Indiana

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Indiana Medicaid

Administrator

Indiana Family and Social Services Administration

Regional Telehealth Resource Center

Upper Midwest Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: NLC, EMS
Consent Requirements: Yes

Last updated 08/23/2021

Audio Only Delivery

Medicaid: Continuation of Flexibilities through PHE

STATUS: Active, until end of the PHE

Medicaid: Telehealth Policy Update

STATUS: Permanent

Medicaid:  Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid: Updated Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid:  COVID-19 Telemedicine Billing Guidance

STATUS: Active, until end of IN PHE

Medicaid 1915(c) Waiver: Appendix K – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI) Waiver

STATUS: Expired February 28, 2021; extended by Addendum

STATUS: Active, until 6 months after the end of the Federal PHE

Medicaid 1915(c) Waiver: Appendix K – Family Supports Waiver (FSW)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Family Supports Waiver

STATUS: Expired February 28, 2021; extended by Addendum

STATUS: Active, until 6 months after the end of the Federal PHE

Medicaid 1915(c) Waiver: Appendix K – Community Integration and Habilitation (CIH)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Community Integration and Habilitation (CIH)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension- Community Integration and Habilitation (CIH)

STATUS: Active, until 6 months after the end of the Federal PHE

Last updated 08/25/2021

Cross State Licensing

Medical Licensing Board:  COVID-19 Actions

STATUS: Active, until end of PHE.

Professional Licensing Agency: COVID-19 Actions

STATUS: Active

Professional Licensing Agency: COVID-19 Temporary Healthcare Provider Registry

STATUS: Active

Office of Governor: Executive Order 20-17

STATUS: Active.

Last updated 08/23/2021

Easing Prescribing Requirements

Medicaid:  Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid:  COVID-19 Telemedicine Billing Guidance

STATUS: Active, until end of IN PHE

Office of the Governor: Executive Order on Medicaid Telemedicine

STATUS: Active, until end of PHE

Professional Licensing Agency: COVID-19 Actions

STATUS: Active

Last updated 08/25/2021

Miscellaneous

Medicaid:  Updates on Telemedicine Policy

STATUS: Current expansions are under review

Office of the Governor: Extension of Executive Order 20-02

STATUS: Active, until end of PHE

Medicaid 1915(c) Waiver: Appendix K – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI) Waiver

STATUS: Expired, February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI) Waiver

STATUS: Active, until 6 months after the end of the Federal PHE

Medicaid 1915(c) Waiver: Appendix K – Family Supports Waiver (FSW)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Family Supports Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1925(c) Waiver: Appendix K Extension- Family Supports Waiver

STATUS: Active, until 6 months after the end of the Federal PHE

Medicaid 1915(c) Waiver: Appendix K – Community Integration and Habilitation (CIH)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Community Integration and Habilitation (CIH)

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K Extension- Community Integration and Habilitation (CIH)

STATUS: Active, until 6 months after the end of the Federal PHE

HB 1002: Liability Immunity

STATUS: Enacted

Office of the Governor: Executive Order 21-19

STATUS: Active

Last updated 08/19/2021

Originating Site

Medicaid:  Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid:  Home Health and Telemedicine Policy

STATUS: Rescinded by Executive Order 20-17 and July 1, 2021 Bulletin. Certain elements made permanent, See June 8, 2021 Bulletin.

Last updated 08/25/2021

Private Payer

Office of the Governor: Executive Order on telemedicine

STATUS: Rescinded, by EO 21-17 effective Jun. 30, 2021

Office of the Governor: Executive Order 

STATUS: Active

Office of the Governor: Executive Order

STATUS: Active

Last updated 08/19/2021

Provider Type

Medicaid:  Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid: Updated Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid:  Home Health and Telemedicine Policy

STATUS: Rescinded by Executive Order 20-17 and July 1, 2021 Bulletin. Certain elements made permanent, See June 8, 2021 Bulletin.

