DHCFP 1

TelehealthPresented by Marti Coté, R.N.

and Tiffany Lewis

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DHCFP 2

Telehealth is the use of a telecommunications system to substitute for an in-person encounter.

In order to be reimbursed by Nevada Medicaid, an interactive audio and video telecommunications system must be used that permits real-time communication between the provider at the distant site and the recipient at the originating site

What is Telehealth?

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DHCFP 3

DHCFP will reimburse for telehealth services with the following site guidelines:

Originating site must be located in either a rural Health Professional Shortage Area (HPSA), or in a county that is not included in a Metropolitan Statistical Area (MSA)

Distant site provider is located at the time the service is provided via a telecommunication system

Telehealth Sites

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DHCFP 4

The originating sites authorized by law are:

Offices of physician or practitioners; Hospitals; Critical Access Hospitals (CAH); Rural Health Clinics (RHC); Federally Qualified Health Centers (FQHC); Hospital-based or CAH-based Renal Dialysis

Centers (including satellites) Skilled Nursing Facilities (SNF) Community Mental Health Centers (CMHC)

Originating Sites

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DHCFP 5

Practitioners at the distant site who may furnish and receive reimbursement for telehealth services are:

Physicians; Nurse practitioners (NP); Physician assistants (PA): Nurse midwives Clinical psychologists (CP) Clinical social workers (CSW)

Distant Site Practitioners

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DHCFP 6

asynchronous telecommunications single media format

Telehealth communications do NOT include the following without visualization of the patient:

telephone calls images transmitted via fax text messages (electronic mail)

Types of Telehealth communications

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DHCFP 7

Skype Face Time AT&T connect Logitech IP phones

Non-Covered Forms of Communications

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DHCFP 8

Office or other outpatients visits Subsequent hospital care; 1 every 3 days Nursing Facility care services; 1 every 30 days Inpatient consultations Individual psychotherapy Pharmacologic management Diabetes Self-Management Training, individual and

group Smoking cessation services ESRD-related servicesFor more information, refer to CMS Fact Sheet atwww.cms.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

Covered Telehealth Services

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DHCFP 9

The exam of the patient is under control of the distant provider.

A Tele-presenter is not required as condition of payment, unless medically necessary as determined by distant site provider.

No Prior Authorization is required.

Limitations of Services

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DHCFP 10

CP and CSW cannot bill for psychotherapy services that include medical evaluation and management services.

For ESRD-related services, at least one “hands-on” visit must be furnished each month to examine the vascular access site.

DSMT must include at least 1 hour “in-person” of the 10-hour benefit in the year following the initial DMST.

Limitations of Servicescont.

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DHCFP 11

Questions?

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DHCFP 12

Questions?

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