New Mexico

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: NLC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: New Mexico Medicaid
  2. Administrator: New Mexico Human Services Dept., Medical Assistance Division (MAD)
  3. Regional Telehealth Resource Center: Southwest Telehealth Resource Center

Last updated 08/03/2022

Audio-Only Delivery

Medicaid 1915(c) Waiver: Appendix K – Supports Waiver, Developmental Disabilities Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Waiver, Mi Via ICF/IDD Waiver, Medically Fragile Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Waiver, Medically Fragile Waiver, Mi Via Waiver, Supports Waiver Combined

STATUS: Active, Addendum to current waiver and extends it until 6 months after the conclusion of the PHE

Medicaid: COVID-19 Specialty Behavioral Health Service Guidance

STATUS: Active, until end of COVID-19 PHE

Medicaid:  Centennial Care MCO Letter of Direction

STATUS: Active, until end of COVID-19 PHE

Medicaid: Special COVID-19 Guidance

STATUS: Varies. Many active until end of COVID-19 PHE

Medicaid: Special COVID-19 Letter on Telehealth Services

STATUS: Active, until end of COVID-19 PHE

 

Last updated 08/03/2022

Cross-State Licensing

No Reference Found.  Previous COVID-19 waivers expired.

Last updated 08/03/2022

Easing Prescribing Requirements

No Reference Found

Last updated 08/03/2022

Miscellaneous

Speech Language Pathology Board:  Guidance for Providing Patient Care by Electronic Means During the COVID-19 Public Health Emergency

STATUS: Active

 

Last updated 08/03/2022

Originating Site

Medicaid 1915(c) Waiver: Appendix K – Supports Waiver, Developmental Disabilities Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Waiver, Mi Via ICF/IDD Waiver, Medically Fragile Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Waiver, Medically Fragile Waiver, Mi Via Waiver, Supports Waiver Combined

STATUS: Active, Addendum to current waiver and extends it until 6 months after the conclusion of the PHE

Medicaid: COVID-19 Specialty Behavioral Health Service Guidance

STATUS: Active, until end of COVID-19 PHE

Medicaid: Special COVID-19 Guidance

STATUS: Varies.  Many active until end of COVID-19 PHE

Medicaid: COVID-19 FAQs for Providers #2

STATUS: Active

 

Last updated 08/03/2022

Private Payer

Medicaid & Private Payer: Temporary Telehealth Expansion

STATUS: Notice pertains to permanent law

Last updated 08/03/2022

Provider Type

Medicaid 1915(c) Waiver: Appendix K – Supports Waiver, Developmental Disabilities Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Waiver, Medically Fragile Waiver, Mi Via Waiver, Supports Waiver Combined

STATUS: Active, Addendum to current waiver and extends it until 6 months after the conclusion of the PHE

Medicaid: COVID-19 Specialty Behavioral Health Service Guidance

STATUS: Active, until end of COVID-19 PHE

Medicaid: Special COVID-19 Guidance

STATUS: Varies. Many active until end of COVID-19 PHE

Medicaid: COVID-19 FAQs for Providers #2

STATUS: Active

Medicaid: COVID-19 FAQs for MCOs

STATUS: Active

Medicaid: Telehealth Services during the COVID-19 emergency MCOs

STATUS: Active, until end of COVID-19 PHE

 

Last updated 08/03/2022

Service Expansion

Medicaid 1915(c) Waiver: Appendix K – Supports Waiver, Developmental Disabilities Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Waiver, Mi Via ICF/IDD Waiver, Medically Fragile Waiver

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Waiver, Medically Fragile Waiver, Mi Via Waiver, Supports Waiver Combined

STATUS: Active, expires 6 months after the conclusion of the PHE

Medicaid: COVID-19 Specialty Behavioral Health Service Guidance

STATUS: Active, until end of COVID-19 PHE

Medicaid:  Centennial Care MCO Letter of Direction

STATUS: Active, until end of COVID-19 PHE

Medicaid: Special COVID-19 Guidance

STATUS: Varies. Many active until end of COVID-19 PHE

Medicaid: Special COVID-19 Letter on Telehealth Services

STATUS: Active, until end of COVID-19 PHE

 

Last updated 08/05/2022

Definitions

Telemedicine means the use of telecommunications and information technology to provide clinical health care from a distance. “Telemedicine” allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications and information technology in real time or asynchronously, including the use of interactive simultaneous audio and video or store-and-forward technology, or remote patient monitoring and telecommunications in order to deliver health care services to a site where the patient is located, along with the use of electronic media and health information. “Telemedicine” allows patients in remote locations to access medical expertise without travel.

