Georgia

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Georgia Medicaid

Administrator

Georgia Dept. of Community Health

Regional Telehealth Resource Center

Southeast Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

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

Last updated 02/28/2021

Audio Only Delivery

Medicaid: Telehealth Guidance Clarification

STATUS: Active, during GA State of Emergency

Medicaid: Telehealth Guidance for COVID-19

STATUS: Active, during period of COVID-19 Emergency Response

Department of Behavioral Health and Developmental Disabilities: Medication Assisted Treatment and Telehealth

STATUS: Active, during GA State of Emergency

Medicaid:  COVID-19 FAQs

STATUS: Active

Medicaid: Provider Memo on Additional Telehealth Guidance

STATUS: Active, during PHE period

Last updated 02/28/2021

Cross State Licensing

No Reference Found

Last updated 02/28/2021

Easing Prescribing Requirements

Department of Behavioral Health and Developmental Disabilities: Medication Assisted Treatment and Telehealth

STATUS: Active, during GA State of Emergency

Last updated 02/28/2021

Miscellaneous

No Reference Found

Last updated 02/28/2021

Originating Site

Medicaid: Telehealth Guidance Clarification

STATUS: Active, during GA State of Emergency

Medicaid: Telehealth Guidance for COVID-19

STATUS: Active, during period of COVID-19 Emergency Response

Department of Behavioral Health and Developmental Disabilities: Medication Assisted Treatment and Telehealth

STATUS: Active, during GA State of Emergency

Last updated 02/28/2021

Private Payer

No Reference Found

Last updated 02/28/2021

Provider Type

Medicaid: Telehealth Guidance Clarification

STATUS: Active, during GA State of Emergency

Medicaid:  COVID-19 FAQs

STATUS: Active

Medicaid: Provider Memo on Additional Telehealth Guidance

STATUS: Active, during PHE period

Last updated 02/28/2021

Service Expansion

Medicaid:  02 POS code

STATUS: Active, During Health Emergency

Medicaid: Telehealth Guidance for COVID-19

STATUS: Active, during period of COVID-19 Emergency Response

Department of Behavioral Health and Developmental Disabilities: Medication Assisted Treatment and Telehealth

STATUS: Active, during GA State of Emergency

Medicaid:  COVID-19 FAQs

STATUS: Active

Medicaid: Provider Memo on Additional Telehealth Guidance

STATUS: Active, during PHE period

Medicaid 1915(c) Waiver: Appendix K – Comprehensive Supports Waiver Program (COMP)

STATUS: Expired February 28, 2021

GA Department of Community Health: OIG FAQs regarding COVID-19

STATUS: Active

Last updated 02/28/2021

Definitions

Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.

Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Telehealth is the use of telecommunications technologies for clinical care (telemedicine), patient teachings and home health, health professional education (distance learning), administrative and program planning, and other diverse aspects of a health care delivery system.

SOURCE: GA Dept. of Community Health, Physician Services Manual, p. R-1 (Jan. 2021). (Accessed Feb. 2021).

Telehealth is a broad definition of remote healthcare that does not always involve clinical services. Telehealth can be used in telecommunications technologies for patient education, home health, professional health education and training, administrative and program planning, and other diverse aspects of a health care delivery system.

Telehealth involves the use of two-way, real time interactive communication equipment to exchange medical/clinical information between a healthcare practitioner and the member from one site to another via a secure electronic communication system. This includes audio and video communications equipment designed to facilitate delivery of healthcare services in a face-to-face interactive, though distant, engagement.

TeleMental Health is a term defined by Ga. Comp. R. & Regs. R. 135-11-01. and is applicable only to Licensed Social Workers, Professional Counselors and Marriage & Family Therapists when either 1) practicing telehealth as defined above, or 2) providing telephonic intervention when allowable via DCH/DBHDD guidelines). Per this rule and regulation, there are specific practice guidelines and mandatory training pertaining to what is identified as TeleMental Health. Providers shall adhere to these rules and regulations when TeleMental Health is provided by one of these named practitioners.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6, (Jan. 2021). (Accessed Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

Non-covered Services Modalities

  • Telephone conversations.
  • Electronic mail messages.
  • Facsimile.
  • Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
  • Video cell phone interactions.
  • The cost of telehealth equipment and transmission.
  • ailed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 10 (Jan. 2021). (Accessed Feb. 2021).

