Oregon Telehealth Laws & Reimbursement Policies

Oregon Telehealth Laws

Medicaid Telehealth Reimbursement

Summary

Oregon Medicaid provides reimbursement for live video and audio under some circumstances. Store-and-forward and remote patient monitoring are not reimbursed.

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Definitions

“Telemedicine is the use of medical information, exchanged from one site to another, via telephonic or electronic communications, to improve a patient’s health status.”

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Live Video

Policy
Oregon Medicaid will reimburse for live video when billed services comply with their billing requirements.

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Eligible Services/Specialties
Live video services using audiovisual technology can be used in teledentistry.

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Eligible Providers
Eligible Sites
Geographic Limits
Facility/Transmission Fee
The evaluating practitioner at the distant site may bill for the evaluation, but not for the transmission.

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Store-and-Forward

Policy
Other forms of telecommunications, such as telephone calls, images transmitted via facsimile machines and electronic mail are services not covered under specific circumstances.

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Eligible Services/Specialties
A dentist may collect the transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system.

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Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Oregon will reimburse “dental care providers” for remote patient monitoring.

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Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

E-mail and telephone is reimbursed when used for patient consulting and “when billed services comply with the practice guidelines set forth by the Health Service Commission (HSC), applicable HSC approved CPT code requirements and are delivered consistent with the HSC practice guideline.”

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Consent

Teledentistry: A patient receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request. This must be reflected in the patient’s chart documentation.

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Out of State Providers

An out-of-state provider using telemedicine services must be licensed to practice within the State of Oregon or within the contiguous area of Oregon and must be enrolled as a Health Systems Division provider.

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Miscellaneous

The referring and evaluating practitioner must be licensed to practice medicine within the state of Oregon or within the contiguous area of Oregon and must be enrolled as a Division of Medical Assistance Programs (Division) provider.

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Private Payer Laws

Definitions

Treatment of Diabetes: “Telemedical means delivered through a two-way electronic communication, including but not limited to video, audio, Voice over Internet Protocol or transmission of telemetry that allows a health professional to interact with a patient, a parent or guardian of a patient or another health professional on a patient’s behalf, who is at an originating site.”

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Requirements

Health plans must provide coverage of a health service that is provided using synchronous two-way interactive video if the service would be covered when provided in-person, it is a medically necessary service, the service is determined to be safely and effectively provided using live video according to generally accepted health care practices and standards and the technology and application to provide the service meets all standards required by state and federal laws governing privacy and security of protected health information.

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Parity

Oregon requires a health benefit plan to provide coverage of a health service that is provided using synchronous two-way interactive video conferencing under certain circumstances.

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Professional Regulation/Health & Safety

Definitions

Health Care Provider Incentive Program: "Telehealth" means the provision of health services from a distance using electronic communications.

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Consent

Community Treatment and Support Services: Individuals have a right to consent to services prior to the start of services, except in a medical emergency or as otherwise permitted by law.

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Online Prescribing

Cross State Licensing

A physician granted a license to practice medicine across state lines has the same duties and responsibilities and is subject to the same penalties and sanctions as any other provider licensed in Oregon.

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Miscellaneous

Oregon requires out-of-state physicians to acquire active tele-monitoring status through the Oregon Medical Board before they can perform intraoperative tele-monitoring on patients during surgery.

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

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