Medicaid:  COVID-19 Telemedicine Billing Guidance

STATUS: Active, until end of IN PHE

Medicaid: COVID-19 Telemedicine Revised  Billing Guidance

STATUS: Active, until end of IN PHE

Medicaid 1915(c) Waiver: Appendix K – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI) Waiver

STATUS: Active, until February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Family Supports Waiver (FSW)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Family Supports Waiver

STATUS: Active, until February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Community Integration and Habilitation (CIH)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Community Integration and Habilitation (CIH)

STATUS: Active, until February 28, 2021

Last updated 08/19/2021

Service Expansion

Medicaid: Continuation of Flexibilities through PHE

STATUS: Active, until end of the PHE

Medicaid: Telehealth Policy Update certain policies revised by July 1, 2021 Bulletin

STATUS: Permanent

Medicaid:  Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid: Updated Telemedicine FAQs

STATUS: Active, until end of PHE

Medicaid:  Home Health and Telemedicine Policy

STATUS: Rescinded by Executive Order 20-17 and July 1, 2021 Bulletin. Certain elements made permanent, See June 8, 2021 Bulletin.

Medicaid: Facility Fees and revised on Sept. 24, 2020

STATUS: Active, until end of IN PHE

Medicaid:  COVID-19 Telemedicine Billing Guidance

STATUS: Active, until end of IN PHE

Medicaid: COVID-19 Telemedicine Revised  Billing Guidance

STATUS: Active, until end of IN PHE

Medicaid: Telemedicine Services Codes

STATUS: Active, until end of PHE

Office of the Governor: Executive Order on Medicaid Telemedicine

STATUS: Active, until end of PHE

Medicaid 1915(c) Waiver: Appendix K – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI) Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI) Waiver

STATUS: Active, until 6 months after the end of the Federal PHE

Medicaid 1915(c) Waiver: Appendix K – Family Supports Waiver (FSW)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Family Supports Waiver

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1925(c) Waiver: Appendix K Extension- Family Supports Waiver

STATUS: Active, until 6 months after the end of the Federal PHE

Medicaid 1915(c) Waiver: Appendix K – Community Integration and Habilitation (CIH)

STATUS: Expired August 31, 2020; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension – Community Integration and Habilitation (CIH)

STATUS: Expired February 28, 2021; extended by Addendum

Medicaid 1915(c) Waiver: Appendix K Extension- Community Integration and Habilitation (CIH)

STATUS: Active, until 6 months after the end of the Federal PHE

 

Last updated 08/23/2021

Definitions

Telemedicine services are defined as “the use of videoconferencing equipment to allow a medical provider to render an exam or other service to a patient at a distant location.”

Telehealth services are defined as “the scheduled remote monitoring of clinical data through technologic equipment in the member’s home.”

SOURCE: IN Medicaid Telemedicine and Telehealth Module Oct. 1, 2019, published Mar. 30, 2021, p.1. (Accessed Aug. 2021).

Telehealth activities means the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across a distance.

Telehealth services has the same meaning as telehealth in IN Code 25-1-9.5-6.

SOURCE: IN Code, 12-15-5-11. ,  SB 3 (2021 Session) and Indiana Health Coverage Programs (IHCP) Bulletin BT202145, June 17, 2021.  (Accessed Aug. 2021). 

Last updated 08/24/2021

Email, Phone & Fax

The IHCP will continue to allow and offer reimbursement for audio-only telehealth. The IHCP will continue to explore the option of audio-only telehealth and its effectiveness in delivering healthcare services and provide updates when more specific policy details have been determined. Until further notice, audio-only telehealth services should be billed according to the guidance released in BT2020106 and used only when the care can be properly delivered via audio-only telehealth.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).

Telemedicine is not the use of:

  • Telephone transmitter for transtelephonic monitoring; or
  • Telephone or any other means of communication for consultation from one provider to another.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019. p. 1. (Accessed Aug. 2021).

Last updated 08/17/2021

Live Video

POLICY

Indiana Code requires reimbursement for medically necessary telehealth services for FQHCs, Rural Health Clinics, Community Mental Health Centers, Critical Access Hospitals and a provider determined by the office to be eligible, providing a covered telehealth service.

SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).

IN Medicaid will follow the rules laid out in SB 3.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).

The Indiana Health Coverage Programs (IHCP) covers telemedicine services, including medical exams and certain other services normally covered by Medicaid.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct 1, 2019, published Mar. 30, 2021, p.1. (Accessed Aug. 2021).   

In any telemedicine encounter, there will be the following:

  • A distant site;
  • An originating site;
  • An attendant to connect the patient to the provider at the distant site; and
  • Videoconferencing equipment, such as a computer or television monitor at the distant and originating sites to allow the patient to have real-time, interactive; and face-to-face communication with the distant provider via IATV technology.

