Arkansas reimbursement for telehealth PDF Print E-mail

April 7, 2015

Gov. Hutchinson signed into law legislation that would amend the standards of practice for AR licensed and certified healthcare providers, and allow coverage and reimbursement parity for physician-provided services via real time audio-video. The new law goes into effect immediately.  

Here's a snapshot of what the new law outlines:

  • New provision that affects the standards of practice for all medical professions when using telemedicine
    • Patient Location:  A patient must be located in a health provider's office or other health care facility.  The home is only permitted when the patient is receiving treatment for end-stage renal disease
    • Provider-patient relationships are required!  A provider-patient relationship must be established before a telemedicine encounter. A relationship may be established:
      • Through a previously conducted in-person exam and being available for follow-up if necessary;
      • Personally and/or professionally knowing the patient and his/her health status and being available for follow-up if necessary;
      • Through a referral by or in consultation with another health professional who has a previously established relationship with the patient and has agreed to supervise the patient's treatment;
      • On-call or cross coverage arrangement; or
      • Other circumstances as provided by the licensing/certification board
    • Exemptions to Relationship Requirement:
      • Emergencies
      • Providing non-patient specific information of a generic nature
    • Definition:  Store-and-forward is not considered telemedicine. The definition of telemedicine is real-time audio-video when the patient is at an originating site and the provider is at a distant site.
      • "Telemedicine" means the medium of delivering clinical healthcare services by means of real-time two-way electronic audio-visual communications, including without limitation the application of secure video conferencing, to provide or support healthcare delivery that facilitates the assessment, diagnosis, consultation, or treatment of a patient's health care while the patient is at an originating site and the healthcare professional is at a distant site.
    • Informed Consent:  Although the law does not create new requirements for patient informed consent, a provider must follow applicable state/federal laws related to informed consent, HIPAA, medical records and confidentiality, and fraud/waste/abuse
    • Licensure:  A provider must be fully licensed or certified to practice in Arkansas in order to treat patients who are located in Arkansas.  Exemptions to this licensure/certification requirement include episodic consultation services
  • New provision that requires coverage and reimbursement of physician services via telemedicine
    • Same definitions and standards referenced above still apply
    • Although the law goes into effect immediately, the parity provisions do not go into effect until 2016.  This section applies to private insurance and all health benefit programs financed by the state including Medicaid, Health Care Independence Program (Private Option), and State employee health plans (not including workers comp)
    • The new law requires health plans to cover telemedicine-provided physician services and reimburse physicians only on the same basis as in-person services.  Although other health providers and services are left out, the law does not prohibit a health plan from covering or reimbursing other services.  It's up to the plan.
    • All terms for annual and lifetime dollar max, deductible, copay, coinsurance, benefit limitations, maximum benefit, and prior authorization must be comparable to in-person terms.            
    • The law does allow a health plan to limit coverage based on medical necessity or undertaking utilization review.  However, utilization review will not be required for emergent services.
    • The new law also gives the state's Insurance Department authority to draft rules to enforce parity and develop guidelines if necessary.

 

 

 

Arkansas Medicaid (Check 'agree' and see page 31, 77, 144 in Section II)

 

The following services may be provided via telemedicine by a mental health professional:
A. Mental Health Evaluation/Diagnosis,
B. Interpretation of Diagnosis,
C. Individual Psychotherapy,
D. Marital/Family Psychotherapy – Beneficiary is not present,
E. Marital/Family Psychotherapy – Beneficiary is present,
F. Psychiatric Diagnostic Assessment,
G. Crisis Intervention,
H. Crisis Stabilization Intervention, Mental Health Professional,
I. Pharmacologic Management by Physician,
J. Collateral Intervention, Mental Health Professional; and
K. Intervention, Mental Health Professional.

 

 

 

For more information visit the ATA Wiki page for Arkansas here

Last Updated on Tuesday, 07 April 2015 15:51