Reimbursement By Region - Mountain West

Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming

 

Telemedicine, often called telehealth, is defined as a two-way, real-time, audio and video connection between a patient and a healthcare provider.

 

Definitions:

Hub and Spoke - A telemedicine connection where the originating site is a health care facility. Typically this is a patient and health care provider in one clinic that connect with an additional provider in another.

Facility to Field - A telemedicine connection where the originating site could be anywhere, but there is some sort of health care provider or telepresenter with the patient.

Direct Connection - A telemedicine connection where the originating site could be anywhere, and there is no health care provider or telepresenter presence required.

 

Private Insurer Parity - Full parity is classified as comparable coverage and reimbursement for telemedicine-provided services to that of in-person services.

Originating Site - Where the patient is located.

Distant Site - The remote location of the provider the patient is communicating with.

Telepresenter - A qualified person who must be present with the patient at the originating site.


Arizona 

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialPartial
Facility to FieldNoPartialPartial
Direct ConnectPartialPartialPartial

Arizona is a unique state with considerable and varying service coverage under its Medicaid FFS, managed care plans, and Indian Health Service. The eligible distant site provider and patient site varies according to the participating AHCCCS program. Arizona has a very specific private insurer parity law that applies only to rural areas and requires parity for only 7 conditions:

  • Trauma

  • Burn

  • Cardiology

  • Infectious Diseases

  • Mental Health Disorders

  • Neurologic diseases including strokes

  • Dermatology


Colorado

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoPartialYes
Direct ConnectPartialNoYes

Colorado Medicaid imposes restrictions on covered services and designates certain provider types to render the service. The program will pay certain facilities as an originating site but that does not limit reimbursement to a distant site provider if a patient is located elsewhere. Requires written informed consent. Rural and distance restrictions are applied under managed care plan.


Idaho

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialPartialNo

Idaho’s Medicaid program covers behavioral health, primary care, physician, specialty, crisis intervention, PT, OT, speech therapy, APRN, and language interpretive services.

Eligible Services:

  • Psychotherapy with evaluation and management

  • Psychiatric diagnostic interview

  • Pharmacological management

  • Developmental disabilities therapeutic consultation

  • Developmental disabilities crisis intervention


Montana

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoPartialYes
Direct ConnectPartialPartialYes

Montana Medicaid does not place limitations on the originating site. However, only physicians are considered eligible providers. 


Nevada

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Nevada Medicaid places frequency limits on some covered telemedicine services. Some telemedicine services require at least 1 in-person visit. Nevada’s private insurer parity law also applies to Medicaid.


New Mexico

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

New Mexico Medicaid covers all services provided by live interactive video the same as if they were provided face to face.


Utah

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesNo
Facility to FieldNoYesNo
Direct ConnectPartialYesNo

Utah Medicaid covers all services via telemedicine, as clinically appropriate, when provided by a physician or authorized provider.


Wyoming

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoNoNo
Direct ConnectPartialNoNo

Wyoming Medicaid imposes restrictions on covered services and designates certain patient settings (excluding the home and school) and eligible distant site providers as a condition of payment.

Eligible providers:

  • Physicians

  • Advanced practice nurses with a specialty of psychiatry/mental health

  • Physician’s assistant (billed under the supervising physician

  • Psychologists and neuropsychologists

  • Mental health professionals (LCSW, LPC, LMFT, LAT)

  • Speech therapist

Eligible originating sites:

  • Hospitals

  • Physician or practitioner offices (includes medical clinics)

  • Psychologists or neuropsychologists

  • Community mental health or substance abuse treatment centers (CMHC/SATC)

  • Advanced practice nurses with specialty of psychiatry/mental health offices

  • Office of a licensed mental health professional

  • Federally Qualified Health Centers

  • Rural Health Clinics

  • Skilled nursing facilities

  • Indian Health Services Clinics

  • Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites)

  • Development Center