The patient must be physically present and participating in the visit.

SOURCE: IN Admin. Code, Title 405, 5-38-3 & 4.IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p.1 & 2. (Accessed Aug. 2021).


ELIGIBLE SERVICES/SPECIALTIES

The following services may not be provided using telehealth: surgical procedures, radiological services, laboratory services, anesthesia services, care coordination without the member present, durable medical equipment (DME)/home medical equipment (HME) services, provider-to-provider consultation, and services that require hands-on physical interaction or manipulation with the patient.

In the future, the IHCP plans to return to using a procedure code set for allowable services provided via telehealth, as written in policy prior to the public health emergency. However, the code set will be expanded to allow for healthcare services that can be provided by the practitioners outlined in SB 3 and will incorporate the ability to provide audio-only telehealth. Until the code set is updated and published, IHCP providers should follow the billing guidance released in BT2020106.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).

All services that are available for reimbursement when delivered as telemedicine are subject to the same limitations and restrictions as they would be if not delivered by telemedicine.

There is a specific telemedicine Services Codes list accessible on the Indiana Medicaid website with CPT codes that are reimbursable when the services are rendered via telemedicine at the distant site and billed with modifier 95 and POS code 02.  Use of GT modifier is optional.

Although reimbursement for ESRD-related services is permitted in the telemedicine setting, the IHCP requires at least one monthly visit for ESRD-related services to be a traditional clinical encounter to examine the vascular access site.

FQHCs/RHCs:  FQHCs and RHCs may bill for telemedicine services if the service rendered is considered a valid FQHC/RHC encounter and a covered telemedicine service.  Other requirements and billing instructions are included in the manual.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 3-4. (Accessed Aug. 2021).

IHCP does not reimburse the following provider types for telemedicine:

  • Ambulatory surgical centers;
  • Outpatient surgical services;
  • Home health agencies or services (For information about home health agency reimbursement for telehealth services, see the Telehealth Services section);
  • Radiological services;
  • Laboratory services;
  • Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled;
  • Anesthesia services or nurse anesthetist services;
  • Audiological services;
  • Chiropractic services;
  • Care coordination services;
  • Durable medical equipment, and home medical equipment providers
  • Optical or optometric services;
  • Podiatric services;
  • Physical therapy services;
  • Transportation services;
  • Services provided under a Medicaid home and community-based services waiver.
  • Provider to provider consultations

SOURCE: IN Admin. Code, Title 405, 5-38-4 ; IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Aug. 2021).

For purposes of a community mental health center, telehealth services satisfy any face to face meeting requirement between a clinician and consumer.

SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).


ELIGIBLE PROVIDERS

The IHCP will allow these providers to provide telehealth services and receive reimbursement for IHCP services, within the established IHCP billing rules and policies:

  • A behavior analyst licensed under IC 25-8.5
  • A chiropractor licensed under IC 25-10
  • A dental hygienist licensed under IC 25-13*
  • The following:
    • A dentist licensed under IC 25-14
    • An individual who holds a dental residency permit issued under IC 25-14-1-5*
    • An individual who holds a dental faculty licensed under IC 25-14-1-5.5*
  • A diabetes educator licensed under IC 25-14.3*
  • A dietitian licensed under IC 25-14.5*
  • A genetic counselor licensed under IC 25-17.3
  • The following:
    • A physician licensed under IC 25-22.5
    • An individual who holds a temporary medical permit under IC 22-22.5-5-4*
  • A nurse licensed under IC 25-23*
  • An occupational therapist licensed under IC 25-23.5
  • Any behavioral health and human services professional licensed under IC 25-23.6
  • An optometrist licensed under IC 25-24
  • A pharmacist licensed under IC 25-26*
  • A physical therapist licensed under IC 25-27
  • A physician assistant licensed under IC 5-27.5
  • A podiatrist licensed under IC 25-29
  • A psychologist licensed under IC 25-33
  • A respiratory care practitioner licensed under IC 25-34.5*
  • A speech-language pathologist or audiologist licensed under IC 25-35.6

Some providers (within the licensure citations above) marked with an asterisk may not be able to enroll as rendering providers in the IHCP and must bill under the IHCP-enrolled supervising practitioner’s National Provider Identifier (NPI) using the appropriate modifiers (as applicable). In addition, providers not on this list are not allowed to practice telehealth and/or receive IHCP
reimbursement for such services, even under the supervision of one of these listed practitioners.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).

