Oregon

At A Glance

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MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

Law Exists: Yes
Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

Licensure Compacts: PTC
Consent Requirements: Yes

FQHCs

Originating sites explicitly allowed for Live Video: No
Distant sites explicitly allowed for Live Video: Yes (telephone encounters)
Store and forward explicitly reimbursed: No
Audio-only explicitly reimbursed: Yes
Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

Medicaid Program: Oregon Medicaid
Administrator: Oregon Health Authority
Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center

Audio-Only Delivery

Medicaid: PHE Authorities and Flexibilities Memo

STATUS: Lists requirements/flexibilities that will end on or before My 11, 2023 and others that extend after May 11, 2023.

Medicaid: Face-to-Face and In-Person Assessment Requirement

STATUS: Announces end of allowance for phone assessments Aug. 15, 2023.

Medicaid: Codes allowed for patients with suspected COVID. Includes telehealth and Audio-only codes.

STATUS: Still accessible on COVID-19 webpage.

State Plan Amendment: Oregon Health Plan coverage of telephone/telemedicine/telehealth services

STATUS: Expired. See PHE Authorities and Flexibilities Memo for items that will continue.

Medicaid: Telemedicine/Telehealth School Based Guidance

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Medicaid: COVID-19 Provider Guide

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Last updated 07/31/2023

Cross-State Licensing

Previous COVID waivers expired or are no longer found.

Last updated 07/31/2023

Easing Prescribing Requirements

Previous COVID-19 waivers expired.

Last updated 07/31/2023

Miscellaneous

Medicaid 1915(c) Waiver: Appendix K Addendum – Aging and People with Disabilities

STATUS: Active, expires six months beyond the end date of the federal Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K – Children’s HCBS Waiver, Adults’ HCBS Waiver, Medically Involved Children’s Waiver (MICW), Medically Fragile (Hospital) Model, Behavioral (ICF/IDD) Model Waiver Combined

STATUS: Active, expires six months beyond the end date of the federal Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K Addendum – Children’s HCBS Waiver, Adults’ HCBS Waiver, Medically Involved Children’s Waiver (MICW), Medically Fragile (Hospital) Model, Behavioral (ICF/IDD) Model Waiver Combined

STATUS: Active, expires six months beyond the end date of the federal Public Health Emergency (PHE)

Last updated 07/31/2023

Originating Site

Medicaid: PHE Authorities and Flexibilities Memo

STATUS: Lists requirements/flexibilities that will end on or before May 11, 2023 and others that extend after May 11, 2023.

Medicaid: COVID-19 Provider Guide

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Medicaid 1915(c) Waiver: Appendix K – Aging and People with Disabilities

STATUS: Active, expires six months beyond the end date of the federal Public Health Emergency (PHE)

Medicaid 1915(c) Waiver: Appendix K Addendum – Aging and People with Disabilities

STATUS: Active, expires six months beyond the end date of the federal Public Health Emergency (PHE)

Last updated 07/31/2023

Private Payer

Consumer and Business Services: Telehealth Guidance for Health Plans

STATUS: Expired

Division of Financial Regulation: Telehealth Page

STATUS: Agreement for expanded telehealth coverage by insurance companies expired as of June 21, 2021. Webpage still active.

Last updated 07/31/2023

Provider Type

Medicaid: PHE Authorities and Flexibilities Memo

STATUS: Lists requirements/flexibilities that will end on or before My 11, 2023 and others that extend after May 11, 2023.

Medicaid: Guidance for Public Education Providers

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Medicaid: COVID-19 Provider Guide

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Last updated 07/31/2023

Service Expansion

Medicaid: PHE Authorities and Flexibilities Memo

STATUS: Lists requirements/flexibilities that will end on or before My 11, 2023 and others that extend after May 11, 2023.

Medicaid: Face-to-Face and In-Person Assessment Requirement

STATUS: Announces end of allowance for phone assessments Aug. 15, 2023.

Medicaid: Codes allowed for patients with suspected COVID. Includes telehealth and Audio-only codes.

STATUS: Still accessible on COVID-19 webpage.

State Plan Amendment: Oregon Health Plan coverage of telephone/telemedicine/telehealth services

STATUS: Expired. See PHE Authorities and Flexibilities Memo for items that will continue.

Medicaid: School Based Guidance

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Medicaid: COVID-19 Provider Guide

STATUS: Still accessible on COVID-19 webpage. Many policies expired due to end of state emergency declaration and federal PHE.

Definitions

“Telemedicine” means the mode of delivering health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a patient’s health care.

“Audio only” means the use of audio telephone technology, permitting real-time communication between a health care provider and a patient for the purpose of diagnosis, consultation or treatment. “Audio only” does not include:

The use of facsimile, electronic mail or text messages.
The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OR Revised Statutes Ch. 743A.058. (Accessed Jul. 2023).

Treatment of Diabetes

“Telemedical means delivered through a two-way electronic communication, including but not limited to video, audio, Voice over Internet Protocol or transmission of telemetry that allows a health professional to interact with a patient, a parent or guardian of a patient or another health professional on a patient’s behalf, who is at an originating site.”

SOURCE: OR Revised Statutes Sec. 743A.185(1)(c). (Accessed Jul. 2023).

Worker’s Compensation

“Telehealth” means providing healthcare remotely by means of telecommunications technology, including but not limited to telemedicine and telephonic or online digital services.

“Telemedicine” means synchronous medical services provided via a real-time interactive audio and video telecommunications system between a patient at an originating site and a provider at a distant site.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jul. 2023).

Last updated 07/31/2023

Parity

SERVICE PARITY

A health benefit plan and a dental-only plan must provide coverage of a health service that is provided using telemedicine if:

The plan provides coverage of the health service when provided in person by a health professional;
The health service is medically necessary;
The health service is determined to be safely and effectively provided using telemedicine according to generally accepted health care practices and standards; and
The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of protected health information.

Plans may not distinguish between originating sites that are rural and urban in providing coverage.

Coverage is subject to the terms and conditions of the plan and the reimbursement specified in the contract between the plan and the health professional.

A health benefit plan and dental-only plan must pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Jul. 2023).

Treatment of Diabetes

A health benefit plan must provide coverage of a telemedical health services provided in connection with the treatment of diabetes if:

The plan provides coverage of the health service when provided in-person by the health professional;
The service is medically necessary;
The telemedical health service relates to a specific patient; and
One of the participants in the telemedical health service is a representative of an academic health center.

A health benefit plan may subject coverage of a telemedical health service to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in-person.

SOURCE: OR Revised Statutes Sec. 743A.185. (Accessed Jul. 2023).

Worker’s Compensation

All services must be appropriate, and the form of communication must be appropriate for the service provided. Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2022 or CPT® 2023.

Equipment or supplies at the distant site are not separately payable.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jul. 2023).

PAYMENT PARITY

Plans not prohibited from the use of value-based payment methods, including capitated, bundled, risk-based or other value-based payment methods, and does not require that any value-based payment method reimburse telemedicine health services based on an equivalent fee-for-service rate.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Jul. 2023).

Worker’s Compensation

Insurers must pay distant site providers at the non-facility rate.

Equipment or supplies at the distant site are not separately payable.

The payment amount for code Q3014 is $35.70 per unit or the provider’s usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.

Professional fees of supporting providers at the originating site are not separately payable.

Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jul. 2023).

Last updated 07/31/2023

Requirements

A health benefit plan and a dental-only plan must provide coverage of a health service that is provided using telemedicine if:

The plan provides coverage of the health service when provided in person by a health professional;
The health service is medically necessary;
The health service is determined to be safely and effectively provided using telemedicine according to generally accepted health care practices and standards; and
The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of protected health information.

Permissible telemedicine applications and technologies include:

Landlines, wireless communications, the Internet and telephone networks; and
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices.

During a state of emergency, a health benefit plan or dental-only plan shall provide coverage of a telemedicine service delivered to an enrollee residing in the geographic area specified in the declaration of the state of emergency, if the telemedicine service is delivered using any commonly available technology, regardless of whether the technology meets all standards required by state and federal laws governing the privacy and security of protected health information.