 

 

Last updated 02/28/2021

Live Video

POLICY

The use of a telecommunications system may substitute for an in-person encounter for professional office visits, pharmacologic management, limited office psychiatric services, limited radiological services and a limited number of other physician fee schedule services. See the telehealth guidelines for program specific policies.


ELIGIBLE SERVICES/SPECIALTIES

An interactive telecommunications system is required as a condition of payment. The originating site’s system, at a minimum, must have the capability of allowing the distant site provider to visually examine the patient’s entire body including body orifices (such as ear canals, nose and throat). The distant site provider should also have the capability to hear heart tones and lung sounds clearly (using a stethoscope) if medically necessary and currently within the provider’s scope of practice. The telecommunication system must be secure and adequate to protect the confidentiality and integrity of the information transmitted.

SOURCE: GA Dept. of Community Health, Physician Services Manual, p. R-1 (Jan. 1, 2021). (Accessed Feb. 2021).  

Claims must use the appropriate CPT or HCPCS code with the GT modifier and or the use of POS 02.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan. 2021). (Accessed Feb. 2021).

The service must be medically necessary and the procedure individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.

Physician Services:  When a provider, licensed in the state of Georgia, determines that medical care can be provided via electronic communication with no loss in the quality or efficacy of the member’s care, telehealth services can be performed.

See telehealth manual for list of eligible telehealth services and codes for specific programs.

Non-Covered Services:

  1. Telephone conversations.
  2. Electronic mail messages.
  3. Facsimile.
  4. Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
  5. Video cell phone interactions.
  6. The cost of telehealth equipment and transmission.
  7. Failed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance, p. 5 & 10 (Jan. 2021). (Accessed Feb. 2021).

Nursing Facilities & Community Behavioral Health Rehabilitation Services

Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telehealth site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth/telemedicine procedure codes.

SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 29 (Jan. 2021) & GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facility Services, p. H-7 (p. 169).  (Jan. 2021). (Accessed Feb. 2021).

Teledentistry

See dental services manual for teledentistry codes.

SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Dental Services, IX-36 (Jan. 2021). (Accessed Feb. 2021).

Autism Spectrum Disorder Services

Prior authorization is required for all Medicaid-covered adaptive behavior services, behavioral assessment and treatment services (not telehealth specific). See manual for eligible codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.15-18 (Jan. 2021), (Accessed Feb. 2021).

Community Behavioral Health and Rehabilitation Services

The Departments of Community Health and Behavioral Health and Developmental Disabilities have authorized telehealth to be used to provide some services in the CBHRS program.  The circumstances in which it can be provided are:

  • For some services, any member who consents may receive services via telehealth;
  • For some services, telehealth is allowed only for members who speak English as a second language, and telehealth will enable the member to engage with a practitioner who can deliver services in his/her preferred language (e.g. American Sign Language, etc.) (one-to-one via Telehealth versus interpreters)

Telehealth is only allowed for certain CBHRS services and only two-way, real-time interactive audio and video communication as described in the Service Definitions section of this Guidance is allowable. Telehealth may not be used for any other Intervention.

See manual for approved codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 20 (Jan. 2021). (Accessed Feb. 2021).

To promote access, providers may use telemedicine as a tool to provide direct interventions to individuals for whom English is not their first language (one-to-one via telemedicine versus use of interpreters). Telemedicine may only be utilized when delivering this service to an individual for whom English is not their first language.

Community behavioral health providers can deliver a wide variety of services via telemedicine.  See manual for specific details and other services allowed.

SOURCE: GA Dept. of Behavioral Health and Developmental Disabilities, Community Behavioral Health Providers Manual, Pg. 22, (listed on multiple pages) (Effective Jan. 1, 2021, through Mar. 31, 2021). (Accessed Feb. 2021).

Teledentistry

The State allows certain services to be delivered via teledentistry.  See manual for approved codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Jan. 2021). (Accessed Feb. 2021).

