OREGON

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Oregon Medicaid provides reimbursement for live video and audio under some circumstances.
Store-and-forward and remote patient monitoring are reimbursed for dental services.

 

Definitions

“Telemedicine is the use of medical information, exchanged from one site to another, via telephonic or electronic communications, to improve a patient’s health status.”

 

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. P. 66 (Sept. 9, 2018).(Accessed Apr. 2019).

Live Video

Policy

Oregon Medicaid will reimburse for live video when billed services comply with their billing requirements.
The referring provider is not required to be present with the client for the consult.
The referring provider may bill an evaluation and management code for the patient visit
only if a separately identifiable visit is performed. The visit must meet all of the criteria of the code billed.
Telephonic codes may be used in lieu of videoconferencing codes, if videoconferencing
equipment is not available.
The evaluating practitioner at the distant site may bill for the evaluation, but not for the transmission.
The authority must provide coverage for behavioral health telemedicine services to the
same extent that the service would be covered if they were provided in-person.

 

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610 (Sept. 9, 2018) & Behavior Health Services Rulebook, Div. 172, 410-172-0850 (May 2, 2018). (Accessed Apr. 2019).
Eligible Services / Specialties

Live video services using audiovisual technology can be used in teledentistry.

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).

 

Behavioral health services identified as allowable for telephonic delivery are listed in the fee schedule.

Source: OR Behavior Health Services Rules 410-172-0850 (May 2, 2018). P. 47 (Accessed Apr. 2019).
Facility/Transmission Fee

The evaluating practitioner at the distant site may bill for the evaluation, but not for the transmission.

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. P. 67 (Sept. 9, 2018). (Accessed Apr. 2019).

 

Oregon Medicaid will provide transmission fees for originating sites, when billed with code Q3014.

Source: Div. of Medical Assistance Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. P. 67 (Sept. 9, 2018). (Accessed Apr. 2019).

Store-and-Forward

Policy

Other forms of telecommunications, such as telephone calls, images transmitted via facsimile machines and electronic mail are services not covered:
• When those forms are not being used in lieu of videoconferencing, due to limited
videoconferencing equipment access; or
• When those forms and specific services are not specifically allowed per the Health
Service Prioritized List and Practice Guideline.

Source: Div. of Medical Assistance Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. P. 67 (Sept. 9, 2018). (Accessed Apr. 2019).

 

Behavioral Health Services Manual:
Unless specifically authorized by OAR 410-120-1200 other types of telecommunication are
not covered such as images transmitted via facsimile machines and electronic mail when:
• Those methods are not being used in lieu of videoconferencing, due to limited
video conferencing equipment access; or
• Those methods and specific services are not specifically allowed pursuant to the
Oregon Health Evidence Review Commission’s Prioritized List of Health Services
and Evidence Based Guidelines.

Source: Div. of Medical Assistance Programs, Behavior Health Services Rulebook, Div. 172, 410-172-0850. P. 47 (May 2, 2018). (Accessed Apr. 2019).
Eligible Services / Specialties

A dentist may collect the transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system.

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).

 

Remote Patient Monitoring

Policy

Oregon will reimburse “dental care providers” for remote patient monitoring.

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).
Email / Phone / Fax

Teledentistry
Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry and health care and public health practices and education.

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).

 

E-mail and telephone is reimbursed when used for patient consulting and “when billed services comply with the practice guidelines set forth by the Health Service Commission (HSC), applicable HSC approved CPT code requirements and are delivered consistent with the HSC practice guideline.” Telephone and e-mail services used in behavioral health must instead comply with the practice guidelines set forth by the Health Evidence Review Commission (HERC) and applicable HERC approved CPT code requirements and be delivered consistent with the HERC Evidence-Based Guidelines.
E-mail, telephone and fax may be used when videoconferencing is not available.

Source: OR Div. of Medical Assistance Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610 & Behavior Health Services Rules 410-172-0850 (Sept. 9, 2018). (Accessed Apr. 2019).
Consent

Teledentistry
A patient receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request. This must be reflected in the patient’s chart documentation.

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).
Out of State Providers

An out-of-state provider using telemedicine services must be licensed to practice within the State of Oregon or within the contiguous area of Oregon and must be enrolled as a Health Systems Division provider. Certain cities within 75 miles of the Oregon border may be closer for Oregon residents than major cities in Oregon, and therefore, these areas are considered contiguous areas, and providers are treated as providing in-state services.

Source: OR Admin Rules 410-120-1180 & OR Admin. Rules 410-123-1265 & OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610 p. 66. (Sept. 9, 2018).(Accessed Apr. 2019).
Miscellaneous

The referring and evaluating practitioner must be licensed to practice medicine within the state of Oregon or within the contiguous area of Oregon and must be enrolled as a Division of Medical Assistance Programs (Division) provider.

 

Source: OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610. P. 66 (Sept. 9, 2018). (Accessed Apr. 2019).

Private Payer Laws

Requirements

Health plans must provide coverage of a health service that is provided using synchronous twoway interactive video if the service would be covered when provided in-person, it is a medically necessary service, the service is determined to be safely and effectively provided using live video
according to generally accepted health care practices and standards and the technology and application to provide the service meets all standards required by state and federal laws governing privacy and security of protected health information. Plans are not required to reimburse a health professional for a service that is not a covered benefit under the plan or who has not contracted with the plan.

 

Source: OR Revised Statutes Sec. 743A.058. (Accessed Apr. 2019).
Definitions

Treatment of Diabetes
“Telemedical means delivered through a two-way electronic communication, including but not limited to video, audio, Voice Over Internet Protocol or transmission of telemetry that allows a health professional to interact with a patient, a parent or guardian of a patient or another health professional on a patient’s behalf, who is at an originating site.”
.

