Medicaid Telehealth Reimbursement
Summary
Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances. Reimbursement for store-and-forward is only specified for teleradiology.
Definitions
Telehealth consultation means any contact between a client and a health care practitioner relating to the health care diagnosis or treatment of such client through telehealth. For the purposes of telehealth, a consultation includes any service delivered through telehealth.
Live Video
Policy
Nebraska Medicaid provides coverage for telehealth at the same rate as in-person services when the technology meets industry standards and is HIPAA compliant.
Eligible Services/Specialties
Click for a list of eligible services and specialties.
Eligible Providers
Nebraska Medicaid-enrolled providers licensed, registered, or certified to practice in Nebraska are eligible for reimbursement.
Eligible Sites
Health care practitioners must assure that the originating sites meet the standards for telehealth, including providing a place where the client’s right for confidential and private services is protected.
Geographic Limits
No reference found.
Facility/Transmission Fee
Nebraska Medicaid reimburses for transmission costs for two-way, real-time interactive communication, unless provided by an internet service provider.
Store-and-Forward
Policy
Asynchronous service is included in the definition for telehealth in Nebraska statutes.
Eligible Services/Specialties
Nebraska Medicaid will reimburse for tele-radiology when it meets the American College of Radiology standards for tele-radiology. There is no other reference to reimbursing for other specialties.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
Medicaid will reimburse for telemonitoring when requirements are met.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reimbursement for telephone.
Consent
Click for a list of consent requirements.
Out of State Providers
Out-of-State Telehealth Services are covered in some circumstances.
Miscellaneous
NE Medicaid does provide an outpatient cardiac rehabilitation program consisting of physical exercise or conditioning and concurrent telemetric monitoring are considered a valuable therapeutic modality. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.
Private Payer Laws
Definitions
Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care provider in the diagnosis or treatment of a patient.
Requirements
Private payers and self-funded employee benefit plans must provide, upon the request of a policyholder, certificate holder, or health care provider, a description of the telehealth and telemonitoring services covered under the relevant policy, certificate, contract, or plan.
Parity
Private payers and self-funded employee benefit plans are prohibited from excluding a service from coverage solely because the service is delivered through telehealth and is not provided through in-person consultation or contact between a licensed health care provider and a patient.
Professional Regulation/Health & Safety
Definitions
Uniform Credentialing Act (Licensed/Credentialed Health Professionals): Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a credential holder in the diagnosis or treatment of a patient.
Consent
No reference found.
Online Prescribing
A physician or physician assistant may establish a provider-patient relationship through telehealth and may prescribe while using telehealth.
Cross State Licensing
Member of the following: Interstate Medical Licensure Compact, Nurse Licensure Compact, and Compact of the Association of State and Provincial Psychology Boards.
Miscellaneous
A stroke system of care task force shall recommend eligible essential health care services for acute stroke care provided through telehealth.
Source: Center for Connected Health Policy
https://www.cchpca.org