Many thanks once again to our colleague, Sylvia Brown, for her assistance in authoring this post.

Last week, Ohio Governor John R. Kasich signed into law H.B. 123 (Gonzales, Watchmann), a bill to provide Medicaid coverage for telehealth services.  The law requires the state’s Medicaid department to establish standards for covering services that are provided through telehealth. 

The Department of Medicaid released its proposed standards quickly after the bill was signed into law.  The proposed rule, 5160-1-18, defines “telemedicine” as the direct delivery of services to a patient provided through synchronous, interactive and real-time electronic communication that includes both audio and video components.  The proposed rule excludes other means of electronic communication from this definition, such as electronic mail and telephone. 

The proposed rule would require that the physical location of the patient at which the telemedical service is provided (the “originating site”) be limited to one of five types of locations:  (1) the office of a medical doctor, doctor or osteopathic medicine, optometrist, or podiatrist; (2) a federally qualified health center (FQHC), rural health center (RHC), or comprehensive primary clinic; (3) an outpatient hospital; (4) an inpatient hospital; or (5) for services not included in the nursing facility per diem payment, a nursing facility.  The proposed rule prescribes no restrictions on the physicial location of the practitioner (the “distant site”) other than that it be located not less than five miles away from the originating site. 

Notably, only medical doctors, doctors of osteopathic medicine or licensed psychologists will be able to provide and receive reimbursement for providing eligible services if the department’s rule, as proposed, is adopted.  This is much narrower than Medicare  telehealth services, which may be provided by various types of practitioners, including physician assistants, nurse practitioners, and clinical social workers.

The proposed rule also provides that Medicaid will cover only evaluation and management services and psychiatry services provided through telehealth.  Claims for originating fees also may be submitted for payment by originating site providers but only by providers other than inpatient hospitals and nursing facilities.  For providers seeking payment for originating fees, the department will not also reimburse the provider for evaluative or management services provided to the patient on the same day.

The department’s proposed rule is available for public comment until March 4, 2014 and will be reviewed through the administrative rule review process.  If you would like to comment on the proposed rule, we are happy to assist.  We have experience advising providers on telehealth reimbursement, as well as the unique, complex, and evolving scope of practice issues related to telehealth.