North Dakota

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

North Dakota Medicaid

Administrator

North Dakota Dept. of Human Services

Regional Telehealth Resource Center

Great Plains Telehealth Resource and Assistance Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: IMLC, PTC, NLC, EMS
Consent Requirements: Yes

Last updated 07/08/2021

Audio-Only Delivery

Office of the Governor: Telehealth and Licensing Requirements

STATUS: Expired. State of emergency rescinded and all related executive orders.

Human Services: Covid-19 Temporary Telehealth Policy for Right Track

STATUS: Active. Expires date national emergency is declared over. National PHE is still active.

Medicaid: COVID-19 Temporary Telehealth Policy

STATUS: Active. Expires date national emergency is declared over. National PHE is still active.

ND Insurance Department: Expansion of Telehealth Services

STATUS: Expired. Executive order based on rescinded.

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Traditional IID/DD HCBS Waiver

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

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

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

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

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Autism Spectrum Disorder (ASD) birth through thirteen

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Traditional IID/DD HCBS Waiver; Children’s Hospice; Medicaid Waiver for Home and Community Based Services; Autism Spectrum Disorder (ASD) birth through thirteen; Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE.

Last updated 07/08/2021

Cross-State Licensing

Office of the Governor: Telehealth and Licensing Requirements

STATUS: Expired. State of emergency rescinded and all related executive orders.

Office of the Governor: Licensing Requirements for Hospitals and Health Care Facilities

STATUS: Expired. State of emergency rescinded and all related executive orders.

Last updated 07/08/2021

Easing Prescribing Requirements

No Reference Found

Last updated 07/08/2021

Originating Site

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Traditional IID/DD HCBS Waiver

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

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

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

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

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Autism Spectrum Disorder (ASD) birth through thirteen

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Traditional IID/DD HCBS Waiver; Children’s Hospice; Medicaid Waiver for Home and Community Based Services; Autism Spectrum Disorder (ASD) birth through thirteen; Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE

Last updated 07/08/2021

Private Payer

Office of the Governor: Telehealth and Licensing Requirements

STATUS: Expired. State of emergency rescinded and all related executive orders.

ND Insurance Department: Expansion of Telehealth Services

STATUS: Includes permanent policies & policies during COVID-19 declaration.

Last updated 07/08/2021

Provider Type

No Reference Found

Last updated 07/08/2021

Service Expansion

Office of the Governor: Telehealth and Licensing Requirements

STATUS: Expired. State of emergency rescinded and all related executive orders.

Medicaid: Teledentistry – COVID-19 Temporary Policy

STATUS: Active. Expires date national emergency is declared over. National PHE is still active.

Medicaid: COVID-19 Temporary Telehealth Policy

STATUS: Active. Expires date national emergency is declared over. National PHE is still active.

ND Insurance Department: Expansion of Telehealth Services

STATUS: Expired. Executive order based on rescinded.

Last updated 07/08/2021

Definitions

Telemedicine is the use of interactive audio-video equipment to link practitioners and patients at different sites. Telemedicine involves two collaborating provider sites: an “originating site” and a “distant site”. The client/patient is located at the originating site and the practitioner is located at the distant site and provides those professional services allowed/reimbursed by ND Medicaid.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157, (Apr. 2021), (Accessed Jul. 2021).

Last updated 07/08/2021

Email, Phone & Fax

Telephonic encounters are not covered by ND Medicaid.

ND Medicaid does not cover non face to face services (e.g., telephone, email).

No reference found for FAX.

SOURCE: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs.  (Apr. 2021) P. 62 & 92 (Accessed Jul. 2021).

Targeted Case Management

Telephone calls, in person and email contacts are allowable costs under transitional care management (TCM).

SOURCE:  North Dakota Department of Human Services: Targeted Case Management – Individuals with a serious mental illness or serious emotional disturbance. (Jan. 2021) P. 7-8 (Accessed Jul. 2021).

Last updated 07/07/2021

Live Video

POLICY

The totality of the communication of the information exchanged between the physician or other qualified healthcare professional 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 a face-to-face interaction.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157, (Apr. 2021), (Accessed Jul. 2021).

