Medicaid & Medicare

Miscellaneous

Medicaid programs sometimes have additional requirements, such as documentation or privacy requirements that get noted in this Miscellaneous section.  Additionally, Medicaid specific grants, pilots, and workgroups are also included in this section.

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Disclaimer

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

Federal

Last updated 12/14/2023

CMS issued a letter to clarify for states that Medicaid …

CMS issued a letter to clarify for states that Medicaid and CHIP coverage and payment of interprofessional consultation is permissible, even when the beneficiary is not present, as long as the consultation is for the direct benefit of the beneficiary.

SOURCE:  Centers for Medicare & Medicaid Services, Coverage and Payment of Interprofessional Consultation in Medicaid and the Children’s Health Insurance Program (CHIP), SHO #23-001, Jan. 5, 2023, (Accessed Dec. 2023).

The Secretary shall conduct a study using medical record review, as described in subparagraph (C), on program integrity related to telehealth services under part B of title XVIII of the Social Security Act.  See bill for details.

SOURCE: House Bill 2617, (2022 Session), (Accessed Dec. 2023).

In January 2023, the Centers for Medicare & Medicaid Services (CMS) implemented a telehealth indicator on Medicare Care Compare and in the Provider Data Catalog (PDC) to expand the information available to patients and caregivers when choosing doctors or clinicians (87 FR 70109 – 70111). In response to the ongoing COVID-19 public health emergency (PHE), CMS expanded Medicare payment for telemedicine services to improve patients’ access to care.

SOURCE: CMS, Telehealth Indicator on Medicare Care Compare – Doctors and Clinicians Public Reporting, Jan. 2023, (Accessed Dec. 2023).

Medicaid Requirements

Unless required by regulation or policy, states are not required to submit a (separate) SPA for coverage or reimbursement of Medicaid coverable services delivered through telehealth if they decide to reimburse for services delivered through telehealth in the same way/amount that they pay for face-to-face services.

States must submit a (separate) reimbursement (attachment 4.19B) SPA if they want to provide reimbursement for services or components of services delivered through telehealth differently than is currently being reimbursed for face-to-face services.

States may submit a coverage SPA to better describe the services they choose to cover through telehealth, such as which providers/practitioners are identified by the state to use telehealth to deliver services; where it is provided; how it is provided, etc. In this case, and in order to avoid unnecessary SPA submissions, it is recommended that a brief description of the framework of telehealth may be placed in an introductory section of the state plan, e.g., Section 3 – Services: General Provisions 3.1 Amount, Duration and Scope of Services, and then a reference made to coverage through telehealth in the applicable benefit sections of the state plan. For example, in the physician section it might say that dermatology services can be delivered via telehealth provided all state requirements related to telehealth as described in the state plan are otherwise met.

SOURCE: Medicaid.gov.  Telehealth (Accessed Dec. 2023).

CMS will add a telehealth indicator to the Physician Compare Finder found on the Medicare website as is applicable and technically feasible.

SOURCE: CY 2023 Physician Fee Schedule, CMS, p. 2088, (Accessed Dec. 2023).

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Alabama

Last updated 02/26/2024

Telemedicine health care providers shall ensure that the telecommunication technology …

Telemedicine health care providers shall ensure that the telecommunication technology and equipment used is sufficient to allow the health care provider to appropriately evaluate, diagnose, and/or treat the recipient for services billed to Medicaid and is HIPAA compliant.

Transmissions must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission information. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver.

The provider shall implement confidentiality protocols that include, but are not limited to:

  • specifying the individuals who have access to electronic records;
  • usage of unique passwords or identifiers for each employee or other person with access to the client records;
  • ensuring a system to prevent unauthorized access, particularly via the internet; and
  • ensuring a system to routinely track and permanently record access to such electronic medical information.

These protocols and guidelines must be available for inspection at the telemedicine site and to Medicaid upon request.

Documentation Requirements

Providers shall document in the medical record detailed information of the telemedicine visits including, but not limited to:

  • Identification of the patient.
  • Identification of parent or legal guardian attending the telemedicine visit if recipient is under the age of medical consent.
  • Physical location of the patient, including the city and state.
  • The medical record documentation must accurately reflect the services rendered and the level of medical decision making to substantiate the procedure code billed.
  • The same “in” and “out” documentation is required for telemedicine as is required for current services with incremental timeframes provided in person.
  • Identification of the provider including credentials.
  • Patient’s consent for the use of telemedicine delivery of health care services. This consent must be documented in the recipient’s medical record.
  • Condition for which the care is being provided.
  • Medical necessity and appropriateness of services billed.
  • Follow up care needed.
  • Other relevant details of the visit, to include BMI recording, when applicable.

Prior authorization is not required for services to be delivered via telemedicine, though prior authorization may be required for the individual procedure codes billed. Refer to the Provider Billing Manual chapter that describes the service provided for prior authorization requirements.

Refer to Appendix A and the respective Alabama Medicaid Provider Billing Manual chapter that describes the service provided for information about Early and Periodic Screening, Diagnostic, and Testing (EPSDT) referrals.

See manual for instructions regarding cost sharing and completing the claim form.

Prescribing Medications

In accordance with Alabama’s Telemedicine Law, an enrolled provider may prescribe a legend drug, medical supplies, or a controlled substance via telemedicine if the prescriber is authorized to do so under state and federal law. However, a prescription for a controlled substance may only be issued via telemedicine if:

  • The telemedicine visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber;
  • The prescriber has had at least one in-person encounter with the patient within the preceding 12 months; and
  • The prescriber has established a legitimate medical purpose for issuing the prescription within the preceding 12 months.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Jan. 2024, (Accessed Feb. 2024).

The following place of service codes apply when filing claims for TCM services:

  • 02: Telehealth – Services provided through telecommunication technology
  • See manual for others.

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt (106, p. 26). Jan. 2024. (Accessed Feb. 2024).

The Telemedicine Services Agreement cannot be submitted electronically.

SOURCE: AL Medicaid Management Information System Provider Manual, Becoming a Medicaid Provider, Ch. 2, p. 2. Jan. 2024. (Accessed Feb. 2024).

Recipient Signatures are not required in the following instances: …

  • Treatment plan review, mental health consultation, pre-hospitalization screening, crisis intervention, family support, Assertive Community Treatment (ACT), Program for Assertive Community Treatment (PACT), and any non-face-to-face services that can be provided by telephone or telemedicine when provided by a Rehabilitation Option Provider or a physician meeting the telemedicine requirements as set forth in the Alabama Medicaid Administrative Code and the Alabama Medicaid Provider Manual. The provider must retain documentation in the medical record to show the services were rendered.

SOURCE: Alabama Admin. Code 560-X-1-.18, (Accessed Feb. 2024).

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Alaska

Last updated 02/27/2024

Are there additional documentation requirements when a service is provided

Are there additional documentation requirements when a service is provided via a telehealth modality?

Yes: Telehealth services are documented episodes of care and require the same clinical documentation as seeing a member in-person, identified in 7 AAC 105.230, plus documentation that describes the telehealth visit, including:

  • Modality: Delivery method (e.g., two-way audio-video or Two-Way Audio Only, and patient initiated online digital services)
  • Location: Member/provider location during encounter (e.g., home, clinic)
  • Consent: Record of the member giving consent for the telehealth encounter

Does documentation need to include the physical address when documenting the location of the encounter?

No: documentation should identify where the patient and provider are located (e.g., home, clinic), but the address of the locations are not needed.

Who may prescribe a substance via telehealth? Under what conditions?

Annual in-person exam is not required when:

  • Alaska-licensed physicians (including osteopaths and podiatrists) and physician assistants may prescribe a controlled substance via telehealth if the provider complies with AS 08.64.364 and federal law.
  • Alaska-licensed APRNs may prescribe a controlled substance via telehealth if the provider complies with AS 08.68.710 and federal law.
  • Prescription, dispensation, and administration of a controlled substance may not be conducted via telehealth except by physicians (including osteopaths and podiatrists), physician assistants, or APRNs.
  • Alaska-licensed dentists and optometrists may only prescribe a controlled substance via telehealth subsequent to an in-person exam.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023), (Accessed Feb. 2024).

Medical Assistance Reform Program

The department shall identify the areas of the state where improvements in access to telehealth would be most effective in reducing the costs of medical assistance and improving access to health care services for medical assistance recipients. The department shall make efforts to improve access to telehealth for recipients in those locations. The department may enter into agreements with Indian Health Service providers, if necessary, to improve access by medical assistance recipients to telehealth facilities and equipment.

SOURCE: Alaska Statute 47.05.270, (Accessed Feb. 2024).

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Arizona

Last updated 02/09/2024

Services provided through Telehealth or resulting from a telehealth encounter …

Services provided through Telehealth or resulting from a telehealth encounter are subject to all applicable statutes and rules that govern prescribing, dispensing and administering prescription medications and devices.

Privacy and confidentiality standards for Telehealth services shall adhere to all applicable statutes and policies governing healthcare services, including the Health Insurance Portability and Accountability Act (HIPAA).

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 5), Approved 8/29/23. (Accessed Feb. 2024).

Health Care Institutions (Certain Licensed Facilities)

Administrators must ensure that policies and procedures for physical health services, habilitation services and behavioral care are established, documented and implemented to protect the health and safety of a resident that … cover telemedicine, if applicable.

SOURCE: AZ Administrative Code, R9-10-2203, [appears in additional sections] (Accessed Feb. 2024).

A report on Engaging Members through Technology is required by AHCCCS contractors for upcoming calendar year.  Must include criteria for identifying and targeting members who can benefit from telehealth services and from web/mobile-based applications, among other items.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Quality Management/Performance Improvement Program Ch 920, (pg. 6), Approved 8/3/23. (Accessed Feb. 2024).

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Arkansas

Last updated 02/06/2024

The distant site provider is prohibited from utilizing telemedicine with …

The distant site provider is prohibited from utilizing telemedicine with a patient unless a professional relationship exists between the provider and patient.  See manual for ways to establish the relationship.   A professional relationship is established if the provider performs a face-to-face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; or if the establishment of a professional relationship is permitted via telemedicine under the guidelines outlined in ASMB regulations.  Telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter and only under the safeguards established by the healthcare professional’s licensing board (See ASMB Regulation 38 for these safeguards including the standards of care).  See manual for full list of requirements on establishing a professional relationship.  Special requirements also exist for providing telemedicine services to a minor in a school setting (see manual).

A healthcare provider providing telemedicine services within Arkansas shall follow applicable state and federal laws, rules and regulations regarding:

  • Informed consent;
  • Privacy of individually identifiable health information;
  • Medical record keeping and confidentiality, and
  • Fraud and abuse.

A health record is created with the use of telemedicine, consists of relevant clinical information required to treat a client, and is reviewed by the healthcare professional who meets the same
standard of care for a telemedicine visit as an in-person visit.  A professional relationship does not include a relationship between a healthcare provider and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • A client-generated medical history;
  • Text messaging;
  • A facsimile machine (Fax) and EFax;
  • Any combination of the above; or
  • Any future technology that does not meet the criteria outlined in this section.

The existence of a professional relationship is not required when:

  • An emergency situation exists; or
  • The transaction involves providing information of a generic nature not meant to be
    specific to an individual client.

Once a professional relationship is established, the healthcare provider may provide healthcare services through telemedicine, including interactive audio, if the healthcare services are within
the scope of practice for which the healthcare provider is licensed or certified and in accordance with the safeguards established by the healthcare professionals licensing board.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Jan. 1, 2022, (Accessed Feb. 2024).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

The plan of care and client service record must include the following:

  • A detailed assessment of the client that determines they are an appropriate candidate for service delivery by telemedicine based on the client’s age and functioning level;
  • A detailed explanation of all on-site assistance or participation procedures the therapist or speech-language pathologist is implementing to ensure:
    • The effectiveness of telemedicine service delivery is equivalent to face-to-face service delivery; and
    • Telemedicine service delivery will address the unique needs of the client.
  • A plan and estimated timeline for returning service delivery to in-person if a client is not progressing towards goals and outcomes through telemedicine service delivery.

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Feb. 2024).

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

If the PASSE allows the use of telemedicine, the PASSE must document what services the PASSE allows, the settings allowed, and the qualifications for individuals to perform services via telemedicine.

SOURCE: AR Medicaid Provider Manual PASSE Program, (3/1/19).  (Accessed Feb. 2024).

The Department of Human Services shall establish the “Continuum of Care Program” for certain women and parents.  The purpose of the program is to facilitate the operation of a statewide telemedicine support network that provides community outreach, consultations, and care coordination for women who are challenged with unexpected pregnancies.  See statute for details.

SOURCE: AR Code Sec. 20-8-1003, (Accessed Feb. 2024).

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California

Last updated 12/20/2023

Establishing New Patients via Telehealth

Providers may establish a relationship …

Establishing New Patients via Telehealth

Providers may establish a relationship with new patients via synchronous video telehealth visits. Providers may establish a relationship with new patients via audio-only synchronous interaction only if one or more of the following applies:

  • The visit is related to sensitive services as defined in subsection (n) or Section 56.06 of the Civil Code. Section 56.06 of the Civil Code defines “sensitive services” as all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender-affirming care, and intimate partner violence, and includes services described in Sections 6924 through 6930 of the Family Code, and Sections 121020 and 124260 of the Health and Safety Code, obtained by a patient at or above the minimum age specified for consenting to the service specified in the section.
  • The patient requests an audio-only modality.
  • The patient attests they do not have access to video.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2023), Pg. 3. (Accessed Dec. 2023).

Documentation

All health care practitioners providing covered benefits or services to Medi-Cal patients must maintain appropriate documentation to substantiate the corresponding technical and professional components of billed CPT® or HCPCS codes. Documentation for benefits or services delivered via telehealth should be the same as for a comparable in-person service. The distant site provider can bill for Medi-Cal covered benefits or services delivered via telehealth using the appropriate CPT or HCPCS codes with the corresponding modifier and is responsible for maintaining appropriate supporting documentation. This documentation should be maintained in the patient’s medical record.

Providers should note the following:

  • Health care providers at the distant site must determine that the covered Medi-Cal service or benefit being delivered via telehealth meets the procedural definition and components of the CPT or HCPCS code(s) associated with the Medi-Cal covered service or benefit as well as any other requirements described in this section of the Medi-Cal provider manual.
  • Health care providers are not required to document a barrier to an in-person visit for Medi-Cal coverage of services provided via telehealth (W&I Code, Section 14132.72[d]).
  • Health care providers at the distant site are not required to document cost effectiveness of telehealth to be reimbursed for telehealth services or store and forward services.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2023), Pg. 4. (Accessed Dec. 2023).

Family PACT

Documentation for benefits or services delivered via telehealth should be the same as for a comparable in-person service. The distant site provider can bill for Family PACT covered benefits or services delivered via telehealth using the appropriate CPT® or HCPCS codes with the corresponding modifier and is responsible for maintaining appropriate supporting documentation. This documentation must be maintained in the client’s medical record.

SOURCE: CA DHCS Medi-Cal Provider Enrollment and Responsibilities Manual. (June 2023). Pg. 18. (Accessed Dec. 2023).

Disabled Individuals

Telehealth services and supports are among the services and supports authorized to be included by individual program plans developed for disabled individuals by regional centers that contract with the State Department of Developmental Disabilities.

SOURCE: Welfare and Institutions Code Sec. 4512. (Accessed Dec. 2023).

Network Adequacy

Medicaid must ensure that all managed care covered services are available and accessible to enrollees of Medicaid managed care plans in a timely manner. Telehealth can be used as a means to meet time and distance standards in some circumstances. See APL for details.

SOURCE: CA Welfare and Institutions Code Sec. 14197. & CA Department of Health Care Services (DHCS). All Plan Letter 23-001: Network Certification Requirements. Jan. 6, 2023. (Accessed Dec. 2023).

Emergency Clinic Telephonic Services

Telehealth services, telephonic services and other specified services must be reimbursed when provided by specific entities during or immediately following an emergency, subject to the Department obtaining federal approval and matching funds. The Department is required to issue guidance for entities to facilitate reimbursement for telehealth or telephonic services in emergency situations by July 1, 2020.

SOURCE: Welfare and Institutions Code Sec. 14132.723 & 724 (AB 1494 – 2019 Legislative Session). (Accessed Dec. 2023).

Privileges/Credentialing

Issues of privileges and credentialing for distant physicians to care for patients via telehealth are determined by the policies of the originating hospital. Hospitals can accept the privileges and credentials for providers at distant hospitals.

SOURCE: Telehealth FAQs, Providers. (Accessed Dec. 2023).

COVID Telehealth Flexibilities

The department shall seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to subdivision (a), as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program. Subject to subdivision (e), the department shall implement those extended waivers or flexibilities for which federal approval is obtained, to commence on the first calendar day immediately following the last calendar day of the federal COVID-19 public health emergency period, and through December 31, 2022.

The department may authorize the use of remote patient monitoring as an allowable telehealth modality for covered health care services and provider types it deems appropriate for dates of service on or after July 1, 2021. The department may establish a fee schedule for applicable health care services delivered via remote patient monitoring.

For purposes of informing the 2022–23 proposed Governor’s Budget, released in January 2022, the department shall convene an advisory group consisting of consultants, subject matter experts, and other affected stakeholders to provide recommendations to inform the department in establishing and adopting billing and utilization management protocols for telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program. The advisory group shall analyze the impact of telehealth in increased access for patients, changes in health quality outcomes and utilization, best practices for the appropriate mix of in-person visits and telehealth, and the benefits or liabilities of any practice or care model changes that have resulted from telephonic visits.

SOURCE: AB 133, Sec. 380 (2021 Session). (Accessed Dec. 2023).

Consent

The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:

  • The availability of Medi-Cal covered telehealth services.
  • The beneficiary’s right to access all medically necessary covered services through in-person, face-to-face visits, and a provider’s and Medi-Cal managed care plan’s responsibility to offer or arrange for that in-person care, as applicable.
  • An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
  • An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
  • Notification of the beneficiary’s right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.

The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.

This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.

SOURCE: Welfare and Institutions Code 14132.725 (e), as amended by SB 184 (2022 Session). (Accessed Dec. 2023).

DHCS Telehealth Research and Evaluation Plan

On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:

  • Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
  • Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
  • Prioritizes research and evaluation questions that directly inform Medi-Cal policy.

SOURCE: Welfare and Institutions Code 14132.725 (g), as amended by SB 184 (2022 Session). (Accessed Dec. 2023).