Providers that can deliver healthcare services via telehealth must be listed as an authorized practitioner in SB 3. Providers not listed as authorized practitioners in SB 3 are not permitted to practice telehealth and/or receive IHCP reimbursement for telehealth services, even under the supervision of one of these listed practitioners.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202145, June 17, 2021, (Accessed Aug. 2021).

The office shall reimburse the following Medicaid providers for medically necessary telehealth services:

  • A federally qualified health center
  • A rural health clinic
  • A community mental health center
  • A critical access hospital
  • A provider, as determined by the office to be eligible, providing a covered telehealth service.

SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).

The distant site physician or practitioner must determine if it is medically necessary for a medical professional to be at the originating site.

 

The office may not impose any distance restrictions on providers of telehealth activities or telehealth services.  Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.

SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).

Federally qualified health centers and rural health centers are eligible distant sites as long as services meet both the requirements of a valid encounter and a covered telemedicine service as defined in the IHCP’s telemedicine policy.  See manual for special billing instructions.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 4. (Accessed Aug 2021).  

Provider types listed under Services Not Reimbursed (under Eligible Services/Specialties section) are not eligible to be reimbursed for telemedicine.

SOURCE: IN Admin. Code, Title 405, 5-38-4(5). (Accessed Aug. 2021).

Reimbursement for telemedicine* services is available to the following providers regardless of the distance between the provider and recipient:

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Community mental health centers
  • Critical access hospitals
  • A provider, as determined by the office to be eligible, providing a covered telemedicine* service

* Word ‘telemedicine’ replaced by ‘telehealth’ in Indiana Code due to passage of Senate Bill 3 (2021 Session).

SOURCE: IN Admin Code, 405 5-38-4(3)IN Code 12-15-5-11.  (Accessed Aug. 2021).


ELIGIBLE SITES

The office may not impose any distance restrictions on providers of telehealth activities or telehealth services.  Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.

SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).

Services may be rendered in an inpatient, outpatient or office setting.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Aug. 2021). 

Federally qualified health centers and rural health clinics acting as the originating site may be reimbursed if it is medically necessary for a medical professional to be with the member, and the service provided includes all components of a valid encounter code.  See manual for billing requirements.

All components of the service must be provided and documented, and the documentation must demonstrate medical necessity. All documentation is subject to post-payment review.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 4-5. (Accessed Aug. 2021).

Separate reimbursement for a provider at the originating site is payable only if that provider’s presence is medically necessary. Documentation must be maintained in the patient’s medical record to support the need for the provider’s presence at the originating site during the visit. Such documentation is subject to post-payment review. If a healthcare provider’s presence at the originating site is medically necessary, billing of the appropriate evaluation and management code is permitted.

SOURCE: IN Admin. Code, Title 405, 5-38-4 & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Aug. 2021).


GEOGRAPHIC LIMITS

The office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.

SOURCE: IN SB 3 (2021 Session). (Accessed Aug. 2021). 


FACILITY/TRANSMISSION FEE

Healthcare Common Procedure Coding System (HCPCS) code Q3014 – Telehealth originating site facility fee, billed with modifier 95, is reimbursable for providers that render services via telemedicine at the originating site.

FQHCs/RHCs:  Separate reimbursement for merely serving as the originating site is not available to FQHCs and RHCs. When the presence of a medical professional is not medically necessary at the originating site, neither the facility fee, as billed by HCPCS code Q3014, nor the facility-specific PPS rate is available, because the requirement of a valid encounter is not met.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 4 & 5. (Accessed Aug. 2021).

Last updated 08/24/2021

Miscellaneous

All services delivered through telehealth are subject to the same limitations and restrictions as they would be if delivered in-person.

Documentation must be maintained by the provider to substantiate the services provided and that consent was obtained. Documentation must indicate that the services were rendered via
telehealth, clearly identify the location of the provider and patient and be available for post-payment review.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).

For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The distant site physician should coordinate with the patient’s primary care physician.

Documentation must be maintained at the distant and originating locations to substantiate the services provided.  It must indicate the services were provided via telemedicine and location of the distant and originating sites.  Documentation is subject to post-payment review.