SOURCE: NM Statute. 59A-22-49.3(L (6)) (Accessed Aug. 2022).

Last updated 08/05/2022

Parity

SERVICE PARITY

An insurer shall provide coverage for services provided via telemedicine to the same extent that the health insurance plan, policy or contract covers the same services in-person.

An insurer shall not limit coverage of services delivered via telemedicine only to those health care providers who are members of the health insurance plan, policy or contract provider network where no in-network provider is available and accessible, as availability and accessibility are defined in network adequacy standards issued by the superintendent.

An insurer shall reimburse for health care services delivered via telemedicine on the same basis and at least at the same rate that the insurer reimburses for comparable services delivered via in-person consultation or contact.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3(A), (F) & (I)., 59A-46-50.3, 59A-47-45.3 & 59A-23-7.12 (Accessed Aug. 2022).


PAYMENT PARITY

An insurer shall reimburse for health care services delivered via telemedicine on the same basis and at least at the same rate that the insurer reimburses for comparable services delivered via in-person consultation or contact.

An insurer shall not impose any annual or lifetime dollar maximum on coverage for services delivered via telemedicine, other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the health insurance plan, policy or contract, or impose upon any person receiving benefits pursuant to this section any copayment, coinsurance or deductible amounts, or any plan, policy or contract year, calendar year, lifetime or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the health insurance plan, policy or contract.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3 (H) & (I). , 59A-46-50.3, 59A-47-45.3 & 59A-23-7.12 (Accessed Aug. 2022).

A plan that provides a benefit conditioned on a covered person’s receipt of a health care service shall provide that benefit if the service is delivered in-person or virtually.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8 (J). (Accessed Aug. 2022).

Last updated 08/05/2022

Requirements

An insurer shall provide coverage for services delivered via telemedicine to the same extent that the health insurance plan, policy or contract covers the same services when those services are provided via in-person consultation or contact.  An insurer shall not impose any unique condition for coverage of services provided via telemedicine.

An insurer shall not impose an originating-site restriction with respect to telemedicine services or distinguish between telemedicine services provided to patients in rural locations and those provided to patients in urban locations; provided that the provisions of this section shall not be construed to require coverage of an otherwise non-covered benefit.

A determination by an insurer that health care services delivered through the use of telemedicine are not covered under the plan shall be subject to review and appeal.

Nothing in this section shall require a health care provider to be physically present with the patient at the originating site unless the consulting provider deems it necessary.

An insurer shall not limit coverage of services delivered via telemedicine only to those health care providers who are members of the health insurance plan, policy or contract provider network where no in-network provider is available and accessible, as availability and accessibility are defined in network adequacy standards issued by the superintendent

Telemedicine services shall be encrypted and conform to state and federal privacy laws.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3.  & 59A-23-7.12 (Accessed Aug. 2022).

A plan that provides a benefit conditioned on a covered person’s receipt of a health care service shall provide that benefit if the service is delivered in-person or virtually.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8 (J). (Accessed Aug. 2022).

Last updated 08/03/2022

Definitions

Behavioral Health

Telemedicine is defined as “the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education”

“Telemedicine services” includes both an originating site and a distant site.  An interactive telehealth communication system must include both interactive audio and video and be delivered on a real-time basis at both the originating and distant sites.

The terms telehealth and telemedicine are used interchangeably in the Medicaid program. To qualify as a billable telemedicine service, the system must meet all federal requirements for interactivity using a secure connection as meets HIPAA standards for privacy and security.

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 27 (Accessed Aug. 2022).

Applied Behavior Analysis

Telehealth includes three means of delivering a service to a recipient when not rendered in person. Check each service’s billing instructions to determine which can be delivered through Telehealth.

Telemedicine is real time audio and video between the location of the recipient (originating site) and the location of the practitioner (distant site). For 97156 and 97157, MAD allows the use of telemedicine to deliver guidance to members of the Family Set. Think of this as a Zoom-like meeting where different Family Set members of the recipient are in different locations all participating in the session.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Aug. 2022).

Last updated 08/03/2022

Email, Phone & Fax

Applied Behavior Analysis

Telephonic is the use of a telephone or cell phone to render services in real time with only audio. Currently only under an Emergency Order from the Governor may some services be rendered telephonically. A MAD supplement is issued informing providers and practitioners of the Emergency Order and codes allowed to be rendered telephonically.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Aug. 2022).

