Miscellaneous

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 Feb. 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 Feb. 2023).

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you furnished the billed service as a professional telehealth service from a distant site. As of January 1, 2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II must submit institutional claims using the GT modifier.

Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the Medicare PFS facility amount for the distant site service.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021, (Accessed Feb. 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 Feb. 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 though telehealth if they decide to reimburse for services delivered though 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 Feb. 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 Feb. 2023).

All procedure codes billed for telemedicine services must be billed with modifier GT.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17), Jan. 2023, & Rehabilitative Services (105-p. 12). Jan. 2023. (Accessed Feb. 2023).

The required face-to-face visit for the initial written prescription or order for Medicaid prescriptions (including under home health services), or orders for certain medical supplies, equipment and appliances may be conducted using telehealth systems.

SOURCE: AL Admin. Code r. 560-X-6-3, p. 8  (Accessed Feb. 2023).

Billing codes for Rehabilitative Services – DMH, DHR, DYS, DCA, to be used after the covid state of emergency are listed.

In addition to modifier HE or HF, only Medicaid approved procedure codes for Telehealth billing can be billed for telemedicine services and must be billed with modifier GT (via interactive audio and video telecommunications system). The Agency will not reimburse providers for origination site or transmission fees.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 9, 12). Jan. 2023. (Accessed Feb. 2023).

Telehealth has a “place of service code” 02 for filing claims for Targeted Case Management (TCM).

SOURCE: AL Medicaid Management Information System Provider Manual, Targeted Case Mgt (106, p. 26). Jan. 2023. (Accessed Feb. 2023).

The Telemedicine Services Agreement cannot be submitted electronically.

SOURCE: AL Medicaid Management Information System Provider Manual, Becoming a Medicaid Provider, 2, p. 2. Jan. 2023. (Accessed Feb. 2023).

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. 2023).

Documentation requirements for telemedicine consultations include:

• Statement that the service was provided using telemedicine
• The address location of the patient
• The address location of the provider
• The method of telemedicine used
• The names of all persons participating in the telemedicine service and their role in the encounter
• The inquiry from the requesting provider
• The consulting provider’s report back to the requesting provider (see policy for more details).

SOURCE: Alaska Medicaid Policy Clarification: Office Consultations via Telemedicine Applications.  March 30, 2017. (Accessed Feb. 2023).

Payment to the presenting provider is limited to the rate established for brief evaluation and management of an established patient.

Receiving providers will be reimbursed in the same manner as reimbursement is made for the same service provided through traditional modes of delivery, not to exceed 100 percent of the rate established in state law.

SOURCE: AK Admin Code, Title 7, 145.270. (Accessed Feb. 2023).

Family psychotherapy may be provided through telemedicine, with or without recipient involvement, if the services could not be provided in person and the clinician documents the reason for providing the service telephonically in the recipient’s treatment notes for each session.

SOURCE: Mental Health Physician Clinic, Psychotherapy (1/2/19) (Accessed Feb. 2023).

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. 2023).

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. 4), Approved Apr. 2022. (Accessed Jan. 2023).

Nursing-Supported Group Homes

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, (Accessed Jan. 2023).

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 Jan. 2023).

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 Jan. 2023).

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, II-20, 25 and 31, (3/1/19).  (Accessed Jan. 2023).

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 Feb. 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 Feb. 2023).

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 Feb. 2023).

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 statute for details.

SOURCE: CA Welfare and Institutions Code Sec. 14197. & CA Department of Health Care Services (DHCS). All Plan Letter 20-003: Telehealth Services Policy. Feb. 27, 2020. (Accessed Feb. 2023).

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 Feb. 2023).

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. March 2021. (Accessed Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider 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. Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via synchronous video interaction only shall also offer those same health care services in-person or facilitate access to in-person services for the patient. 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.

Effective on the date designated by the department pursuant to above, a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also do one of the following:

• Offer those services via in-person, face-to-face contact.
• Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.

In implementing this subdivision, 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, as amended by SB 184 (2022 Session) and AB 32 (2022 Session). (Accessed Feb. 2023).

