New Jersey

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

New Jersey Medicaid reimburses for live video and remote patient monitoring under certain circumstances. Store-and-forward is not explicitly included in reimbursement; however, it could be covered within the definition of telemedicine. Individual Medicaid managed care plans may have their own individual policies regarding telehealth and telemedicine.

 

Definitions

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider. Telemedicine does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission.
Telehealth means the use of information and communications technologies, including telephones, remote patient monitoring devices or other electronic means to support clinical health care, provider consultation, patient and professional health related education, public health, health administration and other services.

 

Source: NJ Statute C.30:4D-6K(e) & NJ Statute C.45:1-61. (Accessed Mar. 2019).

Live Video

Policy

NJ Medicaid must provide coverage and payment for telemedicine or telehealth delivered services on the same basis as when the services are delivered through in-person contact and consultation in NJ. The reimbursement rate may not exceed the rate of in-person contact. Reimbursement is provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner, as appropriate.
NJ Medicaid and NJ FamilyCare programs may limit coverage to services that are delivered by participating health care providers, but may not charge a deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.
The commissioner will apply for a State Plan amendment as necessary to implement this.

 

Source: NJ Statute C.30:4D-6k. (Accessed Mar. 2019).
Eligible Services / Specialties

Psychiatric Services
Telepsychiatry may be utilized by mental health clinics and/or hospital providers of outpatient mental health services to meet their physician related requirements including but not limited to intake evaluations, periodic psychiatric evaluations, medication management and/or psychotherapy sessions for clients of any age.
Before any telepsychiatry services can be provided, each participating program must establish related policies and procedures.
Mental health clinics and hospital providers are limited to billing for services permitted by the Division of Medical Assistance and Health Services.

 

Source: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).

For the Screening and Outreach Program, designed to provide clinical assessment and crisis stabilization services to consumers, a psychiatric evaluation may be completed through the use of telepsychiatry, provided that the screening service has a Division-approved plan setting forth its policies and procedures for providing a psychiatric assessment via telepsychiatry that meets certain criteria (see regulation).

Source: NJAC 10:31-2.3. (Accessed Mar. 2019).
Eligible Sites

Psychiatric Services
A patient may receive services at the mental health clinic or outpatient hospital program.

 

Source: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).
Eligible Providers

Psychiatric Services
• Psychiatrist
• Psychiatric Advanced Practice Nurse

 

SSource: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).

Store-and-Forward

Policy

Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Store-and-forward is not explicitly included, but could fit into these definitions.

 

Source: NJ Statute C.30:4D-6k. (Accessed Mar. 2019).

Remote Patient Monitoring

Policy

Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider
reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Remote patient monitoring is included within definition of telehealth.

 

Source: NJ Statute C.30:4D-6k. (Accessed Mar. 2019).
Email / Phone / Fax

Telemedicine does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission.
Telehealth includes the use of telephones.

 

Source: NJ Statute C.45:1-61. (Accessed Mar. 2019).
Consent

Informed consent is required for telepsychiatry. If a patient chooses not to participate in telepsychiatry, they must be provided alternative face-to-face options and services. If they choose to participate, they must be informed of the location of the psychiatrist/advanced practice nurse providing
the telepsychiatry service.

 

Source: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).
Out of State Providers

Source: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).

 

Source: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).
Miscellaneous

New Jersey’s Medicaid program consists of five managed care health plans. Individual telehealth policies may vary between health plans.

Source: NJ Medicaid & Managed Care. Division of Medical Assistance and Health Services. (Accessed Mar. 2019).

 

Psychiatric Services
If a physical evaluation is required as part of a psychiatric assessment, the hosting provider must have a registered nurse available to share the results of the physical evaluation.
NJ Medicaid does not reimburse for any costs associated with the provision of telepsychiatry services.
Additional requirements are listed in the telepsychiatry memo.

Source: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Mar. 2019).

Private Payer Laws

Requirements

A carrier that offers a health benefits plan shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation. Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.
A carrier may limit coverage to services that are delivered by health care providers in the health benefits plan’s network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

 

Source: NJ Statute C.26:2S-29. (Accessed Mar. 2019).
Definitions

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health
care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider. Telemedicine does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission.
Telehealth means the use of information and communications technologies, including telephones, remote patient monitoring devices or other electronic means to support clinical health care, provider consultation, patient and professional health related education, public health, health administration and other services.