A health benefit plan and a dental-only plan may not:

Distinguish between rural and urban originating sites in providing coverage or restrict originating sites that qualify for reimbursement.
Restrict a health care provider to delivering services only in person or only via telemedicine.
Use telemedicine health care providers to meet network adequacy standard.
Require an enrollee to have an established patient-provider relationship with a provider to receive telemedicine health services from the provider or require an enrollee to consent to telemedicine services in person.
Impose additional certification, location or training requirements for telemedicine providers or restrict the scope of services that may be provided using telemedicine to less than a provider’s permissible scope of practice.
Impose more restrictive requirements for telemedicine applications and technologies than those specified above.
Impose on telemedicine health services different annual dollar maximums or prior authorization requirements than the annual dollar maximums and prior authorization requirements imposed on the services if provided in person.
Require a medical assistant or other health professional to be present with an enrollee at the originating site.
Deny an enrollee the choice to receive a health service in person or via telemedicine.
Reimburse an out-of-network provider at a rate for telemedicine health services that is different than the reimbursement paid to the out-of-network provider for health services delivered in person.
Restrict a provider from providing telemedicine services across state lines if the services are within the provider’s scope of practice and:
- The provider has an established practice within this state;
- The provider’s employer operates health clinics or licensed health care facilities in this state;
- The provider has an established relationship with the patient; or
- The patient was referred to the provider by the patient’s primary care or specialty provider located in this state.
Prevent a provider from prescribing, dispensing or administering drugs or medical supplies or otherwise providing treatment recommendations to an enrollee after having performed an appropriate examination of the enrollee in person, through telemedicine or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.
Establish standards for determining medical necessity for services delivered using telemedicine that are higher than standards for determining medical necessity for services delivered in person.

A health benefit plan and a dental-only plan shall:

Work with contracted providers to ensure meaningful access to telemedicine services by assessing an enrollee’s capacity to use telemedicine technologies that comply with accessibility standards, including alternate formats, and providing the optimal quality of care for the enrollee given the enrollee’s capacity;
Ensure access to auxiliary aids and services to ensure that telemedicine services accommodate the needs of enrollees who have difficulty communicating due to a medical condition, who need an accommodation due to disability or advanced age or who have limited English proficiency;
Ensure access to telemedicine services for enrollees who have limited English proficiency or who are deaf or hard-of-hearing by providing interpreter services reimbursed at the same rate as interpreter services provided in person; and
Ensure that telemedicine services are culturally and linguistically appropriate and trauma-informed.

No later than March 1, 2023, the Department of Consumer and Business Services shall report to the interim committees of the Legislative Assembly related to health on the impact of the reimbursement on the cost of health insurance premiums in this state.

SOURCE: OR Revised Statutes Ch. 743A.058. (Accessed Jul. 2023).

Treatment of Diabetes

A health benefit plan must provide coverage of a telemedical health service provided in connection with the treatment of diabetes if:

The plan provides coverage of the health service when provided in person by the health professional;
The health service is medically necessary;
The telemedical health service relates to a specific patient; and
One of the participants in the telemedical health service is a representative of an academic health center.

A health benefit plan may not distinguish between rural and urban originating sites in providing coverage under subsection (2) of this section.

A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in person.

SOURCE: OR Revised Statutes Sec. 743A.185(1)(c). (Accessed Jul. 2023).

Worker’s Compensation

All services must be appropriate, and the form of communication must be appropriate for the service provided.

Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2023.

Distant site provider: When billing for telemedicine services, the distant site provider must:

Use the place of service (POS) code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
Use modifier 95 to identify the service as a synchronous medical service rendered via a real-time interactive audio and video telecommunications system.

When billing for telehealth services other than telemedicine services, the distant site provider:

Must use the POS code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
May not use modifier 95.

Originating site billing: When billing for telehealth services, the originating site may charge a facility fee using HCPCS code Q3014, if the site is:

The office of a physician or practitioner; or
A health care facility including but not limited to a hospital, rural health clinic, skilled nursing facility, or community mental health center.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jul. 2023).

Medicaid

Last updated 07/31/2023

Consent Requirements

Prior to the delivery of services via a telemedicine or telehealth modality, a member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in a language that the member understands must be obtained by the health system, clinic, or provider and documented in the member’s health record. Consent must include an assessment of member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the member. Consent must be updated at least annually thereafter. For members and their families with LEP or hearing impairments, providers must use qualified or certified health care interpreters, when obtaining patient consent.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement. (Accessed Jul. 2023).

Prior to the delivery of services via a telemedicine or telehealth modality, a client or member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in the language that the client or member understands must be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent must include an assessment of client or member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the client or member. Consent must be updated at least annually thereafter. For clients or members who experience LEP or hearing impairment clients , providers must use qualified or certified health care interpreters when obtaining client or member consent.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

Teledentistry

A patient receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request. This must be reflected in the patient’s chart documentation.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

School Based Health Services

Providers billing Medicaid for SBHS health related services via telehealth must obtain the child’s/student’s parent or guardian’s written or verbal consent to receive the services via telehealth technologies, prior to the delivery of health-related services to an eligible child/student with disabilities using a telehealth modality. Verbal consent must be documented/noted in the child’s plan of care by the practitioner. Consent must be obtained and documented annually or with change in services on the child/students plan of care.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Jul. 2023).

Last updated 07/31/2023

Definitions

SOURCE: OR Statute 414.723, (Accessed Jul. 2023).

“Telemedicine” means the mode of delivering remote clinical health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a member’s healthcare.

“Telehealth” includes telemedicine and also includes the use of electronic information and telecommunications technologies to support remote clinical healthcare, member and professional health-related education, public health, and health administration.

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include video conferencing, store-and-forward imaging, streaming media including services with information transmitted via landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement & OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

Rules for RHCare Clinics, Certification Requirements for CCare Clinics, Certification Requirements for AbortionCare clinics

“Telehealth” means the provision of healthcare remotely by means of telecommunications technology.

SOURCE: OR Admin Code 333-004-3010, (Accessed Jul. 2023).

Behavioral Health Services

“Telehealth” means a technological solution that provides two-way, video-like communication on a secure line.

SOURCE: OAR 309-032-0860, Health Systems Division: Medical Assistance Programs, Behavioral Health Services. (Accessed Jul. 2023).

Telemedicine encompasses different types of programs, services, and delivery mechanisms for medically appropriate covered services within the recipient’s benefit package.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2023).

Telehealth services include a variety of health services provided by synchronous or asynchronous electronic communications, including secure electronic health portal, audio, or audio and video and clinician-to-clinician virtual consultations.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-2. (1/29/23). (Accessed Jul. 2023).

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

Live video, a two-way interaction between a patient and dentist using audiovisual technology;
Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the patient being present in real time;
Remote patient monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and
Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry, health care, public health practices, and education.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

Telehealth for School Based Health Services (SBHS) is a real time interactive and synchronous audio/video technology from site to site regarding a Medicaid-eligible child’s health-related service. Telehealth is the equivalent to face-to-face therapy/treatment between a licensed practitioner/clinician or under the supervision of a practitioner/clinician within the scope of practice.

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical Assistance Programs, School-Based Health Services. (Accessed Jul. 2023).

The Behavioral Health Loan Repayment Program and Behavioral Health Care Bonus and Housing Stipend Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 309-081-0010 and 309-083-0010, (Accessed Jul. 2023).

Health Care Provider Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 409-036-0010, (Accessed Jul. 2023).

Aging and People with Disabilities and Developmental Disabilities

“Technology and Telehealth” means electronic or virtual means or methods, including but not limited to computer technology, web or internet access, social media, videoconferencing or other technological means or methods to improve resident social isolation and allow for the provision of virtual health care.

SOURCE: OR OAR 411-062-0010, (Accessed Jul. 2023).

Last updated 07/31/2023

Email, Phone & Fax

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include the delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan and 410-120-1990 (Accessed Jul. 2023).

“Audio only” does not include:

The use of facsimile, electronic mail or text messages.
The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Ch. 414.723, (Accessed Jul. 2023).

Covered telephonic and online services include services related to evaluation, assessment and management as well as other technology-based services (CPT 98966-98968, 99441-99443, 99421-99423, 98970-98972, G2012, G2061-G2063, G2251-G2252).

Covered telephone and online services billed using these codes do not include either of the following:

Services related to a service performed and billed by the physician or qualified health professional within the previous seven days, regardless of whether it is the result of patient-initiated or physician-requested follow-up.
Services which result in the patient being seen within 24 hours or the next available appointment.

