New York

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

New York Medicaid

Administrator

New York State Dept. of Health

Regional Telehealth Resource Center

Northeast Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: Yes

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: None
Consent Requirements: Yes

Last updated 07/15/2021

Audio-Only Delivery

Medicaid: Guidance for Adult Social Day Care Telephonically FAQs

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: FAQs on Telehealth and Telephonic Services

STATUS:  Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Comprehensive Guidance Regarding the Use of Telehealth including Telephonic Services During COVID-19

STATUS: Active, extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Guidance for Adult Social Day Care Services Telephonically

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Telehealth and Telephonic Services for Adult Day Health Care Program

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Guidance for Home and Community-Based Services

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Guidance for Children and Family Treatment and Support Service Providers

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Factsheet for Consumers during COVID-19

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Office of Mental Health:  Telemental Health and Program Guidance

STATUS: Active, until end of NY disaster emergency. Based on Waiver, believed to be still in effect.

Office of Mental Health: RTF Treatment and Documentation Standards, Visitation, Telemental Health Utilization, and Restraint Response during COVID-19 Emergency Period

STATUS: Active

Office of Mental Health: COVID-19 Disaster Emergency FAQ

STATUS: Active

Office of Mental Health: Clinic Treatment Program

STATUS: Active during state of emergency. NY state of emergency ended however based on waiver may still be active.

Medicaid 1915(c) Waiver: Appendix K – Children’s Waiver

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – OPWDD/Home and Community Based Services Waiver

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI)

STATUS: Active, expires six months after the end of the federal PHE.

Last updated 07/15/2021

Cross-State Licensing

No Reference Found

Last updated 07/15/2021

Easing Prescribing Requirements

Office of Mental Health:  Telemental Health and Program Guidance

STATUS: Active, until end of NY disaster emergency. Based on Waiver, believed to be still in effect.

Office of Mental Health: COVID-19 Disaster Emergency FAQ

STATUS: Active

Last updated 07/15/2021

Miscellaneous

Office of Mental Health: Waiver to Help Providers

STATUS: Effective June 25, 2021 and effective for 60 days until stayed, modified, suspended or terminated.

Office of Mental Health: Assisted Outpatient Treatment (AOT) Frequently Asked Questions

STATUS: Active

Office of Mental Health: Streamlined process to permanently add telemental health

STATUS: Active

Office of Professions: Telepractice Guidance

STATUS: Active

Office of Professions:  COVID-19 FAQs

STATUS: NY State of Emergency ended, however Department understands concern and will take that into consideration

Medicaid 1915(c) Waiver: Extension for NHTD and TBI

STATUS: Expires six months after the end of the federal PHE.

Last updated 07/15/2021

Originating Site

Medicaid: FAQs on Telehealth and Telephonic Services

STATUS:  Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Comprehensive Guidance Regarding the Use of Telehealth including Telephonic Services During COVID-19

STATUS: Active, extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Factsheet for Consumers during COVID-19

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid 1915(c) Waiver: Appendix K – OPWDD/Home and Community Based Services Waiver

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI)

STATUS: Active, expires six months after the end of the federal PHE.

Last updated 07/15/2021

Private Payer

Department of Financial Services:  Coronavirus and Telehealth Services

STATUS: Appears to have expired since NY State of Emergency ended on June 24.

Department of Financial Services:  FAQs on Health Insurance

STATUS: Unclear if it’s been updated since expiration of emergency.

Worker’s Compensation Board: Allowing Telemedicine

STATUS: Expired July 11, 2021

Department of Financial Services: Requirement for COVID-19/Telehealth coverage

STATUS: Expired July 6, 2021

Last updated 07/15/2021

Provider Type

Medicaid: FAQs on Telehealth and Telephonic Services

STATUS:  Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Comprehensive Guidance Regarding the Use of Telehealth including Telephonic Services During COVID-19

STATUS: Active, extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Factsheet for Consumers during COVID-19

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Office of Mental Health: COVID-19 Disaster Emergency FAQ

STATUS: Active

Office of Mental Health: Clinic Treatment Program

STATUS: Active during state of emergency. NY state of emergency ended however based on waiver may still be active.

