Ohio

CURRENT STATE LAWS & POLICY


AT A GLANCE

Medicaid Program

Ohio Medicaid

Administrator

Ohio Department of Job and Family Services

Regional Telehealth Resource Center

Upper Midwest Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes, with limitations
Remote Patient Monitoring: Yes, with limitations

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: None
Consent Requirements: Yes

Last updated 07/06/2021

Audio-Only Delivery

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS:  Active for duration of COVID-19 emergency.  OH State of Emergency ended on June 18.

Medicaid Managed Care: Telehealth Provider Guide

STATUS:  References permanent policies, as well as COVID-19 specific scenarios.

Medicaid: Emergency Telehealth Rules

STATUS:  Not specified, however OH State of Emergency ended on June 18.

Medicaid: COVID-19 Telehealth Emergency Rule July 17 and Appendix

STATUS:  Expired

Medicaid: When Medicaid Telehealth Coverage Differs from Medicare and Third-Party Telehealth Coverage

STATUS:  Expired. OH State of Emergency ended on June 18.

Medicaid: Emergency Rules FAQs

STATUS:  Expired

Medicaid: Telehealth Billing Guidelines during COVID-19 Mar. 9, 2020 – Nov. 14, 2020

STATUS:  Expired

Medicaid: Infographic on Telehealth Expansions

STATUS:  Expired

Dept. of Mental Health & Addiction: Behavioral Health Services

STATUS:  Expired. Permanent regulation adopted.

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Medicaid 1915(c) Waiver: Appendix K – Individual Options, Level One, and Self-Empowered Life Funding Waiver (SELF)

STATUS:  Active, until 6 months after the conclusion of the PHE (See extension)

Medicaid 1915(c) Waiver: Appendix K – Assisted Living, Ohio Home Care Waiver, My Care Ohio, PASSPORT

STATUS:  Active, until 6 months after the conclusion of the PHE (See extension)

Medicaid 1915(c) Waiver: Appendix K Addendum – Individual Options, Level One, and Self-Empowered Life Funding Waiver (SELF)

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

Medicaid 1915(c) Waiver: Appendix K – Assisted Living, Ohio Home Care Waiver, My Care Ohio, PASSPORT

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

 

Last updated 07/06/2021

Cross-State Lincensing

Medical Board:  Telemedicine Guidance

STATUS:  Varies.  OH State of Emergency ended on June 18. Federal public health emergency is still active.

Last updated 07/06/2021

Easing Prescribing Requirements

Medical Board:  Telemedicine Guidance

STATUS:  Varies.  OH State of Emergency ended on June 18. Federal public health emergency is still active.

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Mental Health and Addiction Services: COVID-19 and Opioid Treatment Telehealth

STATUS:  Active, until document updated

Mental Health and Addiction Services: COVID-19 Guidance for the Field Office Based Opioid Treatment

STATUS:  Active, until document updated

Last updated 07/06/2021

Miscellaneous

No Reference Found

Last updated 07/06/2021

Originating Site

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS:  Active for duration of COVID-19 emergency.  OH State of Emergency ended on June 18.

Medicaid: Emergency Telehealth Rules

STATUS:  Not specified, however OH State of Emergency ended on June 18.

Medicaid: Telehealth Billing Guidelines during COVID-19 Mar. 9, 2020 – Nov. 14, 2020

STATUS:  Expired

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Medicaid 1915(c) Waiver: Appendix K Addendum – Individual Options, Level One, and Self-Empowered Life Funding Waiver (SELF)

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

Last updated 07/06/2021

Private Payer

HB 122: Private Payer Reimbursement

STATUS: Pending

Last updated 07/06/2021

Provider Type

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS:  Active for duration of COVID-19 emergency.  OH State of Emergency ended on June 18.

Medicaid: Emergency Telehealth Rules

STATUS:  Not specified, however OH State of Emergency ended on June 18.