HIPAA/Privacy Compliance

Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.

SOURCE: Welfare and Institutions Code 14132.725 (h), as amended by SB 184 (2022 Session). (Accessed Dec. 2023).

Telehealth Requirements

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider – including FQHCs/RHCs – furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice. The department may provide specific exceptions to the requirement based on a Medi-Cal provider’s access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance. In making such exceptions, the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission or other applicable federal law or regulation.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider – including FQHCs/RHCs – furnishing applicable health care services via synchronous video interaction or audio-only synchronous interaction shall also offer those same health care services in-person or facilitate access to in-person services for the patient. The department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.

SOURCE: Welfare and Institutions Code 14132.725 & Welfare and Institutions Code 14132.100, as amended by SB 184 (2022 Session), AB 32 (2022 Session), and AB 1241 (2023 Session). (Accessed Dec. 2023).

Medi-Cal Enrollment Procedure and Exemptions for Remote Mental Health Services

Effective March 29, 2023, the Department of Health Care Services (DHCS) is establishing Medi-Cal provider enrollment requirements and procedures that will be exempt from certain established place of business requirements for the following modes of service:

  • Remote service providers who offer mental health services exclusively through telehealth modalities, and
  • Transportation providers located in California.

In accordance with Welfare & Institutions (W&I) Code Section 14043.75(b), enrollment requirements and procedures are established for providers offering Medi-Cal covered mental health services exclusively through telehealth modalities, including non-specialty mental health services (NSMHS) covered under Medi-Cal Fee-For-Service and Medi-Cal Managed Care Plans and Specialty Mental Health Services (SMHS) covered by county mental health plans, and for Non-Emergency Medical Transportation (NEMT) and Non-Medical Transportation (NMT) providers.

The following provider types are able to apply for enrollment as remote service-only providers:

  • Licensed Clinical Social Workers;
  • Licensed Marriage and Family Therapists;
  • Licensed Professional Clinical Counselors;
  • Nurse Practitioners specializing in Psychiatry;
  • Physicians specializing in Psychiatry; and
  • Psychologists

Remote service providers requesting consideration for enrollment in the Medi-Cal program must complete and submit an application for their appropriate provider type through the Provider Application and Validation for Enrollment (PAVE) portal with the required supporting documents and a completed and signed Remote Services-Only Provider Attestation. For more detailed information, providers may refer to the Requirements and Procedures for the Medi-Cal Enrollment of Providers Offering Services Remotely or Indirectly from their Business Address located on the Provider Enrollment page of the Medi-Cal Provider website.

SOURCE: CA Dept. of Health Care Services. Medi-Cal Update – Psychological Services. March 2023. (Accessed Dec. 2023).

Community-Based Adult Services (CBAS)

CBAS Emergency Remote Services (ERS) are authorized under the California Advancing and Innovating Medi-Cal (CalAIM) 1115 Demonstration Waiver (Waiver) that was implemented October 1, 2022. CBAS supports and services delivered in the community, at the doorstep or in the home, and via telehealth allow for immediate response during participant emergencies. DHCS and MCPs are required to cover ERS as part of the CBAS benefit when participants meet the criteria established in ERS policy, including that ERS is determined to be the appropriate service for the participant and their emergency situation, and the CBAS provider meets the criteria specified in this ACL. See ACL for additional information.

SOURCE: CA Dept. of Health Care Services. All Center Letter 22-04. Launch of New CBAS ERS. Aug. 2022. (Accessed Dec. 2023).

Signature Requirement for Medication Delivery

In accordance with W&I Code, Section 14043.341, providers must obtain either a handwritten or electronic signature for prescription medications sent to a client. Providers may obtain the signature of a client or the recipient either before the medication is sent, or upon receipt when delivered to the client.

Signature Prior to Delivery – Providers have two options to obtain a client’s signature when the client is not in person, such as during a telehealth visit:

  • Recorded oral signature: Providers must ensure that they are able to collect an audio or video recording that can be stored in the provider’s case record and retrieved upon request. Providers may use either of the following two options for audio or videorecorded signatures
    • Recording only the signature portion of the telehealth visit. When recording only the signature portion of the visit, providers must record the portion of the visit where the client acknowledges and confirms the medications they will be receiving and provides their understanding that the oral signature holds the same weight as a written signature; or –
    • Recording the entire visit with the oral signature included
  • Electronic signature: Providers may obtain an electronic signature. Consistent with the Uniform Electronic Transactions Act, California Civil Code Section 1633.2, an “electronic signature” is an electronic sound, symbol, or process attached to or logically associated with an electronic record and executed or adopted by a person with the intent to sign the electronic record. An electronic signature includes a “digital signature” defined in subdivision (d) of Section 16.5 of the Government Code to mean an electronic identifier, created by a computer, intended by the party using it to have the same force and effect as a manual signature. Regardless of the type of electronic signature collected, providers must ensure that they are able to store and/or easily access documentation of the electronic signature in the client’s medical record

Signature upon Receipt of Delivery – Providers may obtain a client’s handwritten or electric signature upon receipt of delivery if the delivery service offers physical or electronic return receipts, such as those offered through the United States Postal Service. Providers must retain documentation of the signature in the client’s medical record.

SOURCE: CA DHCS Medi-Cal Provider Enrollment and Responsibilities Manual. (Aug. 2022). Pg. 20-21. (Accessed Dec. 2023).

Workers’ Compensation

Telehealth is included in the Official Medical Fee Schedule (OMFS) for California’s Workers’ Compensation system and consistent with Medicare’s List of Telehealth Services for Calendar Year 2023 (ZIP).

Recently passed regulations authorize a remote health evaluation or medical-legal evaluations through the use of electronic means of creating a virtual meeting between the physician and injured worker when both parties can visually see and hear each other and may not be in the same physical space or site. Evaluations can be completed through remote health when a hands on physical examination is not necessary and certain conditions are met.

Remote health is defined as remote visits via video-conferencing, video-calling, or such similar technology that allows each party to see and converse with the other via a video and audio connection. The evaluation must be conducted with the same standard of care as in person visit and must comply with all relevant state and federal privacy laws.

SOURCE: CA Division of Workers’ Compensation Order of the Administrative Director – Effective July 1, 2023; CA Code of Regulations, Title 8, Section 9789.1.2 & CA Code of Regulations, Title 8, Section 46.3, as proposed to be added by permanent rule. (Accessed Dec. 2023).

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Colorado

Last updated 01/25/2024

Services appropriately billed to managed care should continue to be …

Services appropriately billed to managed care should continue to be billed to managed care. All managed care requirements must be met for services billed to managed care. Managed care may or may not reimburse telemedicine costs.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 1/24. (Accessed Jan. 2024).

All Health First Colorado providers using telemedicine to deliver Health First Colorado services must employ existing quality-of-care protocols and member confidentiality guidelines when providing telemedicine services. Health benefits provided through telemedicine must meet the same standard of care as in-person care. Record-keeping should comply with Health First Colorado requirements in 10 CCR 2505-10, Section 8.130.2.

Transmissions must be performed on dedicated secure lines or must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver. Providers of telemedicine services must implement confidentiality procedures that include, but are not limited to:

  • Specifying the individuals who have access to electronic records.
  • Using unique passwords or identifiers for each employee or other person with access to the member records.
  • Ensuring a system to routinely track and permanently record such electronic medical information.
  • Members must be advised of their right to privacy and that their selection of a location to receive telemedicine services in private or public environments is at the member’s discretion.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 1/24. (Accessed Jan. 2024).

Specialty Code 878 is a new code that will be added to the Colorado interChange for Provider Types 16 (Clinic) and 25 (Non-Practitioner). Telemedicine only providers are to use Specialty Code 878. Telemedicine and in-person providers will continue to use the appropriate specialty code for their chosen provider type. Providers choosing telemedicine can only have one specialty. The telemedicine specialty does not allow Primary Care Medical Provider (PCMP) enrollment with a Regional Accountable Entity (RAE).

SOURCE: CO Department of Health Care Policy and Financing. Provider News, Issue 48. May 2022. (Accessed Jan. 2024).

Rural Provider Access and Affordability Stimulus Grant Program

Pursuant to C.R.S. § 25.5-1-207, the Rural Provider Access and Affordability Stimulus Grant Program provides grants to qualified providers to improve health care affordability and access to health care services in rural communities and to drive financial sustainability for rural hospitals and clinics. Rural Stimulus Grant funds must be used for Health Care Affordability Projects or Health Care Access Projects to improve health care affordability and access in Rural Communities.

  • Health Care Access Project means a project that expands access to health care in Rural Communities including but not limited to expanding access to Telemedicine including remote monitoring support.
  • Health Care Affordability Project means a project that modernizes the information technology infrastructure of Qualified Rural Providers including but not limited to enabling technologies, including telehealth and e-consult systems, that allow Qualified Rural Providers to communicate, share clinical information, and consult electronically to manage patient care.

SOURCE: 10 CCR 2505-10 8.8000. (Accessed Jan. 2024).

Veterans Mental Health Services Program

There is established in the Division of Veterans Affairs a veterans mental health services program to promote access to mental health services for eligible veterans by reimbursing providers for sessions with an eligible veteran. The division shall reimburse providers who participate in the program for mental health-care sessions, either in person or by telehealth, with eligible veterans. Each eligible veteran may receive twenty-six reimbursed sessions per year. Subject to available appropriations, an eligible veteran may receive, and the division shall reimburse a provider for, additional reimbursed sessions if a provider determines additional sessions are necessary. The division shall determine a reasonable rate of reimbursement for each mental health-care session with an eligible veteran pursuant to the program, which rate must be the same regardless of whether the appointment is for a telehealth or an in-person appointment.

SOURCE: Colorado Revised Statutes 28-5-714. (Accessed Jan. 2024).

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Connecticut

Last updated 01/10/2024

Effective Now Until June 30, 2024

A telehealth provider may

Effective Now Until June 30, 2024

A telehealth provider may only provide a telehealth service to a patient when the telehealth provider:

  • Is communicating through real-time, interactive, two-way communication technology or store and forward transfer technology;
  • Has determined whether the patient has health coverage that is fully insured, not fully insured or provided through Medicaid or the Children’s Health Insurance Program, and whether the patient’s health coverage, if any, provides coverage for the telehealth service;
  • Has access to, or knowledge of, the patient’s medical history, as provided by the patient, and the patient’s health record, including the name and address of the patient’s primary care provider, if any;
  • Conforms to the standard of care applicable to the telehealth provider’s profession and expected for in-person care as appropriate to the patient’s age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient’s condition; and
  • Provides the patient with the telehealth provider’s license number, if any, and contact information.

Nothing prevents a health care provider from:

  • Providing on-call coverage pursuant to an agreement with another health care provider or such health care provider’s professional entity or employer;
  • consulting with another health care provider concerning a patient’s care;
  • ordering care for hospital outpatients or inpatients; or
  • using telehealth for a hospital inpatient, including for the purpose of ordering medication or treatment for such patient in accordance with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time.

“Health care provider” means a person or entity licensed or certified pursuant to chapter 370, 372, 373, 375, 376 to 376b, inclusive, 378, 379, 380, 381a, 383 to 383c, inclusive, 384b, 397a, 399 or 400j of the general statutes or licensed or certified pursuant to chapter 368d or 384d of the general statutes.

A telehealth provider who provides health care or health services to a patient through telehealth until June 30, 2024, shall:

  • Accept as full payment for such health care or health services:
    1. An amount that is equal to the amount that Medicare reimburses for such health care or health services if the telehealth provider determines that the patient does not have health coverage for such health care or health services; or
    2. The amount that the patient’s health coverage reimburses, and any coinsurance, copayment, deductible or other out-of-pocket expense imposed by the patient’s health coverage, for such health care or health services if the telehealth provider determines that the patient has health coverage for such health care or health services. If the patient’s health coverage uses a provider network, the amount of such reimbursement, and such coinsurance, copayment, deductible or other out-of-pocket expense, shall not exceed the in-network amount regardless of the network status of such telehealth provider.
    3. If a telehealth provider determines that a patient is unable to pay for any health care or health services described in subdivisions (1) and (2) of this subsection, the provider shall offer to the patient financial assistance, if such provider is otherwise required to offer to the patient such financial assistance, under any applicable state or federal law.

SOURCE: HB 5596 (2021 Session) & SB 2 (2022 Session). (Accessed Jan. 2024).

Permanent Statute/Policy

The Commissioner is required to submit a report by Aug. 1, 2020 to the joint standing committees of the General Assembly on the categories of health care services in which the department is utilizing telehealth services, in what cities or regions of the state such services are being offered and any cost savings realized by the state by providing telehealth services.

SOURCE: CT General Statute 17b, Sec. 245e. (Accessed Jan. 2024).

Effective for dates of service January 1, 2021 and forward, telemedicine claims should no longer be billed with POS 02.

SOURCE: CT Department of Social Services, Medical Assistance Program, Provider Bulletin 2020-100, Dec. 2020. (Accessed Jan. 2024).

The executive director of the Office of Health Strategy, established under section 19a-754a of the general statutes, shall conduct a study regarding the provision of, and coverage for, telehealth services in this state. Such study shall include, but need not be limited to, an examination of (1) the feasibility and impact of expanding access to telehealth services, telehealth providers and coverage for telehealth services in this state beginning on July 1, 2024, and (2) any means available to reduce or eliminate obstacles to patient access to telehealth services, telehealth providers and coverage for telehealth services in this state, including, but not limited to, any means available to reduce patient costs for telehealth services and coverage for telehealth services in this state. Not later than January 1, 2023, the executive director shall submit a report on the findings of such study, in accordance with the provisions of section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health, human services and insurance.

SOURCE: SB 2 (2022 Session), sec. 41. (Accessed Jan. 2024).

DSS’ continued expectation is that enrolled CMAP providers will perform clinically appropriate services including, but not limited to, ensuring timely access to in-person services when medically necessary or requested by the HUSKY Health member for optimum quality of care. Therefore, all enrolled billing entities must have the capacity to deliver services inperson and must provide services in-person to the full extent that is clinically appropriate for their patients and to the full extent necessary if the HUSKY Health member does not consent to receiving one or more services via telehealth. Having the capacity means that the provider must have a physical location in CT, (or an approved applicable border state as approved as part of enrollment) where the provider has a room or set of rooms to see members in-person and can maintain the member’s privacy and confidentiality during the visit.

Each provider is responsible for ensuring that the provision of a service performed via telehealth complies with all applicable requirements, including, but not limited to Department of Public Health (DPH) practitioner licensing and scope of practice requirements, DSS regulations, provider bulletins/Important Messages, Frequently Asked Questions (FAQs), billing and documentation requirements and any other applicable State or Federal statute, regulation, or any other requirement. Note that, in accordance with sections 17b-245e and 17b-245g of the Connecticut General Statutes, services detailed in this bulletin as covered via telehealth are authorized by DSS under that authority, notwithstanding any DSS regulations or policies that may otherwise have prohibited those services to be rendered via telehealth.

HIPAA and Privacy Related Requirements

Information and data related to telehealth services are protected health information (PHI) to the same extent as in-person services and to the full extent applicable, fall under the scope of the federal Health Insurance Portability and Accountability Act (HIPAA) and all other applicable federal and state health information privacy and security requirements.

Providers must ensure they comply with all applicable requirements, including, but not limited to, using telehealth software, protocols, and procedures that fully comply with HIPAA and all other applicable requirements. Popular social media and telecommunications applications with video capabilities may not comply with HIPAA requirements and in those instances should not be used. Providers must ensure that they fully comply with such requirements, including researching applicable federal HIPAA requirements and, as appropriate, using only HIPAA compliant software to provide audio-visual or audio-only telephone telehealth services. Providers should check with their telehealth vendor to determine if the software is HIPAA compliant.

Providers must develop and implement procedures to verify provider and patient identity prior to provision of a telehealth service. Additionally, providers must ensure that an appropriate, secure, and private location is available for all HUSKY Health members participating in telehealth services.

SOURCE: CT Policy – Provider Bulletin 2023-38. May 2023. (Accessed Jan. 2024).

Hospice Hospital at Home Pilot Program

Recently passed legislation provides that not later than Jan. 1, 2024, the CT Department of Public Health shall establish, in collaboration with a hospital in the state and the CT Department of Social Services, a Hospice Hospital at Home pilot program to provide hospice care to patients in the home through a combination of in-person visits and telehealth.

SOURCE: CT SB 1075 (2023 Session). (Accessed Jan. 2024).

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Delaware

Last updated 01/15/2024

In the absence of a proper provider-patient relationship, providers are …

In the absence of a proper provider-patient relationship, providers are prohibited from issuing prescriptions solely in response to an internet questionnaire, an internet consult, or a telephone consult.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.5.5 p. 77. (Accessed Jan. 2024).

Provider manual lays out three different models for prescribing:

  1. First Model: The distant telehealth practitioner consults with the referring healthcare provider (if present during the telehealth session or by other means) about appropriate medications. The referring provider then executes the prescription locally for the patient.
  2. Second Model: The distant telehealth practitioner works with a referring provider at the originating site to provide front line care, including writing prescriptions. This method is common at mental health centers. The originating site medical professional must be available on site to write the prescription exactly as described by the distant telehealth practitioner.
  3. Third Model: The distant telehealth practitioner directly prescribes and sends/calls-in the initial prescription or refill to the patient’s pharmacy.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual,1/12/24. Sec. 16.5.5 p. 77 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 13.  (Accessed Jan. 2024).

The preferred order of prescribing medications is:

  1. Secure e-prescribe
  2. Fax
  3. Phone
  4. Hard Copy – If a hard copy of a prescription is required, it can be written and sent via delivery service to the referring site for the consumer to pick-up a couple of days after the appointment.

Procedures for Stimulants, Narcotics, and Refills: The distant telehealth practitioner writing the prescription should be available to manage emergencies or any prescription gaps between appointments. The originating site must be able to connect with the distant telehealth practitioner outside of “telehealth transmission hours”.

Procedures for access to care between telehealth visits, including emergency and urgent care: Patients should contact the referring provider or specialist as appropriate.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.5.6 p. 77-78. (Accessed Jan. 2024).

For stimulants, narcotics and refills, hard copy prescriptions can be written and sent via delivery service to the referring site for the consumer to pick up a couple days after the appointment (see manual for more details).

SOURCE: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 13.  (Accessed Jan. 2024).