Dialysis Services

Dialysis services are eligible to be provided under telehealth.  See manual for list of eligible CPT codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 44-46 (Jan. 2021). (Accessed Feb. 2021).

Nursing Facility Specialized Services

Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telehealth site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth procedure codes.  See manual for eligible codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48-51 (Jan. 2021). (Accessed Feb. 2021).

School Based Services

Certain speech language pathology and physical therapy services are reimbursable via telehealth in the school-based setting.  See manual or eligible CPT/HCPCS codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53-54 (Jan. 2021), & GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. X-10 (p. 39) (Jan. 2021). (Accessed Feb. 2021).

The Department of Community Health (DCH) will allow some speech therapy, audiology and therapy services to be rendered via telehealth.

SOURCE: GA Dept. of Community Health, Children’s Intervention Services (CIS). p. X-10 (Jan. 2021). (Accessed Feb. 2021). 

Dialysis Services

The Centers for Medicaid and Medicare Services (CMS) has added Dialysis Services to the list of services that can be provided under Telehealth.

SOURCE: GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10, p. 17 (Jan. 2021)  (Accessed Feb. 2021).

Durable Medical Equipment Services

A face-to-face encounter may be made through the use of telehealth technology by reporting the appropriate E&M code.

SOURCE: GA Dept. of Community Health, GA Medicaid Durable Medical Equipment Services Manual, p. 34  (Jan. 2021). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The consulting provider must be an enrolled provider in Medicaid in the state of Georgia and must document all findings and recommendations in writing, in the format normally used for recording services in the member’s medical records.  The provider at the distant site must obtain prior approval when services require prior approval.  Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 9 (Jan. 2021). (Accessed Feb. 2021).

Autism Spectrum Disorder Services

Practitioners of ASD services can use telehealth to assess, diagnose and provide therapies to patients.  Providers must hold either a current and valid license to practice Medicine in Georgia, hold a current and valid license as a Psychologist as required under Georgia Code Chapter 39 as amended, or hold a current and valid Applied Behavior Analysis (ABA) Certification. In addition to licensed Medicaid enrolled Physicians and Psychologists, Georgia Medicaid will enroll Board Certified Behavioral Analysts (BCBAs) as Qualified Health Care Professionals (QHCPs) to provide ASD treatment services. The BCBA must have a graduate-level certification in behavior analysis. Providers who are certified at the BCBA level are independent practitioners who provide behavior-analytic services. In addition, BCBAs supervise the work of Board-Certified Assistant Behavior Analysts (BCaBAs), and Registered Behavior Technicians (RBTs) who implement behavior-analytic interventions.

New providers must submit an attestation upon enrollment, and existing providers must also do so in order to provide adaptive behavior services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.15 (Jan. 2021). (Accessed Feb. 2021).

Teledentistry

Licensed dentists and dental hygienists are eligible providers.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Jan. 2021). (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs can serve as the originating or distant site. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan. 2021) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 22, (Jan. 2021) (Accessed Feb. 2021).

Nursing Facility Specialized Services

See manual for eligible providers and levels.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48-51 (Jan. 2021). (Accessed Feb. 2021).

School Based Settings

Speech language pathologists are eligible to bill for telehealth services with students in a school-based setting.  This includes time spent assisting the student with learning to use adaptive equipment and assistive technology.

See manual for eligible speech, audiology and physical therapy codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 54 (Jan. 2021). (Accessed Feb. 2021).


ELIGIBLE SITES

The referring provider must be enrolled in GA Medicaid and comply with policy and procedures as outlines in applicable Georgia Medicaid manuals.

The referring provider must be the member’s attending physician, practitioner or provider in charge of their care.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan. 2021). (Accessed Feb. 2021).

Ambulance Providers

They may serve as originating sites and the ambulance may bill a separate origination site fee. They are not authorized to provide distant site services.

Limitation (Emergency Ambulance Services Handbook):  Emergency ambulance services are reimbursable only when medically necessary. The recipient’s physical condition must prohibit use of any method of transportation except emergency for a trip to be covered.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 13 (Jan. 2021) & Emergency Ambulance Services Handbook, p. 19 (Jan. 2021). (Accessed Feb. 2021).

