New York Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

New York Medicaid offers live video reimbursement and some reimbursement for store-and-forward and home health services. The New York State Department of Health released a Medicaid telehealth expansion in 2019. The guidance states that other state offices will be updating guidances and regulation to reflect the changes made, however no other office has released updates at the time of this report.

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Definitions

“Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance.”

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Live Video

Policy
Reimbursement policy applies to fee-for-service. Managed care plans may cover telemedicine at their own option and establish their own payment guidelines and structure.

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Eligible Services/Specialties
NY Medicaid will reimburse for medically necessary services if patient is in a certain location (see live video eligible site section) and certain requirements are met (see live video policy section).

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Eligible Providers
Click for a list of eligible providers.

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Eligible Sites
Click for a list of eligible sites.

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Geographic Limits
Facility/Transmission Fee
Facility/transmission fees may be billed under certain circumstances.

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Store-and-Forward

Policy
NY Medicaid is authorized to establish fees to reimburse the cost of telehealth store-and-forward technology, per a State Plan Amendment submitted and approved by CMS. Store-and-forward technology may be utilized in the specialty areas of dermatology, ophthalmology and other disciplines, as determined by the Commissioner. Services must reduce the need for on-site or in-office visits.

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Eligible Services/Specialties
For the home telehealth program, store-and-forward services may be reimbursed.

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Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
NY Medicaid is authorized to establish fees to reimburse the cost of telehealth remote patient monitoring, per a State Plan Amendment submitted and approved by CMS.

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Conditions
NY will reimburse for remote patient monitoring for certain medical conditions.

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Provider Limitations
Other Restrictions
Certain considerations apply to RPM.

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Email/Phone/Fax

No payment for telephone, e-mail, text messages, or facsimile transmissions.

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Consent

Mental Health: Part of obtaining approval for telepsychiatry services is obtaining informed consent.

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Out of State Providers

A distant site may be located within any of the fifty United States or United States’ territories where a telehealth provider is located when delivering health care services by means of telehealth.

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Miscellaneous

NY Department of Health is encouraging Medicaid Managed Care (MMC) plans to allow for telehealth services. They are allowing MMC plans to request reimbursement of additional cost effective alternative telehealth services.

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Private Payer Laws

Definitions

Telehealth means the use of electronic information and communications technologies by a health care provider to deliver health services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located.

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Requirements

A health plan shall not exclude from coverage services that are provided via telehealth if they would otherwise be covered under a policy, provided that an insurer may exclude coverage of a service by a health care provider where the provider is not otherwise covered under the policy.

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Parity

A health plan shall not exclude from coverage services that are provided via telehealth if they would otherwise be covered under a policy, provided that an insurer may exclude coverage of a service by a health care provider where the provider is not otherwise covered under the policy.

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Professional Regulation/Health & Safety

Definitions

For the home telehealth program, term “telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient.

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Consent

Online Prescribing

Office of Alcoholism and Substance Abuse Services (OASAS): OASAS Telepractice Standards outlines practitioner requirements for prescribing buprenorphine.

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Cross State Licensing

Miscellaneous

Telepsychiatry shall not be utilized in certain personalized Recovery Oriented Services program or Assertive Community Treatment programs.

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

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