Medicaid 1915(c) Waiver: Appendix K – OPWDD/Home and Community Based Services Waiver

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI)

STATUS: Active, expires six months after the end of the federal PHE.

Last updated 07/15/2021

Service Expansion

Medicaid: Guidance for Adult Social Day Care Telephonically FAQs

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: FAQs on Telehealth and Telephonic Services

STATUS:  Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Comprehensive Guidance Regarding the Use of Telehealth including Telephonic Services During COVID-19

STATUS: Active, extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Guidance for Adult Social Day Care Services Telephonically

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Telehealth and Telephonic Services for Adult Day Health Care Program

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Guidance for Home and Community-Based Services

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Guidance for Children and Family Treatment and Support Service Providers

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Medicaid: Factsheet for Consumers during COVID-19

STATUS: Active, NY state of emergency ended but based on Comprehensive Guidance telehealth & telephonic policies extended for remainder of federally declared PHE or until issuance of subsequent guidance.

Office of Mental Health:  Telemental Health and Program Guidance

STATUS: Active, until end of NY disaster emergency. Based on Waiver, believed to be still in effect.

Office of Mental Health: RTF Treatment and Documentation Standards, Visitation, Telemental Health Utilization, and Restraint Response during COVID-19 Emergency Period

STATUS: Active

Office of Mental Health: COVID-19 Disaster Emergency FAQ

STATUS: Active

Office of Mental Health: Telehealth Modifier Use

STATUS: Active

Office of Mental Health: Clinic Treatment Program

STATUS: Active during state of emergency. NY state of emergency ended however based on waiver may still be active.

Medicaid 1915(c) Waiver: Appendix K – OPWDD/Home and Community Based Services Waiver

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI)

STATUS: Active, expires six months after the end of the federal PHE.

Last updated 07/15/2021

Definitions

“Telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program established under section three hundred sixty-six of the social services law, and the child health insurance plan under title one-A of article twenty-five of this chapter, telehealth shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner. This subdivision shall not preclude the delivery of health care services by means of “home telehealth” as used in section thirty-six hundred fourteen of this chapter.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

Telemental Health Services means the use of two-way real-time interactive audio and video to provide and support clinical psychiatric care at a distance. Such services do not include a telephone conversation, electronic mail message, or facsimile transmission between a provider and a recipient or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support Telemental Health Services.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(r) & NY Office of Mental Health, Telepsychiatry Standards Guidance, 2020, pg. 2, (Accessed Jul. 2021).

Teledentistry

Telehealth is defined as “the use of electronic information and communication technologies to deliver health care to patients at a distance, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient (Medicaid member)”.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2020, page 83 (Accessed Jul. 2021).

Last updated 07/15/2021

Email, Phone & Fax

Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

The commissioner may specify in regulation additional acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.

SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Jul. 2021).

Telemental health services do not include telephone conversation, electronic mail message, or facsimile transmission between a provider and a recipient or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support Telemental Health Services.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(r) (Accessed Feb. 2021).

Telephone conversations, e-mail or text messages, and facsimile transmissions between a dentist and a Medicaid member or between two dentists are not considered telehealth services and are not covered by Medicaid when provided as standalone services.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 84 (Accessed Jul. 2021).

 

Last updated 07/15/2021

Live Video

POLICY

Reimbursement policy applies to fee-for-service and Medicaid Managed Care plans.

New York reimburses for two-way electronic audio-visual communications to delivery clinical health care services to a patient at an originating site by a telehealth provider located at a distant site. The totality of the communication of information exchanged between the physician or other qualified health care practitioner and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.

Telehealth should not be used by a provider if it may result in any reduction to the quality of care required to be provided to a Medicaid member or if such service could adversely impact the member.

NY Medicaid does not reimburse for telehealth used solely for the convenience of the practitioner when a face-to-face visit is more appropriate and/or preferred by the member.

New York Medicaid does not reimburse the acquisition, installation, and maintenance of telecommunication devices or systems.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 1-4. (Accessed Jul. 2021).