MAD will reimburse eligible providers for limited professional services delivered by telephone without video.  No additional reimbursement is made to the originating-site for an interactive telemedicine system fee.

SOURCE: NM Administrative Code 8.310.2.12 M(2). (Accessed Aug. 2022).

MAD covers service plan updates through the participation of interdisciplinary teams.

The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.

SOURCE: NM Administrative Code 8.321.2.9 (L)(3c). (Accessed Aug. 2022). 

 

 

Last updated 08/03/2022

Live Video

POLICY

New Mexico Medicaid will reimburse for professional services at the originating-site and the distant-site at the same rate as when the services are furnished without the use of a telecommunication system.

SOURCE: NM Administrative Code 8.310.2.12(M)(d). (Accessed Aug. 2022).

Telemedicine is also covered by NM Managed Care.

SOURCE: NM Medical Assistance Division Managed Care Policy Manual, p. 311. Oct. 2020.  (Accessed Aug. 2022).

Applied Behavior Analysis

Telemedicine applies to multiple Family Sets joining each other in a virtual meeting. MAD encourages AP agencies to use this delivery system to meet the needs of Family Set members who cannot attend during regular business hours groups. A parent who travels for work, could easily keep engaged by participating in during their lunch or dinner time.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Aug. 2022).

Managed Care Program

The benefits package includes telemedicine services.  See Admin. Code 8.308.9.18 for requirements of MCOs related to telemedicine services.

SOURCE: NM Admin Code Sec. 8.309.4.16 & 8.308.9.18. (Accessed Aug. 2022).

Provision of telemedicine services does not require that a certified Medicaid healthcare provider be physically present with the patient at the originating site unless the telemedicine consultant at the distant site deems it necessary.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Aug. 2022).

The MCO is encouraged to use technology, such as telemedicine, to ensure access and availability of services statewide.

SOURCE: NM Administrative Code 8.308.2.12 (Q). (Accessed Aug. 2022).

The alternative benefits package includes telemedicine services.

SOURCE: NM Centennial Care Managed Care Policy Manual, Oct. 1. 2020, (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Applied Behavior Analysis

MAD pays for telemedicine communication system per recipient/per service for the delivery of ABA services.  See manual for specific services and supervision requirements.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 12, (Accessed Aug. 2022).

School-Based Services

Telemedicine services provided in accordance with 8.210.2 NMAC [section may be referencing 8.310.2 NMAC instead]. The modifier “GT” should be utilized when billing for services provided via telemedicine.

SOURCE: NM Medicaid Guide for School-Based Services, pg. 15. (Accessed Aug. 2022).

Noncovered telemedicine services: 

A service provided through telemedicine is subject to the same program restrictions, limitations and coverage which exist for the service when not provided through telemedicine. Telemedicine services are not covered when audio/video technology is used in furnishing a service when the MAP eligible recipient and the practitioner are in the same institutional or office setting.

SOURCE: NM Administrative Code 8.310.2.12 M(4). (Accessed Aug. 2022).

MAD covers service plan updates through the participation of interdisciplinary teams.

The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.

SOURCE: NM Administrative Code 8.321.2.9 (L) & (L)(3c). (Accessed Aug. 2022).

Medication Assisted Treatment for Buprenorphine (MAT) services are reimbursable with telemedicine.

See manual for additional requirements, including online prescribing requirements.

SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, 2021, (Accessed Aug. 2022).


ELIGIBLE PROVIDERS

Reimbursement for professional services at the originating-site and the distant-site are made at the same rate as when the services provided are furnished without the use of a telecommunication system. In addition, reimbursement is made to the originating-site for a real-time interactive audio/video technology telemedicine system fee (where the MAP eligible recipient is located, if another eligible provider accompanies the patient) at the lesser of the provider’s billed charge, or the maximum allowed by MAD for the specific service of procedure. If the originating site is the patient’s home, the originating site fee should not be billed if the eligible provider does not accompany the MAP eligible recipient. The MAP eligible recipient is not reimbursed for their computer/internet.

SOURCE: NM Administrative Code 8.310.2.12 (M)(d). (Accessed Aug. 2022).