Telehealth provider responsibilities include:

  • Verify member eligibility for telehealth services. The service must be medically necessary, written in the patient’s treatment plan, and follow generally accepted standards of care.
  • Except for instances listed in 24 Del.C. Chapter 60, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth but must meet the requirements of Del.C. 24 §6003.
  • Consent is required to assure that the patient is a willing participant in the telehealth delivered service and to assure that the recipient retains a voice in their treatment plan.
  • The patient must be informed and given an opportunity to request an in-person assessment before receiving a telehealth assessment. This consent must be documented in the patient’s record and must identify that the covered medical service was delivered by telehealth.
  • The recipient must be able to adequately communicate, either directly or through a representative, with the originating and distant site practitioners.
  • Comply with Americans with Disabilities Act (ADA) communications regulations, including language translation / interpretation accommodations.
  • The provision of services through telehealth must include accommodations, including interpreter and audio-visual modification, where required under the ADA, to ensure effective communication.

Telehealth operational requirements include:

  • The distant telehealth practitioner cannot be a self-referring practitioner.
  • The distant site provider or other coverage must be available for appropriate followup care with the patient.
  • All telehealth services must comply with HIPAA patient privacy and confidentiality regulations at the site where the patient is located, the site where the distant telehealth practitioner is located, and in the transmission process.
  • All telehealth services must be performed on dedicated secure transmission linkages that meet the minimum federal and state requirements, including but not limited to 45 CFR, Parts 160 and 164 (HIPAA Security Rules). All confidentiality requirements that apply to written medical records will apply to services delivered by telehealth, including the actual transmission of health care data and any other electronic information and records.
  • Secure video-conferencing via personal computers, tablets, or other mobile devices may be considered to meet the requirements of telehealth where it can be demonstrated that the use of the devices and the patient setting comply with this DMAP telehealth policy.
  • Services provided via communications equipment which do not meet this definition, are non-secure, and are non-HIPAA compliant are not covered.
  • All telehealth sites, both originating and distant sites, must have a written procedure detailing a contingency plan for when a failure or interoperability of the transmission or other technical difficulties render the service undeliverable. Telehealth services are not billable to DMAP or MCOs when technical difficulties preclude the delivery of part or all of the telehealth session.

Documentation Requirements:

  • Originating / Referring Providers – The referring provider’s medical records must document all components of the services being billed.
  • Distant Site – All distant telehealth practitioners are required to develop and maintain written documentation in the form of evaluations and progress notes, the same as if the documentation had originated during an in-person visit or consultation, including the mode of communication (telehealth). Distant telehealth practitioners may opt to use electronic medical records in place of paper-based written records.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.4-5 p. 75-77. (Accessed Jan. 2024).

Services billed which indicate telehealth as the mode of service delivery but are not substantiated by either the claim form or written medical records are subject to disallowances in the course of an audit.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.6.2, p. 79. (Accessed Jan. 2024).

Confidentiality, privacy and electronic security standards for telemedicine as well as a contingency plan required of telemedicine sites are listed in the DE Behavioral Health Service Certification and Reimbursement manual.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10. (Accessed Jan. 2024).

The face-to-face encounter for home health services used to evaluate a patient’s condition and recertify services may take place via telehealth.

SOURCE: DE Medical Assistance Program. Home Health Provider Specific Manual, 2/15/20. Sec. 5.2.8, p. 18. (Accessed Jan. 2024).

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District of Columbia

Last updated 12/06/2023

Where an FQHC provides an allowable healthcare service at the …

Where an FQHC provides an allowable healthcare service at the originating or distant site, the FQHC shall be reimbursed the applicable rate (PPS, APM or FFS).  If an FQHC is both the originating and distant site, and both sites render the same healthcare service, only the distant site will be reimbursed.

When DCPS or DCPCS provides any of the allowable healthcare services at the originating or distant site, the provider shall only be reimbursed for distant site healthcare services that are Medicaid eligible and are to be delivered in a licensed education agency.

When an originating site and a distant site are CSAs, and the same provider identification number is used for a service delivered via telemedicine, only the distant site provider shall be eligible for reimbursement of the allowable healthcare services described within this section.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.24, 25, 26 & 27. (Accessed Dec. 2023).

See Transmittal for documentation standards for services delivered via telemedicine in DC Medicaid.

SOURCE: DC Medicaid Department of Health Care Finance. Transmittal #20-42: Documentation Standards for Services Delivered Via Telemedicine. Nov. 30, 2020 (Accessed Dec. 2023).

Telemedicine section also appears in Provider Manuals on:

See regulation and telemedicine guidance for specific technology and medical record requirements.

A provider is required to develop a confidentiality compliance plan.

DHCF is required to send a Telemedicine Program Evaluation survey to providers.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.13, 14 & 15 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, pg. 6-7. (Accessed Dec. 2023).

Emergency Rules

Emergency regulations will expand services for persons with developmental disabilities in the Medicaid Home and Community-Based Services programs and allow the use of remote support services that employ technology.

SOURCE: Department of Health Care Finance, Notice of Emergency and Proposed Rulemaking – Amending 29 DCMR Chapter 90 – Governing Home and Community Based Services Waiver for Individual and Family Support. March 2023. (Accessed Dec. 2023).

Emergency regulations amend billing requirements for Assertive Community Treatment (ACT). This rule also defines the services that constitute a contact, when telehealth can be used, and establishes standards for the types of contacts that a provider must deliver to receive the monthly payment. In addition, this rulemaking updates the procedure by which the Department determines supported employment service eligibility by eliminating the requirement that DBH perform both a needs-based assessment and an independent Diagnostic Assessment or Comprehensive Diagnostic Assessment. DBH will only conduct needs-based assessments to determine service eligibility and such assessments can be conducted through telehealth.

See Transmittals 23-39 and 23-50 for additional details.

SOURCE: Department of Health Care Finance, Notice of Emergency and Proposed Rulemaking – Amending 29 DCMR Chapter 52 – Governing Assertive Community Treatment. Nov. 2023; Department of Behavioral Health – Notice of Emergency and Proposed Rulemaking – Amending 22-A DCMR Ch. 34 and 37 – Assertive Community Treatment Reimbursement, Sept. 2023. (Accessed Dec. 2023).

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Florida

Last updated 02/23/2024

Substance Abuse Services – Telehealth

Providers shall maintain policies and …

Substance Abuse Services – Telehealth

Providers shall maintain policies and procedures outlining how they will provide services through telehealth as described in subsection 65D-30.003(1), F.A.C.

Providers delivering services through telehealth shall provide the service to the same extent the service would be delivered if provided through an in-person service delivery with a provider.

Providers delivering any services by telehealth are responsible for the quality of the equipment and technology employed. Providers are responsible for its safe use. Providers utilizing telehealth equipment and technology must be able meet or exceed the prevailing standard of care. Service providers must meet the following additional requirements:

Must be capable of two (2)-way, real-time electronic communication, and the security of the technology must be in accordance with applicable federal confidentiality regulations 45 CFR §164.312;

The interactive telecommunication equipment must include audio and high-resolution video equipment which allows the staff providing the service to clearly understand and view the individual receiving services;

SOURCE: FL Admin Code Sec. 65D-30.004. (Accessed Feb. 2024).

No reimbursement for equipment used to provide telemedicine services.

SOURCE: FL Admin Code 59G-1.057. (Accessed Feb. 2024).

Telehealth Minority Maternity Care Pilot Programs

 By July 1, 2022, the department shall establish a telehealth minority maternity care pilot program in Duval County and Orange County which uses telehealth to expand the capacity for positive maternal health outcomes in racial and ethnic minority populations. The department shall direct and assist the county health departments in Duval County and Orange County to implement the programs. The pilot programs shall adopt the use of telehealth or coordinate with prenatal home visiting programs to provide services and education to eligible pregnant women up to the last day of their postpartum periods and provide training to participating health care practitioners and other perinatal professionals.

SOURCE: FL Statute 383.2163. (Accessed Feb. 2024).

Early Learning Mental Health Assistance Program

Contracts or interagency agreements with one or more local community behavioral health providers or providers of Community Action Team services to provide a behavioral health staff presence and services at district schools. Services may include, but are not limited to, mental health screenings and assessments, individual counseling, family counseling, group counseling, psychiatric or psychological services, trauma-informed care, mobile crisis services, and behavior modification. These behavioral health services may be provided on or off the school campus and may be supplemented by telehealth as defined in s. 456.47(1).

Policies of the school district which must require that in a student crisis situation, school or law enforcement personnel must make a reasonable attempt to contact a mental health professional who may initiate an involuntary examination pursuant to s. 394.463, unless the child poses an imminent danger to themselves or others, before initiating an involuntary examination pursuant to s. 394.463. Such contact may be in person or through telehealth. The mental health professional may be available to the school district either by a contract or interagency agreement with the managing entity, one or more local community-based behavioral health providers, or the local mobile response team, or be a direct or contracted school district employee.

SOURCE: FL Statute Sec. 1006.041. (Accessed Feb. 2024).

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Georgia

Last updated 01/31/2024

The referring provider must be the member’s attending physician, practitioner, …

The referring provider must be the member’s attending physician, practitioner, or provider in charge of their care. The request must be documented in the member’s record. The physician or practitioner providing the referral must provide pertinen medical information and/or records to the distant site provider via a secure transmission. Notwithstanding the foregoing, referrals for evaluation of physical, mental, or sexual abuse may be made by an appropriate agency or group, including but not limited to, law enforcement or social services agencies.

Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider. Additionally, all electronic documentation must be available for review by the Georgia Department of Community Health, Medicaid Division, Division of Program Integrity and all other applicable divisions of the department.

All transactions must utilize acceptable methods of encryption as well as employ authentication and identification procedures for both the sender and receiver.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 14-17 (Jan. 1, 2024). (Accessed Jan 2024).

Prescribing Medications Via Telehealth:

Providers may prescribe medications through the use of Telemedicine/Telehealth. All prescribers, whether in-state or out-of-state, must have and use his or her unique Drug Enforcement Administration (DEA) registration number to authorize controlled substance prescriptions. DEA regulations require practitioners to obtain a separate DEA registration in each state in which he or she prescribes controlled substances.

Accordingly, out of state practitioners, must obtain a Georgia DEA registration number if prescribing controlled substances to Georgia Medicaid and PeachCare for Kids members who are located within the state of Georgia.  Out-of-state practitioners, who do not prescribe controlled substances to Georgia Medicaid and PeachCare for Kids members within the state of Georgia are not required to have a Georgia DEA registration number.

Ordering, Prescribing, and Referring (OPR) Requirements for Telehealth Services:

  • The physician or non-physician practitioner who wrote the order, prescription or referral must be enrolled in Medicaid as either a participating Medicaid provider or as an OPR provider and his or her NPI number must be included on the claim.
  • The provider’s NPI number must be for an individual physician or non-physician practitioner (not an organizational NPI).
  • The physician or non-physician practitioner must be of a specialty type that is eligible to order, prescribe, or refer.

Professional Liability Insurance Requirements for Providers Rendering Services via Telehealth:

Each individual practitioner providing services through the use of Telemedicine/Telehealth is required to maintain professional liability insurance in the amount of $1 million per occurrence/$3 million per aggregate. Shared policies are prohibited and will not be accepted.  Umbrella and/or Excess Coverage policies will be accepted if the policy indicates professional liability (malpractice) coverage is included. Umbrella policies must include professional liability insurance in the amount of $1 million per occurrence/$3 million per aggregate for each individual practitioner.  The umbrella policy must list each individual practitioner by name and clearly state that the $1m/$3m umbrella reflects individual limits (not shared).

SOURCE: GA Department of Community Health, Provider Messages (All Providers) Sept. 16, 2022. (Accessed Jan 2024).

Elderly and Disabled Waiver Program (CCSP/Community Services)

Provider/member telehealth communication in EDWP will involve a camera telehealth modality encrypted (end to end encryption) software product with established business agreement that protects PHI (protected health information). PHI is information about health status, provision of health care, or payment for health care that is created or collected by a covered entity and can be linked to a specific individual. Applicant/member or Provider with access to landline phone (one way) can be utilized in place of the software requirement. Landline/non internet use is appropriate (copper wires that carry their own power and work during blackouts). Calls not involving billable service work requires I phone or Android encryption cell settings use or landline. Use of electronic health records, member portal access or app use are to be encrypted (end to end encryption) with business agreement as well.

SOURCE: GA Dept. of Health Elderly and Disabled Waiver Program General Services, p. 27 (Jan. 1, 2024).  (Accessed Jan. 2024).

 

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Hawaii

Last updated 02/12/2024

Health Plan Network Adequacy

Rules for classifying/counting providers:

Providers who …

Health Plan Network Adequacy

Rules for classifying/counting providers:

Providers who offer telehealth-based services may be included under the following circumstances:

  • The key role of telehealth in the context of a provider network adequacy analysis is to close network gaps, as opposed to infection control or alternative options for communication, although these are key advantages in other contexts. Therefore, telehealth may be used in this report predominantly to close gaps or enhance the provider network.
  • Telehealth shall only be used to close network gaps for the provider types/types of services only for services that canbe rendered via telehealth.
  • Rules for classifying/counting providers also apply to telehealth providers with some key distinctions.
  • Telehealth may be used to close gaps on neighbor islands, or in rural areas on Oahu. Therefore, a given provider in an urban area on one island willing to provide telehealth services in an urban area on another island may be included twice even within a given provider group. However, if the provider is located on the same island, the provider may only be counted twice if they are located in an urban area, but additionally providing services via telehealth to members in a rural part of the island (and vice versa).
  • In all these instances, the statewide metrics must deduplicate providers within a single provider group.
  • For the purposes of this report, a given provider may only serve via telehealth on a single second island than the one on which they reside. In other words, a given provider may not be used to close network gaps on more than two islands for the purposes of this report even if they in theory can provide telehealth services statewide, to proxy a consideration for a given provider’s capacity. If the provider is located outside Hawaii, they may only serve a single island via telehealth.

If a provider is available to a member via telehealth, the member driving time to the provider shall be zero minutes, unless the member’s telehealth claims typically include an origination site that is non-residential. In these cases, the driving time shall be based on the distance from the member’s residence to the origination site.

“Aggregate Metrics – Physical Network” shall be based on all providers in the network, based on their physical location, and not including their capacity to provide telehealth-basedservices.

SOURCE: Department of Human Services, Med-QUEST Division Health Plan Manual (Oct 1, 2023), p. 170-171, 175, 178.  (Accessed Feb. 2024).

SB 2624 requires the establishment of a telehealth and rural health care pilot projects.

SOURCE: SB 2624 (2022 Session). (Accessed Feb. 2024).

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Idaho

Last updated 02/13/2024

If virtual services are offered, it is the rendering provider’s …

If virtual services are offered, it is the rendering provider’s responsibility to ensure meaningful access to virtual services for individuals with limited English proficiency. Meaningful access includes but is not limited to ensuring high quality audio with a clear and audible transmission of voices and adequate training to users of the technology. Any electronic or written information must be provided to the participant before the virtual care appointment and provided in a form and manner which the participant can understand. The provider must make reasonable accommodations through methods such as a translator or qualified interpreter when necessary.

Technical Requirements:

Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible.

Documentation Requirements

The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and that services were delivered via virtual care. The documentation must be of the same quality as is originated during an in-person visit including but not limited to, billing the CPT® or HCPCS code with the number of minutes closest to the actual time spent providing the service, service type, amount, frequency, duration and time spent with the participant. If the code is a timed code of 15-minute increments, it must be billed with a number of units as described in the Billing 15-Minute Timed Codes section of the General Billing Instructions, Idaho Medicaid Provider Handbook. These documentation requirements are specific to delivery via virtual care and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024)  9.12.1 & 1.12.2, p. 131, ID MedicAide (May 2023).  (Accessed Feb. 2024).

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Illinois

Last updated 02/27/2024

The IL Association of Medicaid Health Plans has created a …

The IL Association of Medicaid Health Plans has created a comprehensive billing manual for IL Medicaid Managed Care that includes some information on telehealth policy as it applies to these health plans. The existence of this guide was relayed to IL Medicaid providers by the IL Dept of Healthcare and Family Services in a Provider Notice issued on 11/17/2023.

SOURCE: IL Dept of Healthcare and Family Services, Provider Notice PRN231117a (Nov 17, 2023).   (Accessed Feb. 2024).

Specific documentation requirements apply for telehealth services.  See administrative code for details.

SOURCE: IL Administrative Code, Title 89 ,140.403(d). (Accessed Feb. 2024).

The Department shall file an amendment to the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities authorized under Section 1915(c) of the Social Security Act to incorporate telehealth services administered by a provider of telehealth services that demonstrates knowledge and experience in providing medical and emergency services for persons with intellectual and developmental disabilities. The Department shall pay administrative fees associated with implementing telehealth services for all persons with intellectual and developmental disabilities who are receiving services under the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities.

SOURCE: SB 1298 (Enacted 2023) & Illinois 305 ILCS 5/5-5a1.  (Accessed Feb. 2024).

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Indiana

Last updated 12/05/2023

Special Considerations for Telehealth

The following special circumstances apply to …

Special Considerations for Telehealth

The following special circumstances apply to telehealth services:

  • The practitioner who will be examining the patient from the distant site must determine if it is medically necessary for a medical professional to be at the originating site. Separate reimbursement for a provider at the originating site is payable only if that provider’s presence is medically necessary. Documentation must be maintained in the patient’s medical record to support the need for the provider’s presence at the originating site during the visit. Such documentation is subject to postpayment review. If a healthcare provider’s presence at the originating site is medically necessary, billing of the appropriate evaluation and management code is permitted.
  • When ongoing services are provided, the member should be seen by a physician for a traditional clinical evaluation at least once a year, unless otherwise stated in policy. In addition, the distant provider should coordinate with the patient’s primary care physician.
  • Office visits conducted via telehealth are subject to existing service limitations for office visits. Telehealth office visits billed using applicable codes from Telehealth and Virtual Services Codes (accessible from the Code Sets page at in.gov/medicaid/providers) are counted toward the member’s office visit limit. See the Evaluation and Management Services module for information about office visit limitations.
  • Although reimbursement for end-stage renal disease (ESRD)-related services is permitted in the telehealth setting, the IHCP requires at least one monthly visit for ESRD-related services to be a traditional clinical encounter to examine the vascular access site.
  • A provider can use telehealth to prescribe a controlled substance to a patient who has not been previously examined. Opioids, however, cannot be prescribed via telehealth, except in cases in which the opioid is a partial agonist (such as buprenorphine) and is being used to treat or manage opioid dependence.

