New Jersey Telehealth Laws & Reimbursement Policies

New Jersey Telehealth Laws

Medicaid Telehealth Reimbursement

Summary

New Jersey Medicaid reimburses for live video and remote patient monitoring under certain circumstances. Store-and-forward is not explicitly included in reimbursement; however, it could be covered within the definition of telemedicine. Individual Medicare managed care plans may have their own individual policies regarding telehealth and telemedicine.

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Definitions

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider.

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Live Video

Policy
NJ Medicaid must provide coverage and payment for telemedicine or telehealth delivered services on the same basis as when the services are delivered through in-person contact and consultation in NJ.

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Eligible Services/Specialties
Psychiatric Services: Telepsychiatry may be utilized by mental health clinics and/or hospital providers of outpatient mental health services to meet their physician related requirements including but not limited to intake evaluations, periodic psychiatric evaluations, medication management and/or psychotherapy sessions for clients of any age.

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Eligible Providers
Click for a list of eligible providers.

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Eligible Sites
Psychiatric Services: A patient may receive services at the mental health clinic or outpatient hospital program.

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Geographic Limits
Facility/Transmission Fee

Store-and-Forward

Policy
Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Store-and-forward is not explicitly included, but could fit into these definitions.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Remote patient monitoring is included within definition of telehealth.

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Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

Telemedicine does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission.

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Consent

Informed consent is required for telepsychiatry. If a patient chooses not to participate in telepsychiatry, they must be made aware of other face-to-face options and services. If they choose to participate, they must be informed of the location of the psychiatrist/advanced practice nurse providing the telepsychiatry service.

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Out of State Providers

A psychiatrist or psychiatric APN may be off-site, but must be licensed in the State of New Jersey.

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Miscellaneous

New Jersey’s Medicaid Program is managed care, with five participating health plans. The health plans may or may not have their own telehealth related policies.

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Private Payer Laws

Definitions

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider.

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Requirements

A carrier that offers a health benefits plan shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation.

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Parity

Insurers must provide coverage and payment for health services delivered through telemedicine or telehealth on the same basis as when the services are delivered through in-person contact and consultation.

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Professional Regulation/Health & Safety

Definitions

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider.

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Consent

With a patient’s oral, written, or digital consent, the patient’s medical information may be forwarded directly to the patient’s primary care provider or health care provider of record, or, up on request by the patient, to other health care providers.

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Online Prescribing

The prescription of Schedule II controlled substances through telemedicine or telehealth is authorized only after an initial in-person examination, and subsequent in-person visit with the patient is required every three months for the duration of prescription. Does not apply when prescribing stimulant for use by a minor under the age of 18 provided the health care provider is using live video when treating the patient and the health care provider has obtained written consent for the waiver form the minor patient’s parent or guardian.

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Cross State Licensing

Member of the Physical Therapy Compact.

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Miscellaneous

Each telehealth or telemedicine organization operating in the State shall annually register with the Department of Health and submit an annual report. See statute for details.

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

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