Ohio Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

Ohio Medicaid reimburses for live video telemedicine. They do not provide reimbursement for store-and-forward or remote patient monitoring.

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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.

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Live Video

Policy
Ohio Medicaid covers live video telemedicine for certain eligible providers, specific services and at specified originating sites.

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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.

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Eligible Providers
Click to see list of eligible providers.

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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.

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Geographic Limits
When the originating site is located within a five mile radius from the distant site, providers are not eligible for reimbursement.

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Facility/Transmission Fee
Originating site eligible for a facility fee using HCPCS code Q3014. See transmittal letter for additional billing rules.

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Store-and-Forward

Policy
Telemedicine is defined as being “synchronous, interactive, real-time”, excluding the use of store-and-forward technology.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

Electronic mail, telephone and facsimile transmission are not telemedicine.

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Consent

The originating site is responsible for obtaining informed consent.

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Out of State Providers

Miscellaneous

Private Payer Laws

Definitions

Requirements

Parity

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.

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Consent

Informed consent is required (“patient’s agreement or signed authorization”). Must be documented in patient’s record.

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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.

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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.

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Miscellaneous

Click to view professional boards with telehealth-specific regulations.

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

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