Reimbursement By Region - Pacific

Alaska, California, Hawaii, Oregon, Washington

 

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.


Alaska 

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesNo
Facility to FieldNoYesNo
Direct ConnectPartialNoNo

Alaska’s telemedicine coverage under the Medicaid plan places no restrictions on patient location. However, dental and ocular care are not covered. Medicaid does not require a telepresenter as a condition of payment, but the state’s Medical Board has practice standard requirements, ruling out direct connections.


California

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

California Medicaid has no requirements for the setting for the patient or the provider, and requires full parity from private insurers.


Hawaii

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Hawaii’s Medicaid agency covers all services provided by live interactive video the same as if they were provided face to face.


Oregon

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoPartialYes
Direct ConnectPartialPartialYes

Oregon Medicaid does not place any restrictions on the patient setting, allowing for all types of connections in the FFS model. There are no provisions for telemedicine reimbursement in the managed care model.


Washington

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Washington Medicaid limits eligible provider types as a condition of reimbursement. The originating site must also be an approved location in order to receive reimbursement.

Eligible Provider Types:

  • Psychiatric advanced registered nurse practitioner (ARNP) or psychiatric mental health nurse practitioner-board certified (PMHNP-BC)
  • Physicians
  • Nurse practitioners
  • Dentists
  • Psychiatrist
  • Psychologists
  • Mental health counselors
  • Independent clinical social workers
  • Advanced social workers
  • Marriage and family therapists

Eligible Originating Sites:

  • Practitioner offices
  • Hospitals
  • Critical Access Hospitals
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Schools
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