Oregon

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Oregon Medicaid

Administrator

Oregon Health Authority

Regional Telehealth Resource Center

Northwest Regional Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: PTC
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

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

STATUS: Active, until end of COVID-19 emergency

Medicaid: School Based Guidance

STATUS: Active, during the COVID-19 emergency

Medicaid: PASRR Level II Evaluations for nursing facilities

STATUS: Permanent

Medicaid: Guidance for Public Education Providers

STATUS: Active

Medicaid:  Telemedicine Billing Webinar FAQs

STATUS: Active

Medicaid: COVID-19 Provider Guide

STATUS: Active

Medicaid: Emergency Rule on Covered Telehealth Services

STATUS: Expired

Medicaid: Emergency Rule on Telemedicine Practice Guidance

STATUS: Expired

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

STATUS: Expired February 28, 2021; extended through Addendum

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 02/28/2021

Cross-State Licensing

Oregon Medical Board: COVID-19 Guidance

STATUS: Active

Last updated 02/28/2021

Easing Prescribing Requirements

Oregon Medical Board: COVID-19 Guidance

STATUS: Active

Last updated 02/28/2021

Miscellaneous

SB 780: COVID-19 Liability Claims

STATUS: Introduced

HB 4212: Utilization Data

STATUS: Enacted

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: Expired March 10, 2021; extended through Addendum

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 02/28/2021

Originating Site

Medicaid: COVID-19 Provider Guide

STATUS: Active

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

STATUS: Expired February 28, 2021; extended through Addendum

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 02/28/2021

Private Payer

Consumer and Business Services:  Telehealth Guidance for Health Plans

STATUS: Active, until end of COVID-19 outbreak

Consumer and Business Services:  Telehealth Page

STATUS: Active

Last updated 02/28/2021

Provider Type

Medicaid: Guidance for Public Education Providers

STATUS: Active

Medicaid:  Telemedicine Billing Webinar FAQs

STATUS: Active

Medicaid: COVID-19 Provider Guide

STATUS: Active

Medicaid: Emergency Rule on Telemedicine Parity

STATUS: Active

Medicaid: Emergency Rule on Covered Telehealth Services

STATUS: Expired

Medicaid: Emergency Rule on Telemedicine Practice Guidance

STATUS: Expired

Last updated 02/28/2021

Service Expansion

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

STATUS: Active, until end of COVID-19 emergency

Medicaid: School Based Guidance

STATUS: Active, during the COVID-19 emergency

Medicaid: PASRR Level II Evaluations for nursing facilities

STATUS: Permanent

Medicaid: Guidance for Public Education Providers

STATUS: Active

Medicaid:  Telemedicine Billing Webinar FAQs

STATUS: Active

Medicaid: COVID-19 Provider Guide

STATUS: Active

Medicaid: Physical, Occupational and Speech Therapy

STATUS: Active

Medicaid: Emergency Rule on Telemedicine Services

STATUS: Active, until March 29, 2021

Medicaid: Newborn Nurse Home Visiting Services Provided by Telehealth

STATUS: Active, until June 29, 2021

Medicaid: Updates to the Prioritized List of Covered Health Services

STATUS: Active, until March 29, 2021

Medicaid: Emergency Rule on Telemedicine Parity

STATUS: Active

Medicaid: Emergency Rule on Covered Telehealth Services

STATUS: Expired

Medicaid: Emergency Rule on Telemedicine Practice Guidance

STATUS: Expired

Last updated 02/28/2021

Definitions

Oregon Health Authority defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement. (Effective Jan. 1, 2021). (Accessed Feb. 2021) & OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021). 

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 Feb. 2021).

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 Feb. 2021).

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 as well as remote monitoring devices.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. C-1. (02/01/21). (Accessed Feb. 2021).

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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

Telephonic and online services, including services related to diagnostic workup are covered for services for new and established patients.

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.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. C-2. (02/01/21). (Accessed Feb. 2021).

Telehealth services may be transmitted via landlines and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR 410-120-1990 & OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Feb. 2021).

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 Feb. 2021).

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 410-130-0610 Telemedicine, 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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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.

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 410-133-0040 & 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Feb. 2021).

Indian Health Services

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 410-147-0120, Healthy Systems Division: Medical Assistance Programs, American Indian/Alaska Native.  (Accessed Feb. 2021).

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. Telephone encounters qualify as a valid encounter for specific services.

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services.  (Accessed Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

Services can be synchronous (using audio and video, video only or audio only) or asynchronous (using audio and video, audio, or text-based media) and may include transmission of data from remote monitoring devices. 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. (Accessed Feb. 2021) & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

Coordinated Care Organizations

CCOs shall provide reimbursement for telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the CCOs 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 CCO contract. However, nothing either in this requirement or within CCO 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: OR Administrative Rules. Rule 410-141-3566. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

Teledentistry is allowed. All billing requirements apply to all 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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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 410-12-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Feb. 2021) & Oregon Health Authority, OHP Fee-for-Service Fee Schedule, Behavioral Health, (10/30/20). (Accessed Feb. 2021).

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):

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.

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 Feb. 2021).

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 Feb. 2021).


ELIGIBLE PROVIDERS

Telehealth providers shall meet the following requirements:

  1. Shall be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per 410-120-1260.
  2. Shall provide services via telehealth that are within their respective certification or licensing board’s scope of practice and comply with telehealth requirements including, but not limited to:
    1. Documenting patient and provider agreement of consent to receive services;
    2. Allowed physical location of provider and patient;
    3. Establishing or maintaining an appropriate provider-patient relationship.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Dentists providing Medicaid services must be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and must 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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021) & OAR 410-133-0140, School-Based Health Services, School Medical Provider Enrollment Provisions.

