Indiana Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

Indiana Medicaid reimburses for live video telemedicine for certain services and providers. Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services. Indiana Medicaid defines telehealth as including remote patient monitoring (RPM) services and reimburses home health agencies for RPM for patients with diabetes, congestive heart failure and COPD.

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Definitions

Telemedicine services are defined as “the use of videoconferencing equipment to allow a medical provider to render an exam or other service to a patient at a distant location.”

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Live Video

Policy
Indiana Code requires reimbursement for video conferencing for FQHCs, Rural Health Clinics, Community Mental Health Centers, Critical Access Hospitals and a provider determined by the office to be eligible, providing a covered telemedicine service.

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

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Eligible Providers
The distant site physician or practitioner must determine if it is medically necessary for a medical professional to be at the originating site.

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Eligible Sites
Services may be rendered in an inpatient, outpatient or office setting.

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Geographic Limits
Facility/Transmission Fee
Originating sites are reimbursed a facility fee.

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Store-and-Forward

Policy
Indiana Medicaid will not reimburse for store-and-forward services. However, restrictions placed on store-and-forward reimbursement shall not disallow the permissible use of store-and-forward technology to facilitate other reimbursable services.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.

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Conditions
Click for a list of eligible conditions.

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Provider Limitations
Reimbursement for home health agencies under certain conditions.

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Other Restrictions
Treating physician must certify the need for home health services and document that there was a face-to-face encounter with the individual.

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Email/Phone/Fax

Click for a list of exceptions to telehealth technology.

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Consent

The originating site must obtain patient consent. The consent must be maintained at the distant and originating sites.

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Out of State Providers

Miscellaneous

For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The distant site physician should coordinate with the patient’s primary care physician.

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Private Payer Laws

Definitions

“Telemedicine services” means health care services delivered by use of interactive audio, video, or other electronic media.

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Requirements

Accident and sickness insurance (dental or vision insurance is excluded) policies and individual or group contracts must provide coverage for telemedicine services in accordance with the same clinical criteria as would be provided for services provided in-person.

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Parity

Coverage must be provided in accordance with the same criteria as would be provided in-person.

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Professional Regulation/Health & Safety

Definitions

“Telemedicine means the delivery of health care services using electronic communications and information technology.

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Consent

A health care provider (as defined in Indiana Code 16-18-2-163(a)) may not be required to obtain a separate additional written health care consent for the provision of telemedicine services.

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Online Prescribing

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to issuing prescriptions electronically or otherwise.

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Cross State Licensing

A provider located outside Indiana may not establish a provider-patient relationship with an individual in Indiana unless the provider and the provider’s employer or the provider’s contractor have certified in writing to the Indiana Professional Licensing Agency that the provider agrees to be subject to the jurisdiction of the courts of law of Indiana and Indiana Substantive and Procedural Laws. This certification must be filed by a provider’s employer or contractor at the time of initial certification and renewed when the provider’s license is renewed.

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Miscellaneous

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

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