Community Behavioral Health and Rehabilitation Services

Member may be located at home, schools and other community-based settings or at traditional sites named in the Department of Community Health Telehealth Guidance.  See manual for detailed instructions explanation for when and which type of practitioner can bill for telehealth services.

Traditional sites include:

  • Physician and Practitioner’s Offices;
  • Hospitals;
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Local Education Authorities and School Based Clinics;
  • County Boards of Health;
  • Emergency Medical Services Ambulances; and
  • Pharmacies.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 20 (Jan. 2021) & GA Dept. of Community Health, Community Behavioral Health Rehabilitation Services Handbook Appendix O (Jan. 2021). (Accessed Feb. 2021).

Teledentistry

Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 40 (Jan. 2021). (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs can serve as originating sites and are paid an originating site facility fee. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan. 2021). & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 22, (Jan. 2021). (Accessed Feb. 2021).

Dialysis Services

Dialysis facilities are eligible originating sites for dialysis services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 44 (Jan. 2021). (Accessed Feb. 2021) & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10, p. 17 (Jan. 2021) (Accessed Feb. 2021).

Nursing Facility Specialized Services

Nursing facilities can be eligible sites for nursing facility specialized services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48 (Jan. 2021) & SOURCE: GA Dept. of Community Health, Nursing Facility Services Handbook, p. H-1 (Jan. 2021). (Accessed Feb. 2021)

School-Based Settings (Local Education Agencies)

Telehealth services are allowed in school-based settings upon enrollment into COS 600.  The following requirements must be met:

  • The provider is an authorized health-care provider enrolled in Georgia Medicaid
  • The client is a child who is receiving the service in a primary or secondary school-based setting
  • The parent or legal guardian of the client provides consent before the service is provided

Telehealth services provided in a school-based setting are also a benefit if the referring provider delegates provision of services to a nurse practitioner, clinical nurse specialist, physician assistant, or other licensed specialist as long as the above-mentioned providers are working within the scope of their professional license and within the scope of their delegation agreement with the provider.

The school must enroll as a Health Check Provider in order to bill the telehealth originating site facility fee.

LEAs must submit an Attestation Form for the provision of telehealth services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53 (Jan. 2021) & GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-4 (p.9). (Jan. 2021).  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found

 


FACILITY/TRANSMISSION FEE

Originating sites are paid an originating site facility fee.  Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan. 2021). (Accessed Feb. 2021).

Community Behavioral Health and Rehabilitation Services

Originating fees (as referenced in some of the other Georgia Medicaid programs) are not offered for telemedicine when utilized in the CBHRS category of service. Telemedicine costs are attributed to the services intervention rates.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 21 (Jan. 2021). (Accessed Feb. 2021).

School-Based Settings (Local Education Agencies)

LEAs that enroll as Health Check providers to serve as telehealth originating sites only will be allowed to bill the originating site facility fee.  The distant site provider must bill for the E/M office visit.  It is the responsibility of the LEA provider to contact the distant site provider to determine if the E/M visit was billed.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53 (Jan. 2021). & GA Dept. of Community Health, Health Check EPSDT. (Jan. 2021). X-6-X-7 (p.68 &69)& GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-6. (Jan. 2021).  (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan. 2021) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 22, (Jan. 2021). (Accessed Feb. 2021).

Ambulance Providers

Ambulances may bill a separate origination site fee.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 13 (Jan. 2021) & Emergency Ambulance Services Handbook, p. 19 (Jan. 2021). (Accessed Feb. 2021).

Dialysis Services

The originating facility/site (Dialysis Facility) will bill with the revenue code and procedure codes listed in the manual.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 44 (Jan. 2021) & GA Medicaid Dialysis Services Handbook, p. IX-10 (Jan. 2021). (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider. Additionally, all electronic documentation must be available for review by the Georgia Department of Community Health, Medicaid Division, Division of Program Integrity and all other applicable divisions of the department.

All transactions must utilize acceptable methods of encryption as well as employ authentication and identification procedures for both the sender and receiver.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.7 & 9 (Oct. 2020). (Accessed Feb. 2021).

