North Dakota

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

North Dakota reimburses for live video telemedicine for most services, with a few exceptions.
They do not provide reimbursement for store-and-forward and no reference was found for remote patient monitoring.

 

Definitions

Telemedicine is the use of interactive audio-video equipment to link practitioners and patients at different sites.

 

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) p. 156 (Accessed Apr. 2019).

Live Video

Policy

North Dakota Medicaid will reimburse for live video services as long as the patient is present during the service. Actual visual contact (face-to-face) must be maintained between practitioner and patient.

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 156 (Accessed Apr. 2019).

 

Telemedicine services are covered by Medicaid under the following criteria:
• Maintain actual visual contact (face-to-face) between the practitioner and patient.
• Be medically appropriate and necessary with supporting documentation included
in the patient’s clinical medical record.
• Be provided via secure and appropriate equipment to ensure confidentiality and
quality in the delivery of the service. Skype or other devices or video conferencing
platforms that are not secure are not acceptable or allowed to be used for telehealth services.
Qualified services must use appropriate coding, including GT and 95 modifiers or place of service 02. The originating site uses HCPC code Q3014.

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 156 (Accessed Apr. 2019).

 

Indian Health Services
Reimbursement for telemedicine is reimbursed at the all-inclusive rate regardless of whether the originating site is outside the “four walls” of the facility or clinic.

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).
Eligible Services / Specialties

Except for the non-covered services noted below, telemedicine can be used for services covered by Medicaid, and otherwise allowed, per CPT, to be rendered via telemedicine.

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).

 

Noncovered Services Include:
• Therapies provided in a group setting
• Store-and-Forward
• Targeted Case Management for High Risk Pregnant Women and Infants
• Targeted Case Management for Individuals in need of Long-Term Care Services

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).

 

All service limits set by ND Medicaid apply to telemedicine services.

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).

 

Reimbursement is made for services provided by licensed professionals enrolled with ND Medicaid and within the scope of practice per their licensure only.

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).
Eligible Providers

All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid
Agency, regardless of location, are eligible to participate in the Telemedicine Program to
provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In
order to participate in the telemedicine program:
• Physicians must be enrolled with Alabama Medicaid with a specialty type of 931
(Telemedicine Service).
• Physician must submit the telemedicine Service Agreement/Certification form.
• Physician must obtain prior consent from the recipient before services are rendered.
This will count as part of each recipient’s benefit limit of 14 annual physician office
visits currently allowed.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17) (Accessed Mar. 2019).

For Nursing Assessment and Care services the following providers are eligible:
• Licensed Registered Nurse
• Licensed Practical Nurse
• Certified Nursing Assistant
• MAC Worker

Source: AL Medicaid Management Information System Provider Manual, (105-60) (Accessed Mar. 2019).
Facility/Transmission Fee

Reimbursement will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional reimbursement for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.
Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.

 

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).

Store-and-Forward

Policy

North Dakota Medicaid does not reimburse for store-and-forward.

 

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 157 (Accessed Apr. 2019).
Email / Phone / Fax

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

 

Source: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (January 2019) P. 93 (Accessed Apr. 2019).

Private Payer Laws

Requirements

An insurer must provide coverage for telehealth delivered health services which is the same coverage for health services delivered by in-person means.
A policy is not required to provide coverage for health services that are not medically necessary, subject to the terms and conditions of the policy.

Source: ND Code Sec. 26.1-36-09.15. (Accessed Apr. 2019).

 

North Dakota’s Worker Compensation Act provides reimbursement for live video.
Eligible services:
• Office or other outpatient visits;
• New and established evaluation and management visits;
• Individual psychotherapy visits;
• Pharmacologic management visits.
The patient must be present and participating in the appointment.
The professional fee is equal to comparable in-person services.
The organization may pay the originating site facility fee, not to exceed twenty dollars.

Source: ND Admin. Code 92-01-02-34 (3d). (Accessed Apr. 2019).
Definitions

Telehealth:
• Means the use of interactive audio, video or other telecommunications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site and that is delivered over a secure connection that complies with the requirements of state and federal laws.
• Includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real-time or through the use of store-and-forward technology.
• Does not include the use of audio-only telephone, electronic mail, or facsimile transmissions.

Source: ND Code Sec. 26.1-36-09.15(1)(g). (Accessed Apr. 2019).

Parity

Payment Parity

Payment of expenses may be established through negotiations conducted between the insurer and health services providers in the same manner as reimbursement of expenses for covered services that are delivered by in-person means.

 

Source: ND Code Sec. 26.1-36-09.15(3). (Accessed Apr. 2019).
Service Parity

An insurer must provide coverage for telehealth delivered services to the same extent as the same coverage for in-person services. They are not required to provide coverage for health services that are not medically necessary.

 

Source: ND Code Sec. 26.1-36-09.15(2). (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Definitions

“Telemedicine” means the practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. The term includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.

Source: ND Admin Code 50-2-15-01 (Accessed Apr. 2019).

 

Stroke system of care task force
“Telemedicine services means the use of interactive audio, video, and other electronic media used for the purpose of diagnosis, consultation, or treatment of acute stroke.”

Source: ND Statute Sec. 23-43-05. (Accessed Apr. 2019).

 

North Dakota uses federal definitions for “internet” and “practice of telemedicine” set in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.

Source: ND Century Code, Sec. 19-02.1-15.1(1)(d). (Accessed Apr. 2019).

 

“Telemedicine means the practice of medicine by a practitioner, other than a pharmacist, who is at a location remote from the patient, and is communicating with the patient, or health care professional who is treating the patient, using a telecommunications system.”

Source: Ryan Haight Online Pharmacy Consumer Protection Act of 2008 [Pub. L. 110-425; 21 U.S.C. 802-803]. (Accessed Apr. 2019).

 

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

Source: ND Admin. Code 61.5-01-02-01. (Accessed Apr. 2019).
Online Prescribing

A valid prescription via e-prescribing means a prescription has been issued for a legitimate medical purpose, in the usual course of professional practice, by a practitioner who has first conducted an in-person medical evaluation of the patient. An in-person medical evaluation can include the referring practitioner having performed the exam, in the case of telemedicine.

Source: ND Centennial Code, Sec. 19-02.1-15.1.(c) & (f) (Accessed Apr. 2019).

 

Miscellaneous

Under the Worker’s Compensation Act, the originating sites may receive a facility fee, not to exceed $20.

Source: ND Admin. Code 92-01-02-34 (3d).(Accessed Apr. 2019).

 

The board shall provide health benefits coverage under a contract for insurance pursuant to section 54-52.1-04 or under a self-insurance plan pursuant to section 54-52.1-04.2 which provides coverage of health services delivered by means of telehealth in the same manner as provided under section 26.1-36-09.15.

Source: ND Statute Sec. 54-52.1-04.13. (Accessed Apr. 2019).
Cross-State Licensing

The ND Medical Board may engage in reciprocal licensing agreements with out-of-state licensing agencies, but is not required to do so.

Source: ND Century Code Sec. 43-17-21 (Accessed Apr. 2019).

 

Member of the Physical Therapy Compact.

Source: PT Compact. Compact Map. HB 1157 (2017). (Accessed Apr. 2019).

 

Member of the Nurses Licensure Compact.

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

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