Nevada

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: Yes
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, PSY
  • Consent Requirements: No

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • 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: Nevada Medicaid
  2. Administrator: Division of Health Care Financing and Policy (DHCFP)
  3. Regional Telehealth Resource Center: Southwest 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 11/04/2022

Audio-Only Delivery

Medicaid: Update to Telehealth Services for Behavioral Health

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Update to Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Update to Telehealth Services for Home Health and Hospice Agencies

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid 1915(c) Waiver: Appendix K – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K Addendum – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Last updated 11/04/2022

Cross State Licensing

No Reference Found

Last updated 11/04/2022

Easing Prescribing Requirements

Medicaid: Update to Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Last updated 11/04/2022

Miscellaneous

Office of the Governor: Proclamation Terminating Declaration of Emergency Related to COVID-19

STATUS: Active

Nevada Health Response: Guidance for the End of the Declaration Emergency

STATUS: Active

Last updated 11/04/2022

Originating Site

Medicaid: Update to Telehealth Services for Home Health and Hospice Agencies

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Telehealth Resource Guide

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Billing Guidelines

STATUS: Active. Still accessible on COVID Informational webpage.

Medicaid 1915(c) Waiver: Appendix K – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K Addendum – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Last updated 11/04/2022

Private Payer

Previous COVID-19 waivers expired.

Last updated 11/04/2022

Provider Type

Medicaid: Update to Telehealth Services for Home Health and Hospice Agencies

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Telehealth Resource Guide

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Billing Guidelines

STATUS: Active. Still accessible on NV DHCFP Announcements & Newsletters webpage.

Medicaid:  Update to Telehealth Services for Behavioral Health Outpatient Treatment Providers, Certified Community Behavioral Health Centers, and Behavioral Health Rehabilitative Treatment Providers

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Memo on Therapy Services during via Telehealth

STATUS: Active, during federal PHE.

Medicaid 1915(c) Waiver: Appendix K – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K Addendum – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Last updated 08/17/2022

Service Expansion

Medicaid: Psychosocial Rehabilitation Services Telehealth Claims

STATUS: Active

Medicaid: Update to Telehealth Services for ABA

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Update to Telehealth Services for Behavioral Health

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Update to Telehealth Services for Home Health and Hospice Agencies

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Update to Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Update to Telehealth Memo

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Services

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid: Telehealth Resource Guide

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid:  Telehealth Billing Guidelines

STATUS: Active. Still accessible on NV DHCFP Announcements & Newsletters webpage.

Medicaid:  Update to Telehealth Services for Behavioral Health Outpatient Treatment Providers, Certified Community Behavioral Health Centers, and Behavioral Health Rehabilitative Treatment Providers

STATUS: Unclear if still active. Still accessible on COVID Informational webpage.

Medicaid 1915(c) Waiver: Appendix K – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K Addendum – Individuals with Intellectual and Developmental Disabilities; Frail Elderly; Persons with Physical Disabilities Combined

STATUS: Active, expires Six (6) months after the end of the Public Health Emergency (PHE)

Last updated 11/04/2022

Definitions

“Telehealth” means the delivery of services from a provider of health care to a patient at a different location through a synchronous interaction using information and audio-visual communication technology, not including audio-only technology, facsimile or electronic mail.

SOURCE: NV Revised Statutes Sec. 616C.730.(6)(d), (Accessed Nov. 2022).

“Telehealth” means the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including facsimile or electronic mail. The term includes, without limitation, the delivery of services from a provider of health care to a patient at a different location through the use of:

(1) Synchronous interaction or an asynchronous system of storing and forwarding information; and

(2) Audio-only interaction, whether synchronous or asynchronous.

SOURCE: NV Revised Statutes Sec. 629.515(c), (Accessed Nov. 2022).

Last updated 11/04/2022

Parity

SERVICE PARITY

Applies to policies delivered, issued or renewed on or after October 1, 2021

A policy of health insurance must include coverage for services provided to an insured through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means.

Various other version of these provisions become effective under various circumstances, including:

  • 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
  • On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
  • On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.

See bill for alternate versions and accompanying effective dates.

SOURCE: NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730 [certain provisions don’t apply to this provision, see text]; Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. (Accessed Nov. 2022).


PAYMENT PARITY

Applies to policies delivered, issued or renewed on or after October 1, 2021

A policy of health insurance must include coverage for services provided to an insured through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means.

