New Mexico

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

New Mexico Medicaid

Administrator

New Mexico Human Services Dept., Medical Assistance Division (MAD)

Regional Telehealth Resource Center

Southwest Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

Licensure Compacts: NLC
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

Medicaid: COVID-19 Guidance for MCOs

STATUS: Active, until end of COVID-19 PHE

Medicaid: Telephonic Codes Rate List

STATUS: Active

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: 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 02/28/2021

Cross-State Licensing

No Reference Found

Last updated 02/28/2021

Easing Prescribing Requirements

No Reference Found

Last updated 02/28/2021

Miscellaneous

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

STATUS: Active

 

Last updated 02/28/2021

Originating Site

Medicaid: COVID-19 Guidance for MCOs

STATUS: Active, until end of COVID-19 PHE

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: Active, until end of COVID-19 PHE

Last updated 02/28/2021

Private Payer

Medicaid & Private Payer: Temporary Telehealth Expansion

STATUS: Active, until end of COVID-19 PHE

Last updated 02/28/2021

Provider Type

Medicaid: COVID-19 Guidance for MCOs

STATUS: Active, until end of COVID-19 PHE

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: Active, until end of COVID-19 PHE

 

Last updated 02/28/2021

Service Expansion

Medicaid: COVID-19 Guidance for MCOs

STATUS: Active, until end of COVID-19 PHE

Medicaid & Private Payer: Temporary Telehealth Expansion

STATUS: Active, until end of COVID-19 PHE

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

Medicaid 1915(c) Waiver: Appendix K – Centennial Care 1115 Demonstration

STATUS: Expired January 26, 2021

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: 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 02/28/2021

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”

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2019) p. 29 (Accessed Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

Last updated 02/28/2021

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). (Accessed Feb. 2021).

Telemedicine is also covered by NM Managed Care.

SOURCE: NM Medical Assistance Division Managed Care Policy Manual, p. 311. Oct. 2020.  (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Effective Oct. 1, 2019 the agency’s telehealth and teleconsultation services fee schedule rates are set at 90% of the Medicare fee schedule and are effective for services provided on or after that date.

SOURCE: NM State Plan Amendment.  Attachment 4.19B.  (2/19/20). (Accessed Feb. 2021).

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 Feb. 2021).


ELIGIBLE PROVIDERS

No Reference Found


ELIGIBLE SITES

School-based services provided via telemedicine are covered.

SOURCE: NM Administrative Code 8.320.6.13(I). (Accessed Feb. 2021).

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 originating site can be any medically warranted site.  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.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Feb. 2021).


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;
  • Maximum allowed by MAD for the specific service or procedure.

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

SOURCE: NM Administrative Code 8.310.2.12 M (4) & (5). (Accessed Feb. 2021).

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. (Accessed Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

There must be an established prescriber-patient relationship to prescribe drugs or medical supplies. This includes prescribing over the Internet, or via other electronic means, based solely on an online questionnaire.  Physicians, psychologists with prescriptive authority, physician assistants and advanced practice nurses may prescribe online during a live video exam. The prescribing clinician must: obtain a medical history, obtain informed consent and generate a medical record.  A physical exam is recorded as appropriate by the telehealth practitioner but the exam may be waived when not normally a part of a typical face-to-face encounter for the services being provided.

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2019) p. 31 (Accessed Feb. 2021).

 

 

Last updated 02/28/2021

Out of State Providers

When the originating site is in New Mexico and the distant site is outside New Mexico, the distant-site provider at the distant site must be licensed in New Mexico for telemedicine, or meet federal requirements for Indian Health Service or tribal contract facilities.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Feb. 2021).

Last updated 02/28/2021

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.

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

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 (3)) (Accessed Feb. 2021).

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 Feb. 2021).


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 Feb. 2021).


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 Feb. 2021).


TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

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 Feb. 2021).

Last updated 02/28/2021

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 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) & (I). (Accessed Feb. 2021).


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.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3(I). (Accessed Feb. 2021).

Recently Adopted Rule

A plan shall pay a benefit to a covered person for eligible telemedicine or otherwise covered services, but shall not offer a benefit for a telemedicine service provided through a contracted provider.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8 (k). (Accessed Feb. 2021).

Last updated 02/28/2021

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 service in-person.  An insurer shall not impose any unique condition for coverage of services provided via telemedicine.

A determination that a service is not covered through the use of telemedicine are subject to review and appeal.  Plans cannot require a health care provider to be physically present with the patient at the originating site unless the consulting provider deems it necessary. Insurers cannot impose an originating-site restriction or distinguish between telemedicine services provided to patients in rural and urban locations.

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

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3. (Accessed Feb. 2021).

Recently Adopted Rule

A plan shall pay a benefit to a covered person for eligible telemedicine or otherwise covered services, but shall not offer a benefit for a telemedicine service provided through a contracted provider.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8 (k). (Accessed Feb. 2021).

Last updated 02/28/2021

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(L) (2012). (Accessed Feb. 2021).

NM issues telemedicine licenses to providers who hold a full, unrestricted license in another state.

SOURCE: NM Statutes Annotated, 1978 Sec. 61-6-11.1. (Accessed Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

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.

SOURCE: NM Administrative Code 16.26.1.7(AA). (Accessed Feb. 2021).

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 Feb. 2021). 

Last updated 02/28/2021

Licensure Compacts

Member of the Nurse Licensure Compact.

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

Last updated 02/28/2021

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 Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

Last updated 02/28/2021

Professional Board Standards

Speech Language Pathology, Audiology, and Hearing Aid Dispensing Practice 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 Feb. 2021).