North Dakota

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
1 / 5

MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

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

FQHCs

  • Originating sites explicitly allowed for Live Video: No
  • Distant sites explicitly allowed for Live Video: No
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: North Dakota Medicaid
  2. Administrator: North Dakota Dept. of Human Services
  3. Regional Telehealth Resource Center: Great Plains Telehealth Resource and Assistance Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

COVID-19

Last updated 01/25/2023

Audio-Only Delivery

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.

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 01/25/2023

Cross-State Licensing

Previous COVID-19 waivers expired.

Last updated 01/25/2023

Easing Consent Requirements

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

STATUS: Active, until 6 Months after the end of 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 end of the Federal PHE

Last updated 01/25/2023

Easing Prescribing Requirements

No Reference Found

Last updated 01/25/2023

Miscellaneous

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 01/25/2023

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 01/25/2023

Private Payer

Previous COVID-19 waivers expired.

Last updated 01/25/2023

Provider Type

Medicaid: COVID-19 Temporary Telehealth Policy

STATUS: Active until the end of the National PHE.

Last updated 01/25/2023

Service Expansion

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.

Private Payer

Last updated 01/25/2023

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). p. 20 (Accessed Jan. 2023).

Last updated 01/25/2023

Parity

SERVICE PARITY

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 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(2) & (5). p. 21 (Accessed Jan. 2023).

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 Jan. 2023).

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). p. 21 (Accessed Jan. 2023).

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 Jan. 2023).

Last updated 11/09/2022

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. p. 21 (Accessed Jan. 2023).

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) p. 34 (Accessed Jan. 2023).

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 Jan. 2023).

Medicaid

Last updated 01/25/2023

Consent Requirements

No Reference Found

Last updated 01/25/2023

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, (Oct. 2022), (Accessed Jan. 2023).

Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, two-way interaction between the patient and at least one dental, medical or health caregiver at one physical location, and an overseeing supervising or consulting dentist or dental provider at another location. The communication is real-time and continuous between all participants who are working together as a group. Use of audiovisual telecommunications technology means that all involved persons can see what is happening and talk about in a natural manner.

SOURCE: North Dakota Human Services Teledentistry Policy (July 2019), (Accessed Jan. 2023)

Last updated 01/25/2023

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. (Oct. 2022) P. 65 & 101 (Accessed Jan. 2023).

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. (Oct. 2022) P. 8 (Accessed Jan. 2023).

Last updated 01/25/2023

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, (Oct. 2022), (Accessed Jan. 2023).

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 Jan. 2023).

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.
  • Use appropriate coding. 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, (Oct. 2022), (Accessed Jan. 2023).

Indian Health Services and Tribally Operated 638 Facilities

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

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, IHS, p. 78, (Oct. 2022), (Accessed Jan. 2023).

Medicaid Services Rendered in Schools

Services rendered in schools may be delivered via telemedicine. See the Telemedicine chapter for additional information on services rendered via telemedicine.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Schools, p. 91, (Oct. 2022), (Accessed Jan. 2023).

Home Health Services

Telemonitoring is a covered service. See remote patient monitoring section.

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. 38, (Jul. 2022), (Accessed Jan. 2023).

Medication Assisted Treatment

The member must require at least one face to face or by telemedicine check‐in per month for prescribing or dispensing of OBOT/OTP medication.

Telemedicine must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA)(28 USC 802) for prescribing and administration of controlled substances.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, MAT, p. 95 & 97, (Oct. 2022), (Accessed Jan. 2023).

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. 158, (Oct. 2022), (Accessed Jan. 2023).

Rural Health Clinics

Coverage and payment of services provided through telemedicine is on the same basis as those provided through face-to-face contact.  See Telemedicine chapter for additional information on services rendered via telemedicine.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, RHCs, p.78, (Oct. 2022), (Accessed Jan. 2023).

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, (Oct. 2022), (Accessed Jan. 2023).

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. 81, (Oct. 2022), (Accessed Jan. 2023).

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.

Health Services billed by schools can be delivered via telemedicine; however, no originating site fee is allowed.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 81 & 158, (Oct. 2022), (Accessed Jan. 2023).

Last updated 01/25/2023

Miscellaneous

Telepharmacy

For services delivered via telepharmacy or telehealth:

  • Both the origination site (where the member is located) and the distant site (where the provider is located) must meet the geographic location, privacy, and space requirements outlined above
  • Provider is responsible for supplying audio and video equipment permitting two-way, real-time interactive communication between the origination and distant sites

SOURCE: ND Human Services, Provider Manual for Pharmacy Medical Billing, May 2022, pg. 4, (Accessed Jan. 2023).

Last updated 01/25/2023

Out of State Providers

No Reference Found

Last updated 01/25/2023

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 01/25/2023

Remote Patient Monitoring

POLICY

Home Health Services

Telemonitoring is a covered service. Medical necessity for the home health services must be supported in the medical record. The visit may be performed via telehealth or in person; telephone encounter is not sufficient.