 

 

Last updated 02/28/2021

Out of State Providers

Out-of-state providers may be licensed under the Interstate Medical Licensure Compact.  Providers should see the Georgia Composite Medical Board for additional information.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 7 (Jan. 2021). (Accessed Feb. 2021).

 

Last updated 02/28/2021

Overview

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

GA Medicaid defines asynchronous or “store-and-forward” as the “transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous communication does not include telephone calls, images transmitted via fax machines and text messages without visualization of the patient (electronic mail).

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6 (Jan. 2021) (Accessed Feb. 2021).

Certain teledentistry codes can be delivered via store-and-forward.

Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Feb. 2021), & Part II Policies and Procedures for Dental Services, p. IX-36 (Jan. 2021). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

The State allows reimbursement for one specific teledentistry store-and-forward codes.  See manual for approved code.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Jan. 2021) & Part II Policies and Procedures for Dental Services, p. IX-36 (Jan. 2021). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site fee (billed as D9996) associated with a real-time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Jan, 2021) & Part II Policies and Procedures for Dental Services, p. IX-35-IX-36 (Jan. 2021). (Accessed Feb. 2021).

Last updated 02/28/2021

Definition

‘Telehealth’ means the use of information and communications technologies, including, but not limited to, telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health related education, public health, and health administration.

‘Telemedicine’ means a form of telehealth which is the delivery of clinical health care services by means of real time two-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 practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in this state, while such patient is at an originating site and the health care provider is at a distant site.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Feb. 2021).

Last updated 02/28/2021

Parity

SERVICE PARITY

An insurer 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 for services provided via telemedicine.  An insurer cannot exclude a service solely because it was delivered as a telemedicine service.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Feb. 2021).


PAYMENT PARITY

Payment must be at least at the rate that the insurer is responsible for coverage for the provision of the same service through in-person consultation or contact; provided, however, that nothing in this subsection shall require a health care provider or telemedicine company to accept more reimbursement than they are willing to charge. 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: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Feb. 2021).

Last updated 02/28/2021

Requirements

Each insurer proposing to issue a health benefit policy shall provide coverage for the cost of health care services provided through telehealth or telemedicine as directed through regulations promulgated by the department.

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services and is not provided through in-person consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services.

For the originating site, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

No insurer shall require its insureds to use telemedicine services in lieu of in-person consultation or contact.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Feb. 2021).

Last updated 02/28/2021

Cross State Licensing

The Board is authorized to issue telemedicine licenses to physicians who are licensed in other states but not licensed in Georgia.  See law for specific requirements to qualify for telemedicine license.

SOURCE:  Official Code of GA Annotated Sec. 43-34-31.1. (Accessed Feb. 2021).

Must be a Georgia licensed practitioner.

SOURCE:  GA Rules & Regulations Sec. 360-3-.07 (Accessed Feb. 2021).

 

Last updated 02/28/2021

Definitions

Applies to: Interactive Physical Therapy Services

“Telehealth” is the use of electronic communications to provide and deliver a host of health-related information and health care services including, but not limited to physical therapy related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions.

SOURCE: GA Rules & Regulations. Sec. 490-9-.06 (Accessed Feb. 2021). 

Applies to: Interactive Physical Therapy Services

‘Telehealth’ means the application of evaluative, consultative, preventative, and therapeutic services delivered through telecommunication and information technologies by licensed occupational therapy practitioners. This may include, but shall not be limited to, telemedicine, telepractice, telecare, telerehabilitation, and e-health services.

SOURCE:  Official Code of GA Annotated Sec. 43-28-3. (Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status.  (Accessed Feb. 2021).

Member of the Interstate Medical Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-34-301. (Accessed Feb. 2021). & IMLC

Member of the Physical Therapy Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-33-31. (Accessed Feb. 2021). & PTC

Member of the Psychology Interjurisdictional Compact.