Covered interprofessional consultations include consultations delivered online, through electronic health records or by telephone
(CPT 99446-99449, 99451-99452)..

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Jul. 2023).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio, or member portal and may include transmission of data from remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan and 410-120-1990 (Accessed Jul. 2023).

SOURCE: OR OAR 410-120-1990 & OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

Behavioral Health

Patient consultations using telephone and online or electronic mail (e-mail) are covered when billed services comply with the practice guidelines set forth by the Health Evidence Review Commission and the applicable HERC-approved code requirements, delivered consistent with the HERC Evidence-Based Guidelines; Patient consultations using videoconferencing, a synchronous (live two-way interactive) video transmission resulting in real time communication between a provider located in a distant site and the recipient being evaluated and located in an originating site, is covered when billed services comply with the billing requirements in rule. Behavioral health services specifically identified as allowable for telephonic delivery are listed on the Behavioral Health Fee schedule published by the Authority.

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2023).

Teledentistry

Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry and health care and public health practices and education.

Unless authorized in OAR 410-120-1200 Exclusions or OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered:

When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

School Based Health Services

Telehealth can be interactive audio/telephonic services provided to a child/student in a geographical area where synchronous audio and video is not available or consent for audio/video is refused for services provided to a child/student.

SOURCE: OR OAR 410-133-0040 Health Systems Division: Medical Assistance Programs, School-Based Health Services. (Accessed Jul. 2023).

The Authority may reimburse telehealth, tele-electronic/telephonic School-Based Health Services (SBHS) provided to the same extent the services would be covered if they were provided in person and billed to Medicaid using appropriate SBHS procedure codes and modifiers. See rule for requirements.

For services covered using synchronous audio and video with modifiers GT, the Division will cover the same services provided by synchronous audio (e.g. telephone), when billed with the same codes but without modifier GT when provision of the same service via synchronous audio and video is not available or feasible, when the patient declines to enable video, or necessary consents cannot reasonably be obtained with appropriate documentation in the child/student’s plan of care.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Jul. 2023).

Indian Health Services

For the provision of services defined in Titles XIX and XXI and provided through an IHS or Tribal 638 facility, an “encounter” is defined as a face-to-face, telephone contact, or a prescription fill as defined in OAR 410-146-0085(8) between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (7) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per 410-130-0610.

Telephone encounters qualify as a valid encounter for specific services. Telephone encounters must include all the same components of the service when provided face-to-face. Providers may not make telephone contacts at the exclusion of face-to-face visits.

SOURCE: OR OAR 410-146-0085, Health Systems Division: Medical Assistance Programs American Indian/Alaska Native. (Accessed Jul. 2023).

Federally Qualified Health Center and Rural Health Clinics

For the provision of services defined in Titles XIX and XXI and provided through an FQHC or RHC, an “encounter” is defined as a face-to-face or telephone contact between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. See rule for limitations for telephone contacts that qualify as encounters. For purposes of this rule, a face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per OAR 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management (MCM) and 410-130-0190, Tobacco Cessation (see also OAR 410-120-1200). Except as set forth below, providers may not make telephone contacts at the exclusion of face-to-face visits. Telephone encounters must include all the same components of the service as if provided face-to-face.

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services. (Accessed Jul. 2023).

Last updated 07/31/2023

Live Video

POLICY

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute 414.723. (Accessed Jul. 2023).

“Synchronous” means an interaction between a provider and a client or member that occurs at the same time using an interactive technology. This may include audio only, video only, or audio with video and may include remote monitoring.

Communications may be between providers, or be between one or more providers and one or more patients, family members /caregivers /guardians.

SOURCE: OAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

Patient consultations using videoconferencing, a synchronous (live two-way interactive) video transmission resulting in real time communication between a provider located in a distant site and the recipient being evaluated and located in an originating site, is covered when billed services comply with the billing requirements. See OAR for billing requirements.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2023).

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical Assistance Programs, School-Based Health Services (Accessed Jul. 2023).

MCEs shall provide reimbursement for telemedicine or telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) as defined in OAR 333-002-0010 for interpretation services provided via telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the MCEs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the MCE contract. However, nothing either in this requirement or within MCE direct agreement(s) with providers referenced herein supersedes any federal or state requirements with regard to the provision and coverage of health care interpreter services.

SOURCE: OAR 410-141-3566 . Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telemedicine and Telehealth Delivered Health Service and Reimbursement Requirements. (Accessed Jul. 2023).

The Oregon Health Authority (OHA) will submit a Medicaid State Plan Amendment to the Centers for Medicare & Medicaid Services (CMS) to change from the flat telehealth rates used during the COVID-19 Public Health Emergency (PHE) to rates based on Relative Value Units (RVUs) multiplied by the Oregon conversion factor. See memo for a table that lists the current PHE rate and the proposed RVU-based rate for covered telehealth codes.

SOURCE: Oregon Health Authority, Notice of intent – OHA will amend the Medicaid State Plan to increase rates for telehealth services. Public Notice, May 18, 2023, (accessed 7/28/23).

ELIGIBLE SERVICES/SPECIALTIES

Providers billing for covered telemedicine services are responsible for the following:

Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the patient in connection with the telemedicine or telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act) except as noted in section (16) below;
Obtaining and maintaining technology used in telemedicine or telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (A) except as noted in section (16) below;
Developing and maintaining policies and procedures to prevent a breach in privacy or exposure of client or member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting;
Maintaining clinical and financial documentation related to telemedicine or telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410;
Complying with all federal and state statutes as required in OAR 410-120-1380.

The Authority will only pay for telemedicine or telehealth services meeting all of the following requirements:

Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
When allowed by individual certification or licensing boards’ scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
- When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
- For establishing a client or member-provider relationship.
All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02.
All claim types except Dental services, shall use modifiers GT or 95 when the telemedicine or telehealth delivered service utilizes a synchronous audio and video modality. When provision of the same service via synchronous audio and video is not available or feasible (e.g., the client or member declines to enable video, or necessary consents cannot reasonably be obtained with appropriate documentation in client or member’s medical record) the claim should not include any modifiers but should continue billing Place of Service as 02.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

Teledentistry

All billing requirements apply to all delivery modalities (live video, store and forward, remote patient monitoring and mobile communication devices). Payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

The dentist who completes diagnosis and treatment planning and the oral evaluation documents these services using the traditional CDT codes, and also reports D9995 or D9996 as appropriate.

An assessment-D0191 is a limited inspection performed to identify possible signs of oral or systemic disease, malformation or injury, and the potential need for referral for diagnosis and treatment. This code may be billed using the modality of teledentistry:

When D0191 is reported in conjunction with an oral evaluation (D0120-D0180) using teledentistry, D0191 shall be disallowed even if done by a different provider;
The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

Behavioral Health

Behavioral health services identified as allowable for telephonic delivery are listed in the fee schedule. See fee schedule for list of covered telehealth services.

For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health, (Accessed Jul. 2023).

Behavioral Health Resource Networks

A comprehensive BHRN must include at minimum the required services below to be funded by the OAC. These services may be provided by one or more entities who refer between and collaborate with each other. To be a BHRN, a BHRN must provide, and maintain sufficient capacity to provide, the following services and supports to individuals who use substances that cause harm or have a substance use disorder in the BHRN’s county or region:

Screening must be conducted by PSS, CRM, PWS or other addiction professional. Screening service must be available 24 hours a day, seven days a week, every calendar day of the year. Screening must be made available to each individual immediately upon first contact. At least one organization within each BHRN within each county or region must meet this requirement: …
- Services must be offered face-to-face or through telehealth. The modality must be based on the needs and preference of the individual as well as any safety concerns identified by the individual or the BHRN.

See rule for additional information.

SOURCE: OR OAR 944-001-0020, Oversights and Accountability Council, Behavioral Resource Networks, (Accessed Jul. 2023).

