ARIZONA

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Arizona Health Care Cost Containment System (AHCCCS) reimburses for live video for certain services delivered at specific originating sites by specific providers. They reimburse for store-andforward for specific specialties and for remote patient monitoring for patients with chronic heart failure. Restrictions apply for all the above.
All services provided via telemedicine must be reasonable, cost effective and medically appropriate. Services are billed by the consulting provider. Tele-presenter services are not billable.

 

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-41), (4/5/2018) & IHS/Tribal Provider Billing Manual (8/42), (10/1/2018). (Accessed Mar. 2019).
Definitions

Service delivery via telemedicine can be in one of two models: Real time means the interactive, two-way transfer of information and medical data, which occurs at two sites simultaneously: the hub site and spoke site … Diagnostic, consultation and treatment services are delivered through interactive, audio, video and/or communication.
Store-and-forward means transferring medical data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation.

 

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-41), (4/5/2018) & IHS/Tribal Provider Billing Manual, (8/42), (10/1/2018). (Accessed Mar. 2019).

Telemedicine is “the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the member, including audio or video communications sent to a health care, provider for diagnostic or treatment consultation.”
Telehealth (or telemonitoring) is “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance. Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote member monitoring devices, which are used to collect and transmit member data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered telemedicine, they may nevertheless be covered and reimbursed as part of a Medicaid coverable service.”
Teledentistry “the acquisition and transmission of all necessary subjective and objective diagnostic data through interactive audio, video or data communications by an AHCCCS registered dental provider to a distant dentist for triage, dental treatment planning, and referral.”

a. Teledentistry includes the provision of preventive and other approved therapeutic services by the AHCCCS registered Affiliated Practice Dental Hygienist, who provides dental hygiene services under an affiliated practice relationship with a dentist.
b. Teledentistry does not replace the dental examination by the dentist; limited, periodic, and comprehensive examinations cannot be billed through the use of Teledentistry alone.

Source: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-22-23). Oct. 2016. (Accessed Mar 2019).

Telemedicine means the practice of health care delivery, diagnosis, consultation, and treatment and the transfer of medical data through interactive audio, video, and data communications that occur in the physical presence of the patient.
Telecommunication technology means “the transfer of medical data from one site to another through the use of a camera, or other similar device, that records (stores) an image which is then sent (forwarded) via telecommunication to another site for teleconsultation. Services delivered using telecommunications technology, but not requiring the member to be present during the consultant’s evaluation, are not considered telemedicine.”

Source: AZ Health Care Cost Containment System Telehealth Policy. Mar. 2015. (Accessed Mar. 2019).

Live Video

Policy

Fee for Service Provider Manual
AHCCCS will reimburse for medically necessary services provided via live video in their
fee for service program.

 

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10/41), (4/5/2018) & IHS/Tribal Provider Billing Manual, (8/42), (10/1/2018). (Accessed Mar. 2019)
Eligible Services / Specialties

Eligible services:
• Cardiology;
• Dermatology;
• Endocrinology;
• Hematology/oncology;
• Home Health
• Infectious diseases;
• Neurology;
• Obstetrics/gynecology;
• Oncology/radiation;
• Ophthalmology;
• Orthopedics;
• Pain clinic;
• Pathology;
• Pediatrics and pediatric sub-specialties;
• Radiology;
• Rheumatology;
• Surgery follow-up and consults;
• Behavioral health services
1. Diagnostic consultation and evaluation;
2. Psychotropic medication adjustment and monitoring;
3. Individual and family counseling;
4. Case management
Behavioral health services are covered for AHCCS and KidsCare patients

 

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10/41-42), (4/5/2018); IHS/Tribal Provider Billing Manual, (8/42), (10/1/2018). (Accessed Mar. 2019); AZ
Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine (Accessed Mar. 2019).

Additional Covered Services (listed in Telehealth Policy)
• Behavioral Health
• Inpatient consultation
• Medical Nutrition Therapy (MTN)
• Office, outpatient, and surgery follow-up-consultations
• Pain management
• Pharmacy management
Telehealth policy lists covered codes.

Source: AZ Health Care Cost Containment System Telehealth Training Manual. p.7, Mar. 2015. (Accessed Mar. 2019).

AHCCCS Policy Manual
AHCCCS covers real-time teledentistry for Early and Periodic Screening, Diagnostic and
Treatment (EPSDT) aged members when provided by a registered dental providers.

