 14.  (Accessed July 2021).

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 July 2021).

The referring provider is not required to be present at the originating site, however the recipient of the services must be present.

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

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 5/20/21. Ch. 16.2.6.1.1, 16.2.6.1.2,& 16.5.1 Telemedicine, pg. 79-80 (Accessed July 2021). 

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, 5/20/21. Ch. 16.5.5 Telemedicine, pg. 81 (Accessed July 2021).


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, 5/20/21. Ch. 16 Telemedicine, Sec. 16.5.2, pg. 80-81. (Accessed July 2021).

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 July 2021).

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. 1, 2020.  Sec. 4.2. p. 8 (Accessed July 2021).

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. 14, 2016.  Sec. 1.8. p. 14 (Accessed July 2021).


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. 14, 2016.  Sec. 1.8. Pg. 11 (Accessed July 2021).

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, 5/20/20. Ch. 16.2.4.3 Telemedicine, pg. 77-78, & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. Pg. 12 (Accessed July 2021).


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, 5/20/21. Ch. 16.2.5.4.1 & 16.2.5.4.2 Telemedicine, pg. 78, & 79 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1. 8. pg. 11 & 12 (Accessed July 2021).


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. 14, 2016.  Sec. 1.8, p. 12. (Accessed July 2021).


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, 5/20/21. Ch. 16 Telemedicine, Sec. 16.2 & 16.8.3, pg. 77-82 (Accessed July 2021).

Last updated 07/09/2021

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, 2/21/20. Sec. 5.2.8,  p. 18. (Accessed July 2021).

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, 5/20/21. Ch. 16 Telemedicine, Sec. 16.11 p. 83 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8, p. 13.  (Accessed July 2021). 

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

SOURCE:  DE Medical Assistance Program.  Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. p. 10 (Accessed July 2021).

Last updated 07/09/2021

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, 5/20/21. Ch. 16.2.4.1 & 16.5.7 Telemedicine pg. 77 & 81. (Accessed July 2021).

Last updated 07/09/2021

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 07/09/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 07/09/2021

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, 5/20/21. Ch. 16.3.4.1 Telemedicine, pg. 80 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. p. 10 (Accessed July 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 07/12/2021

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; Title 18, Ch. 36, Sec. 3571R (As amended by HB 160 (2021 Session)(Accessed July 2021)

“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)(Accessed July 2021)

“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. 36, Sec. 3571R (As amended by HB 160 (2021 Session)(Accessed July 2021)

Last updated 07/12/2021

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, Sec. 3370; & Title 18, Sec. 3571R. (Accessed July 2021).


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, Sec. 3370; & Title 18, Sec. 3571R. (Accessed July 2021).

Last updated 07/12/2021

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, Sec. 3370; & Title 18, Sec. 3571R. (Accessed July 2021).

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.

SOURCE: 18 DE Administrative Code 1409 (Accessed July 2021).

Last updated 07/12/2021

Cross State Licensing

No Reference Found

Last updated 07/12/2021

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: HB 160 (2021 Session). Accessed July 2021.

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 2600. (Accessed July 2021).

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

Last updated 07/12/2021

Licensure Compacts

Member of enhanced Nurse Licensure (NLC) Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status. (Accessed July 2021). & NCBSN. Enhanced Nurse Licensure Compact (eNLC) Interstate Commission Sets Jan. 19, 2018, as Implementation Date for eNLC. (Accessed July 2021).

Member of Physical Therapy Licensure Compact. (Enacted Legislation – Not yet issuing or accepting compact privileges)

SOURCE: PT Compact.  Member States.  (Accessed July 2021). 

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT. PSYPACT Map.  (Accessed July 2021).

Member of Interstate Medical Licensure Compact (IMLC) (Effective July 1, 2022)

SOURCE: HB 160 (2021 Session) (Accessed July 2021) & IMLC Passed; Implementation Delayed (Accessed July 2021)

Last updated 07/12/2021

Miscellaneous

No Reference Found

Last updated 07/12/2021

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.

SOURCE: HB 160 (2021 Session) (Accessed July 2021).

Pharmacists:

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

SOURCE: DE Code, Title 16 Sec. 4744(d)(1)(a). (Accessed July 2021)

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. Sec. 1700.  Sec. 19. (Accessed July 2021)

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

SOURCE: DE Admin Code Sec. 1713(a)(12) (Accessed July 2021)

Last updated 07/12/2021

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.

Exceptions:

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

  • 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.
  • 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.
  • Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
  • 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: HB 160 (2021 Session) (Accessed July 2021)

Physical Therapists and Athletic Trainers

SOURCE: DE Statute Title 24, Sec. 2602 (Accessed July 2021).

Board of Clinical Social Work Examiners

SOURCE: 24 DAC 3920. (Accessed July 2021).

Board of Dentistry and Dental Hygiene

SOURCE: 24 DAC 1100 (Accessed July 2021).

Pharmacy

SOURCE: 24 DAC 2500 (Accessed July 2021).