Idaho

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: No
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, EMS, IMLC, NLC, PSY
  • Consent Requirements: Yes

FQHCs

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

STATE RESOURCES

  1. Medicaid Program: Idaho Medicaid
  2. Administrator: Idaho Dept. of Health and Welfare
  3. Regional Telehealth Resource Center: Northwest Regional 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 11/22/2022

Audio Only Delivery

Medicaid: Information Release MA 22-01: Ongoing COVID-19 Flexibilities Under the Public Health Emergency

STATUS: Active

Medicaid:  Provider Information Regarding Telehealth

STATUS: Active

Medicaid:  COVID-19 Telehealth HIPAA Guidance

STATUS: Active

Medicaid: Social Distancing & Telehealth Reminders for Providers

STATUS: Active

Last updated 11/22/2022

Cross State Licensing

ID Division of Occupational & Professional Licenses: COVID-19 Guidance Allowing Out-of-State Providers to Deliver Services in or into ID

STATUS: Active, Enforcement Discretion in Place until January 1, 2023 unless extended by DOPL

Board of Medicine: Administrative Rules Temporarily Suspended

STATUS: Expired with end of ID State of Emergency

Board of Medicine: Idaho Telehealth Access Act COVID-19 Guidance

STATUS: Expired with end of ID State of Emergency

Board of Medicine: Coronavirus (COVID-19) Information

STATUS: Expired with end of ID State of Emergency

Last updated 11/22/2022

Easing Prescribing Requirements

ID Statute 54-5707: Allows prescribing via telehealth in compliance with federal law

STATUS: Enacted

HB 394: Extends effective dates including HB 38/ID Statute 54-5707 to on and after July 1, 2021.

STATUS: Enacted

Last updated 11/22/2022

Miscellaneous

Medicaid: MedicAide ID Dept of Health and Welfare, Division of Medicaid Bulletin Feb. 2022

STATUS: Active

Executive Order: Regulatory Relief to Support Economic Recovery

STATUS: Active

ID Division of Occupational & Professional Licenses: COVID-19 Guidance Allowing Out-of-State Providers to Deliver Services in or into ID

STATUS: Active, Enforcement Discretion in Place until January 1, 2023 unless extended by DOPL

Medicaid:  COVID-19 Telehealth HIPAA Guidance

STATUS: Active, until end of federal PHE

Last updated 11/22/2022

Private Payer

Department of Insurance:  Temporary Waiver of Provider Restrictions

STATUS:Expired with end of ID State of Emergency

Last updated 11/22/2022

Definitions

No reference found.

Last updated 11/22/2022

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 11/22/2022

Requirements

No Reference Found

Last updated 11/22/2022

Definitions

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

Source: Medicaid Telehealth Policy, General Information and Requirements for Providers. Section 10.9 Pg. 133. Rev. Nov. 18, 2022 (Accessed Nov. 2022).

Covered telehealth services are real-time communication through interactive technology that enables a provider and a patient at two locations separated by distance to interact simultaneously through two-way video and audio transmission.

SOURCE: Idaho Medicaid Provider Handbook: Therapy Services, Section 4.6, p. 37, Nov. 18, 2022. (Accessed Nov. 2022).

Last updated 11/22/2022

Email, Phone & Fax

No reimbursement for telephone, email, text or fax.

SOURCE:  Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers. Nov. 18, 2022, Section 10.9 p. 128. (Accessed Nov. 2022).

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 Nov. 2022).

Last updated 11/22/2022

Live Video

POLICY

Telehealth services are covered and reimbursable fee-for-service if delivered via two-way live video between the provider and the participant. Services must be equal in quality to services provided in-person, and comply with HIPAA privacy requirements, licensure requirements, Medicaid Information Release MA18-07, and all Medicaid rules, regulations and policies.

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.  Nov. 18, 2022, Section 10.9, 10.9.2 & 10.9.4 p. 128-129. (Accessed Nov. 2022).

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.  Nov. 18, 2022, Section 10.9 p. 128 (Accessed Nov. 2022). 

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), Pg. 25 (Accessed Nov. 2022).

For Home Health, the face-to-face encounter that initiates treatment may occur via telehealth.

SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09), Pg. 102 (Accessed Nov. 2022). ID Medicaid Provider Handbook: Home Health and Hospice Services, 1.2.4.1, p. 6. (Mar. 2, 2021). (Accessed Nov. 2022).


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.  Nov. 18, 2022, Section 10.9 p. 128 (Accessed Nov. 2022).

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.  Nov. 18, 2022, Section 10.9.4, pg. 129 (Accessed Nov. 2022).

Physician/Non-Physician Practitioner Services:

Physicians and non-physician practitioners enrolled as Healthy Connections primary care providers are eligible to provide primary care services via telehealth. Other services available through telehealth (manual lists specific CPT codes):

  • 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 is covered via telehealth. Reimbursement is already included in CBRS payment.