Source: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-21), Oct. 2016.
(Accessed Mar. 2019).

Teledentistry services will be reimbursed for enrollees under the age of 21.

Source: AZ Statute, Sec. 36-2907.13. (Accessed Mar. 2019).
Eligible Providers

Eligible Providers
• Physician
• Registered nurse practitioner
• Physician assistant
• Certified nurse midwife
• Clinical psychologist
• Licensed clinical social worker
• Licensed marriage and family therapist
• Licensed professional counselor
Out-of-state providers may provide and bill for spoke and/or hub telehealth services.

Source: AZ Health Care Cost Containment System Telehealth Policy. p.9, Mar. 2015. (Accessed Mar. 2019).

The patient’s primary care provider (PCP), attending physician, other medical professional
employed by the PCP, or an attending physician who is familiar with the patient’s condition
may be present.
Other medical professionals:
• Registered nurses;
• Licensed practical nurses;
• Clinical nurse specialists;
• Registered nurse midwives;
• Registered nurse practitioners;
• Physician assistants;
• Physical, occupational, speech, and respiratory therapists;
• Trained telepresenter familiar with the recipient’s medical condition.

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-42), (4/5/2018) & IHS/Tribal Provider Billing Manual (8/42), (10/1/2018). (Accessed Mar. 2019).
Eligible Sites

Eligible hub or spoke sites for Indian Health Services or tribal providers:
• Indian Health Service clinic;
• Tribally-governed facility;
• Urban clinic for Native Americans;
• Physician or other provider office;
• Hospital;
• Federally Qualified Health Center (FQHC).

Source: AZ Health Care Cost Containment System Telehealth Policy. Mar. 2015. (Accessed Mar. 2019).

 

Fee for service manual definitions:
Hub site – “the location of the telemedicine consulting provider, which is considered the
place of service.”
Spoke site – “the location where the recipient is receiving the telemedicine service.”

Source: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-41), (4/5/2018) & IHS/Tribal Provider Billing Manual, (8/42), (10/1/2018). (Accessed Mar. 2019).
Facility/Transmission Fee

A facility fee is not an AHCCCS covered service.

 

Source: AZ Health Care Cost Containment System Telehealth Policy. p.7 Mar. 2015. (Accessed Mar. 2019).

Store-and-Forward

Policy

No reference found.

 

Eligible Services / Specialties

No reference found.

 

Remote Patient Monitoring

Policy

Telemonitoring is considered necessary for members with Congestive Heart Failure (CHF).

Source: AZ Health Care Cost Containment System. AHCCCS Medical Policy Manual for AHCCCS Covered Services, Ch. 300, Policy 320 Services With Special Circumstances, (320-27). Oc. 2016. (Accessed Mar. 2019).

 

Conditions

The following conditions must be met for Congestive Heart Failure (CHF) patients:
1. Observation/inpatient admission with primary or secondary discharge diagnosis of
CHF within the past two months, or readmission within the past six months;
AND
2. A symptom level at the New York Heart Association class II or greater; CHF is identified by one of the specified ICD-10 diagnostic codes (see manual).

 

Source: AZ Health Care Cost Containment System. AHCCCS Medical Policy Manual for AHCCCS Covered Services, Ch. 300, Policy 320 Services With Special Circumstances, (320-23). Oc. 2016. (Accessed Mar. 2019).
Consent

If there will be a recording of the interactive video service, a separate consent must be obtained.
See manual for full requirements.

 

Source: AZ Health Care Cost Containment System. AHCCCS Medical Policy Manual for AHCCCS Covered Services, Ch. 300, Policy 320 Services With Special Circumstances, p. 180 (320-24). Oct. 2016. (Accessed Mar. 2019).
Out of State Providers

For teledentistry services: A consultation by a non-Arizona licensed provider may occur if:
• It is to a specific patient in the AHCCCS program;
• The provider is registered with AHCCCS;
• The provider is licensed in the state the consultation is being provided from, or the provider is employed by an Indian Health Services, Tribal or Urban Indian Health program and
appropriately licensed based on IHS and Tribal facility requirements.

 

Source: AZ Health Care Cost Containment System, AHCCS Medical Policy Manual, Medical Policy for AHCCCS Covered Services, Ch. 300, Policy 320: Services With Special Circumstances, (320-26). Oct. 2016. (Accessed Mar. 2019).
Miscellaneous

Contractors shall develop and maintain a network of providers that utilizes telemedicine to support an adequate provider network. Telemedicine shall not replace provider choice and/or member preference for physical delivery.