Indian Health Services

Coverage and payment of services provided through telemedicine is on the same basis as those provided through face-to-face contact.

SOURCE: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs.  (Apr. 2021) P. 74 (Accessed Jul. 2021).

Teledentistry

Synchronous teledentistry is reimbursable and reported in addition to other ND Medicaid-covered procedures provided to the patient, when applicable. Dentists and dental offices must report the appropriate CDT Code for these procedures.

The patient record must include the CDT codes that reflect the teledentistry encounter. ND Medicaid reimburses for CDT code D9995 once per date of service. Submissions must be billed using place of service code 02. Service authorization is not required for CDT code D9995.

SOURCE:  North Dakota Department of Human Services: Teledentistry Policy. (July 2019).  (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Qualified services for telemedicine must:

  • Maintain actual visual contact (face-to-face) between the practitioner and patient.
  • Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
  • Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service.
  • The service must be provided using a HIPAA compliant platform.

See manual for appropriate coding.

All service limits set by ND Medicaid apply to telemedicine services.

Except for non-covered services noted below, telemedicine can be used for services covered by Medicaid, and otherwise allowed, per CPT, to be rendered via telemedicine.

Noncovered Services:

  • Therapies provided in a group setting
  • Store and Forward
  • Targeted Case Management for High Risk Pregnant Women and Infants
  • Targeted Case Management for Individuals in need of Long-Term Care Services

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157-158, (Apr. 2021), (Accessed Jul. 2021).

Medication Therapy Management (MTM)

Tele-pharmacy or telehealth is allowed for reimbursement with real time audio and visual conferencing.  Both the origination site (where the recipient is located) and the distant site (where the MTM provider is located) must be in the state of North Dakota.  The origination site must meet privacy and space requirements.

SOURCE: ND Div. of Medical Assistance, Medication Therapy Management Provider Manual, p. 2 & 7, (May 2019), (Accessed Jul. 2021).

Dentistry

See manual for service codes that can be delivered utilizing synchronous real-time teledentistry.

SOURCE: ND Div. of Medical Assistance, Dental Services Provider Manual, p. 21-32, (Jul. 2021), (Accessed Jul. 2021).


ELIGIBLE PROVIDERS

Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.

Payment is made for services provided by licensed professionals enrolled with ND Medicaid and within the scope of practice per their licensure only.

Telemedicine services provided by an Indian Health Service (IHS) facility or a Tribal 638 Clinic functioning as the distant site, are reimbursed at the All-Inclusive Rate (AIR), regardless whether the originating site is outside the “four walls” of the facility or clinic.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157-158, (Apr. 2021), (Accessed Jul. 2021).


ELIGIBLE SITES

Payment will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Apr. 2021), (Accessed Jul. 2021).

Health Services billed by schools can be delivered via telemedicine; however, no originating site fee is allowed. See Services Rendered via Telemedicine chapter for additional information.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 77, (Apr. 2021), (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Payment will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.

Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157-158, (Apr. 2021), (Accessed Jul. 2021).

Last updated 07/08/2021

Miscellaneous

No Reference Found

Last updated 07/08/2021

Out of State Providers

No Reference Found

Last updated 07/08/2021

Overview

North Dakota reimburses for live video telemedicine for most services, with a few exceptions.  They do not provide reimbursement for store-and-forward and no reference was found for remote patient monitoring.

Last updated 07/08/2021

Remote Patient Monitoring

POLICY

Home health services include telemonitoring.

Home Health Telemonitoring will be covered within the same limits noted above. Home Telemonitoring is not allowed for the initial Home Health evaluation visit or for the discharge visit. In addition, Home Health Telemonitoring is limited to no more than forty percent (40%) of the total visits during each certification period.

SOURCE: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs.  (Apr. 2021) P. 59 & 62 (Accessed Jul. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 07/08/2021

Store and Forward

POLICY

North Dakota Medicaid does not reimburse for store-and-forward.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Apr. 2021), (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 07/08/2021

Definitions

Telehealth:

  • Means the use of interactive audio, video or other telecommunications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site and that is delivered over a secure connection that complies with the requirements of state and federal laws.
  • Includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real-time or through the use of store-and-forward technology.
  • Does not include the electronic mail, facsimile transmissions, or audio-only unless for the purpose of e-visits or a virtual check-in.