A provider can use telemedicine to prescribe a controlled substance to a patient who has not been previously examined. Opioids, however, cannot be prescribed via telemedicine, except in cases in which the opioid is a partial agonist (such as buprenorphine) and is being used to treat or manage opioid dependence.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 3. (Accessed Aug. 2021). 

The information above applies to Indiana Health Coverage Programs (IHCP) services provided under the fee-for-service (FFS) delivery system. For information about services provided through the managed care delivery system – including Healthy Indiana Plan (HIP), Hoosier Care Connect, or Hoosier Healthwise services – providers must contact the member’s managed care entity (MCE).

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 1. (Accessed Aug. 2021).  

Prior authorization (PA) is required for all for telehealth services. Telehealth services are indicated for members who require scheduled remote monitoring of data related to the member’s qualifying chronic diagnoses that are not controlled with medications or other medical interventions. Services may be authorized for up to 60 days.  See Telehealth Module for additional requirements.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 7. (Accessed Aug. 2021).

A Medicaid recipient waives confidentiality of any medical information discussed with the health care provider that is:

  • Provided during a telehealth visit; and
  • Heard by another individual in the vicinity of the Medicaid recipient during a health care service or consultation.

SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).

Last updated 08/24/2021

Out of State Providers

Out-of-state providers can perform telemedicine services without fulfilling the out-of-state prior authorization requirement if they have the subtype “telemedicine” attached to their enrollment.

The Provider must be enrolled with a rendering or billing provider classification and be one of the following types:

  • Advanced practice registered nurse
  • Physician assistant
  • Podiatrist
  • Optometrist
  • Physician

The provider must have a license issued from the Indiana Professional Licensing Agency (IPLA) with the Telemedicine Provider Certification.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 5. (Accessed Aug. 2021).

Last updated 08/23/2021

Overview

Indiana Medicaid reimburses for live video telemedicine for certain services and providers.  Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services.  Indiana Medicaid defines telehealth as including remote patient monitoring (RPM) services and reimburses home health agencies for RPM for patients with diabetes, congestive heart failure and COPD.

Changes that were made by recently passed Senate Bill 3 have not yet been transferred into the state’s Medicaid Telemedicine and Telehealth Reference Module, including prohibitions around restricting originating and distant sites.  However, Indiana Medicaid did announce changes to their policies in Bulletin 202142 and BT202145.  Both the Module and Bulletins are listed in the policy finder because both items are still publicly accessible on IN Medicaid’s website. However, it appears that the information in the Bulletins overrides the Module information in cases where it conflicts.

Last updated 08/24/2021

Remote Patient Monitoring

POLICY

Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.

SOURCE: IN Code, 12-15-5-11(c). (Accessed Aug. 2021).


CONDITIONS

The member must be receiving services from a home health agency.  Member must initially have two or more of the following events related to one of the conditions listed below within the previous twelve months:

  • Emergency room visit
  • Inpatient hospital stay

An emergency room visit that results in an inpatient hospital admission does not constitute two separate events.

The two qualifying events must be for the treatment of one of the following diagnoses:

  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Diabetes

SOURCE: IN Admin Code, Title 405, 5-16-3.1(d) & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 7. (Accessed Aug. 2021).


PROVIDER LIMITATIONS

Reimbursement for home health agencies under certain conditions.  A registered nurse must perform the reading of transmitted health information provided from the member in accordance with the written order of the physician.

SOURCE: IN Admin Code, Title 405, 5-16-3.1(d)(5) (Accessed Aug. 2021).


OTHER RESTRICTIONS

Treating physician must certify the need for home health services and document that there was a face-to-face encounter with the individual.

SOURCE: IN Admin Code, Title 405, 5-16-3.1(e) (Accessed Aug. 2021).

Prior authorization is required for all telehealth services and must be submitted separately from other home health service prior authorization requests.  Services may be authorized for up to 60 days.  See Telehealth Module for additional requirements.

Member must also be receiving or approved for other IHCP home health services.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021 p. 6-7. (Accessed Aug. 2021).

Last updated 08/23/2021

Store and Forward

POLICY

The IHCP allows store-and-forward technology (the electronic transmission of medical information for subsequent review by another healthcare provider) to facilitate other reimbursable services; however, separate reimbursement of the originating-site payment is not provided for store-and-forward technology because of restrictions in 405 IAC 5-38-2(4). Only live video is separately reimbursed by the IHCP.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 1. (Accessed Aug. 2021).  