Medicaid: COVID-19 Telehealth Emergency Rule July 17 and Appendix

STATUS:  Expired

Medicaid: When Medicaid Telehealth Coverage Differs from Medicare and Third-Party Telehealth Coverage

STATUS:  Expired. OH State of Emergency ended on June 18.

Medicaid: Emergency Rules FAQs

STATUS:  Expired

Medicaid: Telehealth Billing Guidelines during COVID-19 Mar. 9, 2020 – Nov. 14, 2020

STATUS:  Expired

Medicaid: Infographic on Telehealth Expansions

STATUS:  Expired

Dept. of Mental Health & Addiction: Behavioral Health Services

STATUS:  Expired. Permanent regulation adopted.

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Mental Health and Addiction Services: COVID-19 Guidance for the Field Office Based Opioid Treatment

STATUS:  Active, until document updated

Mental Health and Addiction Services: Guidance for Behavioral Health

STATUS:  Review of permanent policies

Last updated 07/06/2021

Service Expansion

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS:  Active for duration of COVID-19 emergency.  OH State of Emergency ended on June 18.

Medicaid Managed Care: Telehealth Provider Guide

STATUS:  References permanent policies, as well as COVID-19 specific scenarios.

Medicaid: Telehealth Billing Guidelines

STATUS:  Includes permanent policies but also covered services during COVID-19 State of Emergency.  OH State of Emergency ended on June 18.

Medicaid: Emergency Telehealth Rules

STATUS:  Not specified, however OH State of Emergency ended on June 18.

Medicaid: COVID-19 Telehealth Emergency Rule July 17 and Appendix

STATUS:  Expired

Medicaid: When Medicaid Telehealth Coverage Differs from Medicare and Third-Party Telehealth Coverage

STATUS:  Expired. OH State of Emergency ended on June 18.

Medicaid: Emergency Rules FAQs

STATUS:  Expired

Medicaid: Telehealth Billing Guidelines during COVID-19 Mar. 9, 2020 – Nov. 14, 2020

STATUS:  Expired

Medicaid: Infographic on Telehealth Expansions

STATUS:  Expired

Medicaid:  Codes Reimbursed

STATUS:  Expired.

Dept. Of Mental Health & Addiction:  Emergency Rule Interactive Videoconferencing

STATUS:  Expired. Permanent regulation adopted.

Dept. of Mental Health & Addiction: Behavioral Health Services

STATUS:  Expired. Permanent regulation adopted.

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Mental Health and Addiction Services: COVID-19 and Opioid Treatment Telehealth

STATUS:  Active, until document updated

Mental Health and Addiction Services: Guidance for Behavioral Health

STATUS:  Review of permanent policies

Last updated 07/06/2021

Definitions

“Telehealth” is the direct delivery of health care services to a patient related to the diagnosis, treatment, and management of a condition.

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR

The following activities that are asynchronous or do not have both audio and video elements:

  • Telephone calls
  • Remote patient monitoring
  • Communication with a patient through secure electronic mail or a secure patient portal

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021 & OAC 5160-1-18. (Accessed Feb. 2021).

Conversations or electronic communication between practitioners regarding a patient without the patient present is not considered telehealth unless the service would allow billing for practitioner-to-practitioner communication in a non-telehealth setting.

SOURCE: OAC 5160-1-18. (Accessed Jul. 2021).

Mental Health Services

Telehealth means the use of, real-time audiovisual communications of such quality as to permit accurate and meaningful interaction between at least two persons, one of which is a certified provider of the service being provided. Asynchronous modalities that do not have both audio and video elements are considered telehealth.

SOURCE: OAC 5122-29-31. (Accessed Jul. 2021).

“Telehealth service” means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

SOURCE:  OH Revised Code, Sec. 5164.95. (Accessed Jul. 2021).

Managed Care

Telehealth, as defined in emergency rule 5160-1-21* of the Ohio Administrative Code (OAC), is the direct delivery
of healthcare services to a patient via synchronous, interactive, real-time electronic communication comprising both audio and video elements; or activities that are asynchronous and do not have both audio and video elements such as telephone calls, images transmitted via facsimile machine, and electronic mail.

