Idaho

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Idaho Medicaid

Administrator

Idaho Dept. of Health and Welfare

Regional Telehealth Resource Center

Northwest Regional Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: No
Payment Parity: No

Professional Requirements

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

Last updated 02/28/2021

Audio Only Delivery

Medicaid:  Provider Information Regarding Telehealth

STATUS: Active, until end of ID State of Emergency

Medicaid:  COVID-19 Telehealth HIPAA Guidance

STATUS: Active, until end of PHE

Medicaid 1915(c) Waiver: Aged and Disabled Waiver

STATUS: Expired January 26, 2021

Medicaid 1915(c) Waiver: Developmental Disabilities Waiver

STATUS: Expired January 26, 2021

Last updated 02/28/2021

Cross State Licensing

Board of Medicine:  Administrative Rules Temporarily Suspended

STATUS: Active

Board of Medicine: COVID-19 FAQs

STATUS: Active

Last updated 02/28/2021

Easing Prescribing Requirements

Board of Medicine: COVID-19 FAQs

STATUS: Active

Last updated 02/28/2021

Miscellaneous

Executive Order: Regulatory Relief to Support Economic Recovery

STATUS: Active

Last updated 02/28/2021

Originating Site

Medicaid:  Provider Information Regarding Telehealth

STATUS: Active, until end of ID State of Emergency

Medicaid:  COVID-19 Guidance for Therapy Services

STATUS: Active, until end of ID State of Emergency

Medicaid: 1135 Aged and Disabled Waiver

STATUS: Expired

Last updated 02/28/2021

Private Payer

Department of Insurance:  Temporary Waiver of Provider Restrictions

STATUS: Active, until end of ID State of Emergency

Last updated 02/28/2021

Provider Type

Medicaid:  COVID-19 Guidance for Therapy Services

STATUS: Active, until end of ID State of Emergency

Last updated 02/28/2021

Service Expansion

Medicaid:  Provider Information Regarding Telehealth

STATUS: Active, until end of ID State of Emergency

Medicaid:  COVID-19 Guidance for Therapy Services

STATUS: Active, until end of ID State of Emergency

Last updated 02/28/2021

Definitions

Telehealth services is two-way live video between the provider and the participant.

Source: Medicaid Telehealth Policy, General Information and Requirements for Providers. Section 8.9 Pg. 122. Rev. Jan. 19, 2021. (Accessed Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

No reimbursement for telephone, email, text or fax.

SOURCE:  Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers. Jan. 19, 2021, Section 8.9 p. 122. (Accessed Feb. 2021).

Fee for service reimbursement is not available for an electronic mail message (e-mail), or facsimile transmission (fax).

SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09). (Accessed Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

Idaho Medicaid reimburses for specific services via live video telehealth, consistent with ID Administrative Code. Telehealth services must be equal in quality to in-person services.

Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties.

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9, 8.9.2 & 8.9.4 p. 122-123. (Accessed Feb. 2021).

Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider who should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered.

SOURCE:  Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9 p. 122. (Accessed Feb 2021). 

Telehealth services that are properly identified in accordance with billing requirements are covered under Medicaid for physicians, within limitations defined by the Department in the Idaho Medicaid Provider Handbook.

SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09) (3/13/20), Pg. 24 (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Services must be equal in quality to services provided in-person.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9 p. 122 (Accessed Feb. 2021).

Place of service 02 (telehealth) is not used by Idaho Medicaid. All normal Place of Service codes are acceptable for telehealth. The place of service used should be the location of the participant. Claims must include a GT modifier (Via interactive audio and video telecommunications systems) on CPT® and HCPCS. FQHC, RHC or IHS providers should not report the GT modifier with encounter code T1015, but should include it with the supporting codes.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9.4, pg. 123 July 23,2020. (Accessed Feb. 2021).

Physician/Non-Physician Practitioner Services:

  • Primary Care Services
  • Specialty Services
  • Health and Behavioral Assessment/Intervention
  • Psychiatric Crisis Consultation (Physicians and psychiatric nurse practitioners only)
  • Psychotherapy with evaluation and management
  • Psychiatric diagnostic interview
  • Pharmacological management
  • Tobacco Use Cessation

School-based Services

Community Based Rehabilitation Services (CBRS) supervision can be delivered via telehealth in educational environments, but not separately reimbursable.

Children with Developmental Disabilities

Therapeutic consultation and crisis intervention can be delivered via telehealth technology through the Bureau of Developmental Disability Services.

Early Intervention Services (EIS) for Infants and Toddlers

Services can be delivered via telehealth as long as the provider is employed by or contracted with the Idaho Infant Toddler Program and meet the IDEA Part C requirements.  Eligible services include:

  • Family training and counseling for child development, per 15 minutes (HCPCS T1027)
  • Home care training, family, per 15 minutes (HCPCS S5110)
  • Medical team conference with interdisciplinary team, 30 minutes (CPT 99366)

Primary Care

Primary care services can be delivered via telehealth.  Providers must be licensed by the Idaho Board of Medicine.

Therapy Services

Licensed occupational and physical therapists and speech language pathologists can provide services through telehealth.  Evaluations and reevaluations must be performed as an in-person visit to the participant and is not covered through telehealth.  Therapeutic procedures and activities are covered via telehealth. (Please see manual for a list of telehealth covered services.)

The therapist must certify that the services can be safely and effectively done with telehealth.  The physician order must specifically allow the services to be provided via telehealth.  The physician or non- physician practitioner order must specifically allow the services to be provided by telehealth.

Interpretation Services

Idaho Medicaid reimburses for interpretation, translation, Braille, and sign language in conjunction with a reimbursable Medicaid service.