Reimbursement for services at the originating-site (where the MAP eligible recipient is located) and the distant-site (where the provider is located) are made at the same amount as when the services provided are furnished without the use of a telecommunication system.  In addition, reimbursement is made to the originating-site for an interactive telemedicine system fee at the lesser of the provider’s billed charge; or the maximum allowed by MAD for the specific service or procedure.

SOURCE: NM Administrative Code 8.310.3.11. (Accessed Aug. 2022). 


ELIGIBLE SITES

School-based services provided via telemedicine are covered.

SOURCE: NM Administrative Code 8.320.6.13(I). (Accessed Aug. 2022).

When the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and NMAC rules or meet federal requirements for providing services to IHS facilities or tribal contract facilities.

SOURCE: NM Administrative Code 8.310.3.9  (F). (Accessed  Aug. 2002).

An interactive HIPAA compliant telecommunication system must include both interactive audio and video and be delivered on a real-time basis at the originating and distant sites. If real-time audio/video technology is used in furnishing a service when the MAP eligible recipient and the practitioner are in the same institutional or office setting, then the practitioner should bill for the service furnished as if it was furnished in person as a face to face encounter. Coverage for services rendered through telemedicine shall be determined in a manner consistent with medicaid coverage for health care services provided through in person consultation. For telemedicine services, when the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and regulations or meet federal requirements for providing services to IHS facilities or tribal contract facilities. Provision of telemedicine services does not require that a certified medicaid healthcare provider be physically present with the MAP eligible recipient at the originating site unless the telemedicine consultant at the distant site deems it necessary.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Aug. 2022).

Telemedicine originating-site

The location of a MAP eligible recipient at the time the service is being furnished via an interactive telemedicine communications system. The origination-site can be any of the following medically warranted sites where services are furnished to a MAP eligible recipient.

  • The office of a physician or practitioner.
  • A critical access hospital (as described in section 1861 (mm)(1) of the Act).
  • A rural health clinic (as described in 1861 (mm)(2) of the Act).
  • A federally qualified health center (as defined in section 1861 (aa)(4) of the Act).
  • A hospital (as defined in section 1861 (e) of the Act).
  • A hospital-based or critical access hospital-based renal dialysis center (including satellites).
  • A skilled nursing facility (as defined in section 1819(a) of the Act).
  • A community mental health center (as defined in section 1861(ff)(3)(B) of the Act).
  • A renal dialysis facility (only for the purposes of the home dialysis monthly ESRD-related clinical assessment in section 1881(b)(3)(B) of the Act).
  • The home of an individual (only for purposes of the home dialysis ESRD-related clinical assessment in section 1881(b)(3)(B) of the Act).
  • A mobile stroke unit (only for the purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke provided in accordance with section 1834(m)(6) of the Act).
  • The home of an individual (only for the purposes of treatment of a substance use disorder or a co-occurring mental health disorder), furnished on or after July 1, 2019, to an individual with a substance use disorder diagnosis.
  • The home of an individual when an interactive audio and video telecommunication system that permits real-time visit is used between the eligible provider and the MAP eligible recipient.
  • A School Based Health Center (SBHC) as defined by section 2110(c)(9) of the Act.

SOURCE: NM Administrative Code 8.310.2.12 (M)(a). (Accessed Aug. 2022).

 Telemedicine distant-site

The location where the telemedicine provider is physically located at the time of the telemedicine service.  All services are covered to the same extent the service and the provider are covered when not provided through telemedicine.  For these services, use of the telemedicine communications system fulfills the requirement for a face-to-face encounter.

SOURCE: NM Administrative Code 8.310.2.12 (M)(b). (Accessed Aug. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Reimbursement is made to the originating site for an interactive telemedicine system fee at the lesser of the following:

  • Provider’s billed charge; or
  • Maximum allowed by MAD for the specific service or procedure.

SOURCE: NM Administrative Code 8.310.2.12 M(d). (Accessed Aug. 2022).

A telemedicine originating-site communication system fee is covered if the MAP eligible recipient was present at and participated in the telemedicine visit at the originating-site and the system that is used meets the definition of a telemedicine system.

SOURCE: NM Administrative Code 8.310.2.12 M(e). (Accessed Aug. 2022).