Providers should always give the member the choice between a traditional clinical encounter versus a telehealth visit. Appropriate consent from the member must be obtained by the provider prior to delivering services. Providers must have written protocols for circumstances when the member requires a hands-on visit with the provider.

SOURCE:  Indiana Health Coverage Programs, Provider Reference Manual, Telehealth and Virtual Services (Sept. 27, 2022), p. 2-3.  (Accessed Dec. 2023).

All services delivered through telehealth are subject to the same limitations and restrictions as they would be if delivered in-person.

Documentation must be maintained by the provider to substantiate the services provided and that consent was obtained. Documentation must indicate that the services were rendered via telehealth, clearly identify the location of the provider and patient and be available for post-payment review.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Dec. 2023).

A Medicaid recipient waives confidentiality of any medical information discussed with the health care provider that is:

  • Provided during a telehealth visit; and
  • Heard by another individual in the vicinity of the Medicaid recipient during a health care service or consultation.

SOURCE: IN Code, 12-15-5-11(e) (Accessed Dec. 2023).

Skills training and development rendered via telehealth

As published in BT202249, the IHCP reimburses for H2014 – Skills training and development, per 15 minutes when the service is rendered through an audiovisual telehealth modality. Skills training and development is covered only for members who have access to Medicaid Rehabilitation Option (MRO) services. The OMPP, in partnership with the Division of Mental Health and Addiction (DMHA), developed the following service parameters for when telehealth delivery satisfies the “face-to-face” contact required for this service.  (See bulletin for additional details).

SOURCE: ICHP Expands and Clarifies Telehealth Coverage BT 202297 (Nov. 8, 2022).  (Accessed Dec. 2023).

Division of Mental Health and Addiction, Adult Mental Health Habilitation Services

The method of the interview (face to face or via telehealth) must be verified by a progress note entry in the clinical documentation. Signed attestation forms will no longer constitute proof of a method of interview.

When delivering services via telehealth, the following service parameters satisfy the “face-to-face” contact required for this service:

  • All clients being considered for telehealth services must be given the option of in-person services prior to telehealth being selected as modality.
  • Client must indicate that telehealth is their preferred method for receiving services.Client must have documented acknowledgement of receipt of informed consent about risks/benefits of the telehealth modality.
  • Within 30 days of the first telehealth session occurring, a licensed behavioral health practitioner, health service provider in psychology (HSPP) or overseeing psychiatric medical professional must document verification that telehealth is thought to be an effective modality for client based on symptoms, severity and access to services.
  • Telehealth modality must be formally reviewed with client every 90 days and adjusted based on need/efficacy.
  • If client is not progressing/stabilizing, evaluation of how treatment will be adjusted must be documented. This adjustment may include increasing in-person sessions.
  • All habilitation and support sessions should have clearly documented connection to diagnosis and/or treatment goals.
  • At minimum, client must have an in-person session with a member of the treatment team every 90 days. This session may be in the home, community or office setting.
  • The number of in-person visits and the percentage of time telehealth will be the delivery method of service will be based on what is clinically appropriate and in agreement with the consumer and/or legal guardian.
  • The use of telehealth should protect against isolating participants by offering services that are in person and shall be invoked to prioritize and facilitate community integration.
  • As required by 45 CFR 164.308 (a)(1)(ii), an accurate and thorough risk analysis shall be conducted for any functions using telehealth services to assess the potential risks and vulnerabilities to the confidentiality, integrity and availability of patient data.
  • All telehealth services will be delivered in a way that respects privacy of the individual especially in instances of toileting, dressing, and so on. Video cameras/monitors are not permitted in bedrooms and bathrooms. Participants are able to turn all telehealth-related devices on/off at their discretion to ensure privacy. The provider that is responsible for the treatment of the individual is responsible for training participants on the use of any telehealth-related devices both initially and ongoing.
  • Telehealth services shall consider and respond to all accessibility needs, including whether hands-on or physical assistance is needed to render the service.
  • Telehealth services must ensure the health and safety of the individual receiving services by adhering to all abuse, neglect and exploitation prevention practices that apply to in-person treatment, as well as by providing participants with resources on how to report incidences of abuse, neglect and exploitation.

SOURCE: IHCP, Division of Mental Health and Addiction, Adult Mental Health Habilitation Services (Oct. 3, 2023), p. 41, 71-72.  (Accessed Dec. 2023).

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Iowa

Last updated 01/15/2024

No reference found.

No reference found.

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Kansas

Last updated 12/06/2023

The same requirements for patient privacy and confidentiality under HIPAA …

The same requirements for patient privacy and confidentiality under HIPAA of 1996 and 42 C.F.R. §2.13, as applicable, that apply to healthcare services delivered through in-person contact also apply to healthcare services delivered through telemedicine. Nothing in this section supersedes the provisions of any state law relating to the confidentiality, privacy, and security or privileged status of protected health information (PHI).

  1. Telemedicine may be used to establish a valid provider-patient relationship.
  2. The same standards of practice and conduct that apply to healthcare services delivered through personal contact also apply to healthcare services delivered through telemedicine.
  3. A person who is authorized by law to provide and provides telemedicine services to a patient must provide the patient with guidance on appropriate follow-up care.
  4. Except when otherwise prohibited by any other provision of law, when the patient consents and has a primary care or other treating physician, the person providing telemedicine services will send within three business days a report to such primary care or other treating physician of the treatment and services rendered to the patient in the telemedicine encounter.
  5. A person licensed, registered, certified, or otherwise authorized to practice by the Behavioral Sciences Regulatory Board will not be required to comply with the provisions of requirement #4 (above).
  6. The provisions of this section shall also apply to the Kansas Medical Assistance Program (KMAP).
  7. KMAP will not exclude an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine, rather than through personal contact, or based upon the lack of a commercial office for the practice of medicine.
  8. The insured’s medical record will serve to satisfy all documentation for the reimbursement of all telemedicine healthcare services, and no additional documentation outside of the medical record will be required.
  9. Payment or reimbursement of covered healthcare services delivered through telemedicine is the payment or reimbursement for covered services that are delivered through personal contact.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-32 (Nov. 2023). (Accessed Dec. 2023).

Home Health Agencies

The face-to-face encounter may occur through telehealth, as implemented by the State.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Home Health Agency, p. 8-7 (Nov. 2023). (Accessed Dec. 2023).

Hospice

Service Intensity Add-on (SIA) Payment for hospice care is not covered if provided by a social worker via telephone.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospice, p. 8-11 (Nov. 2023). (Accessed Dec. 2023).

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Kentucky

Last updated 12/11/2023

The cabinet, in consultation with the Division of Telehealth Services …

The cabinet, in consultation with the Division of Telehealth Services within the Office of Inspector General as established in KRS 194A.105, shall:

  • Provide guidance and direction to providers delivering health care services using telehealth or digital health
  • Promote access to health care services provided via telehealth or digital health
  • Maintain an online telehealth provider directory for consumer use; and
  • No later than thirty (30) days after the effective date of this Act, promulgate administrative regulations in accordance with KRS Chapter 13A to:
    • Establish a glossary of telehealth terminology to provide standard definitions for all healthcare providers who deliver health care services via telehealth, all state agencies authorized or required to promulgate administrative regulations relating to telehealth, and all payors;
    • Establish minimum requirements for the proper use and security of telehealth, including requirements for confidentiality and data integrity, privacy and security, informed consent, privileging and credentialing, reimbursement, and technology 
    • Establish minimum requirements to prevent waste, fraud, and abuse related to telehealth; and
    • Maintain the discretion of state agencies authorized or required to promulgate administrative regulations relating to telehealth to establish requirements to authorize, prohibit, or otherwise govern the use of telehealth in accordance with the state agencies’ respective jurisdictions.

The cabinet is also required to study the impact of telehealth on health care delivery and submit annual reports to the Legislative Research Commission. See statute for details.

SOURCE: KY Statute Sec.  211.334.  (Accessed Dec. 2023).

A health-care facility that receives reimbursement under this section for consultations provided by a Medicaid-participating provider who practices in that facility and a health professional who obtains a consultation under this section shall establish quality-of-care protocols, which may include a requirement for an annual in-person or face-to-face consultation with a patient who receives telehealth services, and patient confidentiality guidelines to ensure that telehealth consultations meet all requirements and patient care standards as required by law.

The Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of Medicaid services shall not deny reimbursement for telehealth services covered by this section based solely on quality-of-care protocols adopted by a health-care facility.

SOURCE: KY Statute Sec. 205.559. (Accessed Dec. 2023).

The cabinet shall provide oversight, guidance, and direction to Medicaid providers delivering care using telehealth.

  • The Department for Medicaid Services shall within 30 days after the effective date of the Act do the following:
    • Promulgate administrative regulations in accordance with KRS Chapter 13A to establish requirements for telehealth coverage and reimbursement rates, which shall be equivalent to coverage requirements and reimbursement rates for the same service provided in person unless the telehealth provider and the department or a managed care organization contractually agree to a lower reimbursement rate for telehealth services; and
    • Create, establish, or designate the claim forms, records required, and authorization procedures to be followed in conjunction with this section and KRS 205.559,
  • Require that specialty care be rendered by a health care provider who is recognized and actively participating in the Medicaid program;
  • Require that any required prior authorization requesting a referral or consultation for specialty care be processed by the patient’s primary care provider and that any specialist coordinates care with the patient’s primary care provider; and
  • Require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services.

The Cabinet for Health and Family Services cannot require a Medicaid provider to be a part of a telehealth network.

SOURCE: KY Statute Sec. 205.5591, (Accessed Dec. 2023).

For FQHCs and RHCs, a “visit” is defined as occurring in-person or via telehealth if authorized by 907 KAR 3:170.

SOURCE: KY 907 KAR 1:055 (37). (Accessed Dec. 2023).

See rule for requirements of health care providers performing a telehealth or digital health service, including those related to confidentiality, patient privacy, consent, credentialing.

SOURCE: KY 900 KAR 12:005 (Accessed Dec. 2023).

Behavioral Health Conditional Dismissal Pilot Program

A pilot program shall be established in no less than ten (10) counties selected by the Chief Justice of the Supreme Court to participate in a behavioral health conditional dismissal program. The pilot program shall begin January 1, 2023, and shall last for four (4) years unless extended or limited by the General Assembly.

Notwithstanding any other provision to the contrary, the clinical assessment may be conducted through telehealth or in person, whether the person charged is in the custody of the jail or has been released.

SOURCE: KY Revised Statutes 533.272533.276. (Accessed Dec. 2023)

Corrections

The Department of Corrections shall:

  • Promulgate administrative regulations to:
    • Require telehealth services in county jails

The department may promulgate administrative regulations in accordance with KRS Chapter 13A to implement a program that provides for reimbursement of telehealth consultations.

See statute for additional Information.

SOURCE: KY Revised Statutes 197.020. (Dec. 2023).

The Division of Telehealth Services has a Telehealth Terminology Glossary available.

SOURCE: KY 900 KAR 12:005. (Accessed Dec. 2023).

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Louisiana

Last updated 02/15/2024

Supports Waiver

View virtual delivery guidelines in manual.

SOURCE: LA

Supports Waiver

View virtual delivery guidelines in manual.

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 8/21/23), (Accessed Feb. 2024).

The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:

  1. An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
  2. Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
  3. The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.

SOURCE: LA Statute Sec. 46:460.54. (Accessed Feb. 2024).

The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 165, (As issued on 6/27/22), (Accessed Feb. 2024).

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Maine

Last updated 02/03/2024

See manual for information regarding telehealth equipment, technology, security, documentation …

See manual for information regarding telehealth equipment, technology, security, documentation and member choice and education requirements.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p. 9-12. (Nov. 6, 2023). (Accessed Feb. 2024).

Beginning January 1, 2018 and annually thereafter, the department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters on the use of telehealth in the MaineCare program, including the number of providers providing telehealth and telemonitoring services, the number of patients served by telehealth and telemonitoring services and a summary of grants applied for and received related to telehealth and telemonitoring.

The Department is required to conduct educational outreach to providers and MaineCare members on telehealth and telemonitoring services.

SOURCE: ME Statute Sec. 3173-H. (Accessed Feb. 2024).

Telepharmacy is a method of delivering prescriptions dispensed by a pharmacist to a remote site. Pharmacies using telepharmacy must follow all applicable State and Federal regulations, including use of staff qualified to deliver prescriptions through telepharmacy.

Providers may dispense prescriptions via telepharmacy when obtaining approval from the Department. Providers must assure that member counseling is available at the remote site from the dispensing provider or the provider delivering the prescription, and that only qualified staff, as defined by the Maine State Board of Pharmacy, deliver prescriptions. The Department may terminate this approval at any time by written notice.

SOURCE: MaineCare Benefits Manual, Pharmacy Services, 10-144 Ch. II, Sec. 80 p. 5 & 30. (Sept. 1, 2017), (Accessed Feb. 2024).

ME established the ME Telehealth and Telemonitoring advisory group to evaluate difficulties related to telehealth and telemonitoring services and make recommendations to the department to improve it statewide.

SOURCE: ME Statute Sec. 3173-I. (Accessed Feb. 2024).

Office of MaineCare Services

ME Medicaid has a telehealth resource page to assist providers and consumers.

SOURCE: ME Dept. of Health and Human Services, Office of MaineCare Services, Telehealth, (Accessed Feb. 2024).

The department shall, to the extent funding allows, establish a statewide child psychiatry telehealth consultation service known as the Maine Pediatric and Behavioral Health Partnership Program, referred to in this subsection as “the program,” to support primary care physicians who are treating children and adolescent patients and need assistance with diagnosis, care coordination, medication management and any other necessary behavioral health questions to serve their patients.  See statute for program details.

SOURCE: 34-B MRSA Sec. 15003, Sub. 11, (Accessed Feb. 2024).

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Maryland

Last updated 02/21/2024

Technical Requirements

Providers delivering services via telehealth must use technology

Technical Requirements

Providers delivering services via telehealth must use technology that supports the standard level of care required to deliver the service rendered. A service delivered via synchronous audio-visual telehealth shall, at a minimum, meet the following technology requirements:

  1. Cameras at both the originating and distant sites that provide clear, synchronous video of the patient and provider, respectively, with the ability to meet the clinical requirements of the service;
  2. Have display monitor size sufficient to support diagnostic needs used in the service via telehealth;
  3. Network connectivity and bandwidth at both the originating and distant site sufficient to provide clear, synchronous two-way video and audio for the full duration of the service;
  4. Unless engaging in a telehealth communication with a participant who is deaf or hard of hearing, microphones and speakers at both the originating and distant sites, respectively, that provide clear, synchronous, two-way audio transmission;
  5. Utilize technology that meets the standards required by state and federal laws governing the privacy and security of protected health information (HIPAA compliant).

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 2-3. Updated Aug. 2023; COMAR 10.09.49.05. (Accessed Feb. 2024).

A dedicated connection that provides bandwidth only for telehealth communications is preferable for services delivered via telehealth.

All technical staff should be trained to use telehealth technology and in HIPAA Compliance.

Please review Maryland Medicaid’s FAQs for additional technological and HIPAA compliance questions.

For audio-visual telehealth, services rendered must be performed via technology that is HIPAA compliant and meets Technical Requirements of COMAR 10.09.49.05.

For audio-only services, services rendered must be performed via technology that meets Technical Requirements of COMAR 10.09.49.05.

Confidentiality

Providers must comply with the laws and regulations concerning the privacy and security of protected health information including but not limited to Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland and the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Particularly, providers:

  1. Shall ensure that all interactive video technology-assisted communication and audio-only communication comply with HIPAA patient privacy and security regulations throughout the transmission process;
  2. May not disseminate any participant images or information to other entities without the participant’s consent, unless there is an emergency that prevents obtaining consent; and,
  3. May not store the video images or audio portion of the service rendered via telehealth for future use.

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 3-4. 8. Updated Aug. 2023, COMAR 10.09.49.06. (Accessed Feb. 2024).

Medical Records

Providers must maintain documentation in the same manner as during an in-person visit or consultation, using either electronic or paper medical records, per the Health-General Article, §4-403, Annotated Code of Maryland. Participants shall have access to all transmitted medical information. Providers may not store the video images or audio portion of the service delivered via telehealth for future use.

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 4. Updated Aug. 2023. (Accessed Feb. 2024).

Medical Record Documentation

The provider shall:

  • Maintain documentation in the same manner as during an in-person visit, using either electronic or paper medical records;
  • Retain telehealth records according to the provisions of Health-General Article, §4-403, Annotated Code of Maryland; and
  • Include the participant’s consent to participate in telehealth or an explanation as to why consent was not available.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04. (Accessed Feb. 2024).

In consultation with interested stakeholders, the Director shall prepare an annual report on behavioral health services for children and young adults in the State.  The report shall include: The number and the percentage of children and young adults who, during the reported year: … Used a public behavioral health service provided through telehealth.

SOURCE: MD Health General Code 7.5-209. (Accessed Feb. 2024).

The Maryland Health Services Cost Review Commission, the Maryland Department of Health, and the Maryland Insurance Administration, shall submit a report to the Senate Finance Committee and the House Health and Government Operations Committee on the impact of providing telehealth services. The Maryland Health Care Commission shall consider both audio–only and audio–visual technologies for purposes of reporting on the impact of providing telehealth services as required by this section.

Until and no later than June 30, 2023, while the Maryland Health Care Commission completes the study and submits the report for consideration by the General Assembly for the adoption of comprehensive telehealth policies by the State:

  • The Maryland Medical Assistance Program is to continue to reimburse health care providers for covered health care services provided through audio–only and audio–visual technology in accordance with the requirements of Section 1 of this Act, and all applicable executive orders and waivers issued in accordance with Chapters 13 and 14 of the Acts of the General Assembly of 2020
  • Insurers, nonprofit health service plans, and health maintenance organizations that are subject to § 15–139 of the Insurance Article as enacted by Section 1 of this Act continue to reimburse health care providers for covered health care services provided through audio–only and audio–visual technology in accordance with the requirements of Section 1 of this Act and all applicable accommodations made by the insurers, nonprofit health service plans, and health maintenance organizations during the Declaration of State of Emergency and Existence of Catastrophic Health Emergency – COVID–19 issued on March 5, 2020, and its renewals

The Maryland Health Care Commission should use the data collected from utilization and coverage of telehealth to complete the report.