Speech Language Pathology

Speech therapy services can be delivered via telehealth. Evaluations must be performed in-person. The speech therapist must certify that the services can safely and effectively be done with telehealth.

SOURCE:  ID Medicaid Provider Handbook, Therapy Services Feb. 2021, pg 38Occupational and Physical Therapy Services Jan. 1, 2020, p. 9  & Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 122-123. (Accessed Feb. 2021).

Community Based Rehabilitation Services (CBRS) supervision is covered via telehealth

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 123. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Physicians and non-physician practitioners enrolled as Healthy Connections primary care providers are eligible to provide primary care services via telehealth.

Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.

Idaho Medicaid will cover therapy services for occupational therapists and physical therapists.

Only one eligible provider may be reimbursed for the same service per participant per date of service.

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 122-123 (Accessed Feb. 2021).

Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.

SOURCE: ID Medicaid Provider Handbook, Therapy Services Feb. 2021, pg 38  (Accessed Feb. 2021).

Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth.

SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner.  Sec. 4.28.3, Pg. 59. (Feb. 2021), (Accessed Feb. 2021).


ELIGIBLE SITES

Telehealth services as an encounter by a facility are reimbursable if the services are delivered in accordance with the ID Medicaid Telehealth Policy.

SOURCE: Idaho MMIS Provider Handbook: Ambulatory Health Care Facility. Nov. 1, 2018., p. 10 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No reimbursement for use of equipment at either the remote or originating site.

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers.  Jan.19, 2021, p. 123.  (Accessed Feb. 2021).

 

 

Last updated 02/28/2021

Miscellaneous

Technical Requirements:

  • Video must be provided in real time with full motion video and audio.
  • Transmission of voice must be clear and audible
  • Telehealth services that cannot be provided as effectively as in-person services are not covered.
  • Video images must be high quality images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9.2 p. 123 (Accessed Feb. 2021). 

Provider Requirements

  • Providers at the distant site must disclose to the patient the performing provider’s identity, location, telephone number and Idaho license number.
  • Telehealth providers must have a systematic quality assurance and improvement program for telehealth that is documented, implemented and monitored.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9 p. 122 (Accessed Feb 2021). 

Documentation Requirements

The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and that services were delivered via telehealth. The documentation must be of the same quality as is originated during an in-person visit. These documentation requirements are specific to delivery via telehealth and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, p. 123 (Accessed Feb. 2021).

Last updated 02/28/2021

Out of State Providers

Providers of telehealth services must be licensed by the Idaho Board of Medicine, Board of Nursing, or in the case of therapeutic consultation and crisis intervention for children’s developmental disabilities services, providers must meet staff qualifications.

Please refer to Idaho Administrative Code for additional information.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9.1 p. 123,Idaho Medicaid Provider Handbook. Agency Professional July 11, 2019. Section 1.4.6 p. 10 & IDAPA 16.03.09 Sec.855. (Accessed Feb. 2021).

Last updated 02/28/2021

Overview

Idaho Medicaid reimburses for live video telehealth for certain providers and for specific services.  There is no reference to store-and-forward or 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

Idaho Medicaid specifies that coverage is available only for ‘two-way live video between the provider and the participant.”

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 122. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

Definitions

No Reference Found

Last updated 02/28/2021

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 02/28/2021

Requirements

No Reference Found

Last updated 02/28/2021

Cross State Licensing

No Reference Found

Last updated 02/28/2021

Definitions

Recently Amended Definition (Effective Now)

Telehealth services means health care services provided by a provider to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer or synchronous interaction between a provider at a distant site and a patient at an originating site.  Such services include, but are not limited to, clinical care, health education, home health and facilitation of self-managed care and caregiver support, and the use of synchronous or asynchronous telecommunications technologies by a provider to deliver patient health care services, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; audio in isolation without access to review of the patient’s medical records, electronic mail messages that are not compliant with the health insurance portability and accountability act (HIPAA), or facsimile transmission

SOURCE: ID Code Sec. 54-5703(6) & HB 342 (2020 Session).(Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: ID Code Sec. 54-1842. & IMLC. (Accessed Feb. 2021).

Member of Nurses Licensure Compact.

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

 

Last updated 02/28/2021

Miscellaneous

No Reference Found

Last updated 02/28/2021

Online Prescribing

Prescribing physicians must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment.

Prescriptions based solely on online questionnaires or consultation outside of an ongoing clinical relationship are prohibited.

SOURCE: ID Code § 54-1733. (Accessed Feb. 2021).

Recently Amended (Effective Now)

If a provider offering telehealth services does not have an established provider-patient relationship with a person seeking such services, the provider shall take appropriate steps to establish a provider-patient relationship by use of technologies sufficient to conduct a patient evaluation and appropriate to diagnose and treatment the patient, provided however, that the applicable Idaho community standard of care must be satisfied.

A provider with an established provider-patient relationship, including a relationship established pursuant to section 54-5705, Idaho Code, may issue prescription drug orders using telehealth services within the scope of the provider’s license and according to any applicable laws, rules and regulations, including the Idaho community standard of care; provided however, that the prescription drug shall not be a controlled substance unless prescribed in compliance with 21 U.S.C. section 802(54)(A).

SOURCE: ID Code Sec. 54-5705 & 5707 & HB 342 (2020 Session). (Accessed Feb. 2021).

Last updated 02/28/2021

Professional Boards Standards

ID Board of Dentistry

SOURCE: IDAPA 24.31.01 Sec. 055 (Accessed Feb. 2021).

ID Board of Psychologist Examiners

SOURCE: IDAPA 24.12.01 Sec. 601 (Accessed Feb. 2021).