Georgia Telehealth Laws & Reimbursement Policies

Georgia TeleHealth Laws

Medicaid Telehealth Reimbursement

Summary

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.

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Definitions

Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.

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Live Video

Policy
Georgia Medicaid reimbursement for telehealth is specific to clinical services rendered via telemedicine. See each program manual for associated telemedicine guidelines.

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Eligible Services/Specialties
Click for a list of eligible services and specialties.

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Eligible Providers
Click for a list of eligible distant site providers.

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Eligible Sites
Click for a list of eligible originating sites.

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Geographic Limits
Facility/Transmission Fee
Rural Health Clinics, FQHCs and LEAs enrolled as Health Check providers can collect a telehealth originating site facility fee.

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Store-and-Forward

Policy
Georgia Medicaid will not reimburse for store-and-forward because an interactive telecommunication system is a condition of payment. The exception is that Georgia Medicaid allows for reimbursement of teledentistry.

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Eligible Services/Specialties
Reimbursement can be made for technical component of store-and-forward applications such as an MRI, X-rays or ultrasounds. However no other reimbursement can be made.

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Geographic Limits
Transmission Fee
The originating site fee (billed as D9996) associated with a real time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.

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Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

No reimbursement for FAX.
No reimbursement for telephone.
No reimbursement for email.

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Consent

The referring provider must obtain prior written consent.

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Out of State Providers

Providers must have a Georgia license and maintain an office, clinic, or other similar physician facility.

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Miscellaneous

Private Payer Laws

Definitions

“Telemedicine means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider's practice, of health care delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical visit with a patient. Standard telephone, facsimile transmissions, unsecured e-mail, or a combination thereof do not constitute telemedicine services.”

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Requirements

Requires payment of telemedicine for services that are covered under the plan, subject to contract terms and conditions.

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Parity

Services must be appropriately provided through telemedicine and in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. It Is also subject to all the terms and conditions of the applicable health benefit plan.

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Professional Regulation/Health & Safety

Definitions

“Telehealth” is the use of electronic communications to provide and deliver a host of health related information and health care services including, but not limited to physical therapy related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions.

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Consent

Online Prescribing

Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult, unless the physician is on-call or covering for another provider and prescribing up to a 72-hour supply of medications for a patient of the other provider.

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Cross State Licensing

Must be a Georgia licensed practitioner.

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Miscellaneous

Click for a list of professional board telehealth-specific regulations.

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

 

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