School Based Health Services

Oregon Health Authority reimburses for all the same covered services outlined in OAR 410-133-0080 when furnished through telehealth (See OAR 410-133-0080):

Screening must be conducted by PSS, CRM, PWS or other addiction professional. Screening service must be available 24 hours a day, seven days a week, every calendar day of the year. Screening must be made available to each individual immediately upon first contact. At least one organization within each BHRN within each county or region must meet this requirement:

Be provided by a licensed practitioner/clinician employed by or contracted by an Oregon public school district or Education Service District, enrolled with Oregon Health Authority (OHA) as a “school medical (SM)” provider with authority to provide SBHS to Oregon Medicaid beneficiaries;
Be performed by or under a supervising licensed practitioner/clinician within the scope of practice governed by their licensing board, who meet the federal requirements as described in medically qualified staff in OAR 410-133-0120, and who hold a current and valid license without restriction from a state licensing board where the provider is located;
Use synchronous audio and visual interactive technologies, including interactive audio/telephonic services provided to a child/student in a geographical area where synchronous audio and video is not available or consent for audio/video is refused for services provided to a child/student;
Include, when applicable, electronic or telephonic communications such as telephone conversation, video conference, or an internet relay chat session for care coordination defined in OAR 410-133-0040(16);
Assist the licensed practitioner/clinician with care coordination and oversight of a Medicaid eligible child/student’s covered health related services provided in support of a child/student’s education program required by the Individuals with Disabilities Education Act (IDEA);
Be compliant with applicable privacy rules and security protections for the child/student in connection with the telehealth communication and confidentiality related to records required by HIPAA and FERPA;
Ensure the telehealth communication obtained, used and maintained is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules set forth in OAR 943 division 14;
Ensure policies and procedures are in place to prevent a breach in privacy or exposure of protected health information or records (whether oral or recorded in any form or medium) to unauthorized individuals.

Providers billing Medicaid for SBHS health related services via telehealth must:

Align services provided within a licensed practitioner/clinician scope of practice governed by their licensing board;
Obtain the child’s/student’s parent or guardian’s written or verbal consent to receive the services via telehealth technologies, prior to the delivery of health-related services to an eligible child/student with disabilities using a telehealth modality. Verbal consent must be documented/noted in the child’s plan of care by the practitioner. Consent must be obtained and documented annually or with change in services on the child/students plan of care;
Model SOAP charting or equivalent for covered health related services required by the Individuals with Disabilities Education Act (IDEA) in compliance with Documentation and Recordkeeping Requirements OAR 410-133-0320;
Describe services provided as telehealth synchronous audio/visual interactive equivalent to face to face; or electronic/telephonic interactive communication described as telephone conversation, video conference, or internet relay chat requiring decision making for coordinating care;
Bill Medicaid using the most appropriate Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes and modifiers for SBHS considered as an OHP covered service. A two-digit modifier assigned to telehealth is required for billing SBHS telehealth services using audio and video interactive technologies;
For services covered using synchronous audio and video with modifiers GT, the Division will cover the same services provided by synchronous audio (e.g. telephone), when billed with the same codes but without modifier GT when provision of the same service via synchronous audio and video is not available or feasible, when the patient declines to enable video, or necessary consents cannot reasonably be obtained with appropriate documentation in the child/student’s plan of care;
Maintain clinical documentation and financial records related to telehealth services as required in OAR 410-120-1360 and these SBHS Rules.

During an emergency declaration, the Authority may reimburse any necessary and appropriate physical, mental, behavioral and oral health service delivered using a telehealth platform when the telehealth delivery reasonably approximates in person services to maximize access to services and reduce barriers in the delivery of these services provided to eligible children included in a child’s Individualized Education Program (IEP) or Individualized family Service Plan (IFSP) required by the Individuals with Disabilities Education Act (IDEA), a Section 504 plan pursuant to Section 504 of the Rehabilitation Act, or other school services plan. Other types of telecommunications are not covered, without necessary and appropriate decision making for an eligible child’s /student’s plan of care.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Jul. 2023).

Reproductive Health Access Program

Covered services provided by telehealth technology may be billed to the RH Program, as appropriate. The CVR must indicate that the visit was conducted via telehealth. All telehealth visits must adhere to applicable state and federal telehealth regulations.

SOURCE: OR OAR 333-004-3110, RH Access Fund Billing and Claims (Accessed Jul. 2023).

Linguistic and Cultural Access

MCEs shall ensure that telemedicine or telehealth services provided are culturally and linguistically appropriate as described in the relevant standards:

National Culturally and Linguistically Appropriate Services (CLAS) Standards;
Tribal based practice standards;
Trauma-informed approach to care as defined in 410-141-3500.

MCEs shall ensure that providers offer meaningful access to health care services for members and their families who experience LEP or hearing impairments by working with qualified or certified health care interpreters to provide language access services as described in OAR 333-002-0040. Such services shall not be significantly restricted, delayed, or inferior as compared to programs or activities provided to English proficient individuals.

MCEs shall ensure that providers collaborate with members to identify modalities for delivering health care services which best meets the needs of the member and considers the member’s choice and readiness for the modality of service selected.

Newborn Nurse Home Visiting Service Requirements

If a family declines home visiting services in their home, an alternate location may be offered, and telemedicine services must be offered and delivered in accordance with ORS 743A.058. Declination of home visiting services in the home must be documented in the client’s medical record.

SOURCE: OAR 333-006-0120, Health Systems Division: Public Health Division, Universally Offered Newborn Nurse Home Program, (Accessed Jul. 2023).

Health benefit plans must reimburse at the case rate for newborn nurse home visiting services conducted via telemedicine pursuant to OAR 333-006-0120 and ORS 743A.058.

SOURCE: OAR 333-006-0190, Health Systems Division: Public Health Division, Universally Offered Newborn Nurse Home Program, (Accessed Jul. 2023).

ELIGIBLE PROVIDERS

Telehealth providers shall meet the following requirements:

Shall be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per 410-120-1260.

Shall provide services via telemedicine or telehealth that are within their respective certification or licensing board’s scope of practice and comply with telmedicine or telehealth requirements including, but not limited to:

Documenting patient and provider agreement of consent to receive services;
Allowed physical location of provider and patient;
Establishing or maintaining an appropriate provider-patient relationship.

The Authority will only pay for telemedicine or telehealth services meeting all of the following requirements:

Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
When allowed by individual certification or licensing boards’ scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
- When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
- For establishing a client or member-provider relationship.
All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02.
All claim types except Dental services, shall use modifiers GT or 95 when the telemedicine or telehealth delivered service utilizes a synchronous audio and video modality. When provision of the same service via synchronous audio and video is not available or feasible (e.g., the client or member declines to enable video, or necessary consents cannot reasonably be obtained with appropriate documentation in client or member’s medical record) the claim should not include any modifiers but should continue billing Place of Service as 02.

Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) including providing access to auxiliary aids and services as described in 45 CFR Part 92;

National Culturally and Linguistically Appropriate Services (CLAS) Standards at https://thinkculturalhealth.hhs.gov/clas/standards; and
As applicable to the client or member, Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx;

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

Dentists providing Medicaid services shall be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and shall be enrolled as a Health Systems Division (Division) provider.

Providers billing covered teledentistry/telehealth services are responsible for complying with specific standards. See rule for teledentistry/telehealth services requirements for providers billing.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

See rule for requirements for providers billing behavioral health services.

SOURCE: OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health). (Accessed Jul. 2023).

School Based Health Services

Must be provided by a licensed practitioner/clinician employed by or contracted by an Oregon public school district or Education Service District, enrolled with Oregon Health Authority (OHA) as a “school medical (SM)” provider with authority to provide SBHS to Oregon Medicaid beneficiaries.

Must also be performed by or under a supervising licensed practitioner/clinician within the scope of practice governed by their licensing board, who meet the federal requirements as described in medically qualified staff in OAR 410-133-0120, and who hold a current and valid license without restriction from a state licensing board where the provider is located. See OAR 410-133-0140 for additional provider requirements.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Definitions (Accessed Jul. 2023).

MCEs shall provide reimbursement for telemedicine or telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) as defined in OAR 950-050-0010 for interpretation services provided via telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the MCEs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the MCE contract. However, nothing either in this requirement or within MCE direct agreement(s) with providers referenced herein supersedes any federal or state requirements with regard to the provision and coverage of health care interpreter services.

MCEs shall ensure that providers offer meaningful access to telemedicine/telehealth services by completing a capacity assessment of members in the use of specific approved methods of telemedicine or telehealth delivery that comply with accessibility standards including alternate formats, and provides the optimal quality of care for the member given considerations of member access to necessary devices, access to a private and safe location, adequate internet, digital literacy, cultural appropriateness of telemedicine or telehealth services, and other considerations of member readiness to use telemedicine or telehealth.