Telehealth is an umbrella term for remote care that may include healthcare education and administration as well as real-time clinical services. Telemedicine, a subset of telehealth, describes real-time clinical healthcare services provided through electronic technology when distance separates the patient and healthcare provider.

SOURCE: Managed Care Plan Provider Telehealth Resource Guide, pg. 3, (Accessed Jul. 2021).

Last updated 07/06/2021

Email, Phone & Fax

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR

The following activities that are asynchronous or do not have both audio and video elements:

  • Telephone calls
  • Remote patient monitoring
  • Communication with a patient through secure electronic mail or a secure patient portal

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021 & OAC 5160-1-18.  (Accessed Jul. 2021).

Office of Mental Health and Addiction Services

Services must be provided using interactive, secure, real-time audiovisual communications of such quality
to permit accurate and meaningful interaction between at least two persons, one of which is a certified provider of the service being provided pursuant to Chapter 5122-25 of the Administrative Code. This expressly excludes telephone calls, images transmitted via facsimile machine, and text messages with visualization of the other person. Services that may be provided by certified community behavioral health centers by telephone contact are CPST and SUD case management.

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Jul. 2021).

Pre-admission Screening and Resident Review

Pre-admission Screenings and Resident Reviews (PASRR) should be completed via the electronic HENS system as they are today as these screenings are primarily via desk review. In instances where a face-to-face is required, a telephonic and/or desk review is permissible. Level II evaluations can be provided either by telephone or desk review when appropriate. There is no system or reimbursement impact as these functions are supported by the level II entities and the applicable contractor.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Jul. 2021). 

Last updated 07/06/2021

Live Video

POLICY

Ohio Medicaid covers live video telemedicine for certain eligible providers wherever the covered individual is located.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. & OAC 5160-1-18.  (Accessed Jul. 2021).

The department of Medicaid is required to establish standards for Medicaid payment for health care services the department determines are appropriate to be covered when provided as telehealth services.

SOURCE: OH Revised Code, Sec. 5164.95.(B) (Accessed Jul. 2021).

Inmates of a penal facility or a public institution are not eligible for reimbursement for telehealth services.

SOURCE: OH Admin Code 5160-1-18(E). (Accessed Jul. 2021).

Mental Health

No initial in person visit is necessary to initiate services using telehealth modalities. The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

SOURCE: OAR 5122-29-31 (Accessed Jul. 2021).

Office of Mental Health and Addiction Services

OhioMHAS-certified behavioral health centers are not subject to the Ohio Medicaid Telehealth rule 5160-1-18.
However, if you are a behavioral health provider or other health care entity and are not certified by OhioMHAS, you are/or may be required to follow Ohio Medicaid rule 5160-1-18.

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Jul. 2021).

Teledentistry

The department is required to establish standards for Medicaid payment for services provided through teledentistry.

SOURCE: OH Revised Code, Sec. 5164.951. (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See Medicaid guidance document and appendix to new rule 5160-1-18 for eligible services for telehealth delivery on or after November 15, 2020.

If the practitioner site does not bill the Ohio Department of Medicaid (ODM) directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Feb. 2021).

The following services are eligible for payment when delivered through telehealth from the practitioner site:

  • When provided by a patient centered medical home, or behavioral health providers, evaluation and management of a new patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
  • Evaluation and management of an established patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
  • Inpatient or office consultation for a new or established patient when providing the same quality and timeliness of care to the patient other than by telehealth is not possible
  • Mental health or substance use disorder services described as “psychiatric diagnostic evaluation” or “psychotherapy”
  • Remote evaluation of recorded video or images submitted by an established patient.
  • Virtual check-in by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient.
  • Online digital evaluation and management service for an established patient.
  • Remote patient monitoring.
  • Audiology, speech-language pathology, physical therapy, and occupational therapy services, including services provided in the home health setting.
  • Medical nutrition services.
  • Lactation counseling provided by dietitians.
  • Psychological and neuropsychological testing.
  • Smoking and tobacco use cessation counseling.
  • Developmental test administration.
  • Limited oral evaluation.
  • Hospice services.
  • Private duty nursing services.
  • State plan home health services.
  • Dialysis related services.
  • Services under the specialized recovery services (SRS) program as defined in rule 5160-43-01 of the Administrative Code.
  • Notwithstanding paragraph (D)(2) of this rule, behavioral health services covered under Chapter 5160-27 of the Administrative Code.
  • Optometry services.