Mental Health

A program applying to utilize telemental health must complete a “Telemental Health Services Standards Compliance Attestation” form (Appendix 1) and attach it to the Administrative Action request, or to the email request for designated providers, for approval by OMH. The attestation assures OMH that the provider’s plan for the use of telemental health conforms to the technological and clinical standards. See guidance for further requirements.

SOURCE: NY Office of Mental Health, Telepsychiatry Standards Guidance, 2020, pg. 2, (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Federally Qualified Health Centers (FQHCs)

FQHCs that have “opted into” Ambulatory Patient Groups (APGs) should follow the billing guidance outlined for sites billing under APGs.

FQHCs that have not opted into APGs:

  • When services are provided via telemedicine to a patient located at an FQHC originating site, the originating site may bill only the FQHC offsite services rate code (4012) to recoup administrative expenses associated with the telemedicine encounter.
  • When a separate and distinct medical service, unrelated to the telemedicine encounter, is provided by a qualified practitioner at the FQHC originating site, the originating site may bill the Prospective Payment System (PPS) rate in addition to the FQHC offsite services rate code (4012).
  • If a provider who is onsite at an FQHC is providing services via telemedicine to a member who is in their place of residence or other temporary location, the FQHC should bill the FQHC off-site services rate code (4012) and report the applicable modifier (95 or GT) on the procedure code line.
  • If the FQHC is providing services as a distant site provider, the FQHC may bill their PPS rate.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Jul. 2021).

Telemental Health Services may be authorized by the office for licensed or designated services provided by Telemental Health Practitioners.

Under the Medicaid program, Telemental Health Services are covered when medically necessary and under the following circumstances:

  • The person receiving services is located at the originating/spoke site and the Telemental Health Practitioner is located at the distant/hub site;
  • The person receiving services is present during the encounter;
  • The request for Telemental Health Services and the rationale for the request are documented in the individual’s clinical record;
  • The clinical record includes documentation that the encounter occurred; and
  • The Telemental Health Practitioner at the distant/hub site is (1) authorized in New York State; (2) practicing within his/her scope of specialty practice; (3) affiliated with the originating/spoke site facility; and (4) if the originating/spoke site is a hospital, credentialed and privileged at the originating/spoke site facility.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5 & 596.7 (Accessed Jul. 2021).

Teledentistry

Services provided by means of telehealth must be in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all other relevant laws and regulations governing confidentiality, privacy, and consent.

Reimbursement for teledentistry be made in accordance with existing Medicaid policy related to supervision and billing rules and requirements.  See manual for billing procedures.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 83-86 (Accessed Jul. 2021).


ELIGIBLE PROVIDERS

Providers who may deliver telemedicine services include:

  • Licensed physician
  • Licensed physician assistant
  • Licensed dentist
  • Licensed nurse practitioner
  • Licensed registered professional nurse (only when such nurse is receiving patient- specific health information or medical data at a distant site by means of RPM)
  • Licensed podiatrist
  • Licensed optometrist
  • Licensed psychologist
  • Licensed social worker
  • Licensed speech language pathologist or audiologist
  • Licensed midwife
  • Physical Therapists
  • Occupational Therapists
  • Certified diabetes educator
  • Certified asthma educator
  • Certified genetic counselor
  • Hospital (including residential health care facilities serving special needs populations)
  • Home care services agency
  • Hospice
  • Credentialed alcoholism and substance abuse counselor
  • Providers authorized to provide services and service coordination under the early intervention program
  • Clinics licensed or certified under Article 16 of the MHL
  • Certified and Non-certified day and residential programs funded or operated by the OPWDD
  • Care manager employed by or under contract to a health home program, patient centered medical home, office for people with developmental disabilities Care Coordination Organization (CCO), hospice or a voluntary foster care agency certified by the office of children and family services. (in Public Health Law only)
  • Certified peer recovery advocate services providers certified by the commissioner of addiction services and supports pursuant to section 19.18-b of the mental hygiene law, peer providers credentialed by the commissioner of addiction services and supports and peers certified or credentialed by the office of mental health (in Public Health Law only)
  • Or any other provider as determined by the Commissioner. (in Public Health Law only)

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc & NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 5-6. (Accessed Jul. 2021).