CCOs shall provide reimbursement for telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the CCOs 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 CCO contract. However, nothing either in this requirement or within CCO 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, (Accessed Feb. 2021).


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 can be ensured.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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.

SOURCE: OR OAR 410-133-0040 & 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Definitions (Accessed Feb. 2021).

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.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).


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 February 1, 2021 Prioritized List of Health Services, p. C-1. (02/01/21). (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

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 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 (7) below;
  • Obtaining and maintaining technology used in 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 (7) below;
  • Developing and maintaining policies and procedures to prevent a breach in privacy or exposure of patient 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 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.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021) & OAR 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement Requirements. (Effective Ja. 1, 2021). (Accessed March 2021).

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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Teledentistry

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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Providers shall ensure access to health care services for limited English proficient (LEP) and deaf and hard of hearing patients and their families through the use of qualified and certified health care interpreters to provide meaningful language access services as described in OAR 333-002-0040.

SOURCE: OR OAR Sec. 410-120-1990. (Accessed Feb. 2021).

Last updated 02/28/2021

Out of State Providers

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

SOURCE: OR OAR 410-120-1990 (Accessed Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Overview

As of January 1, 2021, Oregon Health Authority covers medically necessary and appropriate physical, behavioral and oral health services within Oregon Health Plan (OHP) covered benefit plans.

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

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

  • Consulting Providers (CPT 99451, 99446-99449) – See guidance for additional requirements.
  • Requesting Providers (CPT 99452) – See guidance for additional requirements.

Limited information provided by one clinician to another that does not constitute collaboration (e.g., interpretation of an electroencephalogram, report on an x-ray or scan, or reporting the results of a diagnostic test) is not considered a consultation. See HERC prioritized list guidelines for additional criteria.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. C-2. (02/01/21). (Accessed Feb. 2021).

Unless authorized in OAR 410-120-1200 Exclusions, other types of telecommunications are not covered, such as telephone calls without medical decision making, images transmitted via facsimile machines and electronic mail.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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: OR OAR 410-123-1265 & 410-172-0850 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Feb. 2021).

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.”

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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See HERC prioritized list guidelines for covered S&F codes.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. C-2. (02/01/21). (Accessed Feb. 2021). 

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.  See rulebook for specific codes.

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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).


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 February 1, 2021 Prioritized List of Health Services, p. C-1. (02/01/21). (Accessed Feb. 2021).

Definitions

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 Feb. 2021).

Last updated 02/28/2021

Parity

SERVICE PARITY

Oregon requires a health benefit plan to provide coverage of a health service that is provided using synchronous two-way interactive video conferencing 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 synchronous two-way interactive video conferencing 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 health benefit plan and the reimbursement specified in the contract between the plan and the health professional.

SOURCE: OR Revised Statutes Sec. 743A.058. (Accessed Feb. 2021).

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 Feb. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 02/28/2021

Requirements

Health plans must provide coverage of a health service that is provided using synchronous two-way interactive video if the service would be covered when provided in-person, it is a medically necessary service, the service is determined to be safely and effectively provided using live video according to generally accepted health care practices and standards and the technology and application to provide the service meets all standards required by state and federal laws governing privacy and security of protected health information.  Plans are not required to reimburse a health professional for a service that is not a covered benefit under the plan or who has not contracted with the plan.

SOURCE: OR Revised Statutes Sec. 743A.058. (Accessed Feb. 2021).

Last updated 02/28/2021

Cross State Licensing

Out-of-state physicians may receive a license to practice across state lines in Oregon, as long as they are fully licensed in another state and meet certain requirements.

SOURCE: OR Revised Statutes Annotated Sec. 677.139. (Accessed Feb. 2021).

A physician granted a license to practice medicine across state lines has the same duties and responsibilities and is subject to the same penalties and sanctions as any other provider licensed in Oregon, including but not limited to:

  • A physician shall establish a physician-patient relationship;
  • Make a judgment based on some type of objective criteria upon which to diagnose, treat, correct or prescribe;
  • Engage in all necessary practices that are in the best interest of the patient; and
  • Refrain from writing prescriptions based only on an Internet sale or consults.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Feb. 2021).

Last updated 02/28/2021

Definitions

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(26). (Accessed Feb. 2021).

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(28). (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

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.

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

SOURCE: OR Revised Statutes 683.010 & 683.990; (Accessed Feb. 2021).

“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 Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Feb. 2021).

Last updated 02/28/2021

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.”

Requirements:

  • The facility where the surgery is performed must be a licensed hospital or ambulatory surgical center;
  • The facility must grant medical staff membership and/or clinical privileges to the monitoring physician;
  • The facility must request the Board grant Telemonitoring active status to the monitoring physician.

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 Feb. 2021).

Telehealth is considered to meet the definition of “face-to-face” in Assertive Community Treatment when there is live streaming audio and video.

SOURCE: OR Admin. Rules 309-019-0225, Health Systems Division: Behavioral Health Services, Outpatient Behavioral Health Services, Assertive Community Treatment Definitions (Accessed Feb. 2021).

Last updated 02/28/2021

Online Prescribing

No Reference Found

Last updated 02/28/2021

Professional Board Standards

Board of Occupational Therapy

SOURCE: OR Admin. Code 339-010-0006. (Accessed Feb. 2021).

Board of Physical Therapy

SOURCE: OR Admin. Code 848-040-0180. (Accessed Feb. 2021).

Board of Chiropractic Examiners

SOURCE: OAR 811-015-0066. (Accessed Feb. 2021).