SOURCE: OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telemedicine and Telehealth Delivered Health Service and Reimbursement Requirements. (Accessed Jul. 2023).

Dental Care Benefits for Pregnant Individuals

Pregnant clients shall be seen, treated in person or via teledentistry for an OHP-covered service within the following time frames:

For emergency dental care: within 24 hours;
For urgent dental care: within one week.
For routine dental care: within four weeks, unless there is a documented special clinical reason that would make access longer than four weeks appropriate;
For initial dental screening or examination: four weeks.

SOURCE: OAR 410-123-1510, Health Systems Division: Medical Assistance Programs, Dental/Denturist Services. (Accessed Jul. 2023).

ELIGIBLE SITES

The patient may be in the community or in a health care setting.

The provider may be in any location in which appropriate privacy and confidentiality can be ensured.

The Authority will only pay for telemedicine or telehealth services meeting all of the following requirements:

Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
When allowed by individual certification or licensing boards’ scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
- When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
- For establishing a client or member-provider relationship.
All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02.
All claim types except Dental services, shall use modifiers GT or 95 when the telemedicine or telehealth delivered service utilizes a synchronous audio and video modality. When provision of the same service via synchronous audio and video is not available or feasible (e.g., the client or member declines to enable video, or necessary consents cannot reasonably be obtained with appropriate documentation in client or member’s medical record) the claim should not include any modifiers but should continue billing Place of Service as 02.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Jul. 2023).

The authority shall include the costs of telemedicine services in its rate assumptions for payments made to clinics or other providers on a prepaid capitated basis.

SOURCE: OR Statute Ch. 414.723, (Accessed Jul. 2023).

School-Based Health Services

Telehealth may occur between an alternate site such as the child/student’s home, childcare facility, or other public education programs and settings, and the distant site setting of the practitioner/clinician. Telehealth can be interactive audio/telephonic services provided to a child/student in a geographical area where synchronous audio and video is not available or consent for audio/video is refused for services provided to a child/student. Telehealth may include coordinated care defined in Definitions 410-133-0040(16).

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical, School-Based Services. (Accessed Jul. 2023).

The originating site may bill a CDT code only if a separately identifiable service is performed within the scope of practice of the practitioner providing the service. The service must meet all criteria of the CDT code billed.

The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Jul. 2023).

Last updated 07/31/2023

Miscellaneous

Teledentistry

Providers billing for covered teledentistry/telehealth services are responsible for (A) through (D) above, as well as:

A patient receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request;
The patient’s chart documentation shall reflect notification of the right to interactive communication with the distant site dentist;
A patient may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

Providers offering telemedicine or telehealth services, must meet the following requirements:

Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the member in connection with the telemedicine or telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act)) except as noted in section (9) below;
Obtaining and maintaining technology used in telemedicine/telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (b) except as noted in section (9) below;
Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting as described in OAR 943-014-0440;
Maintaining clinical and financial documentation related to telemedicine or telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410;
Complying with all federal and state statutes as required in OAR 410-120-1380.

Providers must also ensure services are within their respective certification or licensing board’s scope of practice and comply with telehealth requirements. See rules for details.

SOURCE: OAR 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement Requirements. (Accessed Jul. 2023).

Network Adequacy

MCEs shall have an access plan that establishes a protocol for monitoring and ensuring access, outlines how provider capacity is determined, and establishes procedures for monthly monitoring of capacity and access and for improving access and managing access in times of reduced participating provider capacity. The access plan and associated monitoring protocol shall address the following: …

The availability of telemedicine within the MCE’s contracted provider network.

SOURCE: OAR 410-141-3515 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Network Adequacy. (AccessedJul. 2023).

“Meaningful access” means member-centered access reflecting the following statute / and standards:

Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) and including providing access to auxiliary aids and services as described in Federal Regulation at 45 CFR Part 92;
National Culturally and Linguistically Appropriate Services (CLAS) Standards
Tribal based practice standards

SOURCE: 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, (Accessed Jul. 2023).

“Face to Face” means a personal interaction where both words can be heard and facial expressions can be seen in person or through telehealth services where there is a live streaming audio and video, if medically appropriate.

SOURCE: OAR 410-172-0600 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services. (Accessed Jul. 2023).

Last updated 07/31/2023

Out of State Providers

The Authority may expand network capacity through remote care and telemedicine, or telehealth services provided across state lines.

SOURCE: OR OAR 410-120-1990 (Accessed Jul. 2023).

A provider located in a state other than Oregon whose services are rendered in that state shall be licensed and otherwise certified by the proper agencies in the state of residence as qualified to render the services. Certain cities within 75 miles of the Oregon border may be closer for Oregon residents than major cities in Oregon, and therefore, these areas are considered contiguous areas, and providers are treated as providing in-state services. See rule for additional requirements.

SOURCE: OR OAR 410-120-1180 (Accessed Jul. 2023).

Last updated 07/31/2023

Overview

OR Health Authority covers telehealth and telemedicine services. The definitions of which encompass video conferencing, store-and-forward imaging, streaming media including services with information transmitted via landlines, and wireless communications, including the Internet and telephone networks. Services must be culturally and linguistically appropriate.

Last updated 07/31/2023

Remote Patient Monitoring

POLICY

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute 414.723. (Accessed Jul. 2023).

Oregon will reimburse “dental care providers” for ‘remote patient monitoring’, which is defined as “personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care”

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

SOURCE: OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan and 410-120-1990 (Accessed Jul. 2023).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Last updated 07/31/2023

Store and Forward

POLICY

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Sec. 414.723, (Accessed Jul. 2023).

Coverage of interprofessional consultations delivered online, through electronic health records or by telephone is included as follows:

(CPT 99446-99449, 99451-99451)

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Jul. 2023).

Behavioral Health Services:

Unless specifically authorized by OAR 410-120-1200 other types of telecommunication are not covered such as images transmitted via facsimile machines and electronic mail when:

Those methods are not being used in lieu of videoconferencing, due to limited video conferencing equipment access; or
Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: 410-172-0850 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jul. 2023).

Teledentistry

Teledentistry can take multiple forms, including ‘store and forward’, defined as “an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the patient being present in real time.”

When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

Communications may be between providers, or between one or more providers and one or more members, family members /caregivers /guardians.

ELIGIBLE SERVICES/SPECIALTIES

HERC prioritized list indicate interprofessional consultation codes through EHRs are reimbursable.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Jul. 2023).

Teledentistry

A dentist may collect the transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the patient being present in real time.

Payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Jul. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Jul. 2023).

Professional Requirements

Last updated 07/14/2023

Cross State Licensing

Effective Until Dec. 31, 2023

A person may not engage in the practice of medicine across state lines, claim qualification to engage in the practice of medicine across state lines or use any title, word or abbreviation to indicate or to induce another to believe that the person is licensed to engage in the practice of medicine across state lines unless the person is licensed in accordance with ORS 677.139.

ORS 677.135 to 677.141 do not apply to a physician or physician assistant engaging in the practice of medicine across state lines in an emergency, as defined by rule of the Oregon Medical Board.

ORS 677.135 to 677.141 do not apply to a licensed physician or physician assistant located outside this state who:

Consults with another physician or physician assistant licensed to practice medicine in this state; and
Does not undertake the primary responsibility for diagnosing or rendering treatment to a patient within this state.

ORS 677.135 to 677.141 do not apply to a licensed physician or physician assistant located outside this state who has an established physician-patient relationship with a person who is in Oregon temporarily and who requires the direct medical treatment by that physician or physician assistant.

SOURCE: OR Revised Statutes Annotated Sec. 677.137, (Accessed Jul. 2023).

Effective Jan. 1, 2024

ORS 677.135 to 677.141 do not apply to a physician or physician assistant engaging in the practice of medicine across state lines in an emergency, as defined by rule of the Oregon Medical Board.

ORS 677.135 to 677.141 do not apply to a licensed physician or physician assistant located outside this state who:

- Consults with another physician or physician assistant licensed to practice medicine in this state; and
- Does not undertake the primary responsibility for diagnosing or rendering treatment to a patient within this state.
Has an established provider-patient relationship with a patient who is in Oregon temporarily for the purpose of business, education, vacation or work and who requires the direct medical treatment by that physician or physician assistant; or
Has, with a patient located in Oregon, an established provider-patient relationship to provide temporary or intermittent follow-up care.