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” 10/22. (Accessed Jan. 2023).

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” 10/22. (Accessed Jan. 2023).

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. 2023).

Effective Now Until June 30, 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 Feb. 2023).

Provider manual lays out three different models for prescribing:

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

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: DE Medical Assistance Program. Practitioner Provider Specific Manual, 10/28/22. Ch. 16 Telemedicine, Sec. 16.11 p. 76-77 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 13.  (Accessed Feb. 2023).

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 Feb. 2023).

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 Feb. 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 Feb. 2023).

Telemedicine section also appears in Provider Manuals on:

• FQHCs (FQHC Billing Manual Version 3.00, 1/2023, p. 51-55). (Accessed Feb. 2023).
• Clinics (Clinic Billing Manual Version 5.07, 1/2023, p. 49-52). (Accessed Feb. 2023).
• Physician (Physician Billing Manual Version 6.08 1/2023, p. 51-55). (Accessed Feb. 2023).
• Inpatient Hospital (Inpatient Hospital Billing Manual Version 7.01, 1/2023, p. 59-62). (Accessed Feb. 2023).
• Outpatient Hospital (Outpatient Hospital Billing Manual Version 6.01, 11/2023, p. 75-768). (Accessed Feb. 2023).
• Behavioral Health (Behavioral Health Billing Manual V2.04 1/2023 p. 67-71). (Accessed Feb. 2023).
• Long Term Care (Long Term Care Billing Manual Version 6.08, 1/2023 p. 51-54). (Accessed Feb. 2023).

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. 7, 2022, pg. 6-7. (Accessed Feb. 2023).

READ LESS

Substance Abuse Services

Prior to initiating services utilizing telehealth, providers shall submit detailed procedures outlining which services they intend to provide. Providers delivering any services by telehealth are responsible for the quality of the equipment and technology employed and 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-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;
• Clinical screenings, assessments, medication management, and counseling are the only services allowable through telehealth; and
• Telehealth services must be provided within the state of Florida except for those licensed for outpatient, intervention, and prevention.

SOURCE: FL Admin Code Sec. 65D-30.004. (Accessed Jan. 2023).

Children’s Medical Services

There is a webpage dedicated to explaining what telemedicine services are to families.

SOURCE: FL Children’s Medical Services: Special Services for children with special needs. Telemedicine Services. (Accessed Jan. 2023).

No reimbursement for equipment used to provide telemedicine services.

SOURCE: FL Admin Code 59G-1.057. (Accessed Jan. 2023).

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 Jan. 2023).

School-Based Mental Health Assistance Allocation

The mental health assistance allocation is created to provide funding to assist school districts in establishing or expanding school-based mental health care. Before the distribution of the allocation, the school district must develop and submit a detailed plan outlining the local program and planned expenditures to the district school board for approval. The plans must include elements related to 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.

SOURCE: FL Statute 1011.62. (Accessed Jan. 2023).

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. 7 & 10 (Jan 2023). (Accessed Jan. 2023).

Recently Passed Legislation (6/2022)

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

SOURCE: SB 2624 (2022 Session). (Accessed Jan. 2023).

Technical Requirements:

• Video must be provided in real time with full motion video and audio.
• Transmission of voice must be clear and audible
• Telehealth services that cannot be provided as effectively as in-person services are not covered.
• Video images must be high quality images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication

Provider Requirements

• Providers at the distant site must disclose to the patient the performing provider’s identity, location, telephone number and Idaho license number.
• Telehealth providers must have a systematic quality assurance and improvement program for telehealth that is documented, implemented and monitored.
• If an operator who is not an employee of the involved agency is needed to run the teleconferencing equipment or is present during the conference or consultation, that individual must sign a confidentiality agreement.
• Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider. The PCP should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered, if applicable, and any other pertinent information from the visit.

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 telehealth. The documentation must be of the same quality as is originated during an in-person visit. These documentation requirements are specific to delivery via telehealth 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. Nov. 18, 2022, p. 128-129 (Accessed Feb. 2023).