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

Telemental Health

Telemental Health Services may be authorized by the office for licensed or designated services provided by Telemental Health Practitioners, as defined in section 596.4 of this Part, from a site distant from the location of a recipient, where the recipient is physically located at a provider site licensed by the office, or the recipient’s place of residence or other temporary location within or outside the state of New York.

‘Telemental health practitioner’ means a physician, nurse practitioner in psychiatry, psychologist, mental health counselor, social worker, marriage and family therapist, creative arts therapist, or psychoanalyst who is providing Telemental Health Services from a distant or hub site.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(q) & 596.5(a) (Accessed Jul. 2021).

As the final step in the approval process, though not required, OMH Field Office licensing staff may conduct a remote readiness review to either or both the originating and/or distant sites to review the use of Telemental Health Services as part of the routine certification process.  See guidance for detials.

SOURCE: NY Office of Mental Health, Telepsychiatry Standards Guidance, 2020, pg. 2, (Accessed Jul. 2021).

Home Telehealth

Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates or fees established for home telehealth services and subject to federal financial participation shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth as defined in Section 2999-cc.

SOURCE: NY Statute, Social Services Law SOS §367-u.  (Accessed Jul. 2021).

Teledentistry

Dentists providing services via telehealth must be licensed and currently registered in accordance with NYS Education Law or other applicable law and enrolled in NYS Medicaid. Telehealth services must be delivered by dentists acting within their scope of practice.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 83 (Accessed Jul. 2021).

Originating and Distant sites must be located within the fifty United States or United States’ territories and may include:

  • Facilities licensed under Article 28 of the Public Health Law (PHL): hospitals, nursing homes and diagnostic and treatment centers;
  • Facilities licensed under Article 40 of the PHL: hospice programs;
  • Facilities as defined in subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL): clinics certified under Articles 16, 31 and 32;
  • Certified and non-certified day and residential programs funded or operated by the Office of People with Developmental Disabilities (OPWDD);
  • Private physician or dentist offices located within the State of New York;
  • Adult care facilities licensed under Title 2 of Article 7 of the Social Security Law (SSL);
  • Public, private and charter elementary and secondary schools located within the State of New York;
  • School-age child care programs located within the State of New York;
  • Child daycare centers located within the State of New York; and,
  • The member’s place of residence in New York State, or other temporary location in or out of state.

SOURCE:  Dental Procedure Manual. 1/1/20. P. 83 (Accessed. Jul. 2021).


ELIGIBLE SITES

The distant site is any secure location within the fifty United States or United States’ territories where the telehealth provider is located while delivering health care services by means of telehealth.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3. (Accessed Jul. 2021).

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

Telemental Health

The recipient can be physically located at a provider site licensed by the office, or the recipient’s place of residence or other temporary location within or outside the state of New York.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5(a) (Accessed Jul. 2021).

Originating site means a site at which a patient is located at the time health care services are delivered to him or her by means of telehealth.

SOURCE: NY Public Health Law Article 29 – G Section 2999- cc, (Accessed Jul. 2021).

As the final step in the approval process, though not required, OMH Field Office licensing staff may conduct a remote readiness review to either or both the originating and/or distant sites to review the use of Telemental Health Services as part of the routine certification process.  See guidance for detials.

SOURCE: NY Office of Mental Health, Telepsychiatry Standards Guidance, 2020, pg. 3, (Accessed Jul. 2021).

Teledentistry

Originating Site is defined as “a site at which a patient is located at the time health care services are delivered to him or her by means of telehealth.”

Originating and Distant sites must be located within the fifty United States or United States’ territories and may include:

  • Facilities licensed under Article 28 of the Public Health Law (PHL): hospitals, nursing homes and diagnostic and treatment centers;
  • Facilities licensed under Article 40 of the PHL: hospice programs;
  • Facilities as defined in subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL): clinics certified under Articles 16, 31 and 32;
  • Certified and non-certified day and residential programs funded or operated by the Office of People with Developmental Disabilities (OPWDD);
  • Private physician or dentist offices located within the State of New York;
  • Adult care facilities licensed under Title 2 of Article 7 of the Social Security Law (SSL);
  • Public, private and charter elementary and secondary schools located within the State of New York;
  • School-age child care programs located within the State of New York;
  • Child daycare centers located within the State of New York; and,
  • The member’s place of residence in New York State, or other temporary location in or out of state.