SOURCE: ND Century Code Sec. 26.1-36-09.15(1)(g). (Accessed Jul. 2021).

Last updated 07/08/2021

Parity

SERVICE PARITY

An insurer must provide coverage for telehealth delivered services to the same extent as the same coverage for in-person services.  They are not required to provide coverage for health services that are not medically necessary.

SOURCE: ND Century Code Sec. 26.1-36-09.15(2) & (5). (Accessed Jul. 2021).

Insurance carriers must start or continue to provide covered services via telehealth visits. These services include, but are not limited to the following:

  • Office visits for patients
  • Physical therapy plan evaluation
  • Occupational therapy plan evaluation
  • Speech therapy plane valuation
  • Behavioral health and substance use disorder treatment
  • Diabetes Education
  • Nutrition Counseling.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Jul. 2021).


PAYMENT PARITY

Payment or reimbursement of expenses for covered health services delivered by means of telehealth under this section may be established through negotiations conducted by the insurer with the health services providers in the same manner as the insurer establishes payment or reimbursement of expenses for covered health services that are delivered by in-person means.

SOURCE: ND Century Code Sec. 26.1-36-09.15(3). (Accessed Jul. 2021).

In addition to traditional telehealth services carriers must expand telehealth under the CMS guidance and now offer coverage for e-visits and virtual check-ins. Insurance carriers shall establish reasonable requirements for the coverage of these virtual check-ins and e-visits in accordance with the guidance issued by CMS on MArch 17, 2020.  See bulletin for required codes.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Jul. 2021).

Last updated 07/08/2021

Requirements

An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.

A policy is not required to provide coverage for health services that are not medically necessary, subject to the terms and conditions of the policy.

SOURCE: ND Century Code Sec. 26.1-36-09.15. (Accessed Jul. 2021).

Telehealth. The organization may pay for audio and video telecommunications instead of a face-to-face “hands on” appointment for CPT codes designated by the American medical association as telehealth codes. As a condition of payment, the patient must be present and participating in the telemedicine appointment. The professional fee payable is equal to the fee schedule amount for the service provided. The organization may pay the originating site a facility fee at the scheduled amount.

SOURCE: ND Admin. Code 92-01-02-34 (3d). (Accessed Jul. 2021).

Insurance carriers must start or continue to provide covered services via telehealth visits. These services include, but are not limited to the following:

  • Office visits for patients
  • Physical therapy plan evaluation
  • Occupational therapy plan evaluation
  • Speech therapy plane valuation
  • Behavioral health and substance use disorder treatment
  • Diabetes Education
  • Nutrition Counseling.

In addition to traditional telehealth services carriers must expand telehealth under the CMS guidance and now offer coverage for e-visits and virtual check-ins. Insurance carriers shall establish reasonable requirements for the coverage of these virtual check-ins and e-visits in accordance with the guidance issued by CMS on MArch 17, 2020.  See bulletin for required codes.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Jul. 2021).

Last updated 07/08/2021

Cross State Licensing

The board may also, in its discretion, enter into reciprocal agreements with the licensing agencies of other states or territories or the District of Columbia providing for a reciprocal waiver of further examination or any part thereof.

SOURCE: ND Century Code Sec. 43-17-21 (Accessed Jul. 2021).

Medical Nutrition Therapy and Nutrition Care Services

An individual providing services regulated by this chapter via telehealth shall comply with, and is subject to, all licensing and disciplinary provisions of this chapter.

SOURCE: Senate Bill 2187 (2021 Session) & ND Century Code Ch. 43-44-19 (Accessed Jul. 2021).

Last updated 07/08/2021

Definitions

“Telemedicine” means the practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. The term includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.

SOURCE: ND Admin Code Sec. 50-2-15-01 (Accessed Jul. 2021).

Stroke system of care task force

“Telemedicine services means the use of interactive audio, video, and other electronic media used for the purpose of diagnosis, consultation, or treatment of acute stroke.”