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

SOURCE: IL Administrative Code, Title 89 ,140.403(d). (Accessed Feb. 2023).

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 Feb. 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 Feb. 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 Feb. 2023).

Iowa Medicaid uses the POS 02 code adopted by Medicare.

Iowa Medicaid will recognize Modifier 95 – Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System, as informational only.

SOURCE: IA Admin Code, 441-79.1(7)b(1) [references POS 02 only] & Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Jan. 2023).

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. 2-31 (Jan. 2023). (Accessed Feb. 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 (Jan. 2023). (Accessed Feb. 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 (Jan. 2023). (Accessed Feb. 2023).

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 Feb. 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 Feb. 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 Feb. 2023).

For FQHCs and RHCs, a “visit” is defined as occurring in-person or via telehealth.

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

The Telehealth Program

The program provides a repository of information and resources including state telehealth laws, policies and guidelines; answers to frequently asked questions; educational materials and webinars; statewide telehealth services directory; publications and journals; links to associations, organizations and professional licensure boards and other state and national programs and resources.

The program is one of five business units, along with the Cabinet Privacy Program, the Kentucky Health Benefit Exchange, the Kentucky Health Information Exchange (KHIE) and analytics for health and human services. Telehealth has the ability to work with the Cabinet Privacy Program dealing with HIPAA policies and procedures around the proper use and security for telehealth; with KHIE for providers to access clinical comprehensive care documents for telehealth services and with the analytics division to measure the value and effectiveness of telehealth.

SOURCE: Kentucky Cabinet for Health and Family Services. (Accessed Feb. 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 533.272 & 533.276. (Accessed Feb. 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.

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

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

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

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 Jan. 2023).

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

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 165, (As issued on Sept. 3, 2020), (Accessed Jan. 2023).

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. (June 15, 2020). (Accessed Jan. 2023).

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 Jan. 2023). 

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 Jan. 2023).

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 Jan. 2023).

Technology requirements for providers:

• A camera that has the ability to manually, or under remote control, provider multiple views of a patient with the capability of altering the resolution, focus, and zoom requirements according to the consultation;
• Have display monitor size sufficient to support diagnostic needs used in the service via telehealth;
• Bandwidth speed and image resolution sufficient to provide quality video to meet a minimum of 15 frames per second, or higher, as industry standards change;
• Unless engaging in a telehealth communication with a participant who is deaf or hard of hearing, audio equipment that ensures clear communication and includes echo cancellation;
• Creates audio transmission with less than 300 millisecond delay;
• Secure and HIPAA compliant telehealth communication;

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

All tech staff must be trained in telehealth technology use and HIPAA compliance.

Provider manual outlines various telehealth provider scenarios.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 3 & 7-8, (Accessed Jan. 2023).

Providers of health care services delivered through telehealth must use video and audio transmission with less than a 300 millisecond delay.  Other minimum technology requirements apply.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.07. (Accessed Jan. 2023).

Providers may not store at originating or distant site video images or audio portion of telemedicine services for future use.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.08. (Accessed Jan. 2023).

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 Jan. 2023).

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 Jan. 2023).

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See bulletin for specific requirements around prescribing, telehealth encounters, documentation and recordkeeping.

Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE:MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

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 Nov. 2022).

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 Nov. 2022).

Recently Passed Legislation

The department of public health shall utilize money in the fund to:

• Provide a grant to each health center to pay for the cost of direct and indirect medication abortion readiness; provided, however, that, the department shall prioritize applications from the University of Massachusetts and state university segments and create a simple application process for community colleges to apply for funding; and provided further, that allowable expenses under these grants shall include, but not be limited to:
  • costs associated with enabling the health center to deliver telehealth services

SOURCE: MA Acts (2022) Chapter 127. (Accessed Nov. 2022).

No reimbursement for remote access for surgical procedures, and use of robotics.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1886, Oct. 1, 2022  (Accessed Nov. 2022).

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Services must be:

• Compliant with HIPAA and security requirements and regulation
• Compliant with industry interoperable standards (i.e., ability for systems and organizations to share data and information)
• Medically appropriate to the condition and needs of the person and/or family.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telehealth Services.  Mar. 16, 2022.  (Accessed Jan. 2023).

