Idaho

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Idaho Medicaid reimburses for live video telehealth for certain providers and for specific services.
There is no reference to store-and-forward or remote patient monitoring.

 

Definitions

Telehealth is defined as health care services delivered by a provider to a participant through the use of electronic communications, information technology, synchronous interaction between a provider at a distant site and a patient at an originating site.

 

Source: Medicaid Telehealth Policy, p. 6. Rev. 7/1/2018. (Accessed Mar. 2019).

Children’s Waiver Services: “Telehealth is an electronic real-time synchronized audio-visual contact between a consultant and participant related to the treatment of the participant. The consultant and participant interact as if they were having a face-to-face service.”

Source: ID Administrative Code 16.03.10.681(07). (Accessed Mar. 2019).

Live Video

Policy

Idaho Medicaid reimburses for specific services via live video telehealth, consistent with ID Administrative Code.
Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible. Reimbursement is also not available for services that cannot be provided as effectively as in-person services due to technical or equipment limitations.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018, p. 1-2. & Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 1, 2019, p. 64. (Accessed Mar. 2019).

Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider who should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered.

Source: Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 1, 2019, p. 63. (Accessed Mar. 2019).

Telehealth services that are properly identified in accordance with billing requirements are covered under Medicaid for physicians, within limitations defined by the Department in the Idaho Medicaid Provider Handbook. Subject to primary care provider communication requirements.
Telehealth services are covered for advanced practice registered nurses enrolled as
Healthy Connections providers, within the limitations defined in the Idaho Medicaid Provider Handbook.

Source: ID Administrative Code 16.03.09 Sec. 210, 502 & 565. (Accessed Mar. 2019).
Eligible Services / Specialties

Services must be equal in quality to services provided in-person.

 

Source: Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 17, 2019. p. 62. (Accessed Mar. 2019)

Allowable codes are listed as part of the Medicaid Fee Schedule. Additionally, five codes were added on July 1, 2018 for psychiatric crisis and early intervention service codes.
Claims must include a HCPCS modifier GT. FQHC, RHC or IHS providers must include
the GT modifier with the CPT or HCPCS Code with their encounter.

Source: ID Medicaid. Telehealth Allowable Codes effective Jan. 1, 2017. & Medicaid Information Release MA 18-07 All
Medicaid Provider Letter. Updated Telehealth Policy. July 1, 2018. (Accessed Mar. 2019). & ID Medicaid Provider Handbook General Billing Instructions. p. 18. January 17, 2019. (Accessed Mar. 2019).

Physician/Non-Physician Practitioner Services:
• Primary Care Services
• Specialty Services
• Health and Behavioral Assessment/Intervention
• Psychotherapy with evaluation and management
• Psychiatric diagnostic interview
• Pharmacological management
• Tobacco Use Cessation
Physician or Psychiatric Nurse Practitioner only services:
• Psychiatric crisis consultation
Behavioral health services can be delivered via telehealth under a managed care contract.
Community Based Rehabilitation Services (CBRS)
CBRS supervision can be delivered via telehealth in educational environments, but not
separately reimbursable.
CBRS supervision can be conducted using telehealth when it is equally effective as direct
on-site supervision.
Developmental Disabilities
Therapeutic consultation and crisis intervention can be delivered via telehealth technology
through the Bureau of Developmental Disability Services.
Early Intervention Services (EIS) for Infants and Toddlers
Services can be delivered via telehealth as long as the provider is employed by or contracted with the Idaho Infant Toddler Program and meet the IDEA Part C requirements.
Primary Care
Primary care services can be delivered via telehealth. Providers must be licensed by the
Idaho Board of Medicine.
Therapy Services
Licensed occupational and physical therapists and speech language pathologists can
provide services through telehealth. Evaluations must be performed as an in-person visit
to the participant and is not covered through telehealth.
The therapist must certify that the services can be safely and effectively done with telehealth. The physician order must specifically allow the services to be provided via telehealth.
Interpretation Services and Technical Specifications
Idaho Medicaid reimburses for oral and sign language interpretive services in conjunction
with a reimbursable Medicaid service.

Source: Medicaid Telehealth Policy. Rev. 7/1/2018. & ID MMIS Provider Handbook. Speech, Language and Hearing Service Providers. Jul. 2, 2018, & Occupational and Physical Therapy Services 7/2/2018, & Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 17, 2019 & ID Administrative Code 16.03.09 Sec. 502 (07b).
(Accessed Mar. 2019).

Children’s Waiver Services
Telehealth resources may be used to provide therapeutic consultation or consultation
during a crisis intervention.

Source: ID Administrative Code 16.03.10.683 (01-7 & 06-f). (Accessed Mar. 2019).

Community Based Rehabilitation Services (CBRS) supervision is included in the CBRS reimbursement rate. It is not separately reimbursable.

Source: Medicaid Telehealth Policy. Rev. 7/1/2018, p. 1. (Accessed Mar. 2019).
Eligible Providers

Eligible Providers:
• Physician or non-physician practitioner
• Psychiatric Nurse Practitioner
• Physical Therapist
• Occupational Therapist
• Speech language pathologists
Only one eligible provider may be reimbursed for the same service per participant per date of service.
Healthy Connections Eligible Providers (if enrolled as primary care providers):
• Advanced practice registered nurse
• Physician assistants
• Certified nurse midwives
Therapeutic Consultation and Crisis Intervention Providers
• Developmental Disabilities Agency; or
• Independent Medicaid provider under agreement with the Department or Infant
Toddler program
Therapeutic consultation and crisis intervention providers must also have a Doctoral or
Master’s degree in psychology, education, and applied behavioral analysis or in a related
discipline. Additional criteria apply.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018. & ID MMIS Provider Handbook. Speech, Language and Hearing Service Providers. Jul. 2, 2018, & Occupational and Physical Therapy Services 7/2/2018, (Accessed Mar. 2019).
Eligible Sites

Telehealth services as an encounter by a facility are reimbursable if the services are delivered in accordance with the ID Medicaid Telehealth Policy.