Indian Health Services

Originating Site Fee:

A telemedicine originating site fee is covered when the requirements of 8.310.2 NMAC are met;

  • Both the originating and distant sites may be IHS or tribal facilities at two different locations or if the distant site is under contract to the IHS or tribal facility and would qualify to be an enrolled provider;
  • A telemedicine originating site fee is not payable if the telemedicine technology is used to connect an employee or staff member of a facility to the eligible recipient being seen at the same facility;

However, even if the service does not qualify for a telemedicine originating site fee, the use of telemedicine technology may be appropriate thereby allowing the service provided to meet the standards to qualify as an encounter by providing the equivalent of face-to-face contact.

SOURCE: NM Administrative Code 8.310.12.12. (8) (Accessed Aug. 2022).

Indian Health Services

A telemedicine communication fee is paid for the originating site at fee schedule rates using the CMS 1500 format; not the OMB rate. The originating clinical service fee is billed on a UB claim form at the OMB rate. Both the originating and distant sites may be IHS or tribal facilities with two different locations; or a distant site can be under contract to the IHS or tribal facility. If the distant site is an IHS or tribal facility, the distant site may also bill the OMB rate when the service is typically paid at OMB rates.

SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 30, (Accessed Aug. 2022).

FQHC

A telemedicine communication fee is paid for the originating site at fee schedule rates using the CMS 1500 format; not the encounter rate. The originating clinical service fee is billed on a UB claim form if for evaluation or therapy and on a CMS 1500 if for a special service and reimbursed at the encounter rate.

SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 30, (Accessed Aug. 2022).

Last updated 08/05/2022

Miscellaneous

MCOs must:

  • Promote and employ broad-based utilization of statewide access to Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine service systems including, but not limited to, access to text telephones or teletype (TTYs) and 711 telecommunication relay services;
  • Follow state guidelines for telemedicine equipment or connectivity;
  • Follow accepted HIPAA and 42 CFR part two regulations that affect telemedicine transmission, including but not limited to staff and contract provider training, room setup, security of transmission lines, etc; the MCO shall have and implement policies and procedures that follow all federal and state security and procedure guidelines;
  • Identify, develop, and implement training for accepted telemedicine practices;
  • Participate in the needs assessment of the organizational, developmental, and programmatic requirements of telemedicine programs;
  • Report to HSD on the telemedicine outcomes of telemedicine projects and submit the telemedicine report; and
  • Ensure that telemedicine services meet the following shared values, which are ensuring: competent care with regard to culture and language needs; work sites are distributed across the state, including native American sites for both clinical and educational purposes; and coordination of telemedicine and technical functions at either end of network connection.

The MCO shall participate in project extension for community healthcare outcomes (ECHO), in accordance with state prescribed requirements and standards, and shall:

  • Work collaboratively with HSD, the university of New Mexico, and providers on project ECHO;
  • Identify high needs, high cost members who may benefit from project ECHO participation;
  • Identify its PCPs who serve high needs, high cost members to participate in project ECHO;
  • Assist project ECHO with engaging its MCO PCPs in project ECHO’s center for Medicare and Medicaid innovation (CMMI) grant project;
  • Reimburse primary care clinics for participating in the project ECHO model;
  • Reimburse “intensivist” teams;
  • Provide claims data to HSD to support the evaluation of project ECHO;
  • Appoint a centralized liaison to obtain prior authorization approvals related to project ECHO; and
  • Track quality of care and outcome measures related to project ECHO.

SOURCE:  NM Administrative Code 8.308.9.18. (Accessed Aug. 2022).

Under 21 U.S.C. § 802(54)(A),(B), for most (DEA-registered) Practitioners in the United States, including Qualifying Practitioners and Qualifying Other Practitioners (“Medication Assisted Treatment Providers”), who are using FDA approved Schedule III-V controlled substances to treat opioid addiction, the term “practice of telemedicine” means the practice of medicine in accordance with applicable Federal and State laws, by a practitioner (other than a pharmacist) who is at a location remote from the patient, and is communicating with the patient, or health care professional who is treating the patient using a telecommunications system referred to in (42 CFR § 410.78(a)(3)) which practice is being conducted in a few unique situations. See manual for more details.

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 28 (Accessed Aug. 2022).

Patient-Centered Initiatives 

The New Mexico PCMH will include State-specific goals tailored to the unique needs of communities and patients.
Core components of the New Mexico PCMH Model include:

Clinical:

  • Improved access to care through flexible scheduling, accommodating walk-ins, utilization of telemedicine, providing after hours and weekend office hours

SOURCE: NM Centennial-Care Managed Care Policy (2019) pg. 304 (Accessed Aug. 2022). 