SOURCE: Official Code of GA Annotated Sec. 43-39-22. (Accessed Feb. 2021) & PSYPACT

 

 

Last updated 02/28/2021

Miscellaneous

No Reference Found

Last updated 02/28/2021

Online Prescribing

In order for a physician to practice within the minimum standards of practice while providing treatment and/or consultation recommendations by electronic or other such means, all the following conditions must be met:

  • All treatment and/or consultations must be done by Georgia licensed practitioners;
  • A history of the patient shall be available to the Georgia licensed physician, physician assistant or advanced practice registered nurse who is providing treatment or consultation via electronic or other such means;
  • Georgia licensed physician, physician assistant or advanced practice registered nurse either: (a) Has personally seen and examined the patient and provides ongoing or intermittent care by electronic or other such means; or (b) Is providing medical care by electronic or other such means at the request of a physician, physician assistant or advanced practice registered nurse licensed in Georgia who has personally seen and examined the patient; or (c) Is providing medical care by electronic or other such means at the request of a Public Health Nurse, a Public School Nurse, the Department of Family and Children’s Services, law enforcement, community mental health center or through an established child advocacy center for the protection for a minor, and the physician, physician assistant or advanced practice registered nurse is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care; or (d) Is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.
  • The Georgia licensed physician, physician assistant or advanced practice registered nurse providing treatment or consultations by electronic or other means must maintain patient records on the patient and must document the evaluation and treatment along with the identity of the practitioners providing the service by electronic or other means, and if there is a referring practitioner, a copy of this record must also be provided to the referring physician, physician assistant or advanced practice registered nurse.
  • To delegate to a nurse practitioner or to supervise a physician assistant doing telemedicine, the physician must document to the board that that the provision of care by telemedicine is in his or her scope of practice and that the NP or PA has demonstrated competence in the provision of care by telemedicine.
  • Patients treated by electronic or other such means or patient’s agent must be given the name, credentials and emergency contact information for the Georgia licensed physician, physician assistant and/or advanced practice registered nurse providing the treatment or consultation. Emergency contact information does not need to be provided to those treated within the prison system while incarcerated but should be provided to the referring provider. For the purposes of this rule, “credentials” is defined as the area of practice and training for physicians, and for physician assistants and advanced practice registered nurses, “credentials” shall mean the area of licensure and must include the name of the delegating physician or supervising physician.
  • The patient being treated via electronic or other means or the patient’s agent must be provided with clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. In the case of prison patients, prison staff will be provided this information if the consult is provided to an inmate.
  • The physician, physician assistant or nurse practitioner who provides care or treatment for a patient by electronic or other such means must make diligent efforts to have the patient seen and examined in person by a Georgia licensed physician, physician assistant or nurse practitioner at least annually.

SOURCE: GA Rules & Regulations revised 360-3-.07. (Accessed Feb. 2021). 

Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult, unless the physician is on-call or covering for another provider and prescribing up to a 72-hour supply of medications for a patient of the other provider.

There is also an exception for licensed physician from prescribing Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder to a patient in the physical presence of a licensed nurse, provided the initial diagnosis was made and an initial prescription was issued in accordance with 21 U.S.C. § 829(e), including but not limited to the following:

  • The physician has conducted at least one in-person medical evaluation of the patient; or
  • The physician is covering for a licensee who is temporarily unavailable and has conducted at least one in-person medical evaluation of the patient; or
  • The physician is engaged in the practice of telemedicine in accordance with Board Rule 360-3-.07 and with 21 U.S.C. §§ 802(54) and 829(e)(3)(A), including, but not limited to:
    • Where the patient is being treated by, and physically located in, a hospital or clinic registered with the U.S. Drug Enforcement Agency (“DEA”), the physician is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(A) are met; or
    • Where the patient is being treated by, and physically in the presence of, a licensee who is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(B) are met; or
    • Where the physician has obtained from the U.S. Attorney General a special registration for telemedicine in accordance with 21 U.S.C. §§ 802(54)(E) and 831(h).

Providing treatment via electronic or other means is considered unprofessional conduct unless a history and physical examination of the patient has been performed by a Georgia licensee.

SOURCE: GA Rules & Regulations revised 360-3-.02. (Accessed Feb. 2021).

Last updated 02/28/2021

Professional Boards Standards

GA Composite Medical Board

SOURCE:  GA Rules & Regulations Sec. 360-3-.07 (Accessed Feb. 2021).

GA Board of Physical Therapy

SOURCE: GA Rules & Regulations Sec. 490-9-.06 (Accessed Feb. 2021).