Medicaid Telehealth Reimbursement
Summary
Ohio Medicaid reimburses for live video telemedicine. They do not provide reimbursement for store-and-forward or remote patient monitoring.
Definitions
“Telemedicine” is the direct delivery of services to a patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements.
Live Video
Policy
Ohio Medicaid covers live video telemedicine for certain eligible providers, specific services and at specified originating sites.
Eligible Services/Specialties
The department of Medicaid is required to establish standards for Medicaid payment for health care services the department determines are appropriate to be covered when provided as telehealth services.
Eligible Providers
Click to see list of eligible providers.
Eligible Sites
“Originating site” is the physical location of the patient at the time a health care service is provided through the use of telemedicine. The originating site may be one of five places. Click to see list.
Geographic Limits
When the originating site is located within a five mile radius from the distant site, providers are not eligible for reimbursement.
Facility/Transmission Fee
Originating site eligible for a facility fee using HCPCS code Q3014. See transmittal letter for additional billing rules.
Store-and-Forward
Policy
Telemedicine is defined as being “synchronous, interactive, real-time”, excluding the use of store-and-forward technology.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
No reference found.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
Electronic mail, telephone and facsimile transmission are not telemedicine.
Consent
The originating site is responsible for obtaining informed consent.
Out of State Providers
No reference found.
Miscellaneous
No reference found.
Private Payer Laws
Definitions
No reference found.
Requirements
No reference found.
Parity
No reference found.
Professional Regulation/Health & Safety
Definitions
Physicians – Obtaining a Telemedicine certificate by an out of state provider: The practice of telemedicine means the practice of medicine in this state through the use of any communication, including oral, written, or electronic communication, by a physician located outside this state.
Consent
Informed consent is required (“patient’s agreement or signed authorization”). Must be documented in patient’s record.
Online Prescribing
A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.
Cross State Licensing
Ohio issues telemedicine certificates that allow the holder to engage in the practice of telemedicine in the state. Providers with telemedicine certificates cannot practice in OH without a special activity certificate.
Miscellaneous
Click to view professional boards with telehealth-specific regulations.
Source: Center for Connected Health Policy
https://www.cchpca.org
What are the regulations governing telehealth in Ohio?
Following significant advancements in the medical field, Ohio has embraced the use of telehealth to offer seamless healthcare services to its residents. The Ohio telehealth system is guided by regulations set by the Ohio Medical Board. These regulations require an established physician-patient relationship prior to offering telemedicine services, except in particular circumstances, such as during a public health emergency. Physicians are expected to adhere to the same standards of care as in-person visits and obtain informed consent from patients prior to a telehealth consultation. They are also required to maintain proper documentation for all telehealth interactions. Always ensure to check with your healthcare provider or the Ohio Medical Board for the most up-to-date regulations and practices concerning telehealth in Ohio.