When services are provided by an Article 28 facility, the telehealth dentist must be credentialed and privileged at both the originating and distant sites in accordance with Section 2805-u of PHL.

SOURCE:  Dental Procedure Manual. 1/1/20. P. 84 (Accessed. Jul. 2021).

The commissioner may specify in regulation acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.

SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

When services are provided via telemedicine to a member located at an Article 28 originating site (outpatient department/clinic, emergency room), the originating site may bill only CPT code Q3014 (telehealth originating-site facility fee) through APGs to recoup administrative expenses associated with the telemedicine encounter.

When a separate and distinct medical service, unrelated to the telemedicine encounter, is provided by a qualified practitioner at the originating site, the originating site may bill for the medical service provided in addition to Q3014. The CPT code billed for the separate and distinct service must be appended with the 25 modifier.

When a telemedicine service is being provided by a distant-site practitioner to a member located in a private practitioner’s office (originating site), the originating-site practitioner may bill CPT code Q3014 to recoup administrative expenses associated with the telemedicine encounter.

When a telemedicine service is being provided by a distant-site practitioner to a member located in a private practitioner’s office (originating site) and the originating-site practitioner provides a separate and distinct medical service unrelated to the telemedicine encounter, the originating- site practitioner may bill for the medical service provided in addition to Q3014. The CPT code billed for the separate and distinct medical service must be appended with the 25 modifier.

Only one clinic payment will be made when both the originating site and the distant site are part of the same provider billing entity. In such cases, only the originating site should bill Medicaid for the telemedicine encounter.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 8-10. (Accessed Jul. 2021).

The originating site can bill for administrative expenses only when a telemental health service connection is being provided and a qualified mental health professional is not present at the originating site with the patient at the time of the encounter.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.7(e) (Accessed Jul. 2021).

Last updated 07/15/2021

Miscellaneous

Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in section 2999-cc(4) of the public health law.

SOURCE: Social Services Law Article 367-u. (Accessed Jul 2021).

Culturally competent translation and/or interpretation services must be provided when the member and distant practitioner do not speak the same language.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6. (Accessed Jul. 2021).

The patient must be present for telemental health services for Medicaid reimbursement.  Telemental health is also defined as “real-time”.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(r) (Accessed Jul. 2021).

See rule for requirements needed for approval for telemental health services.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5 & 596.6. (Accessed Jul. 2021).

Mental Health

See clinical guidelines for tele-mental health services in guidance document.  Also includes billing gudiance, managed care reimbursement, technology and telecommunications guidance, and guidance for contracting with telemedicine companies.

SOURCE: NY Office of Mental Health, Telepsychiatry Standards Guidance, 2020, pg. 7-9, (Accessed Jul. 2021).

Last updated 07/15/2021

Out of State Providers

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

A distant site must be located within any of the fifty United States or United States’ territories where a telehealth provider is located when delivering health care services by means of telehealth.

The originating site must be located within the fifty United States or United States’ territories.

Practitioners providing services via telehealth must be licensed or certified, currently registered in accordance with NYS Education Law or other applicable law, and enrolled in NYS Medicaid.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3 & 6. (Accessed Jul. 2021).

The distant site must possess a current, valid license, permit, or limited permit to practice in New York State.

Psychiatrists and nurse practitioners in psychiatry may deliver services from a site located within the United States, including from a space in a place of residence approved by the Office of Mental Health; and

Mental health practitioners may deliver services from a site located within the State of New York, including from a space in a place of residence approved by the Office of Mental Health.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.6. (Accessed Jul. 2021).

