Medicaid Telehealth Reimbursement
Summary
North Dakota reimburses for live video telemedicine for most services, with a few exceptions. They do not provide reimbursement for store-and-forward and no reference was found for remote patient monitoring.
Definitions
Telemedicine is the use of interactive audio-video equipment to link practitioners and patients at different sites.
Live Video
Policy
North Dakota Medicaid will reimburse for live video services as long as the patient is present during the service. Actual visual contact (face-to-face) must be maintained between practitioner and patient.
Eligible Services/Specialties
Except for the Non Covered services noted below, telemedicine can be used for services covered by Medicaid, and otherwise allowed, per CPT, to be rendered via telemedicine.
Eligible Providers
Reimbursement is made for services provided by licensed professional enrolled with ND Medicaid and within the scope of practice per their licensure only.
Eligible Sites
No reference found.
Geographic Limits
No reference found.
Facility/Transmission Fee
Reimbursement will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional reimbursement for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.
Store-and-Forward
Policy
North Dakota Medicaid does not reimburse for store-and-forward.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
While there is no indication that telehealth may be used to deliver home health services, a visit to demonstrate medical necessity for those services may be performed via telehealth or in-person.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reference found for email.
No reimbursement for telephone.
No reference found for FAX.
Consent
No reference found.
Out of State Providers
No reference found.
Miscellaneous
No reference found.
Private Payer Laws
Definitions
Click for private payer law definitions.
Requirements
An insurer must provide coverage for telehealth delivered health services which is the same coverage for health services delivered by in-person means.
A policy is not required to provide coverage for health services that are not medically necessary, subject to the terms and conditions of the policy.
Parity
An insurer must provide coverage for telehealth delivered services to the same extent as the same coverage for in-person services. They are not required to provide coverage for health services that are not medically necessary.
Professional Regulation/Health & Safety
Definitions
“Telemedicine” means the practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. The term includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.
Consent
Physical Therapy: The physical therapist may use telehealth technology as a vehicle for providing only services that are legally or professionally authorized. The patient’s written or verbal consent will be obtained and documented prior to such consultation.
Online Prescribing
A valid prescription via e-prescribing means a prescription has been issued for a legitimate medical purpose, in the usual course of professional practice, by a practitioner who has first conducted an in-person medical evaluation of the patient. An in-person medical evaluation can include the referring practitioner having performed the exam, in the case of telemedicine.
Cross State Licensing
The ND Medical Board may engage in reciprocal licensing agreements with out-of-state licensing agencies, but is not required to do so.
Miscellaneous
Under the Worker’s Compensation Act, the originating sites may receive a facility fee, not to exceed $20.
Source: Center for Connected Health Policy
https://www.cchpca.org