Medicaid Telehealth Reimbursement
Summary
Colorado Medicaid reimburses for live video for medical and mental health services. They also provide reimbursement for remote patient monitoring for patients with certain chronic conditions. Colorado Medicaid requires a member to be present and participating in a telemedicine service, excluding the possibility of utilizing store-and-forward, except in the case of teledentistry for an interim therapeutic restoration.
Definitions
Telemedicine is not a unique service, but a means of providing selected services approved by Health First Colorado through live interactive audio and video telecommunications equipment.
Live Video
Policy
CO Medicaid will cover telemedicine direct member services which can involve up to two collaborating providers and the member. It is also acceptable for an originating provider not to be present, as long as the telecommunication equipment facilitates live contact between a member and a distant provider.
Eligible Services/Specialties
Colorado Medicaid will reimburse for medical and mental health services.
Eligible Providers
A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.
Eligible Sites
If no originating provider is present, then the location of the originating site is at the member’s discretion and can include the member’s home.
Geographic Limits
No reference found.
Facility/Transmission Fee
The originating site is eligible for a facility fee.
Store-and-Forward
Policy
The member must be present during any Telemedicine Direct Member Services.
Eligible Services/Specialties
Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
The CO Medical Assistance Program will reimburse for Remote Patient Monitoring at a flat fee set by the state board.
Conditions
Click for a list of requirements.
Provider Limitations
Acute home health agencies and long-term home health agencies are reimbursed for the initial installation and education of telehealth monitoring equipment and can be billed once per client per agency. The agency can also bill for every day they receive and review the client’s clinical information.
Other Restrictions
Click for a list of additional restrictions for home health services.
Email/Phone/Fax
No reimbursement for telephone.
No reimbursement for FAX.
Consent
The Medicaid requirement for face-to-face contact between provider and member may be waived prior to treating the member through telemedicine for the first time.
Out of State Providers
No reference found.
Miscellaneous
Managed care may or may not reimburse telemedicine costs.
Private Payer Laws
Definitions
Telehealth means a mode of delivery of healthcare services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions, store-and-forward transfers and services provided through HIPAA Compliant interactive audio visual communication or the use of a HIPAA compliant application via a cellular telephone. Telehealth does not include the delivery of health care services via voice only telephone communication or text messaging, facsimile machine or electronic mail.
Requirements
A health benefit plan that is issued, amended or renewed shall not restrict or deny coverage solely because the service is provided through telehealth or based on the communication technology or application used to deliver the telehealth services, subject to the terms and conditions of the plan. A health plan is not required to pay for consultation provided by a provider by telephone or facsimile unless the consultation is provided through HIPAA compliant interactive audio-visual communication or the use of a HIPAA compliant application via a cellular telephone.
Parity
CO insurers cannot deny coverage solely because the service is provided through telehealth. However, use of the word solely, may mean they can find other reasons, such as the service doesn’t meet the appropriate standard of care in the insurer’s view.
Professional Regulation/Health & Safety
Definitions
“Telehealth” means a mode of delivery of health care services through telecommunication systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education and care management of a resident’s health care when the resident and practitioner are located at different sites. Telehealth includes ‘telemedicine’ as defined in Section 12-36-102.5(8), C.R.S.”
Consent
Click for a list of consent requirements.
Online Prescribing
Pharmacists are prohibited from dispensing prescription drugs if they know, or should have known, that it was on the basis of an internet-based questionnaire, an Internet-based consult, or a telephone consultation, all without a valid pre-existing patient-practitioner relationship.
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.
Miscellaneous
Colorado law includes in its definition of “health care services” the rendering of services via telemedicine.
Source: Center for Connected Health Policy
https://www.cchpca.org