Last updated 07/15/2021

Overview

New York Medicaid offers live video reimbursement and some reimbursement for store-and-forward and home health services. The New York State Department of Health released a Medicaid telehealth expansion in 2019 and the Office of Mental Health released telepsychiatry guidance in November 2019.

Additional guidance has been released since however they appear to be tied to the COVID-19 emergency and temporary.

Last updated 07/15/2021

Remote Patient Monitoring

POLICY

RPM included within definition of “telehealth” in statute requiring Medicaid Reimburse telehealth delivery of services.

Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates or fees established for home telehealth services provided pursuant to subdivision three-c of section thirty-six hundred fourteen of the public health law.

Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in subdivision four of section two thousand nine hundred ninety-nine-cc of the public health law.

SOURCE: Social Services Law Title 11, Article 367-u & NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Jul. 2021).

Remote patient monitoring (RPM) uses digital technologies to collect medical data and other personal health information from members in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, blood pressure, heart rate, weight, blood sugar, blood oxygen levels and electrocardiogram readings. RPM may include follow-up on previously transmitted data conducted through communication technologies or by telephone.

Follow-up is included in the monthly time component.

Remote patient monitoring services are billed using CPT code “99091” and should not be billed more than once per member per month. Billing should occur on the last day of each month in which RPM is used. A fee of $48.00 per month will be paid for RPM for a minimum of 30 minutes per month spent collecting and interpreting a member’s RPM data.

FQHCs that have opted out of APGs are unable to bill for RPM services.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4 & 11-12. (Accessed Jul. 2021).


CONDITIONS

Medical conditions that may be treated/monitored by means of RPM include, but are not limited to:

  • Congestive heart failure
  • Diabetes
  • Chronic obstructive pulmonary disease
  • Wound care
  • Polypharmacy
  • Mental or behavioral problems
  • Technology-dependent care, such as continuous oxygen, ventilator care, total parenteral nutrition, or enteral feeding.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4. (Accessed Jul. 2021).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

The following considerations apply to RPM:

  1. Medical conditions that may be treated/monitored by means of RPM include, but are not limited to, congestive heart failure, diabetes, chronic obstructive pulmonary disease, wound care, polypharmacy, mental or behavioral problems, and technology-dependent care such as continuous oxygen, ventilator care, total parenteral nutrition or enteral feeding.
  2. RPM must be ordered and billed by a physician, nurse practitioner or midwife, with whom the member has or has entered into a substantial and ongoing relationship. RPM can also be provided and billed by an Article-28 clinic, when ordered by one of the previously mentioned qualified practitioners.
  3. Members must be seen in-person by their practitioner, as needed, for follow-up care.
  4. RPM must be medically necessary and shall be discontinued when the member’s condition is determined to be stable/controlled.
  5. Payment for RPM while a member is receiving home health services through a Certified Home Health Agency (CHHA) is pursuant to PHL Section 3614 (3-c)(a) – (d) and will only be made to that same CHHA.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4-5. (Accessed Jul. 2021).

Last updated 07/15/2021

Store and Forward

POLICY

Store-and-forward technology involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site.

Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4. (Accessed Jul.  2021).

Reimbursement for store-and-forward is made to the consulting distant-site practitioner and is paid at 75 percent of the Medicaid fee for the service provided.

The consulting provider must provide the requesting originating-site practitioner with a written report of the consultation and use the GQ modifier in order for payment to be made.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Jul. 2021).

Teledentistry

Store-and-Forward Technology – involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site. Accompanying payable services will be reimbursed at 75% of the requested fee, not exceeding 75% of the current Medicaid fee.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 85 (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Store-and-forward services may be reimbursed, based on the definition of telehealth.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Jul. 2021).

Teledentistry

Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the
member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 85 (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Teledentistry

Procedure code Q3014 may be used by the provider at the originating site.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 85 (Accessed Jul. 2021).

Last updated 07/15/2021

Definitions

Telehealth means the use of electronic information and communications technologies by a health care provider to deliver health services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located.

SOURCE: NY Insurance Law Article 32 Section 3217-h & Article 43 Section 4306-g. (Accessed Jul. 2021).

