Ohio

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Ohio Medicaid reimburses for live video telemedicine. They do not provide reimbursement for store-and-forward or remote patient monitoring.

 

Definitions

1. “Telemedicine” is the direct delivery of services to a patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements. The following
activities are not telemedicine:
a. The delivery of service by electronic mail, telephone, or facsimile transmission;
b. Conversations between practitioners regarding the patient without the patient present
either physically or via synchronous, interactive, real-time electronic communication; and
c. Audio-video communication related to the delivery of service in an intensive care unit.

Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016) (Accessed Apr. 2019) & OAC 5160-1-18. (Accessed Apr. 2019).

 

Telehealth service means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

Source: OH Revised Code, Sec. 5164.95. (Accessed Apr. 2019).

Live Video

Policy

Ohio Medicaid covers live video telemedicine for certain eligible providers, specific services and at specified originating sites.

 

Source: OH Fact Sheet: Telemedicine Billing Guidance (Dec. 2016) & OH Admin Code 5160-1. (Accessed Apr. 2019).
Eligible Services / Specialties

The department of Medicaid is required to establish standards for Medicaid payment for health care services the department determines are appropriate to be covered when provided as telehealth services.

Source: Revised Code, Sec. 5164.95.(B) (Accessed Apr. 2019).

 

See fact sheet for list of eligible CPT codes.

Source: OH Fact Sheet: Telemedicine Billing Guidance (Dec. 2016). (Accessed Apr. 2019).
Eligible Providers

Eligible Distant Site Providers
• Physicians (MD, DO)
• Psychologists
• Federally Qualified Health Center (medical and mental health)

 

Source: OH Fact Sheet: Telemedicine Billing Guidance (Dec. 2016). (Accessed Apr. 2019).
Eligible Sites

“Originating site” is the physical location of the patient at the time a health care service is
provided through the use of telemedicine. The originating site may be one of five places:
a. The office of a medical doctor, doctor of osteopathic medicine, optometrist, or
podiatrist;
b. A federally qualified health center, as defined in chapter 5160-28 of the Administrative Code, rural health center, or primary care clinic;
c. An outpatient hospital;
d. An inpatient hospital; or
e. A nursing facility.

Source: OAC 5160-1-18. (Accessed Apr. 2019).

 

Provider types eligible as an originating site, either using a Q3014 HCPCS code or a GQ modifier:
• Primary Care Clinic
• Outpatient Hospital
• Rural Health Clinic (Medical)
• Federally Qualified Health Clinic (Medical)
• Physician
• Professional Medical Group
• Podiatrist
• Optometrist
See fact sheet for additional billing rules.

Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016), (Accessed Apr. 2019).

 

Excluded places of service for originating or distant site providers:
• Home (originating or distant site)
• Inpatient hospital
• Nursing facility
• Inpatient psychiatric hospitals
• Other POS exclusions for E&M and psychiatric codes

Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016), (Accessed Apr. 2019).

Geographic Limits

When the originating site is located within a five mile radius from the distant site, providers are not eligible for reimbursement.

 

Source: OAC 5160-1-18.(C(2) (Accessed Apr. 2019).
Facility/Transmission Fee

Originating site eligible for a facility fee using HCPCS code Q3014. See transmittal letter for additional billing rules.

Source: Fact Sheet: Telemedicine Billing Guidance (Dec. 2016), (Accessed Apr. 2019).

 

No originating site provider may receive both a telemedicine originating fee and payment for an evaluation and management service provided to a patient on the same day.
No institutional (facility) claim may be submitted by the distant site provider for the health care service delivered through the use of telemedicine.

Source: OAC Ann. 5160-1-18(D). (Accessed Apr. 2019).

Store-and-Forward

Policy

Telemedicine is defined as being “synchronous, interactive, real-time”, excluding the use of store-and-forward technology.

 

Source: OAC 5160-1-18. (Accessed Apr. 2019). & Fact Sheet: Telemedicine Billing Guidance (Dec. 2016) (Accessed Apr.2019).
Email / Phone / Fax

Electronic mail, telephone and facsimile transmission are not telemedicine.