“Store and forward” means the transmission of a patient’s medical information from an originating site to the practitioner at a distant site without the patient being present for subsequent review by a health care provider at the distant site. Restrictions placed on store and forward reimbursement in this rule shall not disallow the permissible use of store and forward technology to facilitate reimbursable services.

Indiana Medicaid will not reimburse for store-and-forward services. However, restrictions placed on store-and-forward reimbursement shall not disallow the permissible use of store-and-forward technology to facilitate other reimbursable services.

SOURCE: IN Admin. Code, Title 405, 5-38-2 & 4. (Accessed Aug. 2021)


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/24/2021

Definitions

“Telehealth services” means health care services delivered by use of technology allowed under IC 25-1-9.5-6, including the following:

  • Medical exams and consultations
  • Behavioral health, including substance abuse evaluations and treatment

SOURCE: IN Code, 27-8-34-5 & 27-13-1-34. as amended by SB 3 (2021). (Accessed Aug. 2021).

Last updated 08/25/2021

Parity

SERVICE PARITY

Coverage must be provided in accordance with the same clinical criteria as would be provided in-person.

SOURCE: IN Code, 27-8-34-6 & 27-13-7-22. (Accessed Aug. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 08/25/2021

Requirements

Accident and sickness insurance (dental or vision insurance is excluded) policies and individual or group contracts must provide coverage for telehealth services in accordance with the same clinical criteria as would be provided for services provided in-person.

Coverage for telehealth services may not be subject to a dollar limit, deductible or coinsurance requirement that is less favorable to a covered individual than those applied to the same health services delivered in-person.

A separate consent cannot be required.

If a policy provides coverage for telehealth services via:

  • Secure video conferencing;
  • Store and forward technology; or
  • Remote patient monitoring technology;

between a provider in one (1) location and a patient in another location, the policy may not require the use of a specific information technology application for those services.

SOURCE: IN Code, 27-8-34-6 & 27-13-7-22. as amended by SB 3 (2021). (Accessed Aug. 2021).

Last updated 08/25/2021

Cross State Licensing

A practitioner who is physically located outside Indiana is engaged in the provision of health care services in Indiana when the practitioner:

  • Establishes a provider-patient relationship under this chapter with; or
  • Determines whether to issue a prescription under this chapter for;

an individual who is located in Indiana.

A practitioner may not establish a provider-patient relationship with or issue a prescription for an individual who is located in Indiana unless the practitioner and the practitioner’s employer or the practitioner’s contractor, for purposes of providing health care services under this chapter, have certified in writing to the Indiana professional licensing agency, in a manner specified by the Indiana professional licensing agency, that the practitioner and the practitioner’s employer or practitioner’s contractor agree to be subject to:

  • The jurisdiction of the courts of law of Indiana; and
  • Indiana substantive and procedural laws;

Concerning any claim asserted against the practitioner, the practitioner’s employer, or the practitioner’s contractor arising from the provision of health care services under this chapter to an individual who is located in Indiana at the time the health care services were provided. The filing of the certification under this subsection shall constitute a voluntary waiver by the practitioner, the practitioner’s employer, or the practitioner’s contractor of any respective right to avail themselves of the jurisdiction or laws other than those specified in this subsection concerning the claim. However, a practitioner that practices predominately in Indiana is not required to file the certification required by this subsection.

A practitioner shall renew the certification required under subsection (b) at the time the practitioner renews the practitioner’s license.

A practitioner’s employer or a practitioner’s contractor is required to file the certification required by this section only at the time of initial certification.

SOURCE: IN Code, 25-1-9.5-9. (Accessed Aug. 2021).

Last updated 08/25/2021

Definitions

“Telehealth means the delivery of health care services using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including:

  • Secure videoconferencing
  •  store-and-forward technology; or
  • Remote patient monitoring technology;

Between a provider in one location and a patient in another location.  The term does not include:

  • Electronic mail
  • An instant messaging conversation
  • Facsimile
  • Internet questionnaire
  • Internet consultation

The term does not include a health care service provided by:

  • An employee of a practitioner; or
  • An individual who is employed by the same entity that employs the practitioner;

who is performing a health care service listed in previous sections under the direction and that is customarily within the specific area of practice of the practitioner.