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: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 65 (Oct. 2022), (Accessed Jan. 2023).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Last updated 01/25/2023

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, (Oct. 2022), (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 01/25/2023

Consent Requirements

Physical Therapy:

“Consultation by telehealth” means that a physical therapist renders professional or expert opinion or advice to another physical therapist or professional health care provider via electronic communications or computer technology from a distant location. The patient’s written or verbal consent will be obtained and documented prior to such consultation. All records used or resulting from a consultation by means of telehealth are part of a patient’s record and are subject to applicable confidentiality requirements.

SOURCE: ND Admin. Code 61.5-01-02-01(3). (Accessed Jan. 2023).

Last updated 01/25/2023

Cross State Licensing

The board may in its discretion license by endorsement an applicant who has complied with licensure requirements and who has passed an examination given by a recognized certifying agency approved by the licensing agency, provided such examination was, in the opinion of the board, equivalent in every respect to its examination. 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. In any case the applicant must appear before the board for such examination into the applicant’s qualifications as may be required by the board.

SOURCE: ND Century Code Sec. 43-17-21 p. 8 (Accessed Jan. 2023).

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: ND Century Code Ch. 43-44-19 p. 11 (Accessed Jan. 2023).

Last updated 01/25/2023

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 Jan. 2023).

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.  The stroke system of care task force shall recommend
eligible essential health care services for acute stroke care provided through telemedicine services.

SOURCE: ND Century Code Sec. 23-43-05. (Accessed Jan. 2023).

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 Jan. 2023).

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 Jan. 2023).

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 Jan. 2023).

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, (Accessed Jan. 2023).

Physicians

“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. “Telemedicine” includes direct interactive patient encounters, asynchronous store-and-forward technologies, and remote monitoring.

SOURCE: ND Century Code 43-17-01, (Accessed Jan. 2023).

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: ND Century Code Ch. 43-44-01 (Accessed Jan. 2023).

Last updated 01/25/2023

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE:  PT Compact. Compact Map.  (Accessed Jan. 2023).

Member of the Nurses Licensure Compact.

SOURCE:  Current NLC States & Status.  Nurse Licensure Compact.  (Accessed Jan. 2023).

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. Interstate Medical Licensure Compact. (Accessed Jan. 2023).

Member of Emergency Medical Services Compact.

SOURCE: Interstate Commission for EMS Personnel Services, EMS Compact Member States, (Accessed Jan. 2023).

Advanced Practice Registered Nurse (APRN) Compact

SOURCE: NCSBN, APRN Compact, (Accessed Jan. 2023).

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

Last updated 01/25/2023

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). p. 34 (Accessed Jan. 2023).

Dentistry

Each patient shall have access to health provider information as it pertains to their treating doctor or potential doctors. Any entity utilizing telehealth shall 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 or during the rendering of dental services.

SORUCE: ND Admin. Code 20-02-01-9, (Accessed Jan. 2023).

Last updated 01/25/2023

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 Jan. 2023).

A licensee practicing telemedicine shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient. A licensee practicing telemedicine shall verify the identity of the patient seeking care and shall disclose, and ensure the patient has the ability to verify, the identity and licensure status of any licensee providing medical services to the patient.

Before initially diagnosing or treating a patient for a specific illness or condition, an examination or evaluation must be performed. An examination or evaluation may be performed entirely through telemedicine, if the examination or evaluation is equivalent to an in-person examination.

  • An examination utilizing secure videoconferencing or store-and-forward technology for appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation meets this standard, as does an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of the provider’s profession, providing necessary physical findings to the licensee. An examination or evaluation consisting only of a static online questionnaire or an audio conversation does not meet the standard of care.
  • Once a licensee conducts an acceptable examination or evaluation, whether in-person or by telemedicine, and establishes a patient-licensee relationship, subsequent followup care may be provided as deemed appropriate by the licensee, or by a provider designated by the licensee to act temporarily in the licensee’s absence. In certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as teleradiology or intensive care unit monitoring, it is not medically necessary for an independent examination of the patient to be performed.
A licensee practicing telemedicine is subject to all North Dakota laws governing the adequacy of medical records and the provision of medical records to the patient and other medical providers treating the patient.
A licensee must have the ability to make appropriate referrals of patients not amenable to diagnosis or complete treatment through a telemedicine encounter, including a patient in need of emergent care or complementary in-person care.

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Jan. 2023).

A controlled substance that is a prescription drug may not be delivered, distributed, or dispensed by means of the internet without a valid prescription, but nothing in this subsection may be construed to imply that one in-person medical evaluation by itself demonstrates that a prescription has been validly issued for a legitimate medical purpose within the usual course of professional practice.

This section applies to the delivery, distribution, and dispensing of a controlled substance by means of the internet from a location whether within or outside this state to a person or an address in this state.

Nothing in this section applies to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the practice of telemedicine in accordance with applicable federal and state laws.