 

Source: OH Admin. Code 5160-1-18(A)(1)(a). (Accessed Apr. 2019).
Consent

The originating site is responsible for obtaining informed consent.

 

Source: OAC 5160-1-18(B)(1). (Accessed Apr. 2019).
Out of State Providers

Providers must have an Alabama license.

 

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

No reference found.

 

Professional Regulation /
Health & Safety

Definitions

Physicians – Obtaining a Telemedicine certificate by an out of state provider.
The practice of telemedicine means the practice of medicine in this state through the use of any communication, including oral, written, or electronic communication, by a physician located outside this state.

Source: OH Revised Code Annotated, 4731.296. (Accessed Apr. 2019).

 

Physical Therapy Practice
“Telehealth means 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 distances.”

Source: OH Admin. Code 4755-27-01. (Accessed Apr. 2019).

 

Speech Language Pathology
Telehealth means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiology or speech-language pathology services to an individual from a provider through hardwire or internet connection.

Source: OH Admin. Code 4753-2-01 (Accessed Apr. 2019).
Consent

Speech Language Pathology
A provider is required to inform the patient of specific telehealth limitations.

Source: OH Admin. Code 4753-2-01(D). (Accessed Apr. 2019).

 

Informed consent is required (“patient’s agreement or signed authorization”). Must be documented in patient’s record.

Source: OH Admin. Code 4731-11-09. (Accessed Apr. 2019).
Cross-State Licensing

Ohio issues telemedicine certificates that allow the holder to engage in the practice of telemedicine in the state. Providers with telemedicine certificates cannot practice in OH without a special activity certificate.
The OH Medical Board may issue, without examination, a telemedicine certificate to a person who meets all of the following requirements:
1. Holds a current, unrestricted license to practice medicine and surgery or osteopathic medicine and surgery or osteopathic medicine and surgery issued by another state that requires license holders to complete at least fifty hours of continuing medical education every two years.
2. The person’s principal place of practice is in that state.
3. The person does not hold a license issued under this chapter authorizing the practice of medicine and surgery or osteopathic medicine and surgery in this state.
4. The person meets the same age, moral character, and educational requirements individuals must meet under sections 4731.09 and 4731.14 of the Revised Code and, if applicable, demonstrates proficiency in spoken English in accordance with section 4731.142 of the Revised Code.

 

Source: OH Revised Code Annotated, Sec. 4731.296). (Accessed Apr. 2019).

 

The [state medical] board shall convert a telemedicine certificate to a license issued under section 4731.14 of the Revised Code on receipt of a written request from the certificate holder. Once the telemedicine certificate is converted, the holder is subject to all requirements and privileges attendant to a license issued under section 4731.14 of the Revised Code, including continuing medical education requirements.

Source: OH Revised Code Ann. 4731-296(F). (Accessed Apr. 2019).

 

Physical Therapy
Physical therapists and physical therapist assistants must hold a valid OH physical therapy license to treat a patient located in Ohio via telehealth.

Source: OH Admin. Code 4755-27-01. (Accessed Apr. 2019).
Online Prescribing

A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.
Non-Controlled Substances Exceptions
Prescribing is allowed when a patient is remote from the physician by complying with the following:
• Establish the patient’s identity and physical location;
• Obtain the patient’s informed consent;
• Forward medical record to patient’s primary care provider (upon consent);
• Conduct an appropriate evaluation;
• Establish or confirm a diagnosis and treatment plan;
• Document information in patient’s medical record;
• Provide or recommend appropriate follow-up care;
• Make medical record of the visit available to patient; and
• Use appropriate technology sufficient to conduct all steps.
Additional restrictions apply for controlled substances. See regulation.

Source: OH Admin. Code 4731-11-09. (Accessed Apr. 2019).

 

A patient evaluation performed within the previous twenty-four months via telemedicine by a healthcare provider acting within the scope of their professional license is acceptable for satisfying the
criteria to be an “active patient”.

Source: OAC 4731-11-01. (Accessed Apr. 2019).
Miscellaneous

Professional Board Telehealth-Specific Regulations
• State Board of Speech Language Pathology and Audiology (OH Admin. Code 4753-2-01 (Accessed
Apr. 2019)).

Contact us to discuss your telehealth initiatives in Ohio


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