Reimbursement By Region - North Central: West

Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota

 

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.


Iowa 

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialPartialNo

Iowa Medicaid will cover some mental health services via telemedicine offered through their contracted plan. Iowa also will provide services to individuals with 2 chronic conditions, including 24/7 access to the care team that includes but is not limited to a phone triage system with appropriate scheduling during/after regular business hours to avoid unnecessary ER visits and

hospitalizations. Use of email, text messaging, patient portals and other technology as available to the practice to communicate with patients is encouraged.


kansas

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialPartialNo

Kansas Medicaid will reimburse for telemedicine for office visits, individual psychotherapy, and pharmacological management services. Medicaid will also reimburse for “home telehealth” using real time audio/video to monitor patients at home, instead of a nurse visiting the home.


Minnesota

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoPartialYes
Direct ConnectPartialNoYes

Minnesota Medicaid places frequency limits on some covered telemedicine services. Distant site providers are limited to specialty physicians or oral surgeons. A telepresenter is required at the originating site, and must be a specific type of provider. 


Missouri

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Missouri Medicaid limits reimbursement to specific originating sites, ruling out facility to field and direct to home connections. Originating sites must be one of the following:

  • Physician or other health care provider office

  • Hospital

  • Critical Access Hospital

  • Rural Health Clinic

  • Federally Qualified Health Center

  • Missouri state habilitation center or regional office

  • Community mental health center

  • Missouri state mental health facility

  • Missouri state facility

Eligible providers:

  • Physicians

  • Advanced registered nurse practitioners, including nurse practitioners with a mental health specialty

  • Psychologists

Telehealth services are limited to:

  • Consultation made to confirm a diagnosis

  • Evaluation and management services

  • A diagnosis, therapeutic or interpretive service

  • Individual psychiatric or substance abuse assessment diagnostic interview examinations

  • Individual psychotherapy


A telepresenter is also required at the originating site.


Nebraska

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialPartial
Facility to FieldNoPartialPartial
Direct ConnectPartialPartialPartial

Nebraska Medicaid only places restrictions on services provided to children if they have access to the same service within 30 miles of their home. Telemedicine providers must have their facilities registered as telehealth sites for Medicaid reimbursement. While there are no broad private insurance parity laws, private insurers are required to cover autism treatments administered via telemedicine.


North Dakota

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoNoYes
Direct ConnectPartialPartialYes

North Dakota Medicaid imposes restrictions on the patient settings and covered services as a condition of payment. A telepresenter must be with the patient, ruling out direct connections.

Eligible services:  

  • New and established Office and other outpatient E/M services

  • Psychiatric diagnostic evaluation

  • Individual psychotherapy

  • Pharmacologic management

  • Speech Therapy, individual

  • Initial inpatient telehealth consultation


South Dakota

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoNoNo
Direct ConnectPartialNoNo

South Dakota Medicaid limits the type of originating site allowed and requires that it not be in the same community as the distant site. Eligible services and providers are limited as well.

Eligible services:

  • Patient office consultation

  • Inpatient hospital consultation

  • Pharmacologic management

  • Office or other outpatient visit

  • Diabetes outpatient self-management education services

Originating sites approved for a facility fee include:

  • Office of a physician or practitioner

  • Outpatient hospital

  • Critical Access Hospital

  • Rural Health Clinic

  • Federally Qualified Health Center

  • Indian Health Services Clinic

  • Community Mental Health Center