A physician or physician assistant who is located outside this state and practices medicine as described in subsection (3) of this section is subject to this chapter and rules adopted pursuant to this chapter, including but not limited to the disciplinary authority of the board, while or as a result of practicing medicine as described in subsection (3) of this section.

SOURCE: OR Revised Statutes Annotated Sec. 677.137 as amended by SB 232, (Accessed Jul. 2023).

Upon application, the Oregon Medical Board may issue to an out-of-state physician a license for the practice of medicine across state lines if the physician holds a full, unrestricted license to practice medicine in any other state of the United States, has not been the recipient of a professional sanction by any other state of the United States and otherwise meets the standards for Oregon licensure .

In the event that an out-of-state physician has been the recipient of a professional sanction by any other state of the United States, the board may issue a license for the practice of medicine across state lines if the board finds that the sanction does not indicate that the physician is a potential threat to the public interest, health, welfare and safety.

A physician or physician assistant shall apply on a form provided by the board, accompanied by nonrefundable fees for the application and the license in amounts determined by rule of the board. The board shall adopt necessary and proper rules to govern the renewal of licenses issued under this section.

A license for the practice of medicine across state lines is not a limited license for purposes of ORS 677.132.

A license for the practice of medicine across state lines does not permit a physician or physician assistant to practice medicine in this state except when engaging in the practice of medicine across state lines.

SOURCE: OR Revised Statutes Annotated Sec. 139. (Accessed Jul. 2023).

A telemedicine licensee is subject to all the provisions of the Medical Practice Act (ORS Chapter 677), and to all the administrative rules of the Oregon Medical Board.

A telemedicine licensee has the same duties and responsibilities and is subject to the same penalties and sanctions as any other physician or physician assistant licensed under ORS Chapter 677, including but not limited to the following:

The telemedicine licensee must establish an appropriate provider-patient relationship;
The telemedicine licensee must make a judgment based on some type of objective criteria upon which to diagnose, treat, correct, or prescribe;
The telemedicine licensee must engage in all necessary practices that are in the best interest of the patient; and
The telemedicine licensee must provide for an acceptable continuity of care for patients, including follow-up care, information, and documentation of care provided to the patient or suitably identified care providers of the patient.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Jul. 2023).

“The practice of medicine across state lines” means:

The rendering directly to a person of a written or otherwise documented medical opinion concerning the diagnosis or treatment of that person located within Oregon for the purpose of patient care by a physician or physician assistant located outside Oregon as a result of the transmission of individual patient data by telemedicine as defined in Oregon Laws 2022, chapter 45, section 14, from within Oregon to that physician, the physician’s agent, or physician assistant outside Oregon; or

The rendering of medical treatment directly to a person located within Oregon by a physician or physician assistant located outside Oregon as a result of the outward transmission of individual patient data by telemedicine as defined in Oregon Laws 2022, chapter 45, section 14, from within this state to that physician, the physician’s agent, or a physician assistant outside the state.

SOURCE: OR Admin. Rules, 847-025-0010. (Accessed Jul. 2023).

A license to practice across state lines is not required of a physician or physician assistant:

Engaging in the practice of medicine across state lines in an emergency; or
Located outside this state who consults with another physician or physician assistant licensed to practice medicine in this state, and who does not undertake the primary responsibility for diagnosing or rendering treatment to a patient in Oregon;
Located outside the state and has an established provider-patient relationship with a person who is in Oregon temporarily and who requires the direct medical treatment by that physician or physician assistant.

SOURCE: OR Admin. Rules, 847-025-0020. (Accessed Jul. 2023).

A license for the practice of medicine across state lines does not permit a telemedicine licensee to practice medicine in the state of Oregon except when engaging in the practice of medicine across state lines.

A license to practice medicine across state lines is not a limited license per ORS 677.132 or ORS 677.535.

A telemedicine licensee must not:

Act as a dispensing physician as described in ORS 677.010(5) or dispensing physician assistant as described in ORS 677.511;
Prescribe controlled substances for the management of chronic pain to a person located in Oregon;
Provide written documentation for purposes of ORS 475C.783;
Employ a physician assistant as defined in ORS 677.495 to treat a person located within Oregon;
Assert a lien for services under ORS 87.555;
Act as a supervising physician of an Oregon-certified First Responder or Emergency Medical Technician as defined in ORS 682.245;
Be eligible for any tax credit provided by ORS 316.076;
Participate in the Rural Health Services Program under 442.550 to 442.570; or
Prescribe medication based only on a sale or form over the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in ORS 677.095 and 677.265 is met.

SOURCE: OR Admin. Rules, 847-025-0030. (Accessed Jul. 2023).

To qualify for a license to practice medicine across state lines:

An applicant must hold a full, unrestricted license to practice medicine in another state, must not have been the recipient of a previous disciplinary or other action by any other state or jurisdiction and must otherwise meet the standards of licensure under ORS chapter 677.
An applicant who meets the qualifications for a license to practice medicine across state lines with the exception of being the recipient of previous disciplinary or other action by another state or jurisdiction may be issued a license for the practice of medicine across state lines if the Board finds that the previous disciplinary or other action does not indicate that the applicant is a potential threat to the public interest, health, welfare and safety of the citizens of the state of Oregon.
An applicant does not qualify for a license to practice medicine across state lines if the applicant is the subject of a pending investigation by a state medical board or another state or federal agency.

SOURCE: OR Admin. Rules, 847-025-0040. (Accessed Jul. 2023).

Oregon medical board requires a ‘Telemedicine Active’ license to practice medicine across state lines.

SOURCE: OR Practice of Medicine Across State Lines (Telemedicine) Practice Description Form. Revised 8/2022, (Accessed Jul. 2023).

An active Oregon license is needed for out-of-state physicians providing services for Oregon patients with no patient contact for telemedicine and telemonitoring. It is not needed for pathology and teleradiology.

SOURCE: OR Medical Board. Application Process. FAQs. (Accessed Jul. 2023).

An active or telehealth licensed doctor of optometry in Oregon who volunteers to provide professional services to a charitable nonprofit corporation may request the additional practice location license required for that location from the Board at no charge.

SOURCE: OR Admin Rules, 852-050-0021. (Accessed Jul. 2023).

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Jul. 2023).

Last updated 07/31/2023

Definitions

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, through the use of a variety of electronic and telecommunications technologies, to a patient at a remote location staffed by a pharmacy technician.

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The remote location at which a patient receives pharmacy services through the use of telepharmacy must be affiliated with the pharmacy where the pharmacist providing the pharmacy services through telepharmacy regularly engages in the practice of pharmacy.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

Regarding remote supervision of a pharmacy technician in order to facilitate the use of telepharmacy; and
Describing the pharmacy services that a pharmacist may provide through telepharmacy.

SOURCE: OR Revised Statutes 689.700, (Accessed Jul. 2023).

Health Care Provider Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin. Rules 409-036-0010. (Accessed Jul. 2023).

Community Treatment and Support Services

Telehealth means a technological solution that provides two-way, video-like communication on a secure line.

SOURCE: OR Admin. Rules. 309-032-0860. (Accessed Jul. 2023).

Health Planning

“Telemedicine means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications.”

SOURCE: OR Revised Statutes 442.015(26). (Accessed Jul. 2023).

Board of Chiropractic Examiners

“‘Telehealth’ means a variety of methods, through the use of electronic and telecommunications technologies, for the distance delivery of health care services, including chiropractic services, excluding in-person services, and clinical information designed to improve the health status of a patient, and to enhance delivery of the health care services and clinical information.”

SOURCE: OR Admin. Rules 811-015-0066. (Accessed Jul. 2023).

Physical Therapy

“‘Telehealth service’ means a physical therapy intervention, including assessment or consultation that can be safely and effectively provided using synchronous two-way interactive video conferencing, or asynchronous video communication, in accordance with generally accepted healthcare practices and standards. For purposes of these rules, ‘telehealth service’ also means, or may be referred to, as ‘telepractice, teletherapy, or telerehab’.”

SOURCE: OR Administrative Rule, Sec. 848-040-0100(13). (Accessed Jul. 2023).

