COLORADO

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Colorado Medicaid reimburses for live video for medical and mental health services. They also provide reimbursement for remote patient monitoring for patients with certain chronic conditions.
Colorado Medicaid requires a member to be present and participating in a telemedicine service, excluding the possibility of utilizing store-and-forward, except in the case of teledentistry for an interim therapeutic restoration.

 

Definitions

Telemedicine is not a unique service, but a means of providing selected services approved by Health First Colorado through live interactive audio and video telecommunications equipment.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine,” p.1, (12/18). (Accessed Mar. 2019).

Telehealth services include the installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the client’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

Source: CO Medical Assistance Program, Home Health Billing Manual, p. 12 (6/18). (Accessed Mar. 2019).

Telehealth allows for the monitoring of a member’s health status remotely via equipment, which transmits data from the member’s home to the member’s home health agency. The purpose of providing telehealth services is to assist in the effective management and monitoring of members whose medical needs can be appropriately and cost-effectively met at home through the frequent monitoring of data and early intervention.

Source: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Mar. 2019).

Live Video

Policy

CO Medicaid will cover telemedicine direct member services which can involve up to two collaborating providers and the member. It is also acceptable for an originating provider not to be present, as long as the telecommunication equipment facilitates live contact between a member and a distant provider.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” (6/18). (Accessed Mar. 2019).

Services shall be subject to reimbursement policies developed by the medical assistance program. Reimbursement must be, at minimum, the same as in-person services.

Source: CO Revised Statutes 25.5-5-320. (Accessed Mar. 2019).

In-person contact between a health care provider and a recipient is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through telehealth and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in-person. The services are
subject to the reimbursement policies developed pursuant to the state medical assistance program.

Source: CO Revised Statutes 25.5-5-321.5. (Accessed Mar. 2019).
Eligible Services / Specialties

Colorado Medicaid will reimburse for medical and mental health services.

 

Source: CO Revised Statutes 25.5-5-320. (Accessed Mar. 2019).
Eligible Providers

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.
A specialist is eligible to be an originating provider or distant provider.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p. 2, 12/18. (Accessed Mar. 2019).
Eligible Sites

If no originating provider is present, then the location of the originating site is at the member’s discretion and can include the member’s home. However, members can be required to choose a location suitable to delivery of telemedicine services that may include adequate lighting and environmental noise levels.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p.2, 12/18. (Accessed Mar. 2019).
Facility/Transmission Fee

The originating site is eligible for a facility fee.
Providers eligible for the originating site facility fee include:
• Physician
• Clinic
• Osteopath
• Doctorate Psychologist
• MA Psychologist
• Physician Assistant
• Nurse Practitioner
Other sites can serve as an originating site, but cannot collect the facility fee.
Using modifier GT adds $5.00 to the procedure code billed for the service for distant site
providers for the transmission fee. A specific list of eligible codes is provided in the manual. Other codes can be billed, but don’t pay the telemedicine transmission fee.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p.4-5, 12/18. (Accessed Mar. 2019).

The CO Medical Assistance Program will reimburse for transmission costs, at a rate set by their state department.

Source: CO Revised Statutes 25.5-5-320(3). (Accessed Mar. 2019).

Store-and-Forward

Policy

The member must be present during any Telemedicine Direct Member Services.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” 6/18. (Accessed Mar. 2019).

In-person contact between a health care provider and a recipient is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through store-and-forward transfer and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in-person. The services are subject to the reimbursement policies developed pursuant to the state medical
assistance program.

Source: CO Revised Statutes 25.5-5-321.5. (Accessed Mar. 2019).
Eligible Services / Specialties

Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.

 

Source: CO Revised Statutes 25.5-5-321.5. (Accessed Mar. 2019).
Email / Phone / Fax

No reimbursement for telephone.
No reimbursement for FAX.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p.1, (12/18). (Accessed Mar. 2019).
Consent

The Medicaid requirement for face-to-face contact between provider and member may be waived prior to treating the member through telemedicine for the first time. The rendering provider must furnish each member with all of the following written statements which must be signed by the member or the member’s legal representative:
• The member retains the option to refuse the delivery of health care services via telemedicine at any time without affecting the member’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the member would otherwise be entitled.
• All applicable confidentiality protections shall apply to the services.
• The member shall have access to all medical information resulting from the telemedicine services as provided by applicable law for client access to his or her medical records.
These requirements do not apply in an emergency.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p.3-4, (12/18). (Accessed Mar. 2019).
Miscellaneous

Managed care may or may not reimburse telemedicine costs.

 

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p.1, (12/18). (Accessed Mar. 2019).

Providers of telemedicine services must implement confidentiality procedures that include, but are not limited to:
• Specifying the individuals who have access to electronic records.
• Using unique passwords or identifiers for each employee or other person with access to the member records.
• Ensuring a system to routinely track and permanently record such electronic medical
information.
• Members must be advised of their right to privacy and that their selection of a location to receive telemedicine services in private or public environments is at the member’s discretion.

Source: CO Department of Health Care Policy and Financing. “Telemedicine” p.3, (12/18). (Accessed Mar. 2019).