The State is to use the report required to establish comprehensive telehealth policies for implementation after the Declaration of State of Emergency and Existence of Catastrophic Health Emergency – COVID–19 issued on March 5, 2020, and its renewals expire.

SOURCE: HB 123/SB 3 (2021 Session). (Accessed Feb. 2024).

The Maryland Health Care Commission shall study and make recommendations regarding the delivery of health care services through telehealth, including payment parity for the delivery of health care services through audiovisual and audio–only telehealth technologies. In conducting the study, the Maryland Health Care Commission shall:

  1. Determine whether it is more or less costly for health care providers to deliver health care services through telehealth;
  2. Determine whether the delivery of health care services through telehealth requires more or less clinical effort on the part of the health care provider;
  3. To help inform the debate on payment parity, identify the aspects of telehealth that are subject to overuse or underuse or yield greater or lower value;
  4. Assess the adequacy of reimbursement for behavioral health services delivered in person and by telehealth; and
  5. Address any other issues related to telehealth as determined necessary by the Commission.

On or before December 1, 2024, the Maryland Health Care Commission shall submit a report on its findings and recommendations to the General Assembly, in accordance with § 2–1257 of the State Government Article.

SOURCE: HB 1148/SB 582/SB 534 (2023 Session). (Accessed Feb. 2024).

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Massachusetts

Last updated 01/12/2024

A provider may prescribe medications via telehealth as otherwise described …

A provider may prescribe medications via telehealth as otherwise described in this bulletin and in accordance with the following requirements.

  • Providers must comply with all applicable state and federal statutes and regulations governing medication management and prescribing services when delivering these services via telehealth.
  • Providers who deliver prescribing services via telehealth must maintain policies for providing patients with timely and accurate prescriptions by use of mail, phone, e-prescribing, and/or fax. Providers must document prescriptions in the patient’s medical record consistent with in-person care.

Providers must adhere to the following best practices when delivering services via telehealth.   Providers are encouraged to have documented policies and procedures that incorporate these best practices.

  • Providers must properly identify the patient using, at a minimum, the patient’s name, date of birth, and MassHealth ID.
  • Providers must disclose and validate the provider’s identity and credentials, such as the provider’s license, title, and, if applicable, specialty and board certifications.
  • For an initial appointment with a new patient, the provider must review the patient’s relevant medical history and any available medical records with the patient before initiating the delivery of the service.
  • For existing provider-patient relationships, the provider must review the patient’s medical history and any available medical records with the patient during the service.
  • Before each patient appointment, the provider must ensure that the provider is able to deliver the service to the same standard of care and in compliance with licensure regulations and requirements, programmatic regulations, and performance specifications related to the service (e.g., accessibility and communication access) using telehealth, as is applicable to the delivery of the services in person. If the provider cannot meet this standard of care or other requirements, the provider must direct the patient to seek in-person care.
  • To the extent feasible, providers must ensure the same rights to confidentiality and security as provided in face-to-face services.
  • Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
  • Providers must obtain the member’s consent to receive services via telehealth and inform the member (a) of any relevant privacy considerations, and (b) that the member may revoke their consent to receive services via telehealth at any time.
  • Providers must inform patients of the location of the provider rendering services via telehealth (i.e., distant site) and obtain the location of the patient (i.e., originating site).
  • The provider must inform the patient of how the patient can see a clinician in-person in the event of an emergency or as otherwise needed.

Documentation and Recordkeeping

Providers delivering services via telehealth must meet all health records standards required by the applicable licensing body, as well as any applicable regulatory and program specifications required by MassHealth. This includes storage, access, and disposal of records.

In addition to complying with all applicable MassHealth regulations pertaining to documentation of services, providers must include a notation in the medical record that indicates that the service was provided via telehealth.

MassHealth may audit provider records for compliance with all regulatory requirements, including recordkeeping and documentation requirements, and may apply appropriate sanctions to providers who fail to comply.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Jan. 2024).

Telehealth. Services including the prescribing of controlled substances must be in accordance with state and federal regulations.

SOURCE: MA Regulations Sec. 418.412, (Accessed Jan. 2024).

Medicaid contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Jan. 2024).

Behavioral Health Services

A provider may prescribe Schedule II controlled substances via telehealth only after conducting an initial in-person examination of the patient. Ongoing in-person examinations are required every three months for the duration of the prescription.

SOURCE: MassHealth All Provider Bulletin 281, p. 2, Jan. 2019. (Accessed Jan. 2024).

Home Health Agency

See bulletin for documentation requirements.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Jan. 2024).

Adult Foster Care

See bulletin for documentation requirements.

STATUS: MassHealth Adult Foster Care, Bulletin 29, Apr. 2023, (Accessed Jan. 2024).

Therapy

See bulletin for documentation requirements.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Therapist Bulletin 18, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Jan. 2024).

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Michigan

Last updated 01/16/2024

Privacy and Security

MDHHS requires a HIPAA compliant real-time interactive …

Privacy and Security

MDHHS requires a HIPAA compliant real-time interactive system at both the originating and distant sites, allowing instantaneous interaction between the beneficiary and provider via the telecommunication system.

When providing services via telemedicine, sufficient privacy and security measures must be in place and documented to ensure confidentiality and integrity of beneficiary-identifiable information. This includes, but is not limited to, ensuring any tracking technologies used by websites, mobile applications, or any other technology used, comply with applicable law regarding use or disclosure of beneficiary-identifiable information. Transitions, including beneficiary email, prescriptions, and laboratory results, must be secure within existing technology (i.e., password protected, encrypted electronic prescriptions, or other reliable authentication, techniques). All beneficiary-physician email, as well as other beneficiary-related electronic communications, should be stored and filed in the beneficiary’s medical record, consistent with transitional recordkeeping policies and procedures.

Prior Authorization

There are no prior authorization (PA) requirements when providing services via telemedicine for Fee-for-Service (FFS) beneficiaries or for those accessing Behavioral Health Services through Prepaid Inpatient Health Plans (PIHPs)/Community Mental Health Services Programs (CMHSPs) unless the equivalent in-person service requires PA. Authorization requirements for beneficiaries enrolled in Medicaid Health Plans (MHPs) may vary. Providers must refer to individual MHPs for any authorization or coverage requirements.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2141-2142 Jan. 1, 2024, & MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Jan. 2024).

The Michigan Department of Health and Human Services requires a health insurance, portability and accountability act of 1986 compliant real time interactive system at both the originating and distant sites, allowing simultaneous interaction between the beneficiary and practitioner via the telecommunication system. The technology used must meet the needs for audio and visual compliance in accordance with state and federal standards. Practitioners must ensure the privacy of the beneficiary and the security of any information shared via telemedicine.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Jan. 2024).

A contingency plan, including referral to an acute care facility or Emergency Room (ER) for treatment as necessary for the safety of the beneficiary, is required when utilizing telemedicine technologies. This plan must include a formal protocol appropriate to the services being rendered.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2141 Jan. 1, 2024, (Accessed Jan. 2024).

Covered services for community health workers includes health system navigation and resource coordination, including helping a beneficiary with a telehealth appointment and/or educating a beneficiary on the use of telehealth technology.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 23-74, Medicaid Coverage of Community Health Worker (CHW)/Community Health Representative (CHR) Services, Dec. 1, 2023, (Accessed Jan. 2024).

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Minnesota

Last updated 02/29/2024

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Services must …

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Services must be:

  • Compliant with industry interoperable standards (i.e., ability for systems and organizations to share data and information).
  • Compliant with Health Insurance Portability and Accountability Act (HIPAA) privacy and security requirements and regulations.
  • Medically necessary for the person and/or family.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telehealth Services.  Mar. 16, 2022.  (Accessed Feb. 2024).

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Mississippi

Last updated 12/23/2023

See documentation requirements in rule.

SOURCE: MS Admin. Code 23,

See documentation requirements in rule.

SOURCE: MS Admin. Code 23, Part 225, Rule 3.6 (Accessed Dec. 2023).

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Missouri

Last updated 01/20/2024

No later than July 1, 2022, there shall be established …

No later than July 1, 2022, there shall be established within the department a statewide telehealth network for forensic examinations of victims of sexual offenses in order to provide access to sexual assault nurse examiners (SANE) or other similarly trained appropriate medical providers.  A statewide coordinator for the telehealth network shall be selected by the director of the department of health and senior services and shall have oversight responsibilities and provide support for the training programs offered by the network, as well as the implementation and operation of the network.  The statewide coordinator shall regularly consult with Missouri-based stakeholders and clinicians actively engaged in the collection of forensic evidence regarding the training programs offered by the network, as well as the implementation and operation of the network.

SOURCE: MO Revised Statute Ch. 192.2520 (Accessed Jan. 2024).

For purposes of the provision of telemedicine services in the MO HealthNet Program, the provider-patient relationship may be established by the following:

  • An in-person encounter through a medical interview and physical examination;
  • Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the patient’s care; or
  • A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

In order to establish a provider-patient relationship through telemedicine—

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
  • Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

See regulation for special documentation and confidentiality and data integrity requirements.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(D) & (E), (Accessed Jan. 2024).

Special documentation requirements apply.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23); MO HealthNet, Physician Manual, Sec. 2.67, p. 113 (9/1/23)MO HealthNet, Rural Health Clinic, Sec. 1.14, p. 10 (9/1/23). (Accessed Jan. 2024).

Precertification and Utilization Review

All services are subject to utilization review for medical necessity and program compliance. Reviews can be performed before services are furnished, before payment is made, or after payment is made.

Certain procedures or services can require precertification from the MO HealthNet Division or its authorized agents. Services for which a precertification was obtained remain subject to utilization review at any point in the payment process. A service provided through Telemedicine is subject to the same precertification and utilization review requirements which exist for the service when not provided through Telemedicine.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23), (Accessed Jan. 2024).

School-based Therapy Services

Place of service school (03) must be used for services provided in a school or on school grounds. If a school district is providing telehealth services on school grounds, the GT modifier must be used.

SOURCE: MO HealthNet, Therapy Manual, p. 22 (9/1/23). (Accessed Jan. 2024).

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Montana

Last updated 02/13/2024

Telemedicine/Telehealth Requirements

  • To the extent possible, providers must ensure members

Telemedicine/Telehealth Requirements

  • To the extent possible, providers must ensure members have the same rights to confidentiality and security as provided during traditional office visits.
  • Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
  • Telemedicine/telehealth does not alter the scope of practice of any healthcare provider; or authorize the delivery of healthcare services in a setting or manner not otherwise authorized by law.
  • Record keeping must comply with Administrative Rules of Montana (ARM) 37.85.414.
  • Enrolled providers delivering services via telemedicine/telehealth must submit claims using the appropriate CPT or HCPCS code, place of service, and modifier for the services rendered.

SOURCE:  MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Feb. 2024).

Providers must also use the telehealth place of service of 02 for claims submitted on a CMS-1500 claim. By coding with the GT modifier and the 02 place of service, the provider is certifying that the service was a face-to-face visit provided via interactive audio-video telemedicine.

If a rendering provider’s number is required on the claim for a face-to-face visit, it is required on a telemedicine claim.

Confidentially requirements apply (see manual).

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Feb. 2024).

A provider shall:

  • ensure an enrollee receiving telehealth services has the same rights to confidentiality and security as provided for traditional office visits;
  • follow consent and patient information protocols consistent with the protocols followed for in person visits; and
  • comply with recordkeeping requirements established by the department by rule.

Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.

The department shall adopt rules for the provision of telehealth services, including but not limited to:

  • billing procedures for enrolled providers;
  • the services considered clinically appropriate for telehealth purposes;
  • recordkeeping requirements for providers, including originating site providers; and
  • other requirements for originating site providers, including allowable provider types, reimbursement rates, and requirements for the secure technology to be used at originating sites.

SOURCE: Montana Code Annotated 53-6-122 (Accessed Feb. 2024).

Telehealth is allowed for therapy in a youth facility under certain circumstances.

SOURCE: Montana Administrative Rules Sec. 37.97.906, (Accessed Feb. 2024).

Abortion

Supporting documentation for abortions must include a physical examination, including vital signs, heart, lungs, abdomen, extremities, and estimate of gestational age (if imaging is not available).

A lawsuit has been filed challenging the rule amendments adopted under Montana Administrative Register (MAR) Notice No. 37-1024, and seeking preliminary and permanent injunction against the rule amendments.  A temporary restraining order has been entered, enjoining enforcement of the rule changes pending hearing on the request for a preliminary injunction. Accordingly, Montana Medicaid has postponed implementation of the rule amendments adopted under MAR 37-1024 until further notice. See: Medicaid Coverage of Abortion Services Notice.

SOURCE: MT Administrative Rules Sec. 37.86.104, (Accessed Feb. 2024).

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Nebraska

Last updated 01/04/2024

NE Medicaid does provide an outpatient cardiac rehabilitation program consisting …

NE Medicaid does provide an outpatient cardiac rehabilitation program consisting of physical exercise or conditioning and concurrent telemetric monitoring. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.

SOURCE: NE Admin. Code Title 471, Sec. 10-006.16(B) (Accessed Jan. 2024).

The commission may establish a telehealth system to provide access for deaf and hard of hearing persons in remote locations to mental health, alcoholism, and drug abuse services. The telehealth system may (a) provide access for deaf or hard of hearing persons to counselors who communicate in sign language and are knowledgeable in deafness and hearing loss issues, (b) promote access for hard of hearing persons through contacts with counselors in which hard of hearing persons receive both visual cues, or reading lips, and auditory cues, (c) offer remote interpreter services for deaf or hard of hearing persons to interact with counselors who are not fluent in sign language, and (d) promote participation in educational programs.

The commission shall set and charge a fee between the range of twenty and one hundred fifty dollars per hour for the use of the telehealth system. The commission shall remit all fees collected pursuant to this section to the State Treasurer for credit to the Telehealth System Fund.

SOURCE: NE Statute Sec. 71-4728-.04, (Accessed Jan. 2024).

Keep Required Documentation

  • The medical record for telehealth services must follow all applicable laws regarding documentation. The use of telehealth technology must be documented in the medical record. Providers are also required to document the reason for the delivery of treatment or services through telehealth.
  • Providers are required to have mitigation plans in place and to provide an active and ongoing assessment of their ability to meet patients’ most immediate and critical treatment needs.
  • Claims for services provided via telehealth must include the specific telehealth modifiers and place-of-service codes outlined in the fee schedules.

SOURCE: NE Medicaid Program, Bulletin 23-38:  Guidance on Telehealth, Dec. 29, 2023, (Accessed Jan. 2024).

The Telehealth System Fund is created. The fund shall be used for any expenses related to the operation and maintenance of the telehealth system established in section 71-4728.04. Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act.

SOURCE: NE Statute Sec. 71-4732-.01, (Accessed Jan. 2024).

A health care facility licensed under the Health Care Facility Licensure Act that receives reimbursement under the Nebraska Telehealth Act for telehealth consultations shall establish quality of care protocols and patient confidentiality guidelines to ensure that such consultations meet the requirements of the act and acceptable patient care standards.

SOURCE: NE Statute Sec. 71-8507, (Accessed Jan. 2024).

The department shall adopt and promulgate rules and regulations to carry out the Nebraska Telehealth Act, including, but not limited to, rules and regulations to: (1) Ensure the provision of appropriate care to patients; (2) prevent fraud and abuse; and (3) establish necessary methods and procedures.

SOURCE: NE Statute Sec. 71-8508, (Accessed Jan. 2024).

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Nevada

Last updated 12/18/2023

No reference found.

No reference found.

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New Hampshire

Last updated 12/19/2023

An individual providing services by means of telemedicine or telehealth …

An individual providing services by means of telemedicine or telehealth directly to a patient shall:

  • Use the same standard of care as used in an in-person encounter;
  • Maintain a medical record; and
  • Subject to the patient’s consent, forward the medical record to the patient’s primary care or treating provider, if appropriate.
  • Provide meaningful language access if the individual is practicing in a facility that is required to ensure meaningful language access to limited-English proficient speakers pursuant to 45 C.F.R. section 92.101 or RSA 354-A, or to deaf or hard of hearing individuals pursuant to 45 C.F.R. section 92.102, RSA 521-A, or RSA 354-A.

Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.

SOURCE: NH Revised Statute 310-A:1-g, (Accessed Dec. 2023).

See regulations for confidentiality and patient rights requirements.

Source: NH Admin Rules, HE-C 5004.06 and 07, (Accessed Dec. 2023).

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New Jersey

Last updated 02/02/2024

See Newsletter for specific documentation, prescribing and technology requirements, as …

See Newsletter for specific documentation, prescribing and technology requirements, as well as requirements to meet the standard of care as a traditional face-to-face visit.

A mental health screener, screening service, or screening psychiatrist subject to the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.) shall not be required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes, and shall not be required to request and obtain a waiver from existing regulations, prior to engaging in telemedicine or telehealth.

An initial face-to-face visit is not required to establish a provider-patient relationship. The provider must review and be familiar with the patient’s history and medical records, when applicable, prior to the provision of any telehealth services.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 3-4 (Accessed Feb. 2024).

Psychiatric Services

If a physical evaluation is required as part of a psychiatric assessment, the hosting provider must have a registered nurse available to complete and share the results of the physical evaluation.

NJ Medicaid does not reimburse for any costs associated with the provision of telepsychiatry services including but not limited to the contracting of professional services and the telecommunication equipment are the responsibility of the provider and are not directly reimbursable by New Jersey Medicaid.

Additional requirements are listed in the telepsychiatry memo.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013. (Accessed Feb. 2024).

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New Mexico

Last updated 02/26/2024

MCOs must:

  • Promote and employ broad-based utilization of statewide access

MCOs must:

  • Promote and employ broad-based utilization of statewide access to Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine service systems including, but not limited to, access to text telephones or teletype (TTYs) and 711 telecommunication relay services;
  • Follow state guidelines for telemedicine equipment or connectivity;
  • Follow accepted HIPAA and 42 CFR part two regulations that affect telemedicine transmission, including but not limited to staff and contract provider training, room setup, security of transmission lines, etc; the MCO shall have and implement policies and procedures that follow all federal and state security and procedure guidelines;
  • Identify, develop, and implement training for accepted telemedicine practices;
  • Participate in the needs assessment of the organizational, developmental, and programmatic requirements of telemedicine programs;
  • Report to HSD on the telemedicine outcomes of telemedicine projects and submit the telemedicine report; and
  • Ensure that telemedicine services meet the following shared values, which are ensuring: competent care with regard to culture and language needs; work sites are distributed across the state, including native American sites for both clinical and educational purposes; and coordination of telemedicine and technical functions at either end of network connection.