 

Source: NJ Statute C.26:2S-29(e). & NJ Statute C.45:1-61. (Accessed Mar. 2019).

Parity

Payment Parity

Reimbursement must be made for health care services delivered through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate for in-person contact.
A health care plan may limit coverage to services that are delivered by health care providers in a plan’s network, but may not charge any deductible, copayment, or coinsurance for a health care service in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

 

Source: NJ Statute C.26:2S-29. (Accessed Mar. 2019).
Service Parity

Insurers must provide coverage and payment for health services delivered through telemedicine or telehealth on the same basis as when the services are delivered through in-person contact and consultation.
A health care plan is not prohibited from providing coverage only for services that are medically necessary, subject to the terms and conditions of the plan.
A health care plan may not require a covered person to use telemedicine or telehealth in
lieu of receiving an in-person service from an in-network provider

Source: NJ Statute C.26:2S-29. (Accessed Mar. 2019).

 

The above also applies to contracts purchased by the State Health Benefits Commission and the School Employees’ Health Benefits Commission.

Source: NJ Statute C.52:14-17.29w & C.52:14-17.46.6h (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

Definitions

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site,
either with or without the assistance of an intervening health care provider. Telemedicine does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission.
Telehealth means the use of information and communications technologies, including telephones, remote patient monitoring devices or other electronic means to support clinical health care, provider consultation, patient and professional health related education, public health, health administration and other services.

 

Source: : NJ Statute C.45:1-61. (Accessed Mar. 2019).
Online Prescribing

The prescription of Schedule II controlled substances through telemedicine or telehealth is authorized only after an initial in-person examination, and subsequent in-person visit with the patient is required every three months for the duration of prescription. Does not apply when prescribing
stimulant for use by a minor under the age of 18 provided the health care provider is using live video when treating the patient and the health care provider has obtained written consent for the waiver form the minor patient’s parent or guardian.

Source: NJ Statute C.45:1-62(e). (Accessed Mar. 2019).

 

A provider patient relationship shall include:
• Properly identifying the patient, using at minimum the patient’s name, date of birth, phone number, and address.
• Disclosing and validating the provider’s identity and credentials, such as license, title, specialty, and board certifications.
• Review of patient’s medical records, prior to initiating contact.
• Determining whether the provider will be able to meet the standard of care, prior to initiating contact, for each unique patient encounter.
See statute for exceptions.

Source: NJ Statute C.45:1-63(3)(a). (Accessed Mar. 2019).
Consent

With a patient’s oral, written, or digital consent, the patient’s medical information may be forwarded directly to the patient’s primary care provider or health care provider of record, or, up on request by
the patient, to other health care providers.

 

Source: NJ Statute C.45:1-62. (Accessed Mar. 2019).
Cross-State Licensing

Member of the Physical Therapy Compact.

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

 

Must be licensed in the State of New Jersey. Subject to New Jersey jurisdiction if either the patient or the provider is located in NJ at the item services are provided.

Source: NJ Statute C.45:1-62. (Accessed Mar. 2019).
Miscellaneous

Each telehealth or telemedicine organization operating in the State shall annually register with the Department of Health and submit an annual report. See statute for details.

Source: NJ Statute C.45:1-64. (Accessed Mar. 2019).

 

The Telemedicine and Telehealth Review Commission shall review information reported by telemedicine and telehealth organizations and make recommendations to improve the effectiveness and quality of telemedicine and telehealth services provided by New Jersey.

Source: NJ Statute C.45:1-65. (Accessed Mar. 2019).

 

Telemedicine practice standards indicate live video is allowed. Store-and-forward allowed when used in combination with two-way audio without video, if after assessing and reviewing the patient’s medical records, the provider determines that the provider is able to meet the same standard of care as if the health care service was being provided in-person.
See statute for additional telemedicine/telehealth practice standards.

Source: NJ Statute C.45:1-62(c)(2). (Accessed Mar. 2019).

 

A mental health screener, screening service, or screening psychiatrist subject to C.30:4-27.1:
• Shall not be required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes; and
• Shall not be required to request and obtain a waiver from existing regulations, prior to engaging in telemedicine or telehealth.

Source: NJ Statute C.45:1-62(f) (Accessed Mar. 2019).

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