 

Source: Idaho MMIS Provider Handbook: Ambulatory Health Care Facility. Nov. 1, 2018., p. 10 (Accessed Mar. 2019).
Facility/Transmission Fee

No reimbursement for use of equipment at either the distant or originating site.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018, p. 4. & Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 17, 2019, p. 64. (Accessed Mar. 2019).

Store-and-Forward

Policy

Idaho Medicaid will only reimburse for “two-way live video services”.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018. (Accessed Mar. 2019).
Email / Phone / Fax

No reimbursement for telephone, email, text or fax.

 

Source: Idaho Medicaid Provider Handbook. General Provider and Participant Information. Jan 17, 2019, p. 62. & Medicaid Telehealth Policy. Rev. 7/1/2018. (Accessed Mar. 2019).

Reimbursement not available in fee-for-service for telephone, email or fax between a physician and participant.

Source: ID Administrative Code 16.03.09 Sec. 502 (07b). (Accessed Mar. 2019).
Consent

An appropriate consent is required, which must disclose the delivery models, provider qualifications, treatment methods, or limitations and telehealth technologies.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018, p. 4. & Idaho Medicaid Provider Handbook. General Provider and Participant Information. Jan 17, 2019, p. 61. (Accessed Mar. 2019).
Out of State Providers

Providers of telehealth services must be licensed by the Idaho Board of Medicine or in the case of therapeutic consultation and crisis intervention for children’s developmental disabilities services, providers must meet staff qualifications.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018. & Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 17, 2019, p. 63. (Accessed Mar. 2019)
Miscellaneous

Technical Requirements:
• Video must be provided in real-time with full motion video and audio.
• Transmission of voice must be clear and audible.
• Telehealth services that cannot be provided as effectively as in-person services are not covered.
• Notation must be made in the patient’s record to designate services delivered via telehealth.
Technical Requirements:
• Video must be provided in real-time with full motion video and audio.
• Transmission of voice must be clear and audible.
• Telehealth services that cannot be provided as effectively as in-person services are not
covered.
• Notation must be made in the patient’s record to designate services delivered via telehealth.
Provider Requirements
• Providers at the distant site must disclose to the patient the performing provider’s identity,
location, telephone number and Idaho license number.
• Telehealth providers must have a systematic quality assurance and improvement program
for telehealth that is documented, implemented and monitored.
• Providers must develop and document evaluation processes and participant outcomes.
See Telehealth Policy for additional documentation requirements.
Services that have been interrupted or terminated early due to equipment problems will not be
reimbursed.
Only one provider may be reimbursed for the same service per patient and date of service.
Provider Requirements
• Providers at the distant site must disclose to the patient the performing provider’s identity,
location, telephone number and Idaho license number.
• Telehealth providers must have a systematic quality assurance and improvement program
for telehealth that is documented, implemented and monitored.
• Providers must develop and document evaluation processes and participant outcomes.
See Telehealth Policy for additional documentation requirements.
Services that have been interrupted or terminated early due to equipment problems will not be reimbursed.
Only one provider may be reimbursed for the same service per patient and date of service.

 

Source: Medicaid Telehealth Policy. Rev. 7/1/2018. & Idaho Medicaid Provider Handbook. General Provider and Participant Information. January 17, 2019. (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Definitions

Telehealth services means health care services provided by a provider to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer or synchronous interaction between a provider at a distant site and a patient at an originating site.
Such services include, but are not limited to, clinical care, health education, home health and facilitation of self-managed care and caregiver support.

 

Source: ID Code Sec. 54-5703(6). (Accessed Mar. 2019).
Consent

A patient’s consent must be obtained.

 

Source: ID Code Sec. 54-5708. (Accessed Mar. 2019).
Online Prescribing

Prescribing physicians must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment.
Prescriptions based solely on online questionnaires or consults outside of an ongoing clinical relationship are prohibited.

 

Source: ID Code § 54-1733 (2012). (Accessed Mar. 2019).

Prescriptions can be issued using telehealth as long as there is an established provider-patient relationship, provided that the prescription is not for a controlled substance unless prescribed in compliance with 21 USC section 802(54)(A).
If a provider-patient relationship is not yet established, the provider must take appropriate steps to establish the relationship by use of two-way audio and visual interaction, provided that the applicable Idaho community standard of care has been satisfied.

Source: ID Code Sec. 54-5705 & 5707. (Accessed Mar. 2019).
Cross-State Licensing

Member of the Interstate Medical Licensure Compact.

Source: ID House Bill 150. ID Code Title 54, Ch. 18. (Accessed Mar. 2019).

 

Member of Nurses Licensure Compact.

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

Professional Board Telehealth-Specific Regulations
• ID Board of Medicine (Source: IIDAPA 22.01.15) (Accessed Mar. 2019).
• ID Board of Dentistry (Source: IDAPA 19.01.01 Rule 66) (Accessed Mar. 2019).
• ID Board of Psychologist Examiners (Source: IDAPA 24.12.01 Sec. 601) (Accessed Mar. 2019).

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