The MCO shall participate in project extension for community healthcare outcomes (ECHO), in accordance with state prescribed requirements and standards, and shall:

  • Work collaboratively with HSD, the university of New Mexico, and providers on project ECHO;
  • Identify high needs, high cost members who may benefit from project ECHO participation;
  • Identify its PCPs who serve high needs, high cost members to participate in project ECHO;
  • Assist project ECHO with engaging its MCO PCPs in project ECHO’s center for Medicare and Medicaid innovation (CMMI) grant project;
  • Reimburse primary care clinics for participating in the project ECHO model;
  • Reimburse “intensivist” teams;
  • Provide claims data to HSD to support the evaluation of project ECHO;
  • Appoint a centralized liaison to obtain prior authorization approvals related to project ECHO; and
  • Track quality of care and outcome measures related to project ECHO.

SOURCE:  NM Administrative Code 8.308.9.18. (Accessed Feb. 2024).

Under 21 U.S.C. § 802(54)(A),(B), for most (DEA-registered) Practitioners in the United States, including Qualifying Practitioners and Qualifying Other Practitioners (“Medication Assisted Treatment Providers”), who are using FDA approved Schedule III-V controlled substances to treat opioid addiction, the term “practice of telemedicine” means the practice of medicine in accordance with applicable Federal and State laws, by a practitioner (other than a pharmacist) who is at a location remote from the patient, and is communicating with the patient, or health care professional who is treating the patient using a telecommunications system referred to in (42 CFR § 410.78(a)(3)) which practice is being conducted in a few unique situations. See manual for more details.

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 28 (Accessed Feb. 2024).

Patient-Centered Initiatives 

The New Mexico PCMH will include State-specific goals tailored to the unique needs of communities and patients.
Core components of the New Mexico PCMH Model include:

Clinical:

  • Improved access to care through flexible scheduling, accommodating walk-ins, utilization of telemedicine, providing after hours and weekend office hours

SOURCE: NM Centennial-Care Managed Care Policy (2020) pg. 304 (Accessed Feb. 2024).

Referral to Community and Social Support Services

Referrals to community and social support services help overcome access and service barriers, increase self-management skills, and improve overall health. Providers identify available and effective community-based resources and actively link and manage appropriate referrals. Linkages support the personal needs of members and are consistent with the service plan. Community and social support service referral activities may include, but are not limited to:

  • Identifying and patterning with community-based and telehealth resources such as medical and behavioral health care, durable medical equipment (DME), legal services, housing, respite, educational and employment supports, financial services, recovery and treatment plan goal supports, entitlements and benefits, social integration and skill building, transportation, personal needs, wellness and health promotion services, specialized support groups, supports for substance use and prevention and treatment, and culturally-specific programs such as veterans’ or IHS and Tribal programs

SOURCE: NM CareLink Health Homes Policy Manual 2021. (Accessed Feb. 2024).

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New York

Last updated 11/18/2023

Subject to federal financial participation and the approval of the …

Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in section 2999-cc(4) of the public health law.

SOURCE: Social Services Law Article 367-u. (Accessed Nov. 2023).

The superintendent of financial services, in collaboration with the commissioner of health, shall report on the impact of reimbursement for telehealth services that, pursuant to the insurance law and public health law, will be reimbursed by an accident and health insurer and a corporation subject to article 43 of the insurance law, including a health maintenance organization, on the same basis, at the same rate, and to the same extent the equivalent services are reimbursed when delivered in person. The report shall, at a minimum, and to the extent possible, contain information regarding the use of telehealth services broken down by: social service district or county; age and gender of patients; procedure codes, diagnosis codes, and associated descriptions or modifiers; claims paid amount totals; claims information such as categories of services, specialty or type codes; and trends in the types of telehealth services used such as primary care, behavioral and mental health care, and the number of telehealth visits by provider type. The report shall include such utilization information dating from the effective date of this act and ending on the one-year anniversary of such effective date, and shall be submitted to the governor, the temporary president of the senate, and the speaker of the assembly by December 31, 2023.

SOURCE: A 9007 (2022 Session), part V, p. 28. (Accessed Nov. 2023).

Demonstration rates of payment or fees shall be established for telehealth services provided by a certified home health agency, a long term home health care program or AIDS home care program, or for telehealth services by a licensed home care services agency under contract with such an agency or program, in order to ensure the availability of technology-based patient monitoring, communication and health management. Reimbursement is provided only in connection with Federal Food and Drug Administration-approved and interoperable devices that are incorporated as part of the patient’s plan of care.

SOURCE: NY Public Health Law Article 36 Section 3614(3-c). (Accessed Nov. 2023).

Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) are prohibited from being delivered via telehealth.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 635-13.4(c). (Accessed Nov. 2023).

Each agency that operates a clinic treatment facility shall provide the Office for People with Developmental Disabilities (OPWDD) information it requests, including but not limited to the following: services provided by CPT/HCPCS and/or CDT codes, where such services were delivered, including the location of both the provider and the individual when services are delivered via telehealth, (i.e., on-site or at a certified satellite site, or, prior to April 1, 2016, off-site) and revenues by funding SOURCE or payee. These data shall correspond to the identical time period of the cost report.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 679.6(b). (Accessed Nov. 2023).

MMC Considerations

  1. MMC Plans are required to cover, at a minimum, services that are covered by NYS Medicaid FFS and included in the MMC benefit package, when determined medically necessary and must provide telehealth coverage as described in this guidance. To allow DOH to adequately track telehealth use, MMC Plans must ensure claims allow the use of the telehealth modifiers established in this guidance, and may establish additional claiming requirements beyond those set out in the FFS billing instructions in this guidance.
  2. MMC Plans must adhere to the payment parity requirements outlined in “VII. Billing Rules for Telehealth Services”, “A. Payment Parity with In-Person Services” on page 8 of this issue.
  3. MMC Plans may not limit enrollee access to telehealth/telephonic services to solely the MMC Plan telehealth vendors and must cover appropriate telehealth/telephonic services provided by other network providers.
  4. Questions regarding MMC reimbursement or documentation requirements should be directed to the MMC Plan of the enrollee.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 17. (Accessed Nov. 2023).

Credentialing and Privileging Physicians

NYS hospitals acting as originating sites are required to ensure that physicians who are providing consultations via telehealth at distant sites are appropriately credentialed and privileged. A hospital facility, including one that is acting as a telehealth originating site, may enter into a contract with an outside entity to carry out all or part of the professional application and verification process (physician credentialing). This includes activities associated with the collection and verification of information specific to credentials and prior affiliations/employment. A hospital originating site may therefore enter into a contract with the distant site to receive and collect credentialing information, perform all required verification activities, and act on behalf of the originating site hospital for such credentialing purposes regarding those physicians who will be providing patient consultations via telehealth. Such contracts must establish that the originating site hospital retains ultimate responsibility for the physician credentialing. Distant site hospitals may not delegate, through a contract, their responsibility for peer review, quality assurance/quality improvement activities and decision-making authority for granting medical staff membership or professional privileges (physician privileging).

Certified Asthma Educators (Verification Requirements)

The hospital, Diagnostic and Treatment Centers (D&TCs) or office serving as the originating site is responsible for ensuring that the Certified Asthma Educator (CAE) providing self-management training services via telehealth, is a NYS licensed, registered, or certified health care professional, who is also certified as an educator by the National Asthma Educator Certification Board (NAECB). NAECB and CBDCE educators are expected to practice within the scope of practice that is appropriate to their respective discipline, as defined by the NYSED Office of the Professions.

Certified Diabetes Educators

Certification through the Certification Board for Diabetes Educators (CBDCE) is no longer required. Registered dieticians can enroll as NYS Medicaid providers and deliver diabetes self-management training via telehealth.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 7. (Accessed Nov. 2023).

TeleMental Health

See clinical and program-specific guidance for telemental health services in guidance document.  Also includes billing guidelines, managed care reimbursement, technology and telecommunications guidance, and guidance for contracting with telemedicine companies.

SOURCE: NY Office of Mental Health, Telehealth Services Guidance for OMH Providers, 2023. (Accessed Nov. 2023).

Office of Alcoholism and Substance Abuse Services (OASAS)

Telepractice services, as defined in this Part, may be authorized by the office for the delivery of certain addiction services provided by practitioners employed by, or pursuant to a contract or memorandum of understanding (MOU) with a program certified by the office.  See regulation for details.

SOURCE: NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Nov. 2023).

Recently Effective Legislation – Community-Based Paramedicine Demonstration Program

Legislation requires the Department to establish a community paramedicine demonstration program to evaluate the role of emergency medical services personnel in the delivery of health care services in the community in non-emergent settings. The program shall authorize mobile integrated and community paramedicine programs operating under COVID emergency policies to continue in the same manner and capacity as currently approved for a period of two years. The program shall include authorizing emergency medical service personnel to provide community paramedicine, use alternative destinations, telemedicine to facilitate treatment in place, and other services as approved by the Commissioner.

SOURCE: NY Public Health Law Sec. 3018 as added by S 6749 (2023 Session). (Accessed Nov. 2023).

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North Carolina

Last updated 12/12/2023

Unless otherwise required for a specific service, Medicaid shall not …

Unless otherwise required for a specific service, Medicaid shall not require prior approval for 1H, Telehealth, Virtual Communications and Remote Patient Monitoring. Prior authorization or an initial in-person examination is not required in order to receive care via telehealth, virtual patient communication, or remote patient monitoring; however, when establishing a new relationship with a patient via these modalities, the provider shall meet the prevailing standard of care and complete all appropriate exam requirements and documentation dictated by relevant CPT or HCPCS coding guidelines.

Provider(s) shall comply with the following in effect at the time the service is rendered:

  • All applicable agreements, federal, state and local laws and regulations including the Health Insurance Portability and Accountability Act (HIPAA) and record retention requirements; and
  • All NC Medicaid’s clinical (medical) coverage policies, guidelines, policies, provider manuals, implementation updates, and bulletins published by the Centers for Medicare and Medicaid Services (CMS), DHHS, DHHS division(s) or fiscal contractor(s).

Provider(s) are expected to send documentation of any telehealth services rendered to a beneficiary’s identified primary care provider or medical home within 48 hours of the encounter for medical services (including behavioral health medication management), obtaining required consent when necessary (as per 42 CFR Part 2 for relevant substance use disorder related disclosures). Documentation can be sent by any HIPAA-compliant secure means.

Claims for all telehealth, virtual communication, and remote patient monitoring services must be billed according to the guidance in Attachment A below.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 7, June 1, 2023. (Accessed Dec. 2023).

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North Dakota

Last updated 02/19/2024

No reference found.

No reference found.

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Ohio

Last updated 02/16/2024

See administrative code for additional provider responsibilities related to HIPAA …

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

SOURCE: OAC 5160-1-18. (Accessed Feb. 2024).

Mental Health Services Provided by Agencies

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

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

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

SOURCE: OAC 5122-29-31. (Accessed Feb. 2024).

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Oklahoma

Last updated 07/03/2023

All telehealth activities must comply with Oklahoma Health Care Authority …

All telehealth activities must comply with Oklahoma Health Care Authority (OHCA) policy, and all other applicable State and Federal laws and regulations.

See administrative code for specific documentation requirements.

SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(8) & (f). (Accessed Dec. 2023).

Health Access Networks (HANs) must Facilitate members’ access to all levels of care, including primary, outpatient, specialty, certain ancillary services, and acute inpatient care, within a community or across a broad spectrum of providers across a service region or the state through improved access to specialty care, telehealth, and expended quality improvement strategies.

SOURCE: OK Admin. Code Sec. 317:25-9-2. (Accessed Dec. 2023).

“Emergency detention” means the detention of a person who appears to be a person requiring treatment in a facility approved by the Commissioner of Mental Health and Substance Abuse Services as appropriate for such detention after the completion of an emergency examination, either in person or via telemedicine, and a determination that emergency detention is warranted for a period not to exceed one hundred twenty (120) hours or five (5) days, excluding weekends and holidays, except upon a court order authorizing detention beyond a one hundred twenty (120) hour period or pending the hearing on a petition requesting involuntary commitment or treatment as provided by 43A of the Oklahoma Statutes.

“Face-to-face”means, for the purpose of the delivery of behavioral health care, an in-person encounter between the health care provider and the consumer, or a telehealth encounter with two-way video functionality.

SOURCE: OK Admin. Code Sec. 450:17-1-2. (Accessed Dec. 2023).

On April 11, 2023, OCR announced that it is providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered healthcare providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period.

In June 2022, OCR issued FAQs on healthcare services delivered via telehealth (audio/video) and audio-only telecommunication to provide additional clarification, including how you can continue to use audio-only modalities after the PHE. HIPAA-covered entities can use remote communication technologies to provide telehealth services, including audio-only services, in compliance with the HIPAA Privacy Rule.  See letter for additional details.

SOURCE: OK Health Care Authority, Letter 2023-10 RE: Post-PHE HIPAA Compliancy for Telehealth & Audio-only Services, May 19, 2023, (Accessed Jul. 2023).

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Oregon

Last updated 12/20/2023

Providers shall develop and maintain care coordination policies and procedures …

Providers shall develop and maintain care coordination policies and procedures to offer local provider options to clients or members when in-person services are clinically indicated or requested by the client or member and the provider does not offer these services.

 

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 Dec. 2023).

CCOs shall ensure that network providers offering telemedicine or telehealth services, must meet the following requirements:

  • Provide services using telehealth that are within their respective certification or licensing board’s scope of practice and comply with telemedicine or telehealth requirements including but not limited to:
    • Documenting patient and provider agreement of consent to receive services;
    • Allowed physical locations of provider and patient;
    • Establishing or maintaining an appropriate provider-patient relationship.
  • 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 (11) of this rule;
  • 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 (11) of this rule;
  • 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 Dec. 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. (Accessed Dec. 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:  OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, (Accessed Dec. 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 Dec. 2023).

 

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Pennsylvania

Last updated 01/22/2024

Technology Requirements:

Technology used for telehealth, whether fixed or mobile, …

Technology Requirements:

Technology used for telehealth, whether fixed or mobile, should be capable of presenting sound and image in real-time and without delay. Telehealth equipment should clearly display the practitioners’ and participants’ faces to facilitate clinical interactions. The telehealth equipment must meet all state and federal requirements for the transmission or security of health information and comply with the Health Insurance Portability and Accountability Act (HIPAA).

Delivery of Services:

The medical record for the individual served must indicate each time a service is provided using telehealth including the receipt of informed consent prior to the start of the session, start time of service and end time of service. Additionally, if the individual served or their legal guardian, as applicable, consents to the recording of a telehealth service, documentation of consent must be included in the medical record.

Provider Policies:

  • Providers using telehealth must maintain written policies for the operation and use of telehealth equipment. Policies must include the provision of periodic staff training to ensure telehealth is provided in accordance with the guidance in this bulletin as well as the provider’s established patient care standards.
  • Providers must maintain a written policy detailing a contingency plan for transmission failure or other technical difficulties that render the behavioral health service undeliverable. Contingency plans should describe how the plan will be communicated to individuals receiving services.
  • Prior to delivering services through telehealth, providers or practitioners should provide information to the individual receiving services that supports the delivery of quality services. At a minimum, information should address the importance of the individual being in a private location, preventing interruptions and distractions such as from children or other family members, visitors in the household and from other communication or bandwidth reducing devices. When services are being provided to a child, youth or young adult, consideration should also be given to how much caregiver involvement will be needed during the appointment.

Determining Appropriateness for Telehealth Delivery of Services

Licensed practitioners and provider agencies delivering services through telehealth must have policies that ensure that services are delivered using telehealth only when it is clinically appropriate to do so and that licensed practitioners are complying with standards of practice set by their licensing board for telehealth where applicable.

Factors to consider include, but are not limited to:

  • The preference of the individual served and/or the preference of parents/guardians
  • Whether there is an established relationship with the service provider and the length of time the individual has been in treatment
  • Level of acuity needed for care
  • Risk of harm to self or others
  • Age of a minor child
  • Ability of the individual served to communicate, either independently or with accommodation such as an interpreter or electronic communication device
  • Any barriers to in-person service delivery for the individual
  • Access to technology of the individual served
  • Whether privacy for the individual served could be maintained if services are delivered using telehealth
  • Whether the service relies on social cueing and fluency

The preference of the individual served and their legal guardian(s), as applicable, should be given high priority when making determinations of the appropriateness of the telehealth delivery. However, no service should be provided through telehealth when, in the best clinical judgement of the licensed practitioner, it is not clinically appropriate. When the use of telehealth is not clinically appropriate, the licensed practitioner or provider agency must offer the services in-person. If the individual disagrees with the clinical determination, the licensed practitioner or provider agency may refer the individual to other in-network providers or the managed care organization.

Guidance specific to delivering children’s services through telehealth is included in Attachment A.

SOURCE:  PA Department of Human Services, Office of Mental Health and Substance Abuse Services Bulletin OMHSAS-22-02, pgs. 4-5 & 7-8, July 1, 2022, (Accessed Jan. 2024).

Pennsylvania Residents Temporarily Out-of-State

Behavioral Health Services may be provided using telehealth to meet the behavioral healthcare needs of Pennsylvania residents who are temporarily out of the state as long as the delivery of services out-of-state is consistent with the authorization for services and treatment plan, the individual continues to meet eligibility for the Pennsylvania MA Program, and the Pennsylvania provider agency or licensed practitioner has received authorization to practice in the state or territory where the individual will be temporarily located.

SOURCE:  PA Department of Human Services, Office of Mental Health and Substance Abuse Services Bulletin OMHSAS-22-02, July 1, 2022, (Accessed Jan. 2024).

Technology Requirements

Providers should fully document the services rendered and the telecommunication technology used to render the service in the MA beneficiary’s medical record. If the service was rendered using audio-only technology, providers are to document that the services were rendered using audio-only technology and the reason audio/video technology could not be used.

Technology used for telehealth, whether fixed or mobile, should be capable of presenting sound and image in real-time and without delay. The telehealth equipment should clearly display the rendering practitioner’s and participant’s face to facilitate clinical interactions and must meet all state and federal requirements for the transmission and security of health information, including HIPAA.