Children with Developmental Disabilities

Therapeutic consultation and crisis intervention can be delivered via telehealth technology through the Bureau of Developmental Disability Services. See manual for specific codes.

Early Intervention Services (EIS) for Infants and Toddlers

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)

Therapy Services (Occupational, Physical Therapists & Speech Language Pathologists)

Covered telehealth services are real-time communication through interactive technology that enables a provider and a patient at two locations separated by distance to interact simultaneously through two-way video and audio transmission. Evaluations and reevaluations must be provided in-person and not by telehealth. The therapist must certify that the services can safely and effectively be done with telehealth and the physician or nonphysician practitioner order must specifically allow the services to be provided by telehealth. Therapists must adhere to all requirements of their licensing board for telehealth services. Specific service codes found in manual.

Interpretation Services

Idaho Medicaid will reimburse for interpretation, translation, Braille and sign language services provided to participants in person or through telehealth.

SOURCE:  ID Medicaid Provider Handbook, Therapy Services Nov. 18, 2022 pg 37 & Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Nov. 18, 2022, p. 124-129. (Accessed Nov. 2022).

Psychiatric Crisis

Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via telehealth.

SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (Nov. 18, 2022), p. 67. (Accessed Nov. 2022).


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 (97110, 97530) 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 Nov. 18 2022 p. 128-129 (Accessed Nov. 2022).

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

SOURCE: ID Medicaid Provider Handbook, Therapy Services Nov. 18, 2022 pg 37  (Accessed Nov. 2022).

Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth, using CPT 90839 and 90840.

Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.

SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner.  Sec. 4.32.3, Pg. 67, (4.36) 71. Nov. 18, 2022, (Accessed Nov. 2022).

FQHCs, RHCs & IHS

Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks.

SOURCE:  ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services, Nov. 18, 2022, p. 30.  (Accessed Nov. 2022).


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 Medicaid Provider Handbook: IHS, FQHC, RHC Services. Nov. 18, 2022 p. 30 (Accessed Nov. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Therapy Services

Therapy services covered via telehealth are listed in the table below. Reimbursement is according to the numerical fee schedule. There is no additional fee for either the originating or the distant site.

SOURCE:  ID Medicaid Provider Handbook, Therapy Services Nov. 18, 2022 pg 37 (Accessed Nov. 2022).

Last updated 11/22/2022

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

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.
  • If an operator who is not an employee of the involved agency is needed to run the teleconferencing equipment or is present during the conference or consultation, that individual must sign a confidentiality agreement.
  • Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider. The PCP should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered, if applicable, and any other pertinent information from the visit.

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. Nov. 18, 2022, p. 128-129 (Accessed Nov. 2022).

Last updated 11/22/2022

Out of State Providers

Medicaid Providers are required to be licensed, certified, or registered with the appropriate state authority. The claims processing system verifies the effective dates of the provider’s license against the date of service. Provider licensure must be up to date in their provider file or claims will be denied at the header level. Providers are required to split claims for covered and non-covered dates of service, or update their license with Gainwell Technologies and resubmit the claim.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Nov. 18, 2022 Sections 6.4 & 10.9.1 p. 39  (Accessed Nov. 2022).

Last updated 11/22/2022

Overview

Idaho Medicaid reimburses for live video telehealth for certain providers and for specific services and specifies that delivery must be through two-way live video.  There is no reference to store-and-forward or remote patient monitoring.

Last updated 11/22/2022

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 11/22/2022

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 Nov. 18, 2022, p. 128. (Accessed Nov. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/23/2022

Cross State Licensing

Where permitted by law, an applicant, in good standing with no restrictions upon or actions taken against their license to practice in a state, territory or district of the United States or Canada is eligible for licensure by endorsement to practice medicine in Idaho.

SOURCE: IDAPA – Division Of Occupational And Professional Licenses -24.33.03, p. 3 (Accessed Nov. 2022)

Last updated 11/23/2022

Definitions

“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; and health administration. The term “telehealth services” does not include audio in isolation without access to and 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 transmissions.

“Telehealth technologies” means synchronous or asynchronous telecommunications technologies capable of assisting 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; and health administration.

SOURCE: ID Code Sec. 54-5703(6)ID Admin Code 24.33.03 (201)(06). (Accessed Nov. 2022).

Telepsychology Services mean psychological services provided by a provider through the use of electronic communications, information technology, asynchronous store and forward transfer of information or synchronous interaction between the provider at a distant site and a service recipient at an original site. Such services include, but are not limited to, assessing, testing, diagnosing, treating, education, and consulting.

SOURCE: ID Admin Code 24.12.01 (601). (Accessed Nov. 2022).

Last updated 11/23/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: ID Code Sec. 54-1842. & IMLC. (Accessed Nov. 2022).

Member of Nurses Licensure Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status. (Accessed Nov. 2022) 

Member of EMS Compact.

