Section 471-1-004 - TELEHEALTH SERVICES FOR PHYSICAL AND BEHAVIORAL HEALTH SERVICESThis section applies to medical services in Medicaid fee-for-service and Managed Care.
004.01DEFINITIONS. The following definitions apply to this section: 004.01(A)CHILD. An individual under 19 years of age.004.01(B)COMPARABLE SERVICE. A service provided face-to-face.004.01(C)DISTANT SITE. The location of the provider of the telehealth service.004.01(D)ORIGINATING SITE. The location of the client at the time of the telehealth consultation.004.01(E)TELEHEALTH CONSULATION. Any contact between a client and a health care practitioner relating to the health care diagnosis or treatment of such client through telehealth. For the purposes of telehealth services, a consultation includes any service delivered through telehealth.004.01(F)TELEMONITORING. The remote monitoring of a client's vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.004.02APPLICABLE LAWS. Health care practitioners providing telehealth services must follow all applicable state and federal laws and regulations governing their practice and the services they provide.004.03ORIGINATING SITES. Health care practitioners must ensure that the originating sites meet the standards for telehealth services. Originating sites must provide a place where the client's right to receive confidential and private services is protected.004.04INFORMED CONSENT. Before an initial telehealth consultation, the health care practitioner must provide the client the following written information which must be acknowledged by the client in writing or via email: (A) Alternative options are available, including in-person services. These alternatives are specifically listed on the client's informed consent statement;(B) All existing laws and protections for services received in-person also apply to telehealth, including: (i) Confidentiality of information;(ii) Access to medical records; and(iii) Dissemination of client identifiable information;(C) Whether the telehealth consultation will be or will not be recorded;(D) The identification of all the parties who will be present at each telehealth consultation, and a statement indicating that the client has the right to exclude anyone from either the originating or the distant site; and(E) The written consent form becomes a part of the client's medical record and a copy must be provided to the client or the client's authorized representative.004.05BEHAVIORAL HEALTH SERVICES FOR CHILDREN. For each client who is a child who is receiving telehealth behavioral health services, the following protections must be in place: (A) An appropriately trained staff member or employee familiar with the child's treatment plan or familiar with the child must be immediately available in person to the child receiving a telehealth behavioral consultation in order to attend to any urgent situation or emergency that may occur during provision of such service. This requirement may be waived by the child's parent or legal guardian. The medical record must document the waiver; and(B) In cases in which there is a threat that the child may harm himself or herself or others, before an initial telehealth consultation the health practitioner must work with the child and his or her parent or guardian to develop a safety plan. Such plan must document actions the child, the health care practitioner, and the parent or guardian will take in the event of an emergency or urgent situation occurring during or after the telehealth consultation. Such plan may include having a staff member or employee familiar with the child's treatment plan immediately available in person to the child if such measures are deemed necessary by the team developing the safety plan.004.06TELECOMMUNICATIONS TECHNOLOGY COSTS. Telehealth services and transmission costs are covered by Medicaid when: (1) The technology used meets industry standards;(2) The technology is Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant; and(3) The telehealth technology solution in use at both the originating and the distant site must be sufficient to allow the health care practitioner to appropriately complete the service billed to Medicaid.004.06(A)STANDARDS. The standards above apply to any peripheral diagnostic scope or device used during the telehealth consultation.004.06(B)COVERAGE. Coverage is available for teleradiology services when the services meet the American College of Radiology standards for teleradiology.004.07TELEMONITORING REIMBURSEMENT. Medicaid will reimburse for telemonitoring when all of the following requirements are met: (1) The services are from the originating site;(2) The client is cognitively capable to operate the equipment or has a willing and able person to assist in the transmission of electronic data;(3) The originating site has space for all program equipment and full transmission capability; and(4) The provider must maintain a client's record containing data supporting the medical necessity of the service, all transmissions and subsequent review received from the client, and how the data transmitted from the client is being utilized in the continuous development and implementation of the client's plan of care.004.07(A)PER DIEM RATE. Telemonitoring is paid at a daily per diem rate set by Medicaid and includes the following: (i) Health care practitioner review and interpretation of the client data;(ii) Equipment and all supplies, accessories, and services necessary for proper functioning and effective use of the equipment;(iii) Medically necessary visits to the home by a health care practitioner; and(iv) Training on the use of equipment and completion of necessary records.004.07(B)FIXED PAYMENT. No additional or separate payment beyond the fixed payment is allowable.004.08PRACITIONER CONSULTATION REIMBURSEMENT. Medicaid will reimburse a consulting health care practitioner when all of the following requirements are met: (1) After obtaining and analyzing the transmitted information, the consulting health care practitioner reports back to the referring health care practitioner;(2) The consulting health care practitioner must bill for services using the appropriate modifier; and(3) Payment is not made to the referring health care practitioner who sends the medical documentation.004.08(A)EXCLUSIONS. Practitioner consultation is not covered for behavioral health services when the client has an urgent psychiatric condition requiring immediate attention by a licensed mental health practitioner.004.09REIMBURSEMENT OF TELEHEALTH. Telehealth services are reimbursed by Medicaid at the same rate as the service when it is delivered in person in accordance with each service specific chapter in Title 471 NAC.004.10REIMBURSMENT OF ORGINATION SITE FEE. The originating site fee is paid to the Medicaid-enrolled facility hosting the client for telehealth services at a rate set forth in the Medicaid fee schedule or under arrangement with the Managed Care Organization (MCO).004.11OUT-OF-STATE TELEHEALTH SERVICES. Out-of-State telehealth services are covered if the telehealth services otherwise meet the regulatory requirements for payment for services provided outside Nebraska and: (A) When the distant site is located in another state and the originating site is located in Nebraska; or(B) When the Nebraska client is located at an originating site in another state, whether or not the provider's distant site is located in or out of Nebraska.004.12DOCUMENTATION. The medical record for telehealth services must follow all applicable statutes and regulations on documentation. The use of telehealth technology must be documented in the same medical record, and must include the following telehealth information: (A) Documentation of which site initiated the call;(B) Documentation of the telecommunication technology utilized; and(C) The time the service began and ended.471 Neb. Admin. Code, ch. 1, § 004
Amended effective 11/8/2016.Amended effective 9/21/2020