Commissioner of Human Services: Extension of COVID-19 Human Services Program Modifications

When the peacetime emergency declared by the governor in response to the COVID-19 outbreak expires, is terminated, or is rescinded by the proper authority, the following modifications issued by the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and including any amendments to the modification issued before the peacetime emergency expires, shall remain in effect until July 1, 2023:

1. CV16: expanding access to telemedicine services for Children’s Health Insurance Program, Medical Assistance, and MinnesotaCare enrollees; and
2. CV21: allowing telemedicine alternative for school-linked mental health services and intermediate school district mental health services.

Study of Telehealth Expansion and Payment Parity

The commissioner of health, in consultation with the commissioners of human services and commerce, shall study the impact of telehealth expansion and payment parity under this article on the coverage and provision of health care services under public health care programs.

The study must review and make a number of recommendations relating to specified issues such as payment parity and audio-only policy impacts. A preliminary report is due by January 15, 2023 and should include whether audio-only communication should be allowed as a telehealth option beyond June 30, 2023. The commissioners shall present a final report to the chairs and ranking minority members of these specified legislative committees by January 15, 2024.

SOURCE: HF 33, Sec. 26 (2021 Session). (Accessed Jan. 2023).

See documentation requirements in rule.

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

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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 Mar. 2023).

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 Mar. 2023). 

Special documentation requirements apply.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13.22.E, p. 211 (Feb. 6, 2023); MO HealthNet, Physician Manual, Telehealth Services, p. 287 (Feb. 3, 2023) & MO HealthNet, Rural Health Clinic, p. 166 (Feb. 6, 2023). (Accessed Mar. 2023).

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 13, p. 211 (Feb. 6, 2023), (Accessed Mar. 2023).

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. 174 (Jan. 1, 2023). (Accessed Mar. 2023).

Providers must also use the telehealth place of service of 02 for claims. 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 Jan. 2023).

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 Jan. 2023).

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

SOURCE: Montana Administrative Rules Sec. 37.97.906, (Accessed Jan. 2023).

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

No reference found.

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 Feb. 2023).

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 Dec. 2022).

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 Dec. 2022).

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. 2023).

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. 2023).

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. 2023).

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. 2023).

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 Feb. 2023).

Culturally competent translation and/or interpretation services must be provided when the member and distant practitioner do not speak the same language.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6. (Accessed Feb. 2023).

Recently Effective Legislation

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 Feb. 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 Feb. 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 Feb. 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 Feb. 2023).

TeleMental Health

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

SOURCE: NY Office of Mental Health, Telemental Health Services Guidance, 2019, pg. 7-9, (Accessed Feb. 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 Feb. 2023).

Providers shall comply with the following in effect at the time the service was rendered:

• All applicable agreements, federal, state and local laws and regulations including HIPAA and medical retention requirements.
• All Medicaid’s clinical (medical) coverage policies, guidelines, policies, provider manuals, implementation updates and bulletins published by CMS, DHHS, its divisions or its fiscal contractor(s).

Since telehealth services are considered professional services, a beneficiary and provider relationship may be established via telehealth.

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.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 3 & 9-10, Oct. 1, 2022. (Accessed Feb. 2023).

Telepharmacy

For services delivered via telepharmacy or telehealth:

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

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

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 Mar. 2023).

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 Mar. 2023).

Opioid Treatment Programs

Telehealth meetings will only be conducted for stable patients.

SOURCE: OAC 5122-40-05, (Accessed Mar. 2023).

Recently Passed Legislation

The Appalachian Community Grant Program is hereby established. The Program shall be administered by the Department of Development, in consultation with local development districts, with the goal of investing in sustainable, transformational projects in the Appalachian region of Ohio. The Program shall award grants, in amounts determined by the Department, to applicants that operate exclusively within the thirty-two-county Appalachian region of Ohio.