Various other version of these provisions become effective under various circumstances, including:

  • 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
  • On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
  • On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.

See bill for alternate versions and accompanying effective dates.

SOURCE: NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730 [certain provisions don’t apply to this provision, see text]; Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. (Accessed Nov. 2022).

Last updated 11/04/2022

Requirements

Certain provisions apply to policies delivered, issued or renewed on or after October 1, 2021

Insurers shall not:

  • Require an enrollee to establish an in-person relationship with a provider or provide any additional consent to or reason for obtaining services through telehealth
  • Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license
  • Refuse to provide services through telehealth because the distant site or originating site or the technology used to provide the services;
  • Require covered services to be provided through telehealth as a condition of providing coverage for such services; or
  • Categorize a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.

A policy may not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in-person or by other means.

Insurers are not required to:

  • Ensure that covered services are available to an enrollee through telehealth at a particular originating site
  • Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or
  • Enter into a contract with any provider of health care or cover any service if the insurer is not otherwise required by law to do so.

Various other version of these provisions become effective under various circumstances, including:

  • 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
  • On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
  • On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.

See bill for alternate versions and accompanying effective dates.

SOURCE: NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730 [certain provisions don’t apply to this provision, see text]; Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. (Accessed Nov. 2022).

When making any determination concerning the availability and accessibility of the services of any network plan or proposed network plan pursuant to this section, the Commissioner shall consider services that may be provided through telehealth, as defined in NRS 629.515, pursuant to the network plan or proposed network plan to be available services.

SOURCE: NV Revised Statues Sec. 687B.490(7). (Accessed Nov. 2022).

Last updated 11/04/2022

Definitions

Telehealth is the use of a telecommunications system to substitute for an in-person encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services.

“Telehealth” is defined as the delivery of service from a provider of health care to a patient at a different location through the use of telecommunication technologies, not including facsimile or electronic mail.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3400 & 3403, p. 1  (Jun. 1, 2022), (Accessed Nov. 2022).

Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional consultations, office visits, office psychiatry services and a limited number of other medical services.

The telecommunications system used must be an interactive audio and video system. Standard telephones, facsimile machines or electronic mail do not meet this criteria.

Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional consultations, office visits, office psychiatry services and a limited number of other medical services.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (Nov. 18, 2020); School Health Services (1/20/22), pg. 57. (Accessed Nov. 2022).

Last updated 11/04/2022

Email, Phone & Fax

Audio only telehealth for behavioral health delivery is limited to:

  • Targeted Case Management
  • Crisis Intervention Services

Non-Covered Services

  • Images transmitted via facsimile machines (faxes)
  • Text messages
  • Electronic mail (email)

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.6, p. 3 (Jun. 1, 2022) (Accessed Nov. 2022).

Medicaid does not reimburse providers for telephone calls between providers and patients (including those in which the provider gives advice or instructions to or on behalf of a patient) except documented psychiatric treatment in crisis intervention (e.g. threatened suicide).

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Physician Services Chapter, Section 603, p. 5 (Jul. 13, 2022) (Accessed Nov. 2022).

For crisis intervention, modifier GT includes telephonic services.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Behavioral Health Outpatient Treatment, p. 17 (3/18/22), (Accessed Nov. 2022)NV Dept. of Health and Human Svcs., Provider Type 82 Billing Guide, Behavioral Health Rehabilitative Treatment, p. 3. (2/1/19). (Accessed Nov. 2022). Special Clinics: Substance Abuse Agency Model (SAAM) p. 5 (2/16/22) (Accessed Nov. 2022), School Health Services (SHS), p. 25 (Jan. 20, 2022). (Accessed Nov. 2022).

Case management services are reimbursable when provided to Medicaid eligible recipients, on a one-to-one (telephone or face-to-face) basis.

Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers. Monitoring may involve either face-to-face or telephone contact, at least annually.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Case Management Section 2500, pgs. 2 & 4 (Jan. 30, 2019) (Accessed Nov. 2022). 

Last updated 11/03/2022

Live Video

POLICY

The State Plan for Medicaid must include:

  • A requirement that the State, and, to the extent applicable, any of its political subdivisions, shall pay for the nonfederal share of expenses for services provided to a person through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means; and
  • A provision prohibiting the State from:
    • Requiring a person to obtain prior authorization that would not be required if a service were provided in person or through other means, establish a relationship with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to paying for services as described in paragraph (a). The State Plan for Medicaid may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or through other means.
    • Requiring a provider of health care to demonstrate that it is necessary to provide services to a person through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to paying for services.
    • Refusing to pay for services because of the distant site from which a provider of health care provides services through telehealth or the originating site at which a person who is covered by the State Plan for Medicaid receives services through telehealth; or the technology used to provide the services.
    • Requiring services to be provided through telehealth as a condition to paying for such services.
    • Categorizing a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.

