Medicaid Telehealth Reimbursement
Summary
New Hampshire Medicaid follows the Center for Medicare and Medicaid Services requirements and Federal regulations for the use of telehealth and telemedicine. Reimbursement is available for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring services, based on Medicare restrictions.
Definitions
“Telehealth services” and the term “telemedicine” shall comply with 42 C.F.R. section 410.78 and the Centers for Medicare and Medicaid Services requirements.
Live Video
Policy
Limited reimbursement for some live video services. NH Medicaid follows the reimbursement policies of Medicare with the exception of CMS’ geographic requirement.
Eligible Services/Specialties
New Hampshire Medicaid complies with the Centers for Medicare and Medicaid Service requirements for telehealth. See Medicare’s list of CPT codes for a full list of services reimbursable under New Hampshire Medicaid.
Eligible Providers
Click for a list of eligible providers.
Eligible Sites
Click for a list of eligible sites.
Geographic Limits
New Hampshire Medicaid does not follow 42 CFR 410.78(b)(4), listing geographic and site restrictions on originating sites. No other reference found.
Facility/Transmission Fee
New Hampshire Medicaid complies with the Centers for Medicare and Medicaid Service requirements for telehealth. Based on the Medicare requirements, originating sites are eligible for a facility fee.
Store-and-Forward
Policy
There is no reimbursement for store-and-forward as telehealth must use interactive telecommunications systems permitting two-way, real-time interactive communication.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
There is no reimbursement for remote patient monitoring as telehealth must use interactive telecommunications systems permitting two-way, real-time interactive communication.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
Consent
Parental consent is required when delivering medical services reimbursed by Medicaid to children in public schools.
Out of State Providers
No reference found.
Miscellaneous
As of December 1, 2013 New Hampshire Medicaid transitioned to a managed care model of administration under three health plans. These plans each have their own telehealth coverage policy.
Private Payer Laws
Definitions
“Telemedicine, as it pertains to the delivery of health care services, means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Telemedicine does not include the use of audio-only telephone or facsimile.”
Requirements
Insurers are not prohibited from providing coverage for only those services that are medically necessary and subject to the terms and conditions of the covered person’s policy.
Parity
Insurers may not deny coverage for services on the sole basis that the coverage is provided through telemedicine if the health care service would be covered if it were provided through in-person consultation between the covered person and a health care provider.
Professional Regulation/Health & Safety
Definitions
Telemedicine means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Telemedicine shall not include the use of audio-only telephone or facsimile.
Consent
Patient consent is required prior to forwarding medical records to the patient’s primary care or treating provider, if appropriate.
Online Prescribing
A physician-patient relationship requires an in-person exam that may take place via a face-to-face two-way real time interactive communication.
Cross State Licensing
Member of the following: Interstate Medical Licensure Compact, Nurse Licensure Compact, Physical Therapy Compact.
Miscellaneous
A committee has been established to study health care reimbursement for telemedicine and telehealth in New Hampshire. The committee must report its findings by Nov. 1, 2018.
Source: Center for Connected Health Policy
https://www.cchpca.org