Delaware Telehealth Laws & Reimbursement Policies

Delaware Telehealth Laws

Medicaid Telehealth Reimbursement

Summary

Delaware Medical Assistance Program (DMAP) reimburses for live video telemedicine for certain providers and for patients at specific sites. DMAP does not reimburse for store-and-forward and makes no reference to remote patent monitoring.

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Definitions

Telemedicine is a cost-effective alternate to face-to-face encounters where access to care is compromised due to the lack of available service providers in the patient’s geographical location.  This definition is modeled on Medicare’s definition for telehealth services located at 42 CFR Sec. 410.78.  Note that the Federal Medicaid statute does not recognize telemedicine as a distinct service.

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Live Video

Policy
DE Medicaid reimburses for live video telemedicine services for up to three different consulting providers for separately identifiable telemedicine services provided to a member per date of service.

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Eligible Services/Specialties
The GT modifier (which indicates the service occurred via interactive audio and video telecommunication system) can be used for Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program.

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Eligible Providers
Click for a list of eligible providers.

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Eligible Sites
Click for a list of eligible sites.

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Geographic Limits
Facility/Transmission Fee
A facility fee for the following originating site providers is covered.

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Store-and-Forward

Policy
Asynchronous or “store-and-forward” applications do not meet the DMAP definition of telemedicine.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

Telephone, chart review, electronic mail messages, facsimile transmissions or internet services for online medical evaluations are not considered telemedicine.

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Consent

Recipient must provide written consent to use telemedicine. It must be obtained by either the referring, consulting, or distant provider. An exception is made for involuntary detention and commitment. An exception applies when a DMAP recipient is detained or committed to a facility for care.

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Out of State Providers

The Distant site provider must be located within the continental US and enrolled in the DE Medicaid program or in a DE Medicaid Managed Care Organization to be reimbursed for services.

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Miscellaneous

Click for a list of miscellaneous requirements.

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Private Payer Laws

Definitions

Telehealth means the use of information and communications technologies consisting of telephone, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

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Requirements

Private payers must provide coverage for the cost of health care services provided through telemedicine, and telehealth as directed through regulations by the Department. Insurers must pay for telemedicine services at the same rate as in-person. Payment for telemedicine must include reasonable compensation to the originating or distant site for the transmission cost.

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Parity

A payer must reimburse the provider for the diagnosis, consultation, or treatment of the patient on the same basis as in-person services for telemedicine.

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Professional Regulation/Health & Safety

Definitions

Click for a list of professional regulation definitions.

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Consent

Informed consent must be obtained to establish a physician-patient relationship over telehealth.

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Online Prescribing

Pharmacists are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to an Internet pharmacy through an Internet site.

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Cross State Licensing

Member of Nurses Licensure compact.

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Miscellaneous

Click for a list of professional regulations with telehealth-specific standards.

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

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