The provisions of this section do not:

  • Require the Director to include in the State Plan for Medicaid coverage of any service that the Director is not otherwise required by law to include; or
  • Require the State or any political subdivision thereof to:
    • Ensure that covered services are available to a recipient of Medicaid through telehealth at a particular originating site; or
    • Provide coverage for a service that is not included in the State Plan for Medicaid or provided by a provider of health care that does not participate in Medicaid.

Various other version of these provisions become effective under various circumstances, including:

  • 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
  • On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
  • On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.

See bill for alternate versions and accompanying effective dates.

SOURCE: NV Revised Statute 422.2721, (Accessed Nov. 2022).

Services provided via telehealth must be clinically appropriate and within the health care professional’s scope of practice as established by its licensing agency. Services provided via telehealth have parity with in-person health care services. Health care professionals must follow the appropriate Medicaid Services Manual (MSM) policy for the specific service they are providing.

  • Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan. Dermatologic photographs (e.g., photographs of a skin lesion) may be considered to meet the requirement of a single media format under this instruction.
  • Reimbursement for the DHCFP covered telehealth services must satisfy federal requirements of efficiency, economy and quality of care.
  • All participating providers must adhere to requirements of the Health Insurance Portability and Accountability Act (HIPAA). The DHCFP may not participate in any medium not deemed appropriate for protected health information by the DHCFP’s HIPAA Security Officer.

Telehealth services follow the same prior authorization requirements as services provided in-person. Utilization of telehealth services does not require prior authorization. However, individual services may require prior authorization when delivered by telehealth.

ESRD visits must include at least one in-person visit to examine the vascular access site by a provider; however, an interactive audio/video telecommunications system may be used for providing additional visits.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403, p. 1; 3403.5, p. 3; & 3403.7, p. 4 (Jun. 1, 2022). (Accessed Nov. 2022).

Effective December 1, 2015, telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice to provide services that can be appropriately provided via telehealth.  The telecommunications system used must be an interactive audio and video system. Standard telephones, facsimile machines or electronic mail do not meet this criteria.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (Nov. 18, 2020). (Accessed Nov. 2022).

Medicaid Managed Care plans must include coverage for services provided through telehealth to the same extent as through provided in-person or by other means.

Medicaid Managed Care plans shall not:

  • Require an enrollee to establish an in-person relationship with a provider or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage;
  • Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license;
  • Refuse to provide coverage for telehealth because of the type of the distant site or originating site in which the provider/enrollee provides/receives services via telehealth; or
  • Require covered services to be provided through telehealth as a condition of providing coverage for such services.

A Medicaid Managed Care plan may not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in-person.

Medicaid Managed Care plans are not required to:

  • Ensure that covered services are available to an enrollee through telehealth at a particular originating site
  • Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or
  • Enter into a contract with any provider of health care or cover any service if the insurer is not otherwise required by law to do so.

SOURCE: NV Revised Statute Sec. 695G.162. (Accessed Nov. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Telehealth services are also covered by Nevada Medicaid. See MSM Chapter 3400, Telehealth Services for the complete coverage and limitations for Telehealth.  Medical Nutrition Therapy may be provided through Telehealth services. See MSM Chapter 3400 for the Telehealth policy.

SOURCE: NV Dept. of Health and Human Svcs., Section 603, p. 4; Sec. 609, pg. 3 (Jul. 13, 2022) (Accessed Nov. 2022).

A licensed professional operating within the scope of their practice under state law may provide the following Telehealth services for Medicaid recipients:

  • Annual wellness visits;
  • Diabetic outpatient self-management;
  • Documented psychiatric treatment in crisis intervention (e.g., threatened suicide); and
  • Office or other outpatient visits

SOURCE: NV Dept. of Health and Human Svcs., Provider Type 20, 24, and 77 (Physician), (Osteopath) and (APRN) Billing Guide, pgs. 9 & 10 (8/17/22). (Accessed Nov. 2022).