SOURCE: ND Century Code Sec. 23-43-05. (Accessed Jul. 2021).

North Dakota uses federal definitions for “internet” and “practice of telemedicine” set in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.

SOURCE: ND Century Code Sec. 19-02.1-15.1(1)(d). (Accessed Jul. 2021).

The term ‘practice of telemedicine’ means, for purposes of this title, 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 section 1834(m) of the Social Security Act.  See statute for additional requirements.

SOURCE: Ryan Haight Online Pharmacy Consumer Protection Act of 2008 [Pub. L. 110-425; 21 U.S.C. 802-803]. (Accessed Jul. 2021).

Physical Therapy:

“Telehealth” is the use of electronic communications to provide and deliver health-related information and health care services, including physical therapy-related information and services, over any distance. Telehealth encompasses health care and health promotion activities, including education, advice, reminders, interventions, and the monitoring of interventions.

SOURCE: ND Admin. Code 61.5-01-02-01. (Accessed Jul. 2021).

Chiropractic Examiners

“Telehealth” means the use of electronic communications to provide and deliver chiropractic related information and chiropractic services, including chiropractic-related information and services, over any distance. Telehealth encompasses chiropractic care and chiropractic promotion activities, including education, advice, reminders, interventions, and the monitoring of interventions.

SOURCE: ND Century Code 43-06-01 & Senate Bill 2060 (2021 Session), (Accessed Jul. 2021).

Dentistry

Telehealth” means the federal Health Insurance Portability and Accountability Act compliant practice of providing health care to a patient of record, using electronic technology or secure communication technologies between a licensee in one location and a patient in another location.

SOURCE: ND Admin Code 20-01-02-01 (Accessed Jul. 2021).

Medical Nutrition Therapy and Nutrition Care Services

“Telehealth” means the use of electronic information and telecommunications technologies to provide services under this chapter to support clinical health care, patient and professional health-related education, public health, and health administration between a licensee in one location and an individual in another location.

SOURCE: Senate Bill 2187 (2021 Session) & ND Century Code Ch. 43-44-01 (Accessed Jul. 2021).

Last updated 07/08/2021

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE:  PT Compact. Compact Map.  (Accessed Jul. 2021).

Member of the Nurses Licensure Compact.

SOURCE:  Current NLC States & Status.  Nurse Licensure Compact.  (Accessed Jul. 2021).

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. Interstate Medical Licensure Compact. (Accessed Jul. 2021).

Last updated 07/08/2021

Miscellaneous

Under the Worker’s Compensation Act, the originating sites may receive a facility fee at the scheduled amount.

SOURCE: ND Admin. Code 92-01-02-34 (3d). (Accessed Jul. 2021).

Last updated 07/08/2021

Online Prescribing

“In-person medical evaluation” means a medical evaluation that is conducted with the patient in the physical presence of the practitioner, without regard to whether portions of the evaluation are conducted by other practitioners, and must include one of the following actions: … The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a practitioner who has conducted an in-person medical evaluation of the patient.

SOURCE: ND Century Code Sec. 19-02.1-15.1.(c) & (f) (Accessed Jul. 2021).

Last updated 07/08/2021

Professional Board Standards

North Dakota statute outlines standard of care and professional ethics for dentists.

SOURCE: House Bill 1151 (2021 Session) & ND Century Code Ch. 43-28-11.3 (Accessed Jul. 2021).

North Dakota statute describes when use of telehealth for the provision of medical nutrition therapy and nutrition care services is allowed.

SOURCE: Senate Bill 2187 (2021 Session) & ND Century Code Ch. 43-44-19 (Accessed Jul. 2021).

Dentistry

Each patient shall have access to health provider information as it pertains to their treating doctor or potential doctors. Any entity, utilizing telehealth must provide upon request of a patient the name of the dentist, telephone number, practice address, and state license number of any dentist who was involved with the provision of services to a patient before, prior to, or during the rendering of dental services.

SOURCE: ND Admin Code 20-01-02-09 (Accessed Jul. 2021).