Last updated 07/15/2021

Parity

SERVICE PARITY

An insurer may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the policy. An insurer may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 32 Section 3217-h, (Accessed Jul. 2021)

A corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract. A corporation may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 43 Section 4306-g. (Accessed Jul. 2021).


PAYMENT PARITY

An insurer may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 32 Section 3217-h, (Accessed Jul. 2021)

A corporation may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 43 Section 4306-g. (Accessed Jul. 2021).

Last updated 07/15/2021

Requirements

An insurer shall not exclude from coverage a service that is otherwise covered under a policy that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth.  Provided, however, that an insurer may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the policy.

An insurer may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 32 Section 3217-h (Accessed Jul. 2021).

A corporation shall not exclude from coverage a service that is otherwise covered under a contract that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth.  Provided, however, that a corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract. A corporation may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth. A corporation may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 43 Section 4306-g. (Accessed Feb. 2021).

Last updated 07/15/2021

Cross State Licensing

Speech Language Pathologists and Audiologists

If you intend to provide telepractice services to a resident of New York State, you must hold a New York State license and be in compliance with the relevant law, rules and regulations.

New York State law permits a person from another state to perform speech-language pathology or audiology services in this State, as long as such services are performed for no more than thirty (30) days in any calendar year and provided that such services are performed in conjunction with and/or under the supervision of Speech-Language Pathologist or Audiologist licensed under Article 159 of the New York State Education Law.

SOURCE: NY Office of the Professions, Speech-Language Pathologists, Practice Guidelines, (Accessed Jul. 2021).

Last updated 07/15/2021

Definitions

“Telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program established under section three hundred sixty-six of the social services law, and the child health insurance plan under title one-A of article twenty-five of this chapter, telehealth shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner. This subdivision shall not preclude the delivery of health care services by means of “home telehealth” as used in section thirty-six hundred fourteen of this chapter.

Telemedicine means the use of synchronous, two-way electronic audio-visual communications to deliver clinical health care services, which shall include the assessment, diagnosis, and treatment of a patient, while such a patient is at the originating site and a telehealth provider is at a distant site.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

Related to Credentialing and Privileging health care practitioners providing telemedicine

“Telemedicine means the delivery of clinical health care services by means of real time two-way electronic audio-visual communications which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care, while such patient is at the originating site and the health care provider is at a distant site.”

SOURCE: NY Public Health Law Article 28 – Section 2805-u. (Accessed Jul. 2021).

Telepractice is a means of delivering services provided by an OASAS certified program subject to any other regulations applicable to the program’s certified modality regarding evaluations, admissions, treatment/recovery plan development and review, discharge, etc. The program must have received an operating certificate “designation” from the Office to utilize this means of service delivery.

SOURCE: NY Office of Alcoholism and Substance Abuse Services. Telepractice Standards for OASAS Designated Providers. (Dec. 2019), p 1, (Accessed Jul. 2021).

Applied Behavior Analysis, Mental Health Practitioners, Psychology Practice & Social Work

Telepractice includes the use of telecommunications and web-based applications to provide assessment, diagnosis, intervention, consultation, supervision, education and information across distance. It may include providing non-face-to-face [applied behavior analysis (ABA) services], psychological, mental health, marriage and family, creative arts, psychoanalytic, psychotherapy and social work services via technology such as telephone, e-mail, chat and videoconferencing.

SOURCE: NY Office of the Professions, Applied Behavior Analysis, Practice Guidelines; Mental Health Practitioners, Telepractice; Psychology Practice, Telepractice Guidelines; Social Work, Telepractice Guidelines, (Accessed Jul. 2021).

Speech Language Pathology and Audiology

“Telepractice” is providing service that is not “in person” and is delivered through the use of technology. Such technology may include, but is not limited to: telephone, telefax, email, internet, or videoconference. It is considered a mode of practice and the same standards that apply to all forms of practice in the speech-language pathology and audiology professions would apply to telepractice. With reference to speech-language pathology and audiology, telepractice is the use of technology for the application of speech language pathology and audiology services over a distance by connecting a qualified and licensed clinician to a client or one clinician to another for assessment, treatment, and/or consultation.