SOURCE: Interstate Commission for EMS Personnel Practice, EMS Compact, (Accessed Nov. 2022).

Member of the Audiology and Speech-Language Pathology Interstate Compact.

SOURCE:  Audiology and Speech-Language Pathology Interstate Compact. (Accessed Nov. 2022).

Member of the Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact Map (Accessed Nov. 2022).

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

Last updated 11/23/2022

Miscellaneous

No Reference Found

Last updated 11/23/2022

Online Prescribing

Prescribers 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 does not constitute a legitimate medical purpose.

SOURCE: ID Code § 54-1733. (Accessed Nov. 2022).

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 two-way audio or audio-visual interaction; 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 title 21 U.S.C.

SOURCE: ID Code Sec. 54-5705 & 5707 (Accessed Nov. 2022).

Last updated 11/23/2022

Professional Boards Standards

ID Board of Dentistry

SOURCE: IDAPA 24.31.01 (Accessed Nov. 2022).

Any dentist who provides any telehealth services to patients located in Idaho must hold an active Idaho license.

SOURCE: IDAPA 24.31.01 as amended by Executive Order 2020-13, p. 163 (Accessed Nov. 2022)

ID Board of Psychologist Examiners (Telepsychology)

SOURCE: IDAPA 24.12.01 (Accessed Nov. 2022)

Idaho State Board Of Medicine

SOURCE: IDAPA -24.33.03, (Accessed Nov. 2022)

Last updated 11/22/2022

Definition of a Visit

Encounters fall into one of two categories depending on the provider. Indian Health Service Clinics (IHS) and Federally Qualified Health Centers (FQHC) provide either dental or medical/mental health encounters. An encounter is defined as a face-to-face contact for the provision of one of these types of services between a participant and one of the following:

  • A physician;
  • A physician assistant;
  • A nurse practitioner;
  • A podiatrist;
  • A chiropractor;
  • A clinical social worker;
  • A clinical psychologist;
  • An other specialized nurse practitioner; or
  • A visiting nurse.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov 18, 2022)., p. 15.  (Accessed Nov. 2022).

Last updated 11/22/2022

Eligible Distant Site

Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks. See the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook for more information about eligible services and billing requirements.

SOURCE: ID Medicaid Provider Handbook, IHS, fQHC, and RHC Services, p. 30 (Nov. 18, 2022).  (Accessed Nov. 2022).

Last updated 11/22/2022

Eligible Originating Site

No reference found.

Last updated 11/22/2022

Facility Fee

No reference found.

Last updated 11/22/2022

Home Eligible

No reference found.

Last updated 11/22/2022

Modalities Allowed

Live Video

Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov. 18, 2022)., p. 30.  (Accessed Nov. 2022).

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: ID Medicaid Provider Handbook: General Information and Requirements for Providers (Nov. 18, 2022), p. 129.  (Accessed Nov. 2022).


Store and Forward

Idaho Medicaid does not reimburse for Store and Forward. See ID Medicaid Store and Forward.


Remote Patient Monitoring

Idaho Medicaid does not reimburse for RPM.  See ID Medicaid RPM.


Audio-Only

Idaho Medicaid does not reimburse for Audio-Only.  See ID Medicaid Email, Phone & Fax.

Last updated 11/22/2022

PPS Rate

The services of Indian Health Services (IHS), Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) are a covered benefit under Idaho Medicaid. Covered services are indicated on the Idaho Medicaid Numerical Fee Schedule with a reimbursement amount. Amounts of $0.00 are covered and require manual pricing per the General Billing Instructions, Idaho Medicaid Provider Handbook. Services must meet the criteria for the procedure found in the Physician and Non-Physician Practitioner and Hospital, Idaho Medicaid Provider Handbooks. Certain procedures must be prior authorized to be covered. See the Prior Authorizations section for more information. Services that qualify as described in the Encounters section shall be billed at the encounter rate.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov. 18 2022)., p. 15.  (Accessed Nov. 2022).

Last updated 11/22/2022

Provider-Patient Relationship

No reference found.

Last updated 11/22/2022

Same Day Encounters

All contact with providers for the same type of encounter counts as a single encounter. An encounter with more than one health professional, or multiple contacts with the same professional, in the same day, and all incidental services constitutes a single encounter. If a participant has a visit with a healthcare professional that qualifies as an encounter, any group education or activities provided on the same day are included in the encounter. Missed appointments, visits to pick up medication, or incidental services on the day of the encounter are not considered a separate encounter. Encounters are limited to three per day for FQHCs. An exception is allowed for an additional encounter of the same type when a participant, subsequent to the first encounter, suffers an illness or injury that requires additional diagnosis and treatment and is supported by documentation. Qualifying additional encounters should be billed with Modifier 59.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov. 18, 2022)., p. 16.  (Accessed Nov. 2022).