Oklahoma Telemedicine Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

SoonerCare reimburses for live video telehealth. Store-and-Forward and Remote Patient Monitoring must be compensable by the Oklahoma Health Care Authority (OHCA) in order to be reimbursed.

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Definitions

For purposes of SoonerCare reimbursement, telemedicine is the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment that occur in real time and when the member is actively participating during the transmission.

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Live Video

Policy
SoonerCare (Oklahoma’s Medicaid program) reimburses for live video when the GT modifier is billed and the proper documentation to include services rendered, location and services provided via telemedicine is maintained.

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Eligible Services/Specialties
OHCA has discretion and final authority to approve or deny telehealth services based on agency and/or SoonerCare members’ needs. See Medicaid Telehealth webpage for full list of eligible CPT Codes for Medical and Behavioral Health Services. Services provided by telehealth must be billed with the appropriate modifier.

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Eligible Providers
To participate, a provider must: Be contracted with SoonerCare and appropriately licensed, bill for services using the appropriate modifier (GT), and maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telemedicine.

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Eligible Sites
The medical or behavioral health related service must be provided at an appropriate site for the delivery of telehealth services. An appropriate telehealth site is one that has the proper security measures in place; the appropriate administrative, physical and technical safeguards should be in place that ensures the confidentiality, integrity and security of electronic protected health information. The location of the room for the encounter at both ends should ensure comfort, privacy and confidentiality.

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Geographic Limits
Facility/Transmission Fee
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.

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Store-and-Forward

Policy
Health care services delivered by telehealth such as remote patient monitoring, store-and-forward, or any other telehealth technology must be compensable by OHCA in order to be reimbursed.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.

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Remote Patient Monitoring

Policy
Health care services delivered by telehealth such as remote patient monitoring, store-and-forward, or any other telehealth technology must be compensable by OHCA in order to be reimbursed.

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Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX.

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Consent

Out of State Providers

A patient may receive telehealth services outside of Oklahoma when medically necessary. Out of state providers must comply with all laws and regulations of the provider’s location, including health care and telemedicine requirements.

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Miscellaneous

All telehealth activities must comply with the HIPAA Security Standards, OHCA policy, and all other applicable State and Federal laws and regulations.

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Private Payer Laws

Definitions

"Telemedicine means the practice of health care delivery, diagnosis, consultation, treatment, including but not limited to, the treatment and prevention of strokes, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.”

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Requirements

For services determined to be appropriately provided by means of telemedicine, health care insurer programs, workers’ compensation programs and state Medicaid managed care contracts shall not require person-to-person contact between a health care practitioner and patient.

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Parity

If a provider determines that telemedicine is an appropriate way to deliver care, an insurer cannot require face-to-face contact.

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Professional Regulation/Health & Safety

Definitions

Telemedicine means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store-and-forward technologies, between a patient and a physician with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit.

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Consent

No dissemination of any member images or information to other entities without written consent from the member.

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Online Prescribing

A physician-patient relationship can be established, provided that a physician: Holds a license to practice medicine, confirms the patient's identity and provides the patient with the treating physician's identity and professional credentials.

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Cross State Licensing

Physician treating patients in OK through telemedicine must be fully licensed in OK.

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Miscellaneous

OK provides, to each eligible healthcare entity, Special Universal Services for telemedicine providers.

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

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