Each application for an Appalachian Planning Grant shall include a formal proposal outlining the proposed project or projects. The Department may establish additional requirements to apply for Appalachian Planning Grants. Each application shall include an overview addressing how any of the following components will be incorporated in the project:

• An infrastructure component, such as main street or downtown redevelopment, improvements to multi-community connecting trails, significant outdoor community space, links to community arts, history, and culture, or access to telemedicine services

SOURCE: OH Amended Substitute HB No. 377 ( 2022 Session). (Accessed Mar. 2023).

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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. 2022).

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. 2022).

“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” for the purposes of the delivery of behavioral health care, means a face-to-face physical contact and in-person encounter between the health care provider and the consumer, including the initial visit. The use of telemedicine shall be considered a face-to-face encounter.

SOURCE: OK Admin. Code Sec. 450:17-1-2. (Accessed Dec. 2022).

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

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

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

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 Mar. 2023).

Providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have limited English proficiency (LEP) and including providing access to auxiliary aids and services.

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

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

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

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

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

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

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

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

Special COVID-19 Report

Requires a disaster emergency report to include data on the use of telemedicine.

SOURCE: Title 35, Sec. 3309(c) (Accessed Mar. 2023).

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.

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 Mar. 2023).

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 Mar. 2023).

Technology Requirements

Technology used for telemedicine, whether fixed or mobile, should be capable of presenting sound and image in real-time and without delay. The telemedicine 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 telemedicine.

Telemedicine 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, they may be utilized as part of a MA covered service, such as a laboratory service, x-ray service or physician service.

Telemedicine 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 99-22-02, May 6, 2022, (Accessed Mar. 2023).

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 Mar. 2023).

No reference found.

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 Jan. 2023).

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 Jan. 2023).

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Originating sites eligible for reimbursement must bill for the service using HCPCS Q3014.

Telemedicine and audio-only services provided at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine/audio-only.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 11 (Sept. 2022). (Accessed Mar. 2023).

The telemedicine provider manual lists temporary COVID-19 specific policies. Please reference manual for additional information.

See telemedicine provider manual for specific documentation requirements.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, ( Sept. 2022), (Accessed Mar. 2023).

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

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p.2-3 (Sept. 2022) (Accessed Mar. 2023).

See manual for documentation requirements for originating and distant sites.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 10 (Sept. 2022) (Accessed Mar. 2023).

Teledentistry

See manual for documentation, reimbursement and claim requirements.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 3-4, (Sept. 2022) (Accessed Mar. 2023).

No Reference Found

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 Dec. 2022).

Children’s Health Insurance Program

Allows reimbursement for live video telemedicine and telehealth services to children with special health care needs.

SOURCE: TX Govt. Code Sec. 531.02162, (Accessed Dec. 2022).

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. 8 and 12 (Dec. 2022). (Accessed Dec. 2022).

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. 4. (Dec. 2022). (Accessed Dec. 2022).

Fees for telemedicine, telehealth and home telemonitoring services are adjusted within available funding.

SOURCE: TX Admin Code. 355.7001(g). (Accessed Dec. 2022).

A valid practitioner-patient relationship must exist between the distant site provider and the patient receiving telemedicine services. 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).

The valid practitioner-patient relationship can be established through a call coverage agreement established in accordance with Texas Medical Board (TMB) administrative rules in 22 TAC §177.20.

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 (Dec. 2022). (Accessed Dec. 2022).

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 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.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 9 (Dec. 2022). (Accessed Dec. 2022).

Radiation Therapy Services

Teletherapy is covered by Texas Medicaid once per day in an outpatient hospital setting.

SOURCE: TX Medicaid Inpatient and Outpatient Hospital Services Handbook, p. 61 (Dec. 2022). (Accessed Dec. 2022).

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. (Dec. 2022). (Accessed Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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, (Accessed Dec. 2022).

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 Dec 2022).

Telepsychiatric consultations are a covered service. Psychiatrist service will be covered by all Managed Care Entities (MCE). If a member receiving the service is part of an MCE, then the provider must be enrolled with the member’s MCE in order to receive reimbursement.