SOURCE: OH Admin Code 5160-1-18(D). (Accessed Jul. 2021).

Mental Health

The following are the services that may be provided via telehealth:

  • General services
  • CPST service
  • Therapeutic behavioral services and psychosocial rehabilitation service
  • Peer recovery services
  • SUD case management service
  • Crisis intervention service
  • Assertive community treatment service
  • Intensive home-based treatment service

Individuals receiving residential and withdrawal management substance use disorder services or mental health day treatment service may receive any of the component services listed above through telehealth.

SOURCE: OAC 5122-29-31. (Accessed Jul. 2021).

Managed Care

Many clinically appropriate services that can be delivered virtually will be eligible for telehealth coverage, including but not limited to: sick visits, well visits, prenatal and postpartum care, behavioral health, and monitoring of chronic conditions. This is especially important for Medicaid members who experience a variety of access related barriers to care and social determinants of health.  All Telemedicine/Telehealth services must be medically necessary and documented and in the applicable medical record in order to be reimbursable. Documentation may be requested to support medical necessity reviews.  See guide for telehealth visit code set.

SOURCE: Managed Care Plan Provider Telehealth Resource Guide, pg. 3-7, (Accessed Jul. 2021).

Office of Mental Health and Addiction Services

Services that may be provided using real-time, interactive videoconferencing as a certified community behavioral health center are:

  • Telehealth
  • General Services
  • Assessments
  • Counseling and therapy including groups up to 12
  • Medical Activities including prescribing as allowed by the State of Ohio Medical Board and practitioner’s
    licensure
  • CPST Services
  • Therapeutic behavioral services and psychosocial rehabilitation services

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Jul. 2021).

Outpatient hospital behavioral health services (OPHBH)

Hospitals are eligible to provide outpatient behavioral health services via telehealth to the extent they appear on the OPHBH fee schedule.

Federally Qualified Health Center and Rural Health Clinics

Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS.

Group therapy will continue to be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).

Services under the Specialized Recovery Services (SRS) program are not currently covered FQHC or RHC services.

Dental

Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth during this state of emergency.  Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services.

Hospice

Hospice services can be provided using telehealth when clinically appropriate.

Home Health Services

Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Jul. 2021).

Nursing Facilities

In accordance with rule 5160-1-18 of the Administrative Code, physician visits may be provided via telehealth.

SOURCE: Ohio Administrative Code 5160-3-19(4). (Accessed Jul. 2021).

Hospice

Hospice providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate procedure code listed in the administrative code. Ohio Department of Medicaid will allow telehealth services to be provided where in-person visits are mandated. Services billed with T2044 and T2045 are not eligible to be provided via telehealth.

SOURCE: Ohio Administrative Code 5160-56-06. (Accessed Jul. 2021).

Home Health and Private Duty Nursing

Reimbursement of home health or private duty nursing (PDN) services in accordance with this chapter are on a per visit basis. A “visit” is the duration of time that a covered home health service or private duty nursing (PDN) service is provided during an in- person or telehealth encounter to one or more individuals receiving medicaid at the same residence on the same date during the same time period.

A visit begins with the provision of a covered service and ends when the in-person or telehealth encounter ends.

SOURCE: Ohio Administrative Code 5160-12-04, (Accessed Jul. 2021).

Registered Nurse Assessment and Registered Nurse Consultation Services

The RN assessment may be completed using telehealth.

