Medicaid Telehealth Reimbursement
Summary
New Mexico Medicaid reimburses for live video telehealth at the same rate as when services are provided in-person as well as store-and-forward. There is no reference to remote patient monitoring.
Definitions
Telemedicine is defined as “the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education”
Live Video
Policy
New Mexico Medicaid will reimburse for live video at the same rate as when the services are furnished without the use of a telecommunication system.
Eligible Services/Specialties
No reference found.
Eligible Providers
No reference found.
Eligible Sites
School-based services provided via telemedicine are covered.
Geographic Limits
No reference found.
Facility/Transmission Fee
Reimbursement is made to the originating site for an interactive telehealth system fee.
Store-and-Forward
Policy
New Mexico Medicaid does reimburse for store-and-forwardstore-and-forward. To be eligible, the service must be provided through the transfer of digital images, sounds, or previously recorded video from one location to another. It does not need to occur in real time.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
Reimbursement is made to the originating site for an interactive telehealth system fee.
Remote Patient Monitoring
Policy
No reference found.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reference found.
Consent
To prescribe medication via telehealth, a prescribing clinician must obtain informed consent, obtain a medical history, and generate a medical record.
Out of State Providers
When the originating site is in New Mexico and the distant site is outside New Mexico, the distant-site provider at the distant site must be licensed in New Mexico for telemedicine, or meet federal requirements for Indian Health Service or tribal contract facilities.
Miscellaneous
Click for a list of additional requirements.
Private Payer Laws
Definitions
Telemedicine means the use of interactive simultaneous audio and video or store-and-forward technology using information and telecommunications technologies by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology.
Requirements
An insurer shall allow covered benefits to be provided through telemedicine services.
Parity
An insurer shall allow covered benefits to be provided through telemedicine services.
Professional Regulation/Health & Safety
Definitions
Click for a list of telehealth definitions from professional regulations.
Consent
Hearing, Speech and Audiology Practitioners: A licensed audiologist, speech-language pathologist or hearing aid dispenser using telecommunication technology to deliver services to a client shall provide notice to the client, guardian, caregiver and multi-disciplinary team as appropriate, including but not limited to the right to refuse telehealth services, options for service delivery and instruction on filing and resolving complaints.
Online Prescribing
Prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship, including prescribing over the internet or via other electronic means that is based solely on an on-line questionnaire is unprofessional conduct, except under specific circumstances.
Cross State Licensing
NM issues telemedicine licenses to providers who hold a full, unrestricted license in another state and has good moral character.
Miscellaneous
Click for a list of professional regulations with telehealth-specific standards.
Source: Center for Connected Health Policy
https://www.cchpca.org