Teledentistry services are covered for eligible members statewide. Providers must bill the appropriate teledentistry code, D9995. See manual for additional teledentistry codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, (Sept. 2022), (Accessed Feb. 2023).

If the required face-to-face encounter for certain durable medical equipment occurred via telehealth it must be documented.

SOURCE: Utah Medicaid Provider Manual: Durable Medical Equipment,  (Sept. 2022).  (Accessed Feb. 2023).

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,  (Jul. 2021).  (Accessed Feb. 2023).

Home and Community Based Services Autism Waiver

For those clients living outside of the Wasatch Front, the BCBA may use tele-health for the supervision time. In-person visits should be used for those clients living inside the Wasatch Front.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services Autism Waiver, (Jan. 2016).  (Accessed Feb. 2023).

A qualified telemedicine and store-and-forward provider must:

• Meet or exceed federal and state legal requirements of medical and health information privacy, including HIPAA
• Provide appropriate informed consent in a language the beneficiary understands. Specific requirements exist, see rule.
• 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.

Services provided through telehealth are subject to the same prior authorization requirements that exist for the service when not provided through telehealth.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.5-6), Telehealth, (Accessed Feb. 2023).

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No reference found.

See Telehealth Supplement for Documentation and Equipment/Technology Requirements.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), (Oct. 2022) (Accessed Nov. 2022).

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 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), and shall include a provision for payment of medical assistance for health care services provided through telemedicine services. 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 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 Nov. 2022).

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 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. 15-16 (Jan. 2023) (Accessed Feb. 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.

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. 18-19 (Jan. 2023) (Accessed Feb. 2023).

• 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.

SOURCE: WAC 182-501-0300 (4)(a), (6)(a), & (8)(b).  (Accessed Mar. 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. 33 (Jan. 2023). (Accessed Feb. 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. 35-36 & 37 (Oct. 2022). (Accessed Feb. 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. 7 (Jan. 2023) (Accessed Feb. 2023).

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. 2023).

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 (Oct. 1, 2020); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); 523.3 Targeted Case Management (Jul. 1, 2016). (Accessed Feb. 2023).

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.

SOURCE:  WI Statute Sec. 49.45 (61)(e), (Accessed Nov. 2022).

Claims for telehealth services must include all modifiers required by coverage policy, in addition to POS code 02 or 10 and the GT, FQ, or 93 modifier, in order to reimburse the claim correctly.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth.  (Accessed Nov. 2022).

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

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. & ForwardHealth Update Dec. 2021 updated Oct. 2022, No. 2021-50. (Accessed Nov. 2022). 

School-Based Services

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 using the IEP team’s chosen term and document whether the service was provided via audio-visual telehealth or audio-only telehealth.

SOURCE: ForwardHealth Update, No. 2022-02, January 2022. (Accessed Nov. 2022). 

“Functionally equivalent” means that when a service is provided via telehealth, the transmission of information must be of sufficient quality as to be the same level of service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth,  ForwardHealth Update No. 2022-01, Jan. 2022, & ForwardHealth Update Dec. 2021 updated Oct. 2022, No. 2021-50. (Accessed Nov. 2022).

Telehealth services must be properly documented when offered at the discretion of the provider as deemed medically necessary.

A single pay to provider can bill both the originating site (spoke site) and the distant site provider (hub site) when applicable.

The GT modifier or 95 modifier must be billed by the distant site.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pgs. 132-133 & 136 (Jan. 1, 2023), WY Division of Healthcare Financing Tribal Provider Manual, pgs. 142, 145, 221, 224 (Jan. 1, 2023) & Institutional Provider Manual pgs. 134 & 137.  (Jan. 1, 2023). (Accessed Jan. 2023).

If the patient and/or legal guardian indicate at any point that he/she wants to stop using the technology, the service should cease immediately, and an alternative appointment set up.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 144 (Jan. 1, 2023), Institutional Provider Manual pg. 142 & WY Division of Healthcare Financing Tribal Provider Manual, pgs.145 &224. (Accessed Jan. 2023).

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. 2023).

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. 2023)