Audio-only telecommunications technology may be used when the beneficiary does not have video capability or for an urgent medical situation, if consistent with state and federal law. Providers must assure the privacy of the beneficiary receiving services and comply with HIPAA and all other federal and state laws governing confidentiality, privacy, and consent. Public facing video communication applications should not be used to render services via telehealth.

Telehealth does not include asynchronous or “store and forward” technology such as facsimile machines, electronic mail systems, or remote patient monitoring devices. While asynchronous applications are not considered telemedicine in the MA Program, they may be utilized as part of a MA covered service, such as a laboratory service, x-ray service or physician service. Telehealth also does not include text messages, although text messages and telephone may continue to be utilized for non-service activities, such as scheduling appointments.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-23-08, Aug. 2, 2023, p. 3-4, (Accessed Jan. 2024).

Guidelines for Telehealth Service Delivery for Children and Youth

The following guidelines are recommended best practices. When delivering services through telehealth, licensed practitioners and provider agencies should ensure that, regardless of age, each child or youth has sufficient caregiver support to engage effectively in services.

  • When services are being delivered through telehealth to children 3 to 5 years old, each child should have a caregiver participate during the provision of services.
  • When services are being delivered through telehealth to children 6 to 9 years old, a caregiver should observe each child during provision of services.
  • When services are being delivered through telehealth to children ages 10 to 13 years old, any child that may need a caregiver during the provision of services should have a caregiver available.
  • When services are being delivered through telehealth to youth 14 years old to 18 years old, any youth that may need a caregiver during the provision of services should have a caregiver available.
  • All children or youth that participate in services through telehealth delivery should have the ability to communicate, either independently or with accommodation such as an interpreter or electronic communication device.

SOURCE: PA Department of Human Services, Office of Mental Health and Substance Abuse Bulletin, OMHSAS 22-02, Attachment A Guidelines for Telehealth Service Delivery for Children and Youth. (Accessed Jan. 2024).

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Puerto Rico

Last updated 12/18/2023

No reference found.

No reference found.

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Rhode Island

Last updated 02/01/2024

Except for requiring compliance with applicable state and federal laws, …

Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer [includes Medicaid] shall impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.

SOURCE: Rhode Island General Laws Sec. 27-81-4 (Accessed Feb. 2024).

Each health insurer shall collect and provide to the office of the health insurance commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data reflecting its telemedicine policies, practices, and experience. OHIC shall provide this information and data to the general assembly on or before January 1, 2022, and on or before each January 1 thereafter.

SOURCE: Rhode Island General Laws Sec. 27-81-7 (Accessed Feb. 2024).

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South Carolina

Last updated 02/08/2024

The referring provider must provide pertinent medical information and/or records

The referring provider must provide pertinent medical information and/or records to the consulting provider via a secure transmission.

Interactive audio and video telecommunication must be used, permitting encrypted communication between the distant site physician or practitioner and the Medicaid beneficiary. The telecommunication service must be secure and adequate to protect the confidentiality and integrity of the telehealth information transmitted.

The telehealth equipment and transmission speed and image resolution must be technically sufficient to support the service billed. Any staff involved in the telehealth visit must be trained in the use of the telehealth equipment and competent in its operation.

A trained healthcare professional at the referring site (patient site presenter) is required to present the beneficiary to the provider at the consulting site and remain available as clinically appropriate (this condition is waived when the referring site is the patient home).

If the beneficiary is a minor (under 18 years old), a parent and/or guardian must present the minor for telehealth service unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telehealth session unless attendance is therapeutically appropriate.

All telehealth activities must comply with the requirements of HIPAA: Standards for Privacy of individually identifiable health information and all other applicable State and Federal Laws and regulations.

The beneficiary must have access to all transmitted medical information, with the exception of live interactive video, as there is often no stored data in such encounters.

Documentation in the medical records must be maintained at the referring and consulting locations to substantiate the service provided. A request for a telehealth service from a referring provider and the medical necessity for the telehealth service must be documented in the beneficiary’s medical record. Documentation must indicate the services were rendered via telehealth. All applicable documentation requirements for services delivered face-to-face also apply to services rendered via telehealth.

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South Dakota

Last updated 12/21/2023

HIPAA Compliant Platform – South Dakota Medicaid requires telemedicine services …

HIPAA Compliant Platform – South Dakota Medicaid requires telemedicine services are in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations as enforced by The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS).

Prior Authorization – The out-of-state prior authorization requirement does not apply if the recipient is located in South Dakota at the time of the service and the provider is located outside of the State. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

See list of recipients in manual that are eligible for medically necessary services covered in accordance with the limitations of the telemedicine chapter.

See manual for documentation requirements.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, (Dec. 2023). (Accessed Dec. 2023).

Teledentistry

See manual for documentation, reimbursement and claim requirements.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 3-4, (Jun. 2023) (Accessed Dec. 2023).

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Tennessee

Last updated 01/21/2024

No reference found.

No reference found.

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Texas

Last updated 01/06/2024

The commission in coordination with the department and single source …

The commission in coordination with the department and single source continuum contractors shall establish guidelines in the STAR Health program to improve the use of telehealth services to provide and enhance mental health and behavioral health care for children placed in the managing conservatorship of the state.

SOURCE: Human Resources Code Title 2, Section D, Chapter 42, 42.260. (Accessed Jan. 2024).

Children’s Health Insurance Program

The executive commissioner by rule shall establish policies that permit reimbursement under Medicaid and the child health plan program for services provided through telemedicine medical services, teledentistry dental services, and telehealth services to children with special health care needs.

SOURCE: TX Govt. Code Sec. 531.02162, [repealed eff. Apr. 1, 2025], (Accessed Jan. 2024).

Procedure codes that are benefits for distant site providers when billed with the 95 modifier (synchronous audiovisual technology) are included in the individual TMPPM handbooks. Procedure codes that indicate remote (telehealth service) delivery in the description do not need to be billed with the 95 modifier.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 12 (Jan. 2024). (Accessed Jan. 2024).

Providers of telehealth or telemedicine must maintain the confidentiality of protected health information (PHI) as required by Federal Register 42, Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, Chapters 111 and 159 of the Texas Occupations Code, and other applicable federal and state law.

See provider manual for other information security and documentation requirements.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5. (Jan. 2024). (Accessed Jan. 2024).

Fees for telemedicine, telehealth, and home telemonitoring services are adjusted within available funding as described in §355.201 of this title (relating to Establishment and Adjustment of Reimbursement Rates by the Health and Human Services Commission).

SOURCE: TX Admin Code. 355.7001(g). (Accessed Jan. 2024).

A valid practitioner-patient relationship must exist between the distant site provider and the patient. A valid practitioner-patient relationship exists between the distant site provider and the patient if:

  • The distant site provider meets the same standard of care required for and in-person service.
  • The relationship can be established through:

    • A prior in-person service.
    • A prior telemedicine service that meets the delivery method requirements specified in Texas Occupations Code §111.005(a)(3).
    • The current telemedicine service that meets the delivery method requirements specified in Texas Occupations Code §111.005(a)(3).

A call coverage agreement established in accordance with Texas Medical Board (TMB) administrative rules in 22 TAC §177.20.

The distant site provider must obtain informed consent to treatment from the patient, patient’s parent, or the patient’s guardian prior to rendering a telemedicine medical service.

Distant site providers that communicate with clients using electronic communication methods other than phone or facsimile must provide clients with written notification of the physician’s privacy practices prior to evaluation and treatment. A good faith effort must be made to obtain the client’s written acknowledgment of the notice, including by email response.

A distant site provider should provide patients who receive a telemedicine service with guidance on the appropriate follow-up care.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Jan. 2024). (Accessed Jan. 2024).

Prescriptions Generated from a Telemedicine Medical Service

A distant site provider may issue a valid prescription as part of a telemedicine service. An electronic prescription (e-script) may be used as permitted by applicable federal and state statues and rules.

The same standards that apply for the issuance of a prescription during an in-person setting apply to prescriptions issued by a distant site provider..

The prescription must be issued for a legitimate medical purpose by the distant site provider as part of a valid practitioner-patient relationship.

The prescribing physician must be licensed in Texas. If the prescription is for a controlled substance, the prescribing physician must have a current valid U.S. Drug Enforcement Administration (DEA) registration number.

A licensed health professional acting under the delegation and supervision of a physician licensed in Texas may also issue a valid prescription. Prescribing must be in accordance with the required prescriptive authority agreement or other forms of delegation.

If the prescription is for a controlled substance, the health professional must have a current valid DEA registration number. If the prescription is for a schedule II controlled substance, the health professional must comply with DEA regulations regarding the use of electronic prescriptions. The health professional may also use the official prescription forms issued with their name, address, phone number, DEA registration number, delegating physician’s name, and delegating physician’s DEA registration number.

As applicable, all drug prescriptions must meet the requirements of the Texas Controlled Substance Act (Texas Health and Safety Code §481), the Texas Dangerous Drug Act (Texas Health and Safety Code §483), and any other federal or state statutes or rules.

Telemedicine medical services used for the treatment of chronic pain with scheduled drugs via audio-only is prohibited, unless a patient:

  • Is an established chronic pain patient of the physician or health professional issuing the prescription;
  • Is receiving a prescription that is identical to a prescription issued at the previous visit; and
  • Has been seen by the prescribing physician or health professional defined under Section 111.001(1) of Texas Occupations Code, in the last 90 days either in-person or via telemedicine using audiovisual communication.

Treatment of a client for acute pain with scheduled drugs using telemedicine is permitted, as provided by 22 TAC §174.5(e). Acute pain is defined by 22 TAC §170.2(2).

All physicians must comply by 22 TAC §174.5 when issuing prescriptions through a telemedicine service.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9-10 (Jan. 2024). (Accessed Jan. 2024).

All client health information generated or utilized during a telehealth or telemedicine service must be stored by the distant site provider in a client health record. If the distant site provider stores the patient health information in an electronic health record, the provider should use software that complies with Health Insurance Portability and Accountability Act (HIPAA) confidentiality and data encryption requirements, as well as with the United States Department of Health and Human Services (HHS) rules implementing HIPAA.

Medical records must be maintained for all telemedicine services.

Documentation for a service provided via telemedicine must be the same as for a comparable in-person service.

If a patient has a primary care provider who is not the distant site provider and the patient or their parent or legal guardian provides consent to a release of information, a distant site provider must provide the patient’s primary care provider with the following information:

  • A medical record or report with an explanation of the treatment provided by the distant site provider
  • The distant site provider’s evaluation, analysis, or diagnosis of the patient

Unless the telemedicine services are rendered to a child in a school-based setting, distant site providers of mental health services are not required to provide the patient’s primary care provider with a treatment summary.

For telemedicine provided to a child in a school-based setting, a notification provided by the telemedicine physician to the child’s primary care provider must include a summary of the service, exam findings, prescribed or administered medications, and patient instructions.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5 & 11. (Jan. 2024). (Accessed Jan. 2024).

Screening activities for crisis stabilization units, including triage and determining if the individual’s need is urgent can be conducted in person or through telehealth.

SOURCE: TX Admin Code, Title 26, Part 1, Ch. 306, Subchapter B, Sec. 306.45, (Accessed Jan. 2024).

A patient can be admitted on a voluntary admission only if a physician has conducted or consulted with a physician who has conducted, either in person or through telemedicine medical services, an admission examination within 72 hours before or 24 hours after admission.

SOURCE: TX Admin Code, Title 26, Part 1, Ch. 568, Subchapter B, Sec. 568.22, (Accessed Jan. 2024).

The commission shall establish policies and procedures to improve access to care under the Medicaid managed care program by encouraging the use of telehealth services, telemedicine medical services, home telemonitoring services, and other telecommunications or information technology under the program.

To the extent permitted by federal law, the executive commissioner by rule shall establish policies and procedures that allow a Medicaid managed care organization to conduct assessments and provide care coordination services using telecommunications or information technology.  See rule for details.

SOURCE: TX Statute Sec. 533.039, [repealed eff. Apr. 1, 2025], (Accessed Jan. 2024).

In the event of a state of disaster declared pursuant to Texas Government Code §418.014 for statewide disasters or limited areas subject to the declaration, the flexibilities listed under subsection (c) of this section will be available until the state of disaster is terminated.

Telehealth and telemedicine have the same meaning as the terms telehealth services and telemedicine medical services defined in §111.001 of the Texas Occupations Code (relating to Definitions).

See rule for additional details.

SOURCE: TX Admin Code Title 26, Part 1, Ch. 306, Subchapter X, 306.1251. (Accessed Jan. 2024).

Hospital Licensing

See rule for neonatal care facility licensing requirements for telehealth/telemedicine services.

SOURCE: TX Admin Code Sec. 133.185, (Accessed Jan. 2024).

A limited services rural hospital (LSRH) shall have an organized medical staff that operates under bylaws approved by the LSRH’s governing body, and which is responsible for the quality of medical care provided to patients by the LSRH.

The governing body’s responsibilities shall include: …

  • ensuring that when telemedicine services are furnished to the LSRH’s patients through an agreement with a distant-site hospital, the agreement meets the requirements of 42 CFR §485.510; and
  • ensuring that when telemedicine services are furnished the services meet all federal and state laws, rules, and regulations.

The medical staff shall adopt, implement, and enforce written bylaws, rules, and regulations to carry out its responsibilities. The bylaws shall: …

  • include criteria for granting privileges to individual practitioners and a procedure for applying the criteria to individuals requesting privileges. For distant-site physicians and practitioners requesting privileges to provide telemedicine services under an agreement with the LSRH, the criteria for determining privileges and the procedure for applying the criteria are also subject to the requirements in the Code of Federal Regulations Title 42 (42 CFR) §485.510(a)(8) and §485.512(a)(9).

The quality and appropriateness of the diagnosis and treatment provided by a physician at the LSRH must be evaluated by one of the following: …

  • One Quality Improvement Organization (QIO) or equivalent entity;
  • in the case of distant-site physicians and practitioners providing telemedicine services to the LSRH’s patient under an agreement between the LSRH and a distant-site hospital, the distant-site hospital; or
  • in the case of distant-site physicians and practitioners providing telemedicine services to the LSRH’s patients under a written agreement between the LSRH and a distant-site telemedicine entity, one QIO or equivalent entity.

SOURCE: TX Admin Code Sec. 511.55, (Accessed Jan. 2024).

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Utah

Last updated 02/28/2024

Home and Community Based New Choices Waiver Services

A non …

Home and Community Based New Choices Waiver Services

A non face-to-face medication reminder system using telecommunication device is covered.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver,  p. 63 (Jul. 2021).  (Accessed Feb. 2024).

Provider Requirements

A provider offering telehealth services shall

  • at all times:
    • act within the scope of the provider’s license under Title 58, Occupations and Professions, in accordance with the provisions of this section and all other applicable laws and rules; and
    • be held to the same standards of practice as those applicable in traditional health care settings;
  • If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, determined by the Division of Professional Licensing in rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, including providing the provider’s licensure and credentials to the patient;
  • Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:
    • obtaining from the patient or another provider the patient’s relevant clinical history; and
    • documenting the patient’s relevant clinical history and current symptoms;
  • be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice;
  • be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated;
  • in accordance with any applicable state and federal laws, rules, and regulations, generate, maintain, and make available to each patient receiving telehealth services the patient’s medical records; and
  • if the patient has a designated health care provider who is not the telemedicine provider:
    • consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
    • collect from the patient the contact information of the patient’s designated health care provider; and
    • within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26B-3-126, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

The last bullet does not apply to prescriptions for eyeglasses or contacts.

A provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

  • an online questionnaire;
  • an email message; or
  • a patient-generated medical history.

A provider may not offer telehealth services if:

  • the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
  • the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

The Division of Professional Licensing created in Section 58-1-103 is authorized to enforce the provisions of this section as it relates to providers licensed under Title 58, Occupations and Professions.

The department is authorized to enforce the provisions of:

  • this section as it relates to providers licensed under this title; and
  • this section as it relates to providers licensed under Chapter 2, Part 1, Human Services Programs and Facilities.

SOURCE: UT Code Sec. 26B-4-704 (Accessed Feb. 2024).

Office of Substance Use and Mental Health is required to award grants to a health facility that implements a program that provides a primary care provider access to a telehealth psychiatric consultation when the primary care provider is evaluating a patient for or providing a patient mental health treatment.  See statute for details.

SOURCE  UT Code 26B-1-328, (Accessed Feb. 2024).

Tenant Housing Services

For each date of service, documentation must include: … Setting in which the service was rendered (when via telehealth, the provider setting and
notation that the service was provided via telehealth).

SOURCE: Utah Medicaid Provider Manual: Housing Related Services and Supports (Aug. 2022).  (Accessed Feb. 2024).

Durable Medical Equipment

In addition, documentation must indicate:

  • the evaluating physician
  • the date of the face-to-face
  • if the evaluation was conducted via telehealth

SOURCE: Utah Medicaid Provider Manual: Medical Supplies and Durable Medical Equipment, (Jan. 2024).  (Accessed Feb. 2024).

Targeted Case Management for Individuals with Serious Mental Illness

For each date of service, documentation must include: … setting in which the service was rendered (when via telehealth, the provider setting and notation that
the service was provided via telehealth).

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management for Individuals with Serious Mental Illness, (Jan. 2024).  (Accessed Feb. 2024).

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Vermont

Last updated 12/05/2023

Qualified telemedicine and store and forward providers shall:

  • Meet or

Qualified telemedicine and store and forward providers shall:

  • Meet or exceed applicable federal and state legal requirements of medical and health information privacy, including compliance with HIPAA.
  • Provide appropriate informed consent, in a language that the beneficiary understands, consistent with 18 VSA § 936l(c)(l) (see code for details)
  • Take appropriate steps to establish the provider-patient relationship and conduct all appropriate evaluations and history of the beneficiary consistent with traditional standards of care.
  • Maintain medical records for all beneficiaries receiving health care services through telemedicine that are consistent with established laws and regulations governing patient health care records.
  • Establish an emergency protocol when care indicates that acute or emergency treatment is necessary for the safety of the beneficiary.
  • Address needs for continuity of care for beneficiaries (e.g., informing beneficiary or designee how to contact provider or designee and/or providing beneficiary or identified providers timely access to medical records).
  • If prescriptions are contemplated, follow traditional standards of care to ensure beneficiary safety in the absence of a traditional physical examination.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.3), Telehealth, (Accessed Dec. 2023).