Services NOT Covered:

  • Basic Skills Training and Psychosocial Rehabilitation services, whether authorized, provided, and billed as stand-alone services or as components of Intensive Outpatient Program, Partial Hospitalization, and Day Treatment must be provided in person
  • Personal care services provided by a Personal Care Attendant
  • Home Health Services provided by a RN, occupational therapist, physical therapist, speech therapist, respiratory therapist, dietician or Home Health Aide
  • Private Duty Nursing services provided by a RN

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403.6, p. 3 (Jun. 1, 2022). (Accessed Nov. 2022).

 


ELIGIBLE PROVIDERS

Telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p.1 (Nov. 18, 2020) (Accessed Nov. 2022).

Indian Health Services and Tribal Clinics should follow the guidelines in the Telehealth Chapter 3400.

SOURCE: Nevada Dept. of Health and Human Svcs., Medicaid Services Manual, Indian Health Services and Clinics, pg. 1, (5/1/20), (Accessed Nov. 2022).

A distant site provider must be an enrolled Medicaid provider.

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating encounter site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 2, 3403.2, p. 1-2 (Jun. 1, 2022). (Accessed Nov. 2022).

Telehealth originating site services can be provided within a community paramedicine provider’s scope of practice as part of a community paramedicine visit when requested in plan of care.

SOURCE: NV Dept. of Health and Human Services, Medicaid Services Manual, Physician Services Chapter 600 Section 604.2, pg. 2 (July 1, 2022), (Accessed Nov. 2022).

A provider is not eligible for payment as both the originating and distant site for the same patient, same date of service.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403.6, p. 1 (Jun. 1, 2022). (Accessed Nov. 2022).


ELIGIBLE SITES

In order to receive coverage for a telehealth facility fee, the originating site must be an enrolled Medicaid provider.

A provider is not eligible for payment as both the originating and distant site for the same patient, same date of service.

If a patient is receiving telehealth services at an originating site not enrolled in Medicaid, the originating site is not eligible for a facility fee from the DHCFP. Examples of this include, but are not limited to, cellular devices, home computers, kiosks and tablets.

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1-2, (Jun. 1, 2022). (Accessed Nov. 2022).

Eligible sites:

  • Office of provider
  • Critical Access Hospital (CAH)
  • Rural Health Clinic (RHC)
  • Federally Qualified Health Center (FQHC)
  • Hospital
  • End Stage Renal Disease (ESRD) Facility
  • Skilled Nursing Facility (SNF)
  • Community Mental Health Centers (CMHC)
  • Indian Health Services/Tribal Organization/Urban Indian Organization
  • School-Based Health Centers
  • Schools
  • Family Planning Clinics
  • Public Health Clinics
  • ·Comprehensive Outpatient Rehabilitation Facilities
  • Community Health Clinics (State Health Division)
  • Special Children’s Clinics
  • Human Immunodeficiency Virus (HIV) Clinics
  • Therapy offices
  • Chiropractic offices
  • Emergency Medical Services (EMS) performing Community Paramedic Services
  • Recipient’s smart phone (no facility fee)
  • Recipient’s home computer (no facility fee)

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (Nov. 18, 2020) (Accessed Nov. 2022). Community Paramedicine, p. 1 (Nov. 4, 2019). (Accessed Nov. 2022).

Specific encounter service limits apply for distant site providers at Indian Health Service, Tribal clinics, or Tribal FQHCs. See billing guide for Nevada AI/AN providers.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines, Indian Health Services (IHS) and Tribal Clinics, p. 1. (05/01/2020) (Accessed Nov. 2022).


GEOGRAPHIC LIMITS

The originating site must be located in the state of Nevada.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1, (Jun. 1, 2022). (Accessed Nov. 2022).

A Medicaid Managed Care Organization may not refuse to provide coverage of telehealth services because where the distant or originating site providing/receiving services via telehealth is located.

SOURCE: NV Revised Statute Sec. 695G.162.  (Accessed Nov. 2022).


FACILITY/TRANSMISSION FEE

Originating site is qualified to receive a facility fee if they are an enrolled Medicaid provider. If a patient is receiving telehealth services at a site not enrolled in Medicaid, the originating site is not eligible to receive a facility fee.

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, pg. 1 & 2 (Jun. 2022). (Accessed Nov. 2022).

A facility fee is not billable if the telecommunication system used is a recipient’s smart phone or home computer.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 2 (Nov. 18, 2020) (Accessed Nov. 2022).