SOURCE: Ohio Administrative Code 5160-12-08, (Accessed Jul. 2021).

Home Health Services

The face- to-face encounter may be completed using telehealth.

SOURCE: Ohio Administrative Code 5160-12-01, (Accessed Jul. 2021).


ELIGIBLE PROVIDERS

Eligible providers:

  • Physician, Psychiatrist
  • Ophthalmologist (in billing guide only)
  • Podiatrist (in billing guide only)
  • Psychologist
  • Physician Assistant
  • Dentist
  • Advanced Practice Registered Nurses:
    • Clinical Nurse Specialist
    • Certified Nurse Midwife
    • Certified Nurse Practitioner
  • Licensed Independent Social Worker
  • Licensed Independent Chemical Dependency Counselor, Supervised practitioners, trainees, residents, and interns
  • Licensed Independent Marriage and Family Therapist
  • Licensed Professional Clinical Counselor
  • Dietitians
  • Audiologist, speech-language pathologist, speech-language pathology aides, audiology aides, and individuals holding a conditional license
  • Occupational and physical therapist and occupational and physical therapist assistants
  • Speech-Language Pathologist
  • Home health aide and hospice aides (in admin code only)
  • Practitioners who are supervised or cannot practice independently (see billing guide for list but many are listed above as well (i.e. physical therapist assistant)
  • Non-Agency Nurses (in billing guide only)
  • Medicaid school program (MSP) practitioners
  • Behavioral health practitioners (in admin code only)
  • Optometrists
  • Pharmacists (in billing guide only)
  • Other practitioners if specifically authorized in rule promulgated under Agency 5160 of the Administrative Code.

Types of providers able to bill: Rendering practitioners listed above, except:

  • Supervised practitioners
  • Occupational therapy assistant
  • Physical therapist assistant
  • Speech-language pathology and audiology aides
  • Individuals holding a conditional license
  • Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a hospice or home health setting (in billing guide only)

Other providers able to bill include:

  • Professional Medical or Dental Group
  • Federally Qualified Health Center
  • Rural Health Clinic
  • Ambulatory health care clinics
  • Outpatient hospitals on behalf of licensed psychologists and independent practitioners not eligible to separately bill when practicing in an outpatient hospital setting.
  • Medicaid school program (MSP)
  • Private duty  or non-Agency nurses
  • Pharmacies (submitted on a professional claim)
  • Home health and hospice agencies (in admin code only)
  • Behavioral health providers (in admin code only)
  • Hospitals operating an outpatient hospital behavioral health program (in admin code only)

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021 & OH Administrative Code 5160-1-18, (Accessed Jul. 2021).

Outpatient Hospitals

Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. Ohio Medicaid will pay according to the Enhanced Ambulatory Patient Grouping (EAPG) pricing as described in OAC rule 5160-2-75.

Federally Qualified Health Center and Rural Health Clinics

For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived.

Nursing Facilities

Nursing facilities (NF) are reimbursed for all telehealth related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth related services they provide. Per the telehealth rule 5160-1-18, physicians and other eligible providers may bill for the services they provide to nursing facility residents from the practitioner’s site in accordance with the rule.  When nursing facilities provide telehealth related services to their residents, they report the costs they incur for those services on the Medicaid NF cost report.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Jul. 2021).

Hospice

Hospice providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate procedure code above. Ohio Department of Medicaid will allow telehealth services to be provided where in-person visits are mandated.

SOURCE: Ohio Administrative Code 5160-56-06. (Accessed Jul. 2021).


ELIGIBLE SITES

“Patient site” is the physical location of the patient at the time a health care service is provided through the use of telehealth.

A modifier as identified in Appendix B of this rule if the physical location of the patient is one of the following locations:

  • The patient’s home (including homeless shelter, assisted living facility, group home, and temporary lodging);
  • School;
  • Inpatient hospital;
  • Outpatient hospital;
  • Nursing facility;
  • Intermediate care facility for individuals with an intellectual disability.

The “practitioner site” is the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth.