Costs and salaries associated with telemedicine visits at an FQHC are included in the cost report and are not billable encounters. The services are reimbursed through the prospective payment system.

Source: CO Department of Health Care Policy and Financing. “Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)” (6/18). p.3, (Accessed Mar. 2019).

Private Payer Laws

Requirements

A health benefit plan that is issued, amended or renewed shall not restrict or deny coverage solely because the service is provided through telehealth or based on the communication technology or application used to deliver the telehealth services, subject to the terms and conditions of the plan.
A health plan is not required to pay for consultation provided by a provider by telephone or facsimile unless the consultation is provided through HIPAA compliant interactive audio-visual communication or the use of a HIPAA compliant application via a cellular telephone.
A carrier shall include in the payment for telehealth interactions reasonable compensation to the originating site for the transmission cost incurred during the delivery of health care services through telehealth except for when the originating site is a private residence.

 

Source: CO Revised Statutes 10-16-123(2)(b). (Accessed Mar. 2019).
Definitions

Telehealth means a mode of delivery of healthcare services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered
person’s health care while the covered person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions, store-and-forward transfers and services provided through HIPAA Compliant interactive audio-visual communication or the use of a HIPAA compliant application via a cellular telephone. Telehealth does not include the delivery of health care services via voice only telephone communication or text messaging, facsimile machine or electronic mail.

 

Source: CO Revised Statutes 10-16-123(4)(e)(I & II). (Accessed Mar. 2019).

Parity

Payment Parity

A health plan carrier must reimburse the treating participating provider or consulting participating provider for services deliver through telehealth on the same basis as the carrier is responsible for reimbursing that provider for the provision of the same service through in-person consultation or contact by that provider.

 

Source: CO Revised Statutes 10-16-123(2)(b). (Accessed Mar. 2019).
Service Parity

CO insurers cannot deny coverage solely because the service is provided through telehealth. However, use of the word solely, may mean they can find other reasons, such as the service doesn’t meet the appropriate standard of care in the insurer’s view.

 

Source: CO Revised Statutes 10-16-123(2)(b). (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

Pharmacists are prohibited from dispensing prescription drugs if they know, or should have known,
that it was on the basis of an Internet-based questionnaire, an Internet-based consult, or a telephone consultation, all without a valid pre-existing patient-practitioner relationship.

 

Source: 3 CO Code of Regulation 719-1. 3.00.21, p. 7. (Accessed Mar. 2019).

Workers’ Compensation
The physician-patient relationship/psychologist-patient relationship can be established through live audio/video services.

Source: 7 CO Regs. Rule 18-5(J)(3)(a). (Accessed Mar. 2019).
Definitions

“Telehealth” means a mode of delivery of health care services through telecommunication systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education and care management of a resident’s health care when the resident and practitioner are located at different sites. Telehealth includes ‘telemedicine’ as defined in Section 12-36-102.5(8), C.R.S.”

 

Source: 6 CO Regs. Rule 1011-1. Ch. 5. (Accessed Mar. 2019).

“Telemedicine means the delivery of medical services and any diagnosis, consultation, or treatment using interactive audio, interactive video, or interactive data communication.”

Source: CO Revised Statutes 12-36-102.5(8). (Accessed Mar. 2019).
Consent

Providers shall give all first-time patients a written statement that includes the following:
• The patient may refuse telemedicine services at any time, without loss or withdrawal of
treatment;
• All applicable confidentiality protections shall apply to the services;
• The patient shall have access to all medical information from the services, under state law.

 

Workers’ Compensation
The patient is required to provide the appropriate consent for treatment

Source: 7 CO Regs. Rule 18-5(J)(3)(b), p. 34. (Accessed Mar. 2019).
Cross-State Licensing

Member of the interstate medical licensure compact.

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

 

Colorado 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: Compact of the Association of State and Provincial Psychology Boards. Legislative Updates. (Accessed Mar. 2019).

 

Member of the Physical Therapy Compact.

Source: Physical Therapy Compact. Compact Map. (Accessed Mar. 2019).

 

Member of the Nurses Licensure Compact.

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

Colorado law includes in its definition of “health care services” the rendering of services via telemedicine.

 

Source: CO Revised Statutes 10-16-102(33). (Accessed Mar. 2019).

Worker’s Compensation Telehealth/Telemedicine Definition Telehealth – a mode of delivery of health care services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, and/or self-management of an injured worker’s health care while the injured worker is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions and store-and-forward
transfers. The term does not include the delivery of health care services via telephone with audio only function, facsimile machine, or electronic mail systems.
Telemedicine means two-way, real time interactive communication between the injured worker, and the provider at the distant site. This electronic communication involves, at minimum, audio and video telecommunications equipment. Telemedicine enables the remote diagnoses and evaluation of injured workers in addition to the ability to detect fluctuations in their medical condition(s) at a remote site in such a way as to confirm or alter the treatment plan, including medications and/or specialized therapy.

Source: 7 CCR 1101-3, Rules 16-2. (Accessed Mar. 2019).

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