Occupational Therapy

“Telehealth” is defined as the use of interactive audio and video, in real time telecommunication technology or store-and-forward technology, to deliver health care services when the occupational therapist and patient/client are not at the same physical location. Its uses include diagnosis, consultation, treatment, prevention, transfer of health or medical data, and continuing education.

SOURCE: OR Admin. Code 339-010-0006(1) (Accessed Jul. 2023).

Teleoptometry

“Telehealth” means the use of electronic and telecommunications technologies, including remote patient monitoring devices and store and forward technology, to support delivery of optometric clinical health care services. “Telehealth” does not include electronic mail communication, facsimile transmission or audio-only telephone communication between a licensed optometrist and a patient, or the use of an automated computer program or managed website to diagnose or treat ocular or refractive conditions.

“Telemedicine” means the delivery of optometric clinical health care services to a patient by a licensed optometrist through telehealth.

SOURCE: OR Revised Statutes 683.230. (Accessed Jul. 2023).

“Telehealth” is the electronic delivery of optometry care across state lines that complies with the requirements of ORS 683.010 through 683.990 and OAR Chapter 853. Telehealth may include phone applications, online systems, remote patient monitoring devices, 2 way audio, visual or other telecommunications or electronic communications.

SOURCE: OAR 852-001-0002. Board of Optometry, Procedural Rules, Definitions. (Accessed Jul. 2023).

As used in this section, “telemedicine” means the practice of medicine and provision of health care services to a patient by a physician or physician assistant from a distance using electronic communications, including synchronous technologies to facilitate an exchange of information between a patient and physician or physician assistant in real time or asynchronous technologies to facilitate an exchange of information between a patient and a physician or physician assistant in other than real time.

SOURCE: OR Revised Statutes Chapter 677 as amended by HB 4034 (2022 Session) and SB 232 (2023 Session). (Accessed Jul. 2023).

Last updated 07/31/2023

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Jul. 2023).

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

Last updated 07/31/2023

Miscellaneous

Oregon requires out-of-state physicians to acquire active telemonitoring status through the Oregon Medical Board before they can perform intraoperative tele-monitoring on patients during surgery.

The Administrative Code defines “telemonitoring” as the “intraoperative monitoring of data collected during surgery and electronically transmitted to a physician who practices in a location outside of Oregon via a telemedicine link for the purpose of allowing the monitoring physician to notify the operating team of changes that may have a serious effect on the outcome or survival of the patient. The monitoring physician is in communication with the operation team through a technician in the operating room.”

The facility where the surgery is to be performed must be a licensed hospital or ambulatory surgical center licensed by the Department of Human Services, must grant medical staff membership and/or clinical privileges to the monitoring physician, and must request the Board grant Telemonitoring active status to the monitoring physician to perform intraoperative telemonitoring on patients during surgery.

Physicians granted Telemonitoring active status must register and pay a biennial active registration fee.

The physician with Telemonitoring active status desiring to have active status to practice in Oregon must submit the reactivation application and fee and satisfactorily complete the reactivation process before beginning active practice in Oregon.

SOURCE: OR Admin. Rules. 847-008-0023. (Accessed Jul. 2023).

Optometry

Telehealth optometrists are subject to all of the provisions of the Oregon optometry law and rules and must meet the same standard of care.

Telehealth prescriptions may only be issued on an initial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine services.

SOURCE: OAR 852-020-0050. (Accessed Jul. 2023).

Scope of School Psychologist

The School Psychologist and Professional School Psychologist License authorizes the holder to perform the following duties:

Provide telemental health supports and services for behavioral and mental health, as trained.

SOURCE: OAR 584-245-0200 Teacher Standards and Practices Commission, Personnel Service Licenses. (Accessed Jul. 2023).

Occupational Therapy Licensing Board Supervision

“Routine supervision” requires the supervisor to have direct contact in person at least every two weeks at the work site or via telehealth as defined in OAR 339-010-0006(9) with interim supervision occurring by other methods, such as telephone or written communication;

“General supervision” requires the supervisor to have at least monthly direct contact in person with the supervisee at the work site or via telehealth as defined in OAR 339-010-0006(9) with supervision available as needed by other methods.

SOURCE: OAR 339-010-0005. (Accessed Jul. 2023).

Supervision of Occupational Therapy Assistants under 339-010-0035 for routine and general supervision, can be done through telehealth, but cannot be done when close supervision as defined in 339-010-0005 is required. The same considerations in (7)(A) through (F) must be considered in determining whether telehealth should be used.

SOURCE: OAR 339-010-0006. (Accessed Jul. 2023).

Last updated 07/31/2023

Online Prescribing

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

Regarding remote supervision of a pharmacy technician in order to facilitate the use of telepharmacy; and
Describing the pharmacy services that a pharmacist may provide through telepharmacy.

SOURCE: OR Revised Statutes 689.700, (Accessed Jul. 2023).

“Telepharmacy” means the delivery of pharmacy services by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician or Pharmacy Technician.

“Telepharmacy system” means a system of telecommunications technologies that enables monitoring, documenting, and recording of the delivery of pharmacy services at a remote location by an electronic method which must include the use of audio and video, still image capture, and store and forward.

See rule for telepharmacy regulations.

SOURCE: OAR 855-139-0005. (Accessed Jul. 2023).

Remote Dispensing Site Pharmacy

A location in Oregon where the practice of pharmacy occurs by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician or Pharmacy Technician must be registered by the board in Oregon as a Retail Drug Outlet RDSP.

SOURCE: OAR 855-139-0010. (Accessed Jul. 2023).

Non-Resident Affiliated Pharmacies

A non-resident pharmacy includes a RDSP Affiliated Pharmacy located outside of Oregon and providing pharmacy services through a telepharmacy system to a Retail Drug Outlet RDSP located in Oregon.

Each non-resident RDSP Affiliated Pharmacy must be registered with the Oregon Board of Pharmacy.

To qualify for registration under these rules, every non-resident RDSP Affiliated Pharmacy must be registered and in good standing with the Board of Pharmacy in the pharmacy’s state of residence.

Each out-of-state non-resident RDSP Affiliated Pharmacy must designate an Oregon licensed Pharmacist-in-Charge (PIC), who is responsible for all pharmacy services and to provide supervision and control of the RDSP. To qualify for this designation, the person must:

Hold a license to practice pharmacy in the resident state;
Be normally working for the RDSP Affiliated Pharmacy a minimum of 20 hours per week;
Complete the annual RDSP PIC self-inspection report prior to February 1 each year; and
Provide the PIC self-inspection report as requested by the board.

Every non-resident RDSP Affiliated Pharmacy will have a Pharmacist-in-Charge (PIC) who is licensed in Oregon prior to initial registration of the RDSP.

The PIC must comply with the requirements of OAR 855-019-0300.

SOURCE: OAR 855-139-0030. (Accessed Jul. 2023).

The Oregon licensed Pharmacist-in-charge of the RDSP Affiliated Pharmacy is responsible for all operations at the RDSP including responsibility for the telepharmacy system and enforcing policies and procedures.

SOURCE: OAR 855-139-0050. (Accessed Jul. 2023).

Technology

A RDSP and its RDSP Affiliated Pharmacy must:

Utilize a shared telepharmacy system and have appropriate technology or interface to allow access to information required to process and fill a prescription drug order;
Use still image capture or store and forward for verification of prescriptions with a camera that is of sufficient quality and resolution so that the Oregon licensed Pharmacist from the RDSP Affiliated Pharmacy can visually identify each

Please see rule for additional requirements.

SOURCE: OAR 855-139-0205. (Accessed Jul. 2023).

Chiropractic Physician

The use of telehealth as described in subsection (2) of this section is not an expansion of the scope of practice of chiropractic physicians. The use of telehealth establishes a doctor-patient relationship.

SOURCE: OAR 811-015-0066. (Accessed Jul. 2023).

Rules for Practice Across State Lines

The telemedicine licensee must establish an appropriate provider-patient relationship;
The telemedicine licensee must make a judgment based on some type of objective criteria upon which to diagnose, treat, correct, or prescribe;
The telemedicine licensee must engage in all necessary practices that are in the best interest of the patient; and
The telemedicine licensee must provide for an acceptable continuity of care for patients, including follow-up care, information, and documentation of care provided to the patient or suitably identified care providers of the patient.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Jul. 2023).

Optometry

“Telehealth prescription” may only be issued on an initial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine.