Some provider types that may bill for an originating site facility fee include:

  • Some Special Clinic provider types
  • Some Applied Behavior Analysis provider types
  • Therapists
  • Chiropractors
  • Providers at End-Stage Renal Disease Facilities

SOURCE: NV Dept. of Health and Human Svcs. Announcement 1048 & 1202. (Accessed Nov. 2022).

Sites eligible for an originating site facility fee include:

  • Office of provider
  • Critical Access Hospital (CAH)
  • Rural Health Clinic (RHC)
  • Federally Qualified Health Center (FQHC)
  • Hospital
  • End Stage Renal Disease (ESRD) Facility
  • Skilled Nursing Facility (SNF)
  • Community Mental Health Centers (CMHC)
  • Indian Health Services/Tribal Organization/Urban Indian Organization
  • School-Based Health Centers
  • Schools
  • Family Planning Clinics
  • Public Health Clinics
  • Comprehensive Outpatient Rehabilitation Facilities
  • Community Health Clinics (State Health Division)
  • Special Children’s Clinics
  • Human Immunodeficiency Virus (HIV) Clinics
  • Therapy offices
  • Chiropractic offices
  • Emergency Medical Services (EMS) performing Community Paramedic Services

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (Nov. 18, 2020) (Accessed Nov. 2022).

If the originating site is enrolled as a Nevada Medicaid provider, they may bill HCPCS code Q3014. If the telecommunication system used is a recipient’s smart phone or home computer, the facility fee may not be billed.

SOURCE: Nevada Dept. of Health and Human Services, School Health Services, pg. 58 (1/20/22), (Accessed Nov. 2022).

Last updated 11/03/2022

Miscellaneous

No Reference Found

Last updated 11/03/2022

Out of State Providers

No Reference Found

Last updated 11/04/2022

Overview

Services provided via telehealth have parity with in-person services.  Nevada Medicaid and the Nevada Check Up (NCU) program reimburses for live video and store-and-forward services under specific conditions. There is no reimbursement for remote patient monitoring.  Audio-only is reimbursed for certain types of behavioral health services.

Last updated 11/04/2022

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 11/04/2022

Store and Forward

POLICY

Asynchronous telehealth services, also known as Store-and-Forward, are defined as the transmission of a patient’s medical information from an originating site to the health care provider distant site without the presence of the recipient.

Reimbursement is available for services delivered via asynchronous telehealth, however, these services are not eligible for originating site facility fees. Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403, p. 1 & Section 3403.4, p. 2 (Jun. 1, 2022). (Accessed Nov. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Store-and-forward services are not eligible for originating site facility fees.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.4, p. 2 (Jun. 1, 2022). (Accessed Nov. 2022).

A facility fee is not billable if the telecommunication system used is a recipient’s smart phone or home computer.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 2 (Nov. 18, 2020) (Accessed Nov. 2022).

Last updated 11/04/2022

Cross State Licensing

Before a provider of health care who is located at a distant site may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State or write a treatment order or prescription for such a patient, the provider must hold a valid license or certificate to practice his or her profession in this State, including, without limitation, a special purpose license. The requirements of this subsection do not apply to a provider of health care who is providing services within the scope of his or her employment by or pursuant to a contract entered into with an urban Indian organization.

SOURCE: NV Revised Statutes Sec. 629.515(1) (Accessed Nov. 2022).

The Board may issue a special purpose license to a physician who is licensed in another state by using equipment that transfers information concerning the medical condition of a patient in this State electronically, telephonically or by fiber optics, including, without limitation, through telehealth, from within or outside this State or the United States.

SOURCE: NV Revised Statutes Sec. 630.261(e). (Accessed Nov. 2022).

 

Last updated 11/04/2022

Definitions

Telehealth means the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including facsimile or electronic mail.  The term includes, without limitation, the delivery of services from a provider of health care to a patient at a different location through the use of:

  • Synchronous interaction or an asynchronous system of storing and forwarding information; and
  • Audio-only interaction, whether synchronous or asynchronous.

SOURCE: NV Revised Statutes Sec. 629.515(4)(c), (Accessed Nov. 2022).

“Veterinary telemedicine” means the use of medical information exchanged from one site to another via electronic communications regarding the health status of an animal or a group of animals and includes, without limitation, communication via telephone, video, a mobile application or an online platform on an Internet website.

SOURCE: NV Revised Statute Ch. 638.014, (Accessed Nov. 2022).