SOURCE: IN Code, 25-1-9.5-6 as amended by SB 3 (2021). (Accessed Aug. 2021).

 “Telehealth” means a specific method of delivery of services, including medical exams and consultations and behavioral health evaluations and treatment, including those for substance abuse, using technology allowed under IC 25-1-9.5-6 to allow a provider to render an examination or other service to a patient at a distant location.

SOURCE: IN code, 16-18-2-348.5 as amended by SB 3 (2021). (Accessed Aug. 2021).

Last updated 08/25/2021

Licensure Compacts

Member of the EMS Personnel Licensure Interstate Compact.

SOURCE:  IN Code 16-31.5.EMS Compact. (Accessed Aug. 2021).

Member of Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact. NCSBN.  (Accessed Aug. 2021).

Member of Physical Therapy Compact (not yet accepting Compact Privileges)

SOURCE: Senate BIll 305 & PT Compact, Map, (Accessed Aug. 2021).

*Physical Therapy Compact website indicates Indiana is a member. However, CCHP has not been able to verify a bill has passed with the Compact language. We have located SB 305, which is listed as last located in the House Ways and Means Committee on March 25, 2021.

Last updated 08/25/2021

Miscellaneous

Every practitioner who is renewing online a license issued by a board must include the following information related to the practitioner’s work in Indiana under the practitioner’s license during the previous two (2) years: … For a practitioner (as defined in IC 25-1-9.5-3.5), whether the practitioner delivers health care services through telehealth (as defined in IC 25-1-9.5-6).

SOURCE: IN Code 25-1-2-10, as amended by Senate Bill 3 (Accessed Aug. 2021).

The medical records must be created and maintained by the practitioner under the same standards of appropriate practice for medical records for patients in an in-person setting.

A patient waives confidentiality of any medical information discussed with the practitioner that is:

  • Provided during a telehealth visit; and
  • Heard by another individual in the vicinity of the patient during a health care service or consultation.

An employer may not require a practitioner, by an employment contract, an agreement, a policy, or any other means, to provide a health care service through telehealth if the practitioner believes that providing a health care service through telehealth would:

  • Negatively impact the patient’s health; or
  • Result in a lower standard of care than if the health care service was provided in an in-person setting.

Any applicable contract, employment agreement, or policy to provide telehealth services must explicitly provide that a practitioner may refuse at any time to provide health care services if in the practitioner’s sole discretion the practitioner believes:

  • That health quality may be negatively impacted; or
  • The practitioner would be unable to provide the same standards of appropriate practice as those provided in an in-person setting.

SOURCE: IN Code, 25-1-9.5-7. as amended by SB 3 (2021). (Accessed Aug. 2021).

Last updated 08/25/2021

Online Prescribing

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to issuing prescriptions electronically or otherwise.

SOURCE: IN Admin. Code, Title 844, 5-3-2. (Accessed Aug. 2021). 

Telehealth may not be used to provide any abortion, including the writing or filling of a prescription for any purpose that is intended to result in an abortion.

SOURCE: IN code, 16-34-1-11 & 25-1-9.5-.5 as amended by SB 3 (2021). (Accessed Aug. 2021).

A practitioner who:

  • Provides health care services through telehealth; or
  • Directs an employee of the practitioner to perform a health care service listed in the chapter;

shall be held to the same standards of appropriate practice as those standards for health care services provided at an in-person setting.

A practitioner who uses telehealth shall, if such action would otherwise be required in the provision of the same health care services in a manner other than telehealth, ensure that a proper provider-patient relationship is established. The provider-patient relationship by a  practitioner who uses telehealth must at a minimum include the following:

  1. Obtain the patient’s name and contact information (see regulation for other related requirements);
  2. Disclose the practitioner’s name and practitioner’s licensure, certification or registration;
  3. Obtain informed consent from the patient;
  4. Obtain the patient’s medical history and information necessary to establish a diagnosis;
  5. Discuss with the patient the diagnosis, evidence for the diagnosis and risks and benefits of the various treatment options;
  6. Create and maintain a medical record for the patient. If a prescription is issued for the patient, and subject to the consent of the patient, the prescriber shall notify the patient’s primary care provider of any prescriptions the provider has issued (see regulation for other related requirements);
  7. Issue proper instructions for appropriate follow-up care
  8. Provide a telehealth visit summary to the patient, including information that indicates any prescriptions that is being prescribed.

