Georgia

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not
reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid
will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward
teledentistry. There is no reference to remote patient monitoring.

 

Definitions

Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real-time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.
Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Telehealth is the use of telecommunications technologies for clinical care (telemedicine), patient teachings and home health, health professional education (distance learning), administrative and program planning, and other diverse aspects of a health care delivery system.

 

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 5, (April 1, 2019). (Accessed Apr. 2019).

Live Video

Policy

Georgia Medicaid reimbursement for telehealth is specific to clinical services rendered via telemedicine. See each program manual for associated telemedicine guidelines.

 

Eligible Services / Specialties

The service must be medically necessary and the procedure individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs. Some services reimbursed include for behavioral and mental health, dentistry, and emergency ambulance services.
See telemedicine manual for list of eligible telemedicine services and codes.
Non-Covered Services:
1. Telephone conversations.
2. Electronic mail messages.
3. Facsimile.
4. Services rendered via a webcam or internet based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption
compliance.
5. Video cell phone interactions.
6. The cost of telemedicine equipment and transmission.
7. Store-and-forward transactions.
8. Failed or unsuccessful transmissions

 

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance, p.23-24 (April 1, 2019) (Accessed Apr. 2019).

Georgia Medicaid will reimburse for mental health services for residents in nursing homes via telemedicine (although not available in all areas of the state) for “dual eligibles” (Medicaid and Medicare).
Nursing facilities and community behavioral health rehabilitation (CBHRS) service providers can arrange for the provision of specialized services to residents either in nursing facilities, via telemedicine or at the CBHRS location for residents in the Preadmission Screening and Resident Review Serious Mental Illness and dually diagnosed populations.

Source: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 23 & 29 (Jan. 2019). (Accessed Mar. 2019) & GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facility Services, p. H-1 (p. 154) & H-7 (p. 160). (Jan. 2019). (Accessed Mar. 2019).

See dental services manual for teledentistry codes.

Source: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Dental Services, p. 2 & IX-35 (Jan. 1, 2019) (Accessed Mar. 2019).
Eligible Providers

FQHCs and RHCs are authorized to serve as a distant site for telehealth services, and may bill the cost of the visit.

 

Source: GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 15, (Apr. 1. 2019), (Accessed Apr. 2019).

Eligible originating sites:
• Provider offices;
• Hospitals;
• Rural Health Clinics (RHC);
• Federally Qualified Health Centers (FQHC);
• Hospital based or CAH based renal Dialysis Centers;
• Skilled nursing facilities;
• Local Education Authorities and School Based Clinics;
• County Boards of Health;
• Emergency Medical Services Ambulances; and
• Pharmacies
• After July 1, 2019, the home for treatment of substance use disorder or co-occurring mental health disorder
• Mobile Stroke Units

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 6-7 (Jan. 1, 2019) (Accessed Mar. 2019).

Local Education Agencies are allowed to enroll in the Health Check Program to serve as telemedicine originating sites only.

Source: GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-4 (p.9). (Jan. 2019). & GA Dept. of Community Health, Health Check EPSDT. (Jan. 2019). X-7. (p. 67). (Accessed Mar. 2019).
Eligible Sites

Eligible originating sites:
• Provider offices;
• Hospitals;
• Rural Health Clinics (RHC);
• Federally Qualified Health Centers (FQHC);
• Hospital based or CAH based renal Dialysis Centers;
• Skilled nursing facilities;
• Local Education Authorities and School Based Clinics;
• County Boards of Health;
• Emergency Medical Services Ambulances; and
• Pharmacies
• After July 1, 2019, the home for treatment of substance use disorder or co-occurring mental health disorder
• Mobile Stroke Units

 

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 6-7 (Jan. 1, 2019) (Accessed Mar. 2019).