SOURCE: OAR 852-001-0002. (Accessed Jul. 2023).

A physician licensed under ORS 677.100 to 677.228, a physician assistant licensed under ORS 677.505 to 677.525 or a physician or physician assistant licensed under ORS 677.139 may use telemedicine to engage in the practice of medicine and provide health care services, including the establishment of a provider-patient relationship, the diagnosis or treatment of a medical condition or the prescription of drugs, to a patient physically located in this state. The physician or physician assistant is not required to be physically located in this state when engaging in the practice of medicine and providing health care services through telemedicine.

The practice of medicine using telemedicine occurs where the patient is physically located.

SOURCE: OR Revised Statutes Chapter 677 as amended by HB 4034 (2022 Session) and SB 232 (2023 Session). (Accessed Jul. 2023).

A pharmacist receiving a prescription is responsible for:

Using professional judgment in dispensing only pursuant to a valid prescription. A Pharmacist must not dispense a prescription if the Pharmacist, in their professional judgment, believes that the prescription was issued without a valid patient-practitioner relationship. In this rule, the term practitioner includes a clinical associate of the practitioner or any other practitioner acting in the practitioner’s absence. The prescription must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of their professional practice and issued pursuant to a valid patient-practitioner relationship.

See rule for additional requirements.

SOURCE: OAR 855-019-0210. (Accessed Jul. 2023).

A telemedicine licensee [physicians practicing medicine across state lines] must not:

Act as a dispensing physician as described in ORS 677.010(5) or dispensing physician assistant as described in ORS 677.511;
Prescribe controlled substances for the management of chronic pain to a person located in Oregon;
Provide written documentation for purposes of ORS 475C.783;
Employ a physician assistant as defined in ORS 677.495 to treat a person located within Oregon;
Assert a lien for services under ORS 87.555;
Act as a supervising physician of an Oregon-certified First Responder or Emergency Medical Technician as defined in ORS 682.245;
Be eligible for any tax credit provided by ORS 316.076;
Participate in the Rural Health Services Program under 442.550 to 442.570; or
Prescribe medication based only on a sale or form over the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in ORS 677.095 and 677.265 is met.

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Jul. 2023).

Last updated 07/31/2023

Professional Board Standards

Board of Occupational Therapy

SOURCE: OR Admin. Code 339-010-0006. (Accessed Jul. 2023).

Board of Physical Therapy

SOURCE: OR Admin. Code 848-040-0180. (Accessed Jul. 2023).

Board of Chiropractic Examiners

SOURCE: OR Admin. Code 811-015-0066. (Accessed Jul. 2023).

Board of Optometry

SOURCE: OR Admin. Code 852-020-0050. (Accessed Jul. 2023).

Oregon Medical Board, Rules for Licensure to Practice Medicine Across State Lines

SOURCE: OR Admin. Code 847-025-0000. (Accessed Jul. 2023).

Oregon Medical Board, Telemedicine

SOURCE: Oregon Medical Board. (Accessed Jul. 2023).

An acupuncturist may engage in the practice of acupuncture via telemedicine for patients located in Oregon.

SOURCE: OR Admin Code 847-070-0020, (Accessed Jul. 2023).

Federally Qualified Health Center (FQHC)

Last updated 07/31/2023

Definition of Visit

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services. (Accessed Jul. 2023).

Last updated 07/31/2023

Eligible Distant Site

OR Medicaid requires providers to be enrolled and meet certain requirements. They also state that the distant site can be any location in which appropriate privacy and confidentiality is ensured, however no explicit reference is made to FQHCs.

See: OR Medicaid Live Video Distant Site

Last updated 07/31/2023

Eligible Originating Site

OR Medicaid indicates patients should be in a community or health care setting but don’t make an explicit reference to FQHCs.

See: OR Medicaid Live Video Eligible Sites.

Last updated 07/31/2023

Facility Fee

OR Medicaid reimburses the facility fee code Q3014 however no explicit mention is made to whether or not FQHCs can be reimbursed for it.

See: OR Medicaid Live Video Facility/Transmission Fee

Last updated 07/31/2023

Home Eligible

No reference found

Last updated 07/31/2023

Modalities Allowed

Live Video

OR Medicaid covers health services delivered using telemedicine, however no explicit reference to whether or not FQHCs can be reimbursed was found.

See: OR Medicaid Live Video.

Store and Forward

OR Medicaid covers asynchronous transmissions in some circumstances however no explicit reference to whether or not FQHCs can be reimbursed was found.

See: OR Medicaid Store and Forward.

Remote Patient Monitoring

OR Medicaid covers remote patient monitoring in some circumstances however no explicit reference to whether or not FQHCs can be reimbursed was found.

See: OR Medicaid Remote Patient Monitoring.

Audio-Only

See: OR Medicaid Email, Phone and Fax.

Last updated 07/31/2023

Patient-Provider Relationship

No reference found

Last updated 07/31/2023

PPS Rate

No reference found.

Last updated 07/31/2023

Same Day Encounters

The following services may be considered as multiple encounters when two or more service encounters are provided on the same date of service with distinctly different diagnoses (see OAR 410-147-0120 and individual program rules listed below for specific service requirements and limitations):

Medical section (3) of this rule and OAR chapter 410, division 130);
Dental (OAR 410-147-0125, and OAR chapter 410, division 123);
Addiction and Alcohol and Chemical Dependency — If a client is also seen for a medical office visit and receives an addiction diagnosis, then the client contacts area single encounter (Refer to AMH’s OARs);
Ophthalmologic services — fitting and dispensing of eyeglasses are included in the encounter when the practitioner performs a vision examination. (OAR chapter 410, division 140);
Maternity Case Management MCM (OAR 410-147-0200);
Physical or occupational therapy (PT/OT) — If this service is also performed on the same date of service as the medical encounter that determined the need for PT/OT (initial referral), then it is considered a single encounter (OAR chapter 410, division 131);
Immunizations — if no other medical office visit occurs on the same date of service; and
Tobacco cessation — if no other medical, dental, mental health or addiction service encounter occurs on the same date of service (refer to OAR 410-130-0190).

A mental health encounter and an addiction and alcohol and chemical dependency encounter provided to the same client on the same date of service will only count as multiple encounters when provided by two separate health professionals and each encounter has a distinctly different diagnosis.

Similar services, even when provided by two different health care practitioners, are not considered multiple encounters.

Clinics may not “unbundle” services that are normally rendered during a single visit for the purpose of generating multiple encounters:

Clinics are prohibited from asking the patient to make repeated or multiple visits to complete what is considered a reasonable and typical office visit, unless it is medically necessary to do so;
Medical necessity must be clearly documented in the patient’s record.

SOURCE: OR OAR 410-147-0140, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services. (Accessed Jul. 2023).

Oregon

MEDICAID REIMBURSEMENT

PRIVATE PAYER LAW

PROFESSIONAL REQUIREMENTS

FQHCs

STATE RESOURCES

COVID-19

Audio-Only Delivery

Cross-State Licensing

Easing Consent Requirements

Easing Prescribing Requirements

Miscellaneous

Originating Site

Private Payer

Provider Type

Service Expansion

Private Payer

Definitions

Parity

SERVICE PARITY

PAYMENT PARITY

Requirements

Medicaid

Consent Requirements

Definitions

Email, Phone & Fax

Live Video

POLICY

ELIGIBLE SERVICES/SPECIALTIES

ELIGIBLE PROVIDERS

ELIGIBLE SITES

GEOGRAPHIC LIMITS

FACILITY/TRANSMISSION FEE

Miscellaneous

Out of State Providers

Overview

Remote Patient Monitoring

POLICY

CONDITIONS

PROVIDER LIMITATIONS

OTHER RESTRICTIONS

Store and Forward

POLICY

ELIGIBLE SERVICES/SPECIALTIES

GEOGRAPHIC LIMITS

TRANSMISSION FEE

Professional Requirements

Consent Requirements

Cross State Licensing

Definitions

Licensure Compacts

Miscellaneous

Online Prescribing

Professional Board Standards

Federally Qualified Health Center (FQHC)

Definition of Visit

Eligible Distant Site

Eligible Originating Site

Facility Fee

Home Eligible

Modalities Allowed

Live Video

Store and Forward

Remote Patient Monitoring

Audio-Only

Patient-Provider Relationship

PPS Rate

Same Day Encounters