SOURCE: Ohio Administrative Code 5160-1-18. (Accessed Jul. 2021).

If the patient is at one of the following locations, a specific modifier identifying the type of location is
required:

  • The patient’s home
  • School
  • Inpatient hospital
  • Outpatient hospital
  • Nursing facility
  • Intermediate care facility for individuals with an intellectual disability

Medicaid covered individuals can access telehealth services wherever they are located. Locations include, but are not limited to:

  • Home
  • School
  • Temporary housing
  • Homeless shelter
  • Nursing Facility
  • Hospital
  • Group home
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)

Penal facility or public institution such as a jail or prison are excluded places of service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

There is no limitation on the practitioner or patient site.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Jul. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 07/06/2021

Miscellaneous

See administrative code for additional provider responsibilities related to HIPAA and other practice standards as well as information about submitting telehealth claims.

SOURCE: OAC 5160-1-18. (Accessed Jul. 2021).

Mental Health Services Provided by Agencies

No initial in person visit is necessary to initiate services using telehealth modalities. The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

The provider must have a written policy and procedure describing how they ensure that staff assisting clients with telehealth services or providing telehealth services are adequately trained in equipment usage.

See rule for additional requirements of behavioral health providers utilizing telehealth.

SOURCE: OAC 5122-29-31. (Accessed Jul. 2021).

Opioid Treatment Programs

Telehealth meetings will only be conducted for stable patients.

SOURCE: OAC 4122-40-05, (Accessed Jul. 2021).

Telemedical procedures will only be allowed for stable patients for purposes of dose adjustment and routine medical appointments. Telemedical induction of any form of medication assisted treatment will only be allowed in accordance with federal and state standards.

SOURCE: OAC 5122-40-09. (Accessed Jul. 2021).

Last updated 07/06/2021

Out of State Providers

Mental Health Services Provided by Agencies

Provider must have a physical location in Ohio or have access to a physical location in Ohio where individuals may opt to receive in person services rather than telehealth services.

SOURCE: OAC 5122-29-31. (Accessed Jul. 2021).

Last updated 07/06/2021

Overview

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward and remote patient monitoring are only reimbursed for certain communication technology-based service codes.

Last updated 07/06/2021

Remote Patient Monitoring

POLICY

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR

The following activities that are asynchronous or do not have both audio and video elements:

  • Telephone calls
  • Remote patient monitoring
  • Communication with a patient through secure electronic mail or a secure patient portal

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021 & OAC 5160-1-18.  (Accessed Jul. 2021).

Remote physiologic monitoring codes 99453, 99454, 99457, and 99458 are listed as a covered telehealth service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. (Accessed Jul. 2021).

Federally Qualified Health Center and Rural Health Clinics

Remote patient monitoring will be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Jul. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 07/06/2021

Store and Forward

POLICY

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR

The following activities that are asynchronous or do not have both audio and video elements:

  • Telephone calls
  • Remote patient monitoring
  • Communication with a patient through secure electronic mail or a secure patient portal

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. & OAC 5160-1-18.  (Accessed Jul. 2021).

Conversations or electronic communication between practitioners regarding a patient without the patient present is not considered telehealth unless the service would allow billing for practitioner to practitioner communication in a non-telehealth setting.

SOURCE: OAC 5160-1-18.  (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

G2010, which is the remote evaluation of recorded video and/or images submitted by an established patient (e.g. store and forward) is listed as a covered telehealth service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 07/06/2021

Definitions

“Telemedicine services” means a mode of providing health care services through synchronous or asynchronous information and communication technology by a health care professional, within the professional’s scope of practice, who is located at a site other than the site where the recipient is located.

SOURCE: OH Revised Code Annotated, 3902.30(A)(5). (Accessed Jul. 2021).

Last updated 07/06/2021

Parity

SERVICE PARITY

A health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for in-person health care services. Plans cannot exclude coverage for a service solely because it is provided as a telemedicine service.