SOURCE: IN Code, 25-1-9.5-7. as amended by SB 3 (2021). (Accessed Aug. 2021).

A prescription for a controlled substance can be issued for a patient the prescriber has not previously examined if the following conditions are met:

  1. The prescriber has satisfied the applicable standard of care in the treatment of the patient.
  2. The issuance of the prescription is within the prescriber’s scope of practice and certification
  3. The prescription meets the requirements outline in the following section and it is not an opioid.  However, opioids may be prescribed if the opioid is a partial agonist that is used to treat or manage opioid dependence.
  4. The prescription is not for an abortion inducing drug

If the prescription is for a medical device, including an ophthalmic device, the prescriber must use telehealth technology that is sufficient to allow the provider to make an informed diagnosis and treatment plan that includes the medical device being prescribed.

Additionally, the following conditions must be met for a prescription for a controlled substance:

  • The prescriber maintains a valid controlled substance registration under IC 35-48-3.
  • The prescriber meets the conditions set forth in 21 U.S.C. 829 et seq.
  • A practitioner acting in the usual course of the practitioner’s professional practices issues the prescription for a legitimate medical purpose.
  • The telehealth communication is conducted using an audiovisual, real time, two-way interactive communication system.
  • The prescriber complies with the requirements of the INSPECT program (IC 35-48-7).
  • All other applicable federal and state laws are followed.

SOURCE: IN Code 25-1-9.5-8.  as amended by SB 3 (2021). (Accessed Aug. 2021).

A pharmacy does not violate this chapter if the pharmacy fills a prescription for an opioid and the pharmacy is unaware that the prescription was written or electronically transmitted by a prescriber providing telehealth services under this chapter.

SOURCE: IN Code 25-1-9.5-11.  as amended by SB 3 (2021). (Accessed Aug. 2021).

A prescriber may not issue a prescription for an ophthalmic device unless the following conditions are met:

  • If the prescription is for contact lenses or eyeglasses, the patient must be at least eighteen (18) years of age but not more than fifty-five (55) years of age.
  • The patient must have completed a medical eye history that includes information concerning the following:
    • Chronic health conditions.
    • Current medications.
    • Eye discomfort.
    • Blurry vision.
    • Any prior ocular medical procedures.
  • The patient must have had a prior prescription from a qualified eye care professional that included a comprehensive in person exam that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).
  • If the patient desires a contact lens prescription, at the discretion of the eye care professional, that patient must have had a prior contact lens fitting or evaluation by a qualified eye care professional that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).
  • The patient:
    • May not use telehealth more than two (2) consecutive times within two (2) years from the date of the examination that occurred under subdivision (3) for a refraction without a subsequent in person comprehensive eye exam; and
    • Must acknowledge that the patient has had a comprehensive eye exam as required under clause (A) before receiving an online prescription.
  • The patient may allow the prescriber to access the patient’s medical records using an appropriate HIPAA compliant process.
  • The prescriber must ensure that the transfer of all information, including the vision test and prescription, comply with HIPAA requirements.
  • The prescriber must use technology to allow the patient to have continuing twenty-four (24) hour a day online access to the patient’s prescription as soon as the prescription is signed by the prescriber.

SOURCE: IN Code 25-1-9.5-13.  as amended by SB 3 (2021). (Accessed Aug. 2021).

Telehealth and telemedicine may not be used to provide any abortion, including the writing or filling of a prescription for any purpose that is intended to result in an abortion.

SOURCE: IN IC 16-34-2-1 &IN HB 1577 (2021). (Accessed Aug. 2021).

If a veterinarian is required to establish a veterinarian-client-patient relationship to perform a health care service, the veterinarian shall ensure that a proper veterinarian-client-patient relationship is established, when providing the service using telehealth.

SOURCE: IN Code 25-1-9.5-15.  as amended by SB 3 (2021). (Accessed Aug. 2021).

Last updated 08/25/2021

Professional Boards Standards

Medical Licensing Board

The board may adopt rules establishing guidelines for the practice of telehealth in Indiana. Adoption of rules may not delay the implementation and provision of telehealth services by a provider under IC 25-1-9.5.

SOURCE: IN Code 25-22.5-2-7 (Accessed Aug. 2021).