“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 at least one in-person medical evaluation of the patient; or
  • Covering practitioner.
“Covering practitioner” means, with respect to a patient, a practitioner who conducts a medical evaluation, other than an in-person medical evaluation, at the request of a practitioner who:
  • Has conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine, within the previous twenty-four months; and
  • Is temporarily unavailable to conduct the evaluation of the patient.

A licensee who has performed a telemedicine examination or evaluation meeting the requirements of this chapter may prescribe medications according to the licensee’s professional discretion and judgment. Opioids may only be prescribed through telemedicine if done so as a federal food and drug administration-approved medication-assisted treatment for opioid use disorder. Opioids may not be prescribed through a telemedicine encounter for any other purpose.

Licensees who prescribe controlled substances, as defined by North Dakota law, in circumstances allowed under this rule, must comply with all state and federal laws regarding the prescribing of controlled substances, and must participate in the North Dakota prescription drug monitoring program.

SOURCE: ND Admin Code Sec. 50-02-15-02, (Accessed Jan. 2023).

Last updated 01/25/2023

Professional Board Standards

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

SOURCE: ND Century Code Ch. 43-28-11.3 (AccessedJan. 2023).

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

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Jan. 2023).

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

SOURCE: ND Century Code Ch. 43-44-19 (Accessed Jan. 2023).

Veterinary Board

Veterinary medicine includes telemedicine, laser therapy, chemotherapy, and rehabilitation services.

SOURCE: ND Admin Code Sec. 87-06-02, (Accessed Jan. 2023).

Federally Qualified Health Center (FQHC)

Last updated 01/25/2023

Definition of Visit

For FQHCs, the term “encounter” is defined as a face-to-face visit with the member during which a qualifying encounter service is rendered. FQHCs may furnish services that qualify as a medical, dental or behavior health encounter.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2022, pg. 49, (Accessed Jan. 2023).

Last updated 01/25/2023

Eligible Distant Site

While there is an explicit reference to Indian Health Service facilities or Tribal 638 clinics being reimbursed as an eligible provider, no reference was found for FQHCs.

See: ND Medicaid Live Video Eligible Providers

Last updated 01/25/2023

Eligible Originating Site

FQHCs are not listed explicitly as an eligible originating site.

See: ND Medicaid Live Video Eligible Sites.

Last updated 01/25/2023

Facility Fee

Facility fee only available to service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility.  No direct reference to FQHCs is made.

See: ND Medicaid Live Video Facility/Transmission Fee

Last updated 01/25/2023

Home Eligible

While the  Telemedicine Section of the General Information Medicaid Manual indicates that Indian Health Service facilities or Tribal 638 clinics can be reimbursed regardless of whether the originating site is outside the four walls of the facility or clinic, no reference is found for FHQCs.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Oct. 2022), (Accessed Jan. 2023). 

Last updated 01/25/2023

Modalities Allowed

Live Video

ND FQHC section of General Information manual refers providers to telemedicine manual.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2022, pg. 50, (Accessed Jan. 2023).

ND Medicaid reimburses for synchronous telemedicine when the amount and nature of the interaction is sufficient to meet the key components of the same service rendered via a face-to-face interaction.  However, no direct reference was found to whether or not FQHCs can be reimbursed for live video  in telemedicine manual.

See: ND Medicaid Live Video

Store and Forward

ND Medicaid does not reimburse for store-and-forward.

See: ND Medicaid Store and Forward

Remote Patient Monitoring

Telemonitoring is a covered service under home health services for ND Medicaid but no reference was found to whether or not FQHCs can be reimbursed for remote patient monitoring.

See: ND Medicaid Remote Patient Monitoring

Audio-Only

Telephonic encounters are not covered by ND Medicaid, with the exception of telephone calls reported as allowable costs under transitional care management (TCM).  No reference was found for FHQCs. 

See: ND Medicaid Audio-Only

Last updated 01/25/2023

Patient-Provider Relationship

No reference found.

Last updated 01/25/2023

PPS Rate

While there is an explicit reference to Indian Health Service facilities or Tribal 638 clinics receiving the all-inclusive rate (AIR), there is no reference found for FQHCs.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Oct. 2022), (Accessed Jan. 2023).

Last updated 01/25/2023

Same Day Encounters

Face-to-face services with more than one health professional and/or multiple services with the same health professionals on the same day and at a single location constitute a single encounter, except when one of the following conditions exist:

  • After the first encounter, the member suffers an illness or injury requiring additional diagnosis or treatment;
  • The member receives more than one type of service: medical, behavioral health, or dental.

Medical nutritional therapy or a diabetes self-management training provided on the same day as a medical encounter is not eligible for a separate encounter. If medical nutritional therapy or diabetes self-management training are the only medical service provided, a medical encounter may be claimed.

See the Telemedicine chapter for additional information on services rendered via telemedicine.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2022, pg. 50, (Accessed Jan. 2023).