Referral to Community and Social Support Services

Referrals to community and social support services help overcome access and service barriers, increase self-management skills, and improve overall health. Providers identify available and effective community-based resources and actively link and manage appropriate referrals. Linkages support the personal needs of members and are consistent with the service plan. Community and social support service referral activities may include, but are not limited to:

  • Identifying and patterning with community-based and telehealth resources such as medical and behavioral health care, durable medical equipment (DME), legal services, housing, respite, educational and employment supports, financial services, recovery and treatment plan goal supports, entitlements and benefits, social integration and skill building, transportation, personal needs, wellness and health promotion services, specialized support groups, supports for substance use and prevention and treatment, and culturally-specific programs such as veterans’ or IHS and Tribal programs

SOURCE: NM CareLink Health Homes Policy Manual 2021. (Accessed Aug. 2022).

Last updated 08/05/2022

Out of State Providers

For telemedicine services, when the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and regulations or meet federal requirements for providing services to IHS facilities or tribal contract facilities. Provision of telemedicine services does not require that a certified medicaid healthcare provider be physically present with the MAP eligible recipient at the originating site unless the telemedicine consultant at the distant site deems it necessary.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Aug. 2022).

When the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and NMAC rules or meet federal requirements for providing services to IHS facilities or tribal contract facilities.

SOURCE: NM Administrative Code 8.310.3.9 (F). (Accessed Aug. 2022). 

Last updated 08/03/2022

Overview

New Mexico Medicaid reimburses for live video telehealth at the same rate as when services are provided in-person as well as store-and-forward.  There is no reference to remote patient monitoring.  They will also reimburse for limited professional services delivered by telephone without video.

Last updated 08/04/2022

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 08/04/2022

Store and Forward

POLICY

MAD will reimburse for services delivered through store-and forward.  To be eligible for payment under store-and-forward, the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another; to allow a consulting provider to obtain information, analyze it, and report back to the referring physician providing the telemedicine consultation.  Store-and-forward telemedicine includes encounters that do not occur in real time (asynchronous) and are consultations that do not require a face-to-face live encounter between patient and telemedicine provider.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Aug. 2022).

Applied Behavior Analysis

Store and Forward Technology is when the originating site practitioner records in real time audio and video a service and then transmits the image to a distant site practitioner.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Applied Behavior Analysis

For Case Supervision, MAD allows a BT or BAA to video a session, store the video and sent to the BA or Supervising BAA for both practitioners to later review and plan for the next intervention with the recipient.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Aug. 2022).


GEOGRAPHIC LIMITS

Applied Behavior Analysis

In New Mexico, recipients are in areas where there is no Internet, so telemedicine delivered services cannot be rendered. For Case Supervision, MAD allows a BT or BAA to video a session, store the video and sent to the BA or Supervising BAA for both practitioners to later review and plan for the next intervention with the recipient.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Aug. 2022).


TRANSMISSION FEE

No Reference Found

Last updated 08/05/2022

Cross State Licensing

Medicine and Surgery

“The practice of medicine across state lines means the rendering of a written or otherwise documented medical opinion concerning diagnosis or treatment of a patient within this state, by a physician located outside this state, as a result of transmission of individual patient data by electronic, telephonic or other means from within this state, to the physician or the physician’s agent, OR the rendering of treatment to a patient within this state, by a physician located outside this state, as a result of transmission of individual patient data by electronic, telephonic or other means from within this state to the physician or the physician’s agent.”

SOURCE: NM Statutes Annotated. Sec. 61-6-6(K). (Accessed Aug. 2022).

The board shall issue a licensed physician a telemedicine license to allow the practice of medicine across state lines to an applicant who holds a full and unrestricted license to practice medicine in another state or territory of the United States.  The board shall establish by rule the requirements for licensure; provided the requirements shall not be more restrictive than those required for licensure by endorsement.

A telemedicine license shall be issued for a period not to exceed three years and may be renewed upon application and payment of fees.

SOURCE: NM Statutes Annotated, 1978 Sec. 61-6-11.1. (Accessed Aug. 2022).

Osteopathic Medicine

The Board of Osteopathic medicine offers a limited telemedicine license that allows an osteopathic physician located outside New Mexico to practice osteopathic medicine on patients located in New Mexico.  The annual fee is $100.

SOURCE: NM Administrative Code 16.17.2.7 & .8, (Accessed Aug. 2022).