 

Source: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine (320-23). (Accessed Mar. 2019).

Private Payer Laws

Requirements

Health Care Service Organizations (HCSO) must provide coverage for specified health care services that are provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the enrollee and a health care provider and provided to an enrollee receiving the service in Arizona. Only applies to specific conditions and settings. A contract may limit the coverage to those health care providers who are members of the
HCSO’s provider network.

 

Source: AZ Rev. Statues. Sec. 20-841.09. (Accessed Mar. 2019).

Health Care Service Organizations (HCSO) are allowed, but not mandated, to provide access to covered services through telemedicine, telephone, and email.

Source: AZ Admin. Code Sec. R20-6-1915. (Accessed Mar. 2019).
Definitions

“Telemedicine means the interactive use of audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. Does not include the sole use of an audio-only telephone, a video-only system, a facsimile machine, instant messages or electronic mail.”

 

Source: AZ Statute 20-841.09. (Accessed Mar. 2019).

Under Arizona Administrative Code, Department of Insurance, Health Care Services Organizations Oversight, “telemedicine means diagnostic, consultation, and treatment services that occur in the physical presence of an enrollee on a real-time basis through interactive audio, video, or data communication.”

Source: AZ Admin. Code Sec. R20-6-1902. (Accessed Mar. 2019).

Parity

Service Parity

No parity. Requirement for telehealth coverage only applies to the following conditions and
settings:
• Trauma
• Burn
• Cardiology
• Infectious diseases
• Mental health disorders
• Neurologic diseases including strokes
• Dermatology
• Pulmonology
• Urology (Eff. Jan. 2020)
• Pain Medicine
• Substance Abuse

 

Source: AZ Rev. Statues. Sec. 20-841.09. (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

Physicians are prohibited from issuing a prescription to patients without having a physical or mental health status examination to establish a provider-patient relationship.
The physical or mental health status examination can be conducting during a real-time telemedicine encounter

 

Source: Arizona Revised Statute Sec. 32-1401(tt) (Accessed Mar. 2019).
Cross State Licensing

An out-of-state doctor may engage in a single or infrequent consultation with an Arizona physician.

Source: AZ Revised Statute Sec. 32-1421. (Accessed Mar. 2019).

 

Arizona adopted the interjurisdictional Compact of the Association of State and Provincial Psychology Boards (PSYPACT). (The Compact becomes effective 1/1/2020 unless a seventh state enacts the Compact before then).

Source: HB 2503 (2016). (Accessed Mar. 2019).

 

Member of the Interstate Medical Licensure Compact.

Source: Interstate Medical Licensure Compact. The IMLC. (Accessed Mar. 2019).

 

Member of Nurse Licensure Compact.

Source: Nurse Licensure Compact. Current NLC States and Status. (Accessed Mar. 2019).

 

Member of Physical Therapy Compact.

Source: PT Compact. Compact Map. (Accessed Mar. 2019.)
Consent

Source: AZ Revised Statute Sec. 32-3251(15) (2015). (Accessed Mar. 2019).

 

Source: AZ Revised Statute Sec. 36-3602 (2012). (Accessed Mar. 2019).
Miscellaneous

Arizona explicitly prohibits the use of telemedicine to provide an abortion.

 

Source: AZ Revised Statute Sec. 36-3604 (2012). (Accessed Mar. 2019).

Professional regulation with telehealth specific standards
• Board of Psychologist Examiners

(Source: AZ Reg. Sec. R4-26-109). (Accessed Mar. 2019).
Definitions

Under Arizona Statute, Public Health & Safety, “telemedicine means the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications sent to a health care provider for diagnostic or treatment consultation.”

Source: AZ Revised Statute Sec. 36-3601. (Accessed Mar. 2019).

Under the Board of Behavioral health, “telepractice” means providing behavioral health services through interactive audio, video or electronic communication that occurs between the behavioral health professional and the client, including any electronic communication for evaluation, diagnosis and treatment, including distance counseling, in a secure platform, and that meets the requirements of telemedicine pursuant to section 36-3602.

Source: AZ Revised Statute Sec. 32-3251(15) (2015). (Accessed Mar. 2019).

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