Arizona Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

Arizona Health Care Cost Containment System (AHCCCS) reimburses for live video for certain services delivered at specific originating sites by specific providers. They reimburse for store-and-forward for specific specialties and for remote patient monitoring for patients with chronic heart failure.

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Definitions

Telemedicine is “the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the member, including audio or video communications sent to a health care provider for diagnostic or treatment consultation.”

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Live Video

Policy
AHCCCS will reimburse for medically necessary services provided via live video in their fee for service program.

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Eligible Services/Specialties
Click to see list of eligible services.

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Eligible Providers
Click to see lists of eligible providers.

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Eligible Sites
Click to see list of eligible sites.

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Geographic Limits
Facility/Transmission Fee
A facility fee is not an AHCCCS covered service.

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Store-and-Forward

Policy
AHCCCS will reimburse for store-and-forward in their fee-for-service program.

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Eligible Services/Specialties
The same services are covered for store-and-forward, as for real time, except for the field of Behavioral Health Services. Real time telemedicine is the only type of reimbursement available in the field of Behavioral Health Services.

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Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Telemonitoring is considered necessary for members with Congestive Heart Failure (CHF).

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Conditions
Click to see the conditions that must be met for Congestive Heart Failure (CHF) patients

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Provider Limitations
Other Restrictions
Other limitations apply. See manual.

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Email/Phone/Fax

Consent

If there will be a recording of the interactive video service, a separate consent must be obtained. See manual for full requirements.

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Out of State Providers

Click for a list of requirements for out-of-state teledentistry.

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Miscellaneous

Contractors shall develop and maintain a network of providers that utilizes telemedicine to support an adequate provider network. Telemedicine shall not replace provider choice and/or member preference for physical delivery.

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Private Payer Laws

Definitions

“Telemedicine means the interactive use of audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. Does not include the sole use of an audio-only telephone, a video-only system, a facsimile machine, instant messages or electronic mail.”

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Requirements

Health Care Service Organizations (HCSO) must provide coverage for specified health care services that are provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the enrollee and a health care provider and provided to an enrollee receiving the service in Arizona. Only applies to specific conditions and settings.

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Parity

No parity. Requirement for telehealth coverage only applies when certain conditions are met.

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Professional Regulation/Health & Safety

Definitions

Under Arizona Statute, Public Health & Safety, "telemedicine means the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications sent to a health care provider for diagnostic or treatment consultation.”

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Consent

Providers must obtain and document oral or written consent before delivery of services. Oral consent should be documented on the patient’s medical record.

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Online Prescribing

Physicians are prohibited from issuing a prescription to patients without having a physical or mental health status examination to establish a provider-patient relationship. The physical or mental health status examination can be conducted during a real-time telemedicine encounter.

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Cross State Licensing

Member of the following: Interstate Medical Licensure Compact, Nurse Licensure Compact, Physical Therapy Compact, and Compact of the Association of State and Provincial Psychology Boards.

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Miscellaneous

Arizona explicitly prohibits the use of telemedicine to provide an abortion.

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Source: Center for Connected Health Policy
https://www.cchpca.org

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