Local Education Agencies are allowed to enroll in the Health Check Program to serve as telemedicine originating sites only

Source: GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-4 (p.9). (Jan. 2019). & GADept. of Community Health, Health Check EPSDT. (Jan. 2019). X-7. (p. 67). (Accessed Mar. 2019).
Facility/Transmission Fee

Rural Health Clinics, FQHCs and LEAs enrolled as Health Check providers can collect a telehealth originating site facility fee.

 

Source: GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Services and Rural Health Clinic Services, p. 22, (Jan. 2019). & GA Dept. of Community Health, Health Check EPSDT. (Jan. 2019). X-7. p.67.
(Accessed Mar. 2019).

FQHCs and RHCs cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

Source: GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 15, (Apr. 1, 2019), (Accessed Apr. 2019).

Store-and-Forward

Policy

Georgia Medicaid will not reimburse for store-and-forward because an interactive telecommunication system is a condition of payment. The exception is that Georgia Medicaid allows for reimbursement of teledentistry

 

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 8 (Apr. 1, 2019) & Part II Policies and Procedures for Dental Services, p. IX-36 (Jan. 1, 2019) (Accessed Apr. 2019).
Eligible Services / Specialties

Reimbursement can be made for technical component of store-and-forward applications such as an MRI, X-rays or ultrasounds. However no other reimbursement can be made.

 

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 22 (Apr. 1, 2019) (Accessed Apr. 2019).

Georgia Medicaid allows for reimbursement of store-and-forward teledentistry.

Source: GA Department of Community Health. Part II Policies and Procedures for Dental Services. p. IX-36 (Jan. 1, 2019) (Accessed Mar. 2019).
Transmission Fee

The originating site fee (billed as D9996) associated with a real-time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.

 

Source: GA Department of Community Health. Part II Policies and Procedures for Dental Services. p. IX-35 (Jan. 1, 2019) (Accessed Mar. 2019).
Email / Phone / Fax

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

 

Consent

The referring provider must obtain prior written consent.

 

Out of State Providers

Providers must have a Georgia license and maintain an office, clinic, or other similar physician facility.

 

Source: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance, p. 22 (Apr. 1, 2019) (Accessed Apr. 2019).

Private Payer Laws

Requirements

Requires payment of telemedicine for services that are covered under the plan, subject to contract terms and conditions.

 

Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). (Accessed Mar. 2019).
Definitions

“Telemedicine means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider’s practice, of health care delivery, diagnosis, consultation, treatment,
or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical visit with a patient. Standard telephone, facsimile transmissions, unsecured e-mail, or a combination thereof do not constitute telemedicine services.”

 

Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). (Accessed Mar. 2019).

Parity

Service Parity

Services must be appropriately provided through telemedicine and in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. It Is also subject to all the terms and conditions of the applicable health benefit plan..

 

Source: Official Code of GA Annotated Sec. 33-24-56.4 (2012). (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Definitions

Applies to: Interactive Physical Therapy Services
“Telehealth” is the use of electronic communications to provide and deliver a host of health-related information and health care services including, but not limited to physical therapy related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions.

 

Source: GA Rules & Regulations. Sec. 490-9-.06 (Accessed Mar. 2019).
Online Prescribing

Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult, unless the physician is on-call or covering for another provider and prescribing up to a 72-hour supply of medications for a patient of the other provider.

 

Source: GA Rules & Regulations revised 360-3-.02(5) (2012). (Accessed Mar. 2019).
Miscellaneous

Professional Board Telehealth-Specific Regulations
• GA Composite Medical Board (Source: GA Rules & Regulations Sec. 360-3-.07) (Accessed Mar. 2019).
• GA Board of Physical Therapy (Source: GA Rules & Regulations Sec. 490-9-.06) (Accessed Mar. 2019).

 

Cross-State Licensing

Must be a Georgia licensed practitioner.

 

Source: GA Rules & Regulations Sec. 360-3-.07 (Accessed Mar. 2019)

Member of Nurse Licensure Compact.

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

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