SOURCE: NY Office of the Professions, Speech Language Pathology and Audiology, Practice Guidelines, (Accessed Jul. 2021).

Physical Therapy

“Telepractice” is providing service that is not “in person” and is facilitated through the use of technology. Such technology may include, but is not limited to, telephone, telefax, e-mail, internet, or videoconference.

SOURCE: NY Office of the Professions, Physical Therapy. Practice Guidelines, (Accessed Jul. 2021).

Last updated 07/15/2021

Licensure Compacts

No Reference Found

Last updated 07/15/2021

Miscellaneous

Telemental health services may only be utilized in personalized Recovery Oriented Services program or Assertive Community Treatment programs under certain conditions.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.3 (Accessed Jul. 2021).

Office of Alcoholism and Substance Abuse Services (OASAS)

Telepractice services, as defined in this Part, may be authorized by the office for the delivery of certain addiction services provided by practitioners employed by, or pursuant to a contract or memorandum of understanding (MOU) with a program certified by the office.  See regulation for details.

SOURCE:  NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Jul. 2021).

Providers requesting authorization to use this means of service delivery must submit a Telepractice Plan and Attestation (Appendix B) to their Regional Office and to the OASAS Bureau of Certification.

OASAS has specific telepractice standards for its providers.  See regulation for details.

SOURCE:  NY Office of Alcoholism and Substance Abuse Services.  Telepractice Standards for OASAS Designated Providers.  (Dec. 2019).  (Accessed Jul. 2021).

Demonstration rates of payment or fees shall be established for telehealth services provided by a certified home health agency, a long term home health care program or AIDS home care program, or for telehealth services by a licensed home care services agency under contract with such an agency or program, in order to ensure the availability of technology-based patient monitoring, communication and health management. Reimbursement is provided only in connection with Federal Food and Drug Administration-approved and interoperable devices that are incorporated as part of the patient’s plan of care.

SOURCE: NY Public Health Law Article 36 Section 3614(3-c). (Accessed Jul. 2021).

Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) are prohibited from being delivered via telehealth.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 635-13.4(c). (Accessed Jul. 2021).

Each agency that operates a clinic treatment facility shall provide the Office for People with Developmental Disabilities (OPWDD) information it requests, including but not limited to the following: services provided by CPT/HCPCS and/or CDT codes, where such services were delivered, including the location of both the provider and the individual when services are delivered via telehealth, (i.e., on-site or at a certified satellite site, or, prior to April 1, 2016, off-site) and revenues by funding SOURCE or payee. These data shall correspond to the identical time period of the cost report.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 679.6(b). (Accessed Jul. 2021).

Last updated 07/15/2021

Online Prescribing

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine requires a preliminary face-to-face evaluation by the Drug Addiction Treatment Act (DATA) 2000 waived prescribing professional, unless otherwise authorized.  See OASAS Telepractice Standards outlines practitioner requirements for prescribing buprenorphine.

SOURCE: NY Office of Alcoholism and Substance Abuse Services. Telepractice Standards for OASAS Designated Providers. (Dec. 2019), p. 3 (Accessed Jul. 2021).

Induction and prescribing of addiction medications must be done in accordance any and all applicable Federal rules and regulations; guidance may be found in the Telepractice Standards for OASAS Designated Providers posted on the OASAS website.

SOURCE:  NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Jul. 2021).

Last updated 07/15/2021

Professional Board Standards

Profession-Specific Telepractice Guidance is available for:

  • Applied Behavior Analysis
  • Audiology
  • Mental Health Practitioners
  • Physical Therapy
  • Psychology
  • Social Work
  • Speech-Language Pathology

SOURCE: NY Office of the Professions, Applied Behavioral Analysis, Practice Alerts – Telepractice; Audiology, Practice Alerts – Telepractice; Mental Health Practitioner, Practice Alerts – Telepractice; Physical Therapy, Practice Alerts – Telepractice; Psychology Practice Alerts – Telepractice; Social Work Practice Alerts – Telepractice; Speech Language Pathology Practice Alerts – Telepractice, (Accessed Jul. 2021).