Source: OR Revised Statutes Sec. 743A.185(c). (Accessed Apr. 2019).

Parity

Service Parity

Oregon requires a health benefit plan to provide coverage of a health service that is provided using synchronous two-way interactive video conferencing if:
• The plan provides coverage of the health service when provided in-person by a
health professional;
• The health service is medically necessary;
• The health service is determined to be safely and effectively provided using synchronous two-way interactive video conferencing according to generally accepted
health care practices and standards; and
• The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of
protected health information.
Plans may not distinguish between originating sites that are rural and urban in providing coverage.
Coverage is subject to the terms and conditions of the health benefit plan and the reimbursement specified in the contract between the plan and the health professional..

Source: OR Revised Statutes Sec. 743A.058. (Accessed Apr. 2019).

 

A health benefit plan must provide coverage in connection with the treatment of diabetes if:
• The plan provides coverage of the health service when provided in-person;
• The service is medically necessary;
• The telemedical health service relates to a specific patient; and
• One of the participants in the telemedical health service is a representative of an
academic health center.
A health benefit plan may subject coverage of a telemedical health service to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in-person.

Source: OR Revised Statutes Sec. 743A.185. (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Definitions

Health Care Provider Incentive Program
“Telehealth” means the provision of health services from a distance using electronic communications

Source: OR Admin. Rules 409-036-0010(26). (Accessed Apr. 2019).

 

Community Treatment and Support Services
Telehealth means a technological solution that provides two-way, video-like communication on a secure line.

Source: OR Admin. Rules. 309-032-0860(28). (Accessed Apr. 2019).

 

Dental Care Services
“‘Telehealth means’ a variety of methods, through the use of electronic and telecommunications
technologies, for the distance delivery of health care services, including dental care services and clinical information designed to improve a patient’s health status and to enhance delivery of the health care services and clinical information.”

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).

 

Health Planning
“Telemedicine means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications.”

Source: OR Revised Statutes 442.015(26). (Accessed Apr. 2019).

 

Board of Chiropractic Examiners
“‘Telehealth’ means a variety of methods, through the use of electronic and telecommunications technologies, for the distance delivery of health care services, including chiropractic services, excluding in-person services, and clinical information designed to improve the health status of a patient, and to enhance delivery of the health care services and clinical information.”

Source: OR Admin. Rules 811-015-0066. (Accessed Apr. 2019).

 

Physical Therapy
“‘Telehealth service’ means a physical therapy intervention, including assessment or consultation that can be safely and effectively provided using synchronous two-way interactive video conferencing, or asynchronous video communication, in accordance with generally accepted healthcare practices and standards. For purposes of these rules, ‘telehealth service’ also means, or may be referred to, as ‘telepractice, teletherapy, or telerehab’.”

Source: OR Administrative Rule, Sec. 848-040-0100(13). (Accessed Apr. 2019).
Consent

Community Treatment and Support Services
No reference found.

Individuals have a right to consent to services prior to the start of services, except in a medical emergency or as otherwise permitted by law.

Source: OR Administrative Rule, Sec. 309-032-0341(e). (Accessed Apr. 2019).

 

Physical Therapy
Verbal, written, or recorded patient consent is required prior to initiating telehealth services and documented in the patient’s permanent record.

Source: OR Administrative Rules, Sec. 848-040-0180(3). (Accessed Apr. 2019).
Miscellaneous

Teledentistry
A patient may request to have real-time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

Source: OR Admin. Rules 410-123-1265 (Accessed Apr. 2019).

 

Oregon requires out-of-state physicians to acquire active tele-monitoring status through the Oregon Medical Board before they can perform intraoperative tele-monitoring on patients during surgery.
The Administrative Code defines “tele-monitoring” as the “intraoperative monitoring of data collected during surgery and electronically transmitted to a physician who practices in a location outside of Oregon via a telemedicine link for the purpose of allowing the monitoring physician to notify the operating team of changes that may have a serious effect on the outcome or survival of the patient.
The monitoring physician is in communication with the operation team through a technician in the operating room.”
Requirements:
• The facility where the surgery is performed must be a licensed hospital or ambulatory
surgical center;
• The facility must grant medical staff membership and/or clinical privileges to the monitoring physician;
• The facility must request the Board grant Telemonitoring active status to the monitoring physician.

Source: OR Admin. Rules. 847-008-0023. (Accessed Apr. 2019).

 

Professional Board Telehealth-Specific Regulations
• Dental Care Services (Source: OR Revised Statutes 679.543(1)) (Accessed Apr. 2019).
• Occupational Therapy (Source: OR Admin. Code 339-010-0006) (Accessed Apr. 2019).
• Physical Therapy (Source: OR Admin. Code 848-040-0180) (Accessed Apr. 2019).
• Board of Chiropractic Examiners (Source: : OAR 811-015-0066) (Accessed Apr. 2019).

Cross-State Licensing

Member of the Physical Therapy Compact.

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

 

Out-of-state physicians may receive a license to practice across state lines in Oregon, as long as they are fully licensed in another state and meet certain requirements.

Source: OR Revised Statutes Annotated Sec. 677.139. (Accessed Apr. 2019).

 

A physician granted a license to practice medicine across state lines has the same duties and
responsibilities and is subject to the same penalties and sanctions as any other provider licensed
in Oregon, including but not limited to:
• A physician shall establish a physician-patient relationship;
• Make a judgment based on some type of objective criteria upon which to diagnose, treat, correct or prescribe;
• Act in the best interest of the patient; and
• Writing prescriptions based only on an Internet sale or consults is prohibited.

Source: OR Admin. Rules, 847-025-0000. (Accessed Apr. 2019)

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