Telemedicine

A limited medical license that allows a physician located outside New Mexico to practice medicine on patients located in New Mexico.

Each applicant for a telemedicine license must be of good moral character and hold a full and unrestricted license to practice medicine in another state or territory of the United States.

Required documentation.

Each applicant for a telemedicine license must submit the required fees as specified in 16.10.9.8 NMAC and the following documentation:

  • A completed signed application, with a passport quality photo taken within six months. Applications are valid for one year from the date of receipt.
  • Verification of licensure in all states where the applicant holds or has held a license to practice medicine, or other health care profession. Verification must be received directly from the other state(s) board, and must attest to the status, issue date, license number, and other information requested and contained on the form.
  • Applicants who have had previous disciplinary or other action against them may be required to meet with the entire board. The board may, in its discretion, issue a license to practice medicine across state lines if it finds that the previous disciplinary or other action does not indicate that the physician is a potential threat to the public.
  • Licensure process. Upon receipt of a completed application, including all required documentation and fees, board staff will request and review an AMA physician profile and FSMB board action databank search. When the application is complete a member or agent of the board will review and may approve the application. A personal interview is not required unless there is a discrepancy in the application that cannot be resolved.
  • Initial license expiration. Telemedicine licenses shall be renewed on July 1 following the date of issue. Initial licenses are valid for a period of not more than thirteen months or less than one month.

SOURCE: NM Administrative Code 16.10.2.8 & 16.10.2.11, (Accessed Aug. 2022). 

Audiologist, Speech-language Pathologist or Hearing Aid Dispensers

An audiologist, speech-language pathologist or hearing aid dispenser licensed in New Mexico may use telecommunication technology to deliver services to a person residing in New Mexico who is physically present at a different location from the provider at the time services are received, so long as the services delivered through use of telecommunication technology meet or exceed the quality of services delivered face-to-face.

An audiologist, speech-language pathologist or hearing aid dispenser who resides outside the boundaries of the state of New Mexico and delivers services or products to residents of New Mexico shall be licensed by the board.

An audiologist, speech-language pathologist or hearing aid dispenser shall not deliver services to a client solely through the use of regular mail, facsimile or electronic mail, although these methods of communication may be used to supplement the face-to-face delivery of services or through the use of telecommunication technology.

SOURCE: NM Administrative Code 16.26.2.20. (Accessed Aug. 2022).

Last updated 08/05/2022

Definitions

“Telehealth means the use of electronic information, imaging and communication technologies, including interactive audio, video and data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education.”

SOURCE: NM Statutes Annotated Sec. 24-1G-3. (Accessed Aug. 2022).

Speech-Language Pathology, Audiology and Hearing Aid Dispensing Practices Board

“Telehealth” means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiology, speech-language pathology or hearing aid dispensing services to an individual from a provider through hardwire or internet connection.

“Telepractice” means the practice of telehealth.

SOURCE: NM Administrative Code 16.26.1.7(AA) & (BB). (Accessed Aug. 2022).

Osteopathic Medicine

“Telemedicine” means the practice of medicine across state lines using electronic communications, information technology or other means between a licensed osteopathic physician out-of-state and a patient in New Mexico. Telemedicine involves the application of secure videoconferencing or store-and-forward technology to provide or support healthcare delivery by replicating the traditional interaction of the in-person encounters between a provider and a patient.

SOURCE: NM Administrative Code 16.17.1.7(T). (Accessed Aug. 2022).

Osteopathic Medicine – Licensure

Telemedicine: A limited medical license that allows an osteopathic physician located outside New Mexico to practice osteopathic medicine on patients located in New Mexico.

SOURCE: NM Administrative Code 16.17.2.7, (Accessed Aug. 2022).

Teledentistry (Will be Repealed July 1, 2024)

Teledentistry means a dentist’s, dental hygienist’s or dental therapist’s use of electronic information, imaging and communication technologies,  including interactive audio, video and data communications as well as store-and-forward technologies, to provide and support dental health care delivery, diagnosis, consultation, treatment, transfer of dental data and education.”

SOURCE: NM Statutes Annotated Sec. 61-5A-3 (Accessed Aug. 2022).

“Teledentistry” means a dentist’s use of health information technology in real time to provide limited diagnostic treatment planning services in cooperation with another dentist, a dental hygienist, a community health coordinator, dental therapist or a student enrolled in a program of study to become a dental assistant, dental hygienist, dental therapist or dentist.