Last updated 11/04/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. Interstate Medical Licensure Compact. (Accessed Nov. 2022).

Member of the Psychology Interjurisdictional Compact of the Association of State and Provincial Psychology Boards.

SOURCE:  Psychology Interjurisdictional Compact. (Accessed Nov. 2022).

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

Last updated 11/04/2022

Miscellaneous

To the extent money is available, the Department shall establish a data dashboard that allows for the analysis of data relating to access to telehealth by different groups and populations in this State. The data dashboard must, to the extent authorized by federal law:

  • Include, without limitation, data concerning health care services, behavioral health services and dental services provided through telehealth; and
  • Allow for the user to sort data based on the race, ethnicity, ancestry, national origin, color, sex, sexual orientation, gender identity or expression, mental or physical disability, income level or location of residence of the patient, type of telehealth service and any other category determined useful by the Department; and
  • Make the data dashboard available on an Internet website maintained by the Department.

The Patient Protection Commission; the Legislative Committee on Healthcare; the Commission on Behavioral Health; Regional Behavioral Health Policy Boards; shall review access by different groups and populations to services provided through telehealth evaluate policies to make such access more equitable (if data dashboard is established). The Commission shall also make data available on the internet.

SOURCE: NV Revised Statutes Ch. 439.245; 439.916(h)& (m)(2); 439B.220(17); 433.314(1)(c); 433.4295(g). (Accessed Nov. 2022).

A hospital may grant staff privileges to a provider of health care who is at another location for the purpose of providing services through telehealth.

SOURCE: NV Revised Statutes Sec. 449.1925. (Accessed Nov. 2022).

Last updated 11/04/2022

Online Prescribing

Before a provider of health care who is located at a distant site may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State or write a treatment order or prescription for such a patient, the provider must hold a valid license or certificate to practice his or her profession in this State, including, without limitation, a special purpose license issued pursuant to NRS 630.261. The requirements of this subsection do not apply to a provider of health care who is providing services within the scope of his or her employment by or pursuant to a contract entered into with an urban Indian organization, as defined in 25 U.S.C. § 1603.

A provider of health care may establish a relationship with a patient using telehealth when it is clinically appropriate to establish a relationship with a patient in that manner. The State Board of Health may adopt regulations governing the process by which a provider of health care may establish a relationship with a patient using telehealth.

SOURCE: NV Revised Statutes Sec. 629.515, (Accessed Nov. 2022).

A bona fide relationship between the patient and the person prescribing the controlled substance shall be deemed to exist if the patient was examined in person, electronically, telephonically or by fiber optics, including, without limitation, through telehealth, within or outside this State or the United States by the person prescribing the controlled substances within the 6 months immediately preceding the date the prescription was issued.

SOURCE: NV Revised Statutes Sec. 639.235(4). (Accessed Nov. 2022).

Before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain, a practitioner, other than a veterinarian, must:

  • Have established a bona fide relationship, as described in subsection 4 of NRS 639.235, with the patient;
  • Perform an evaluation and risk assessment of the patient that meets the requirements of subsection 1 of NRS 639.23912;
  • Establish a preliminary diagnosis of the patient and a treatment plan tailored toward treating the pain of the patient and the cause of that pain;
  • Document in the medical record of the patient the reasons for prescribing the controlled substance instead of an alternative treatment that does not require the use of a controlled substance; and
  • Obtain informed consent to the use of the controlled substance.

If a practitioner, other than a veterinarian, prescribes a controlled substance listed in schedule II, III or IV for the treatment of pain, the practitioner shall not issue more than one additional prescription that increases the dose of the controlled substance unless the practitioner meets with the patient, in person or using telehealth, to reevaluate the treatment plan.

SOURCE: NV Revised Statutes Sec. 639.23911. (Accessed Nov. 2022).

Before prescribing a schedule II, III, or IV controlled substance to continue the treatment of pain of a patient who has used the controlled substance for 90 consecutive days or more, a practitioner, other than a veterinarian must (among other requirements) meet with the patient in-person or through telehealth to review the treatment plan and determine whether continuation of treatment using the controlled substance is medically appropriate.

SOURCE: NV Revised Statutes Sec. 639.23913. (Accessed Nov. 2022).

An advanced practice registered nurse authorized to prescribe controlled substances may do so electronically, telephonically or by fiber optics, including telehealth, from within or outside Nevada or the United States.