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Virgin Islands

Last updated 12/18/2023

Crisis Intervention Program

The Director with the approval of the

Crisis Intervention Program

The Director with the approval of the Commissioner shall establish Crisis Intervention and Prevention Services. This is a community-based program shall provide counseling, consultation, evaluation, treatment and referral, education, and training services, delivered by a crisis intervention team. The program must be designed for persons with behavioral challenges, mental health disorders or substance use disorders who experience a behavioral crisis that threatens their ability to live a full, productive life due to hospitalizations, law enforcement involvement, or placement in restrictive settings. The Department of Health, Division of Behavioral Health shall support persons in the development of behavioral assessments, individualized behavior treatment plans, and intensive intervention with a focus on family coaching.
The program shall provide the following services:
Emergency room services. Crisis intervention and psychiatric emergency services based in a hospital emergency room;
  • Outreach services. Outreach services and crisis intervention beyond the hospital setting;
  • Telephone hot-line services. A community-based telephone crisis intervention hot-line offering 24-hour, 7-days-a-week counseling, consultation, evaluation, treatment and referral services;Telehealth Services. Delivery of health care services, through the use of interactive real-time visual and audio or other electronic media for the purpose of consultation and education concerning diagnosis, treatment, care management and self-management of patient’s physical and mental health and includes real-time interaction between the patient and the telehealth provider, synchronous encounters, asynchronous encounters, store, and forward transfers and telemonitoring;
  • Transportation of persons in crisis to and from the hospital or institution; and
  • Suicide Prevention and School Counseling Program: a program in cooperation and coordination with the Department of Education, Department of Human Services, and the Police shall develop a suicide prevention strategy and an evidence-based model suicide prevention program, counseling for bullying, cyberbullying, and peer pressure counseling to be presented in the elementary, junior, middle, and high schools in the Territory which must include the preparation of relevant educational materials that must be distributed in the schools.

SOURCE:  VI Code annotated 19 VIC Sec. 1020. (Accessed Dec. 2023).

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Virginia

Last updated 01/05/2024

See Telehealth Supplement for Documentation and Equipment/Technology Requirements.

SOURCE:  VA

See Telehealth Supplement for Documentation and Equipment/Technology Requirements.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals), (Oct. 2022) (Accessed Jan. 2024).

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

  • A provision, when in compliance with federal law and regulation and approved by the Centers for Medicare & Medicaid Services (CMS), for payment of medical assistance services delivered to Medicaid-eligible students when such services qualify for reimbursement by the Virginia Medicaid program and may be provided by school divisions, regardless of whether the student receiving care has an individualized education program or whether the health care service is included in a student’s individualized education program. Such services shall include those covered under the state plan for medical assistance services or by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit as specified in § 1905(r) of the federal Social Security Act, and shall include a provision for payment of medical assistance for health care services provided through telemedicine services, as defined in § 38.2-3418.16. No health care provider who provides health care services through telemedicine shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services. …
  • A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.  ….
  • A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for:
    • High-risk pregnant persons;
    • Medically complex infants and children;
    • Transplant patients;
    • Patients who have undergone surgery, for up to three months following the date of such surgery; and
    • Patients with a chronic health condition who have had two or more hospitalizations or emergency department visits related to such chronic health condition in the previous 12 months.

“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.

“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.

SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Jan. 2024).

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Washington

Last updated 12/15/2023

Telemedicine Documentation Requirements

Distant site:

  • Specification of the telehealth modality

Telemedicine Documentation Requirements

Distant site:

  • Specification of the telehealth modality that was used (e.g., visit was conducted via HIPAA-compliant real-time audio/visual)
  • Verification that telemedicine was clinically appropriate for this service
  • Whether any assistive technologies were used
  • The location of the client
  • The location of the provider. Include the following:
    • The state in which the service was provided for users of the following documents:
      • Part 2 (specialized) of HCA’s Mental Health Services Billing Guide
      • HCA’s Substance Use Disorder Billing Guide
      • HCA’s Service Encounter Reporting Instructions (SERI)
    • For all others, the state in which the provider was located at the time services were provided and for specific service locations (e.g., facility-based), whether the provider was in a facility at the time services were provided.
  • The names and credentials (MD, ARNP, RN, PA, etc.) of all provider personnel involved in the telemedicine visit
  • The people who attended the appointment with the client (family, friend, caregiver)
  • The start and end times of the health care service provided by telemedicine
  • Consent for care via the modality that was used

Originating site:

  • Specification of the telehealth modality that was used (e.g., visit was conducted via HIPAA-compliant real-time audio/visual)
  • If there are staff involved in providing the service list the names and credentials (e.g., MD, ARNP, PA, etc.) of all provider personnel involved in the telemedicine visit
  • Any medical service provided (e.g., vital signs, weight, etc.)
  • The start and end times of the health care service provided by telemedicine

SOURCE: WA State Health Care Authority. Medicaid Provider Guide. Telemedicine Policy and Billing, p. 16-17 (Oct. 2023). (Accessed Dec. 2023).

Use place of service (POS) 02 or 10 to indicate that a billed service was furnished as a telemedicine service from a distant site.

When billing with POS 02 or 10:

  • Add modifier 95 if the distant site is designated as a nonfacility.
  • Nonfacility providers must add modifier 95 to the claim to distinguish them from facility providers and ensure that they receive the nonfacility rate.

HCA discontinued the use of modifier GT for claims submitted for professional services (services billed on a CMS-1500 claim form, when submitting paper claims). Distant site practitioners billing for telemedicine services under the Critical Access Hospital (CAH) optional payment method must use modifier GT.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide. Telemedicine Policy and Billing, p. 19-20 (Oct. 2023). (Accessed Dec. 2023).

Health care services that are authorized to be provided through telemedicine or store and forward technology are identified in the agency’s provider guides and fee schedules.

To receive payment for an audio-only telemedicine service, a provider must obtain client consent before delivering the service to the client. The client’s consent to receive services via audio-only telemedicine must:

  • Acknowledge the provider will bill the agency or the agency’s designee, including an agency-contracted managed care entity (managed care organization or behavioral health administrative services organization) for the service; and
  • Be documented in the client’s medical record.

A provider may only bill a client for services if they comply with the requirements in WAC 182-502-0160.

Providers using telemedicine or store and forward technology must document in the client’s medical record the:

  • Technology used to deliver the health care service by telemedicine or store and forward technology (audio, visual, or other means) and any assistive technologies used;
  • Client’s location for telemedicine only. This information is not required when a provider uses store and forward technology;
  • People attending the appointment with the client (e.g., family, friends, or caregivers) during the delivery of the health care service;
  • Provider’s location;
  • Names and credentials (MD, ARNP, RN, PA, CNA, LMHP, etc.) of all originating and distant site providers involved in the delivery of the health care service;
  • Start and end time or duration of service when billing is based on time;
  • Client’s consent for the billing of audio-only telemedicine services.

SOURCE: WAC 182-501-0300 (4)(a), (6)(a), & (8)(b). (Accessed Dec. 2023).

Applied Behavioral Analysis (ABA) Services

If a separately identifiable service for the client is performed on the same day as the telemedicine service, documentation for both services must be clearly and separately identified in the client’s medical record.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, ABA Services, p. 32 (Oct. 2023). (Accessed Dec. 2023).

School-Based Health Services

The documentation requirements are the same as those listed in the documentation section of this billing guide, as well as the following:

  • Documentation that the service was provided through telemedicine
    • Provider must indicate whether the service was delivered through audio/visual or audio-only telemedicine
  • The location of the student
  • The location of the provider

The SBHS program uses two telemedicine modifiers. Telemedicine claims must include one of the following modifiers based on the platform used to deliver the service. Only use modifier 93 when providing services through audio-only telehealth (i.e., telephone with no visual component). Use with either POS 02 or POS 10. Only use telemedicine modifier 95 when providing services through HIPAA compliant audio/visual telehealth. Use with either POS 02 or POS 10.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, SBHS Billing, p. 35-37 (Oct. 2023). (Accessed Dec. 2023).

Telemedicine Best Practices

When conducting telemedicine services, it is important to ensure that the standard of care for telemedicine is the same as that for an in-person visit, providing the same health care service. Refer to the Department of Health for requirements from various commissions (e.g., Medical Commission, Nursing Commission, etc.).

Best practices may include, but are not limited to, the following:

  • Consider the client’s resources when deciding the best platform to provide telemedicine services.
  • Test the process and have a back-up plan; connections can be disrupted with heavy volume. Communicate a back-up plan in the event the technology fails.
  • Introduce yourself, including what your credential is and what specialty you practice. Show a badge when applicable.
  • Ask the client their name and verify their identity. Consider requesting a photo ID when applicable/available.
  • Inform clients of your location and obtain the location of clients. Include this information in documentation.
  • Inform the client of how the client can see a clinician in-person in the event of an emergency or as otherwise needed.
  • Inform clients they may want to be in a room or space where privacy can be preserved during the conversation. Explain that personal health information may be disclosed.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide. Telemedicine Policy and Billing, p. 8. (Oct. 2023) (Accessed Dec. 2023).

Childbirth Education Classes

Agency-approved online classes are allowed with a one-on-one check-in with the client and qualified childbirth education provider during or after the online classes have been completed by the client. As part of the coverage requirements, the provider must follow up with clients participating in online classes through a telemedicine, including audio-only, visit or an in-person visit. If the client does not appear for the follow up visit, the provider must attempt to connect with the client one more time before billing the agency.

SOURCE: WAC 182-533-0390 as amended by Final Rule. (Accessed Dec. 2023).

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West Virginia

Last updated 02/13/2024

See manual for equipment standards and requirements.

SOURCE: WV Dept.

See manual for equipment standards and requirements.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. p. 3 (Effective Jan. 1, 2022). (Accessed Feb. 2024).

Additional instructions regarding telehealth standards and billing available in the following manuals:  Licensed Behavioral Health Center Services (Ch. 503); Substance Use Disorder Services (Ch. 504); Behavioral Health Outpatient Services (Ch. 521); Targeted Case Management (Ch. 523). Limited to specific CPT codes.

SOURCE: WV Dept. of Health and Human Service Medicaid Provider Manual, Chapter—503.12 Licensed Behavioral Health Center Services (Jul. 15, 2018); 504.10 Substance Use Disorder Services (Jan. 1, 2023); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); 523.3 Targeted Case Management (Jul. 1, 2016). (Accessed Feb. 2024).

Sexual Assault Examinations

A hospital is required to have a trained health care provider available or transfer agreement as provided in a county plan, to complete a sexual assault forensic examination. “Available” includes, but not limited, having access to a trained sexual assault forensic examination expert via telehealth.

SOURCE: WV Code Section 15-9B-4(b)(3). (Accessed Feb. 2024).

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Wisconsin

Last updated 01/09/2024

The department may not require a certified provider of Medical …

The department may not require a certified provider of Medical Assistance that provides a reimbursable service to obtain an additional certification or meet additional requirements solely because the service was delivered through telehealth, except that the department may require, by rule, that the transmission of information through telehealth be of sufficient quality to be functionally equivalent to face-to-face contact. The department may apply any requirement that is applicable to a covered service that is not provided through telehealth to any service telehealth service listed under statute.

SOURCE:  WI Statute Sec. 49.45 (61)(e), (Accessed Jan. 2024).

The following cannot be billed to the member:

Telehealth equipment like tablets or smart devices

  • Charges for mailing or delivery of telehealth equipment
  • Charges for shipping and handling of:
    • Diagnostic tools
    • Equipment to allow the provider to assess, diagnose, repair, or set up medical supplies online such as hearing aids, cochlear implants, power wheelchairs, or other equipment

Documentation Requirements

Documentation requirements for a telehealth service are the same as for an in-person visit and must accurately reflect the service rendered. Documentation must identify the delivery mode of the service when provided via telehealth and document the following:

  • Whether the service was provided via audio-visual telehealth, audio-only telehealth, or via telehealth externally acquired images
  • Whether the service was provided synchronously or asynchronously

Additional information for which documentation is recommended, but not required, includes:

  • Provider location (for example, clinic [city/name], home, other)
  • Member location (for example, clinic [city/name], home)
  • All clinical participants, as well as their roles and actions during the encounter (This could apply if, for example, a member presents at a clinic and receives telehealth services from a provider at a different location).

As a reminder, documentation for originating sites must support the member’s presence in order to submit a claim for the originating site fee. In addition, if the originating site provides and bills for services in addition to the originating site fee, documentation in the member’s medical record should distinguish between the unique services provided.

Privacy and Security

Providers are required to follow federal laws to ensure member privacy and security. This may include ensuring that:

  • The location from which the service is delivered via telehealth protects privacy and confidentiality of member information and communications.
  • The platforms used to connect to the member to the telehealth visit are secure.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth, (Accessed Jan. 2024).

Supervision

Supervision requirements and respective telehealth allowances vary depending on service and provider type. Some supervision requirements necessitate the physical presence of the supervising provider to meet the requirements of appropriate delivery of supervision. Such requirements cannot be met through the provision of telehealth, including audio-visual delivery.

Paraprofessional providers are subject to supervision requirements. Paraprofessional providers are providers who do not hold a license to practice independently but are providing services under the direction of a licensed provider. Providers who supervise paraprofessionals are responsible for confirming if the required components of supervision can be met through telehealth delivery.

Personal Care/Home Health Provider Supervision Under permanent policy, supervision of PCWs and home health aides must be performed on site, in person by the RN. State rules and regulations necessitate supervising providers to physically visit a member’s home and directly observe the paraprofessional providing services.

Providers are reminded that effective January 1, 2022, modifier FR should be used for behavioral health services where the supervising provider is present through audio-visual means and the patient and supervised provider are in-person.

This Update applies to telehealth services with supervision components that members receive on a fee-for-service basis and through BadgerCare Plus, Medicaid SSI, and other managed care programs. For information about managed care implementation of the updated policy, contact the appropriate managed care organization (MCO). MCOs are required to provide at least the same benefits as those provided under fee-for-service arrangements.

SOURCE: WI ForwardHealth Update, Feb. 2023, No. 2023-02, (Accessed Jan. 2024).

Supervision requirements and respective telehealth allowances vary depending on service and provider type. Some supervision requirements necessitate the physical presence of the supervising provider to meet the requirements of appropriate delivery of supervision. Such requirements cannot be met through the provision of telehealth, including audio-visual delivery.

Providers who deliver services with supervision requirements are reminded to review ForwardHealth policy, including permanent telehealth policy, and the requirements of their licensing and/or certifying authorities to determine if the supervisory components of the service can be met via telehealth.

See handbook for provider type instructions.

SOURCE:  ForwardHealth Topic #22757, Supervision, (Accessed Jan. 2024).

Documentation

Providers are reminded that they must follow the documentation retention requirements per Wis. Admin. Code § DHS 106.02(9). Providers are required to produce or submit documentation, or both, to the Wisconsin Department of Health Services (DHS) upon request. Per Wis. Stat. § 49.45(3)(f), providers of services shall maintain records as required by DHS for verification of provider claims for reimbursement. DHS may audit such records to verify actual provision of services and the appropriateness and accuracy of claims. DHS may deny or recoup payment for services that fail to meet these requirements. Refusal to produce documentation may result in denial of submitted claims, recoupment of paid claims, application of intermediate sanctions, or termination from the Medicaid program.

This Update applies to telehealth services that members receive on a fee-forservice basis and through BadgerCare Plus, Medicaid SSI, and other managed care programs. For information about managed care implementation of the
updated policy, contact the appropriate managed care organization (MCO). MCOs are required to provide at least the same benefits as those provided under fee-for-service arrangements.

SOURCE: WI ForwardHealth Update, Feb. 2023, No. 2023-02, (Accessed Jan. 2024).

Teledentistry

When a dentist has performed an oral evaluation via teledentistry and a problem is found, the dentist should help refer the member to a dentist who can provide treatment if the dentist is not able to schedule the member for treatment themselves.

All telehealth services must follow the guidelines for submitting documentation for the visit and complying with audio and visual and audio-only visit guidelines.

SOURCE:  ForwardHealth Teledentistry Policy, Topic #22637, (Accessed Jan. 2024).

What options are available for providing my signature or the signature of my representative?

When your signature or the signature of your representative is required, handwritten or electronic signatures are acceptable. If a handwritten signature is specified, an electronic signature will not be accepted.

The following types of signatures are accepted:

  • Handwritten signature—This includes:
    • Signing a paper document and handing it to your provider or returning it to your provider through the mail or fax.
    • Signing a touchpad signature device.
    • Sending a statement by email giving your approval.
    • Taking a picture of a signed document and electronically forwarding it to your provider using methods such as text or email.
  • Electronic signature—The provider handles setting up a way to accept your signature electronically.

SOURCE: Wisconsin Department of Health Services, Medicaid Telehealth Expansion: Frequently Asked Questions, May 11, 2023, (Accessed Jan. 2024).

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Wyoming

Last updated 01/31/2024

Mental Health and Substance Use Disorder

“Engagement services” means face-to-face …

Mental Health and Substance Use Disorder

“Engagement services” means face-to-face staff contact, which may include delivery through telehealth, with an individual who is waiting to be admitted into treatment for the purpose of maintaining the individual’s motivation and to help prepare them for treatment.

SOURCE: WY Amin Rules and Regulations, Agency 048, Mental Health and Substance Use Disorder Services, Ch. 1, Sec.3. (Accessed Jan. 2024).

Behavioral Health Service Provider Certification

DUI/MIP Service Standards

Provide a minimum of eight (8) hours of client face-to-face services, which may be delivered through telehealth, utilizing evidence based curricula that is appropriate to age and developmental levels.

SOURCE: WY Admin Rules and Regulations, Health Dept., Agency 048, Mental Health and Substance Use Disorder Services, Chapter 2, Sec. 14. (Accessed Jan. 2024)

Interpreter Services

ADA requirements:  Title II and Title III of the Americans with Disabilities Act (“ADA”), 42 U.S.C. §§ 12131-34 & 12181-89, prohibits discrimination on the basis of disability in a range of covered areas, including healthcare services. The ADA applies to all types of private and state and local government healthcare providers, including, but not limited to, hospitals, skilled nursing facilities, urgent care centers, physicians, dentists, optometrists, mental health providers, and medical equipment providers. Further, the ADA applies to all services that covered entities provide, including in-person medical services, telehealth appointments and websites.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 332 (Jan. 2, 2024), (Accessed Jan. 2024).

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Medicaid & Medicare

Miscellaneous

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