SOURCE: NMAC Sec. 16.5.1.7 (Accessed Aug. 2022).

Medicine and Surgery Practitioners 

“Telemedicine” means the practice of medicine across state lines.

SOURCE: NM Administrative Code 16.10.2.7, (Accessed Aug. 2022). 

Categories of Active License 

Telemedicine:  A limited medical license that allows a physician located outside New Mexico to practice medicine on patients located in New Mexico. Please see code for telemedicine license requirements.

SOURCE: NM Administrative Code 16.10.2.8, (Accessed Aug. 2022).

Related to Medical Cannabis

Telemedicine means the use of telecommunications and information technology to provide clinical health care from a site apart from the site where the patient is located, in real time or asynchronously, including the use of interactive simultaneous audio and video or store-and-forward technology, or off-site patient monitoring and telecommunications in order to deliver health care services.

SOURCE: NM Administrative Code 7.34.3.7 & 7.34.2.7. (Accessed Aug. 2022).

Last updated 08/05/2022

Licensure Compacts

Member of the Nurse Licensure Compact.

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

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

 

Last updated 08/05/2022

Miscellaneous

New Mexico is also the home of Project ECHO.  The project’s mission is to develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas, and to monitor outcomes of this treatment utilizing technology.

SOURCE: University of New Mexico School of Medicine. Project ECHO. (Accessed Aug. 2022).

The delivery of health care via telehealth is recognized and encouraged as a safe, practical and necessary practice in New Mexico. No health care provider or operator of an originating site shall be disciplined for or discouraged from participating in telehealth pursuant to the New Mexico Telehealth Act [24-25-1 NMSA 1978]. In using telehealth procedures, health care providers and operators of originating sites shall comply with all applicable federal and state guidelines and shall follow established federal and state rules regarding security, confidentiality and privacy protections for health care information.

SOURCE: NM Statutes Annotated Sec. 24-25-4. (Accessed Aug. 2022). 

Last updated 08/05/2022

Online Prescribing

Prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship, including prescribing over the internet or via other electronic means that is based solely on an on-line questionnaire is unprofessional conduct, except for:

  • Physicians and physician assistants on call for another practitioner, or responsible for another practitioner’s patients in an established clinic or office, or acting as locum tenens where a physician-patient relationship has previously been established and documented in the practitioner’s or clinic’s record;
  • Physicians and physician assistants in emergency room or urgent care settings;
  • Prescriptions written to prepare a patient for special examination(s) or laboratory testing;
  • Prescribing or dispensing for immunization programs;
  • The provision of treatment for partners of patients with sexually transmitted diseases when this treatment is conducted in accordance with the expedited partner therapy guidelines and protocol published by the New Mexico department of health; and
  • The provision of consultation, recommendation, or treatment during a face-to-face telehealth encounter online, using standard videoconferencing technology, where a medical history and informed consent are obtained and a medical record generated by the practitioner, and a physical examination is:
    • Recorded as appropriate by the practitioner, or a practitioner such as a physician, a physician or anesthesiologist assistant, or an advanced practice nurse, with the results communicated to the telehealth practitioner; or
    • Waived when a physical examination would not normally be part of a typical physical face-to-face encounter with the patient for the specific services being provided.

SOURCE: NM Administrative Code 16.10.8.8(L). (Accessed Aug. 2022).

Related to Medical Cannabis

Qualified patient means a resident of New Mexico who has been diagnosed by a practitioner as having a debilitating medical condition and has received written certification and a registry identification card pursuant to the Lynn and Erin Compassionate Use Act on the basis of having been diagnosed, in person or via telemedicine, by a practitioner as having a debilitating medical condition.

SOURCE: NM Administrative Code 7.34.3.7 & 7.34.2.7. (Accessed Aug. 2022).

Last updated 08/05/2022

Professional Board Standards

Speech Language Pathology, Audiology, and Hearing Aid Dispensing Practice Board

SOURCE: NM Administrative Code 16.26.2.20. (Accessed Aug. 2022).

New Mexico Board of Dental Health Care

SOURCE: NM Administrative Code Title 16, Ch. 5. (Accessed Aug. 2022). 

New Mexico Board of Osteopathic Medicine

SOURCE: NM Administrative Code 16..17.1.7. (Accessed Aug. 2022).

New Mexico Medical Board

SOURCE: NM Administrative Code 16.10.2. (Accessed Aug. 2022).