SOURCE: NV Revised Statutes Sec. 632.237(4). (Accessed Nov. 2022).

Veterinarians

A veterinarian-client-patient relationship is not established solely through veterinary telemedicine. However, once established, a veterinarian-client-patient relationship may be maintained via veterinary telemedicine between:

  • Medically necessary examinations; or
  • Visits, within periods of time that are appropriate for the medical issue in question, to the premises where the animal is kept.

Advice and recommendations may be provided via veterinary telemedicine in an emergency, but only until the animal can be examined in person by a licensed veterinarian.  See statute for additional requirements related to a veterinarian-client-patient relationship.

SOURCE: NV Revised Statutes Sec. 638.1521(4), (Accessed Nov. 2022).

Last updated 11/04/2022

Professional Board Standards

Board of Nursing (Telenursing)

SOURCE: NV Admin. Code Sec. 632.249. (Accessed Nov. 2022).

Board of Pharmacy (Telepharmacy)

SOURCE: NV Admin Code Sec. 639.391-.399. (Accessed Nov. 2022).

The Board of Medicine is required to adopt regulations regarding a physician assistant’s use of equipment that transfers information concerning the medical condition of a patient electronically, telephonically or by fiber optics, including, without limitation, through telehealth, from within or outside Nevada or the United States.

SOURCE: NV Revised Statutes Sec. 630.275(10). (Accessed Nov. 2022).

The NV Board of Pharmacy is required to adopt regulations regarding the practice of telepharmacy.

SOURCE: NV Revised Statutes Sec. 639.0727. (Accessed Nov. 2022).

There are specific standards for telepractice for speech-language pathology and audiology.

SOURCE: NV Revised Statutes Sec. 637B.244. (Accessed Nov. 2022).

Last updated 11/03/2022

Definition of Visit

A face-to-face “visit” or an “encounter” between a patient and one or more approved licensed Qualified Health Professional and/or certified provider that takes place on the same day with the same patient for the same service type; this includes multiple contacts with the same provider.

SOURCE: Federally Qualified Health Center Manual, Chapter 2900 (pg. 1), (Accessed Nov. 2022).

Last updated 11/03/2022

Eligible Distant Site

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

See: NV Medicaid Live Video Eligible Providers

Last updated 11/03/2022

Eligible Originating Site

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, pg. 2 (Jun. 2022). (Accessed Nov. 2022).

Eligible sites:

  • Federally Qualified Health Center (FQHC)

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (Nov. 18, 2020) (Accessed Nov. 2022).

See: NV Medicaid Live Video Eligible Sites

Last updated 11/03/2022

Facility Fee

An FQHC may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating encounter site must bill the telehealth originating Healthcare Common Procedural Coding System (HCPCS) code and the distant encounter site may bill the encounter code. Refer to MSM Chapter 3400 – Telehealth Services

SOURCE: Federally Qualified Health Center Manual, Chapter 2900 pg.5, (Accessed Nov. 2022).

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

See: NV Medicaid Live Video Facility/Transmission Fee

Last updated 11/03/2022

Home Eligible

Services may include home visits

SOURCE: Federally Qualified Health Center Manual, Chapter 2900 (pg. 3), (Accessed Nov. 2022).

Last updated 11/03/2022

Modalities Allowed

Live Video

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

See: NV Medicaid Live Video


Store and Forward

No reference specifically in FQHC manual chapter.  However, Chapter refers providers to telehealth Services Chapter 3400.  In that chapter, store-and-forward is allowed in some circumstances.

See: NV Medicaid Store and Forward


Remote Patient Monitoring

No reference found.

See: NV Medicaid Remote Patient Monitoring


Audio-Only

No reference specifically in FQHC manual chapter.  However, Chapter refers providers to telehealth Services Chapter 3400.  In that chapter, audio-only is allowed for certain behavioral health delivery.  

See: NV Medicaid Audio-Only

Last updated 11/03/2022

Patient-Provider Relationship

No reference found.

Last updated 11/03/2022

PPS Rate

No reference found.

Last updated 11/03/2022

Same Day Encounters

A face-to-face “visit” or an “encounter” between a patient and one or more approved licensed Qualified Health Professional and/or certified provider that takes place on the same day with the same patient for the same service type; this includes multiple contacts with the same provider.

SOURCE: Federally Qualified Health Center Manual, Chapter 2900 (pg. 1), (Accessed Nov. 2022).