SOURCE: OH Revised Code Annotated, 3902.30 (Accessed  Jul. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 07/06/2021

Requirements

A health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for in-person health care services. Plans cannot exclude coverage for a service solely because it is provided as a telemedicine service.

A health benefit plan may not impose any annual or lifetime benefit maximum on telemedicine services other than what is imposed on all benefits under the plan.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Jul. 2021).

Last updated 07/06/2021

Cross State Licensing

Physical Therapy

If a physical therapy patient is located in Ohio, the physical therapist or physical therapist assistant providing physical therapy services via telehealth shall hold a valid license under sections 4755.40 to 4755.56 of the Revised Code.

SOURCE: OH Admin. Code 4755-27-01(10)(b). (Accessed Jul. 2021).

Optometry

A provider of telehealth services who practices in the state shall be licensed by the board.  A provider of telehealth services who resides out of state and who provides services for Ohio residents shall be licensed by the board.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Jul. 2021).

Last updated 07/06/2021

Definitions

Physical Therapy Practice

“Telehealth means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including, but not limited to physical therapy related information and services, over large and small distances.”

SOURCE: OH Admin. Code 4755-27-01(10). (Accessed Jul. 2021).

Speech Language Pathology

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

SOURCE: OH Admin. Code 4753-2-01(A)(10). (Accessed Jul. 2021).

Counselor, Social Worker and Marriage and Family Therapists

Teletherapy is defined as “Electronic service delivery” which means counseling, social work or marriage and family therapy in any form offered, rendered, or supported by electronic or digitally- assisted approaches, to include when the counselor, social worker or marriage and family therapist and the client are not located in the same place during delivery of services or when electronic systems or digitally-assisted systems are used to support in-person face to face therapy.

SOURCE: OH Admin. Code 4757-5-13 & 4757-3-01(GG). (Accessed Jul. 2021).

Optometry

“Telehealth” means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Jul. 2021).

Last updated 07/05/2021

Licensure Compact

Member of Occupational Therapy Licensure Compact.

SOURCE: Senate Bill 7 (2021 Session), Sec. 4755.062, 4755.14, & 4755.141, (Accessed Jul. 2021).

Last updated 07/06/2021

Miscellaneous

A health care professional providing telemedicine services shall not charge a facility fee, an origination fee, or any fee associated with the cost of the equipment used to provide telemedicine services to a health plan issuer covering telemedicine services.

SOURCE:  OH Revised Code, Sec. 4731.2910.  (Accessed Jul. 2021).

Last updated 07/06/2021

Online Prescribing

A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.

Non-Controlled Substances Exceptions

Prescribing is allowed when a patient is remote from the physician by complying with the following:

  • Establish the patient’s identity and physical location;
  • Obtain the patient’s informed consent;
  • Forward medical record to patient’s primary care provider (upon consent);
  • Conduct an appropriate evaluation;
  • Establish or confirm a diagnosis and treatment plan;
  • Document information in patient’s medical record;
  • Provide or recommend appropriate follow-up care;
  • Make medical record of the visit available to patient; and
  • Use appropriate technology sufficient to conduct all steps.

Separate exceptions exist for prescribing controlled substances when the patient is remote from the physician.  See regulation.

SOURCE: OH Admin. Code 4731-11-09. (Accessed Jul. 2021).

A patient evaluation performed within the previous twenty-four months via telemedicine by a healthcare provider acting within the scope of their professional license is acceptable for satisfying the criteria to be an “active patient”.

SOURCE: OAC 4731-11-01(D). (Accessed Jul. 2021).

Last updated 07/05/2021

Professional Board Standards

Counselor, Social Worker and Marriage and Family Therapist Board

SOURCE: Admin Code 4757-5-13 – Accessed Jul. 2021.

State Board of Speech Language Pathology and Audiology

STATUS: OH Admin. Code 4753-2-01. Accessed Jul. 2021.

Ohio Vision Professionals Board

STATUS: OH Admin. Code 4725-25-01. (Accessed Jul. 2021).