All Medicaid enrollees are eligible to receive services via telehealth provided the services can effectively be delivered remotely and is not inconsistent with guidance issued by the Department.

Anywhere the member is located, including but not limited to the sites below. Reminder: the site must be Health Insurance Portability and Accountability Act (HIPAA) compliant and in agreement with current policies.

• Facilities licensed under Article 28 of the PHL (general hospitals, nursing homes, and diagnostic and treatment clinics);
• Facilities licensed under Article 40 of the PHL (hospice programs);
• Facilities as defined in Subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL) (includes clinics certified under Articles 16, 31 and 32);
• Certified and non-certified day and residential programs funded or operated by OPWDD;
• Private physician's or dentist's offices located within the state of New York;
• Any type of adult care facility licensed under Title 2 of Article 7 of the SSL;
• Public, private and charter elementary and secondary schools located within the state of New York;
• School-age child care programs located within the state of New York;
• Child daycare centers located within the state of New York; and
• The member's place of residence located within the state of New York or other temporary location within or outside the state of New York.

Practitioners can provide telehealth services in any secure location within the fifty United States or United States' territories where the telehealth provider is located while delivering health care services by means of telehealth. Services provided by means of telehealth must be in compliance with the HIPAA and all other relevant laws and regulations governing confidentiality, privacy, and consent (including, but not limited to 45 CFR Parts 160 and 164 [HIPAA Security Rules]; 42 CFR, Part 2; PHL Article 27-F; and MHL Section 33.13). The medical record must document the physical location of the patient as well and the physical location of the telehealth provider.

Confidentiality

1: How is confidentiality maintained for telehealth encounters?
All services must be performed on dedicated secure transmission linkages that meet the minimum federal and state requirements. HIPAA requires that a written business associate agreement (BAA) or contract that provides for privacy and security of protected health information be in place between the telehealth provider and the supporting telehealth vendor. All confidentiality requirements that apply to medical records apply to services delivered by telehealth. The medical record must document the physical location of the patient as well as the physical location of the distant site practitioner.

Patient Rights and Consents

1: What patient rights and consents need to be communicated to Medicaid enrollees?
The practitioner shall provide the Medicaid enrollee with basic information about the services they will be receiving via telehealth and the enrollee shall provide their consent to participate in services utilizing the telehealth technology. Telehealth sessions/services shall not be recorded without the member's consent. Culturally competent translation and/or interpretation services must be provided when the enrollee and the distant practitioners do not speak the same language.

2: Where is the consent documented?
Documentation in the medical record must reflect that the enrollee was made aware of the patient rights policies.

Failure of Transmission FAQs

1: What happens if there are technical issues, and the telehealth encounter is disrupted?
All telehealth providers must have a written procedure detailing a contingency plan in the case of a failure of transmission or other technical difficulty that renders the service undeliverable via telehealth. The policies and procedures must be made available upon audit.

2: Is partial payment available for a telehealth encounter that is disrupted?
No partial payment is available for disrupted telehealth encounters. If the service is undeliverable due to a failure of transmission or other technical difficulty, a claim should not be submitted to Medicaid.

Telehealth can be provided by Medicaid-enrolled providers and providers employed by Medicaid facilities or provider agencies who are authorized to provide in-person services. Telehealth provider is defined in Public Health Law § 2999-cc(2) and shall also include:

1. Voluntary foster care agencies certified by the New York State Office of Children and Family Services and licensed pursuant to article twenty-nine-I of Public Health Law, and providers employed by those agencies.
2. Providers licensed or certified by the New York State Department of Education to provide Applied Behavioral Analysis therapy.
3. Radiologists licensed pursuant to Article 131 of the Education Law and credentialed by the site from which the radiologist practices;
4. All Medicaid providers and providers employed by Medicaid facilities or provider agencies who are authorized to provide in-person services are authorized to provide such services via telehealth as long as such telehealth services are appropriate to meet a patient's needs and are within a provider's scope of practice.

Telehealth Providers FAQs

1: What are the licensure requirements for Article 28 facilities and private practitioners?
Practitioners providing services via telehealth must be New York State licensed and currently registered in accordance with NYS Education Law or other applicable law and enrolled in NYS Medicaid.

2: Are providers required to be credentialed and privileged at both the originating site and the distant in order to provide services via telehealth.
Providers must be credentialed and privileged at both the originating site and the distant site in order to provide telehealth services.

3: Can an out-of-state provider be a telehealth practitioner and provide services to a NYS Medicaid enrollee?
If the out-of-state provider is NYS licensed, enrolled in the Medicaid program and appropriately privileged and credentialled by the originating site, then they can provide services via telehealth.

Billing Rules for Telehealth Services FAQs

1: Are there different fees for telehealth services?
There are no different fees for telemedicine services provided in Medicaid Fee-For-Service; they are paid the same fee as if they were delivered in-person. However, reimbursement for consultations provided via store and forward technology will be paid at 75% of the Medicaid fee for the service provided.

2: Are there different billable codes for teledentistry?
Teledentistry billing is explained the June 2020 issue of Medicaid Update: https://www.health.ny.gov/health_care/medicaid/program/update/2020/docs/mu_no11_jun20.pdf

3: If the originating site provider and the distant site provider belong to the same billing entity/network, can they both submit a claim?
Only one clinic payment will be made when both the originating site and the distant site are part of the same provider network/billing entity. In such cases, only the originating site can bill Medicaid for the telemedicine encounter.

4: If the Article 28 facility bills under APGs, is acting as the originating site, is there a way for the facility to recoup the administrative expenses if it only provides the telehealth encounter?
The Article 28 facility can bill Q3014 in order to recoup administrative expenses associated with the telehealth encounter.

5: Can a claim be submitted if the distant site practitioner is not located in the facility when they are providing telehealth services?
If the distant site practitioner is not located in the facility when they are providing telehealth services, the practitioner can submit a professional claim, and the facility can submit an institutional claim for Q3014.

6: Can an Article 28 provider be reimbursed for providing both a telehealth encounter and a face-to-face visit in the same day?
If the separate and distinct service by the same physician or other qualified health care professional occurs on the same day as the telehealth encounter, then the CPT code billed for the separate and distinct services must be appended with the 25 modifier.

7: Under what circumstances can a distant site provider delivering a telemedicine consult to a Medicaid enrollee who is a hospital inpatient be able to submit a claim?
A professional claim can be submitted only if the distant site provider is a physician. All other practitioner services are included in the APR-DRG payment to the facility. An Article 28 clinic, including FQHCs, cannot bill Medicaid for telehealth services provided to a hospital inpatient.

Specific Billing Rules for Dual Eligibles FAQs

1: Will Medicaid reimburse for services not normally available under Medicare?
If the service provided is one that is not within the scope of services covered by Medicare (e.g., dental, store-and-forward) but it is an eligible telehealth service under Medicaid, then the telehealth encounter may be billed to Medicaid. If the service is normally covered by Medicare but only as a face-to-face encounter, then the telehealth encounter cannot be billed to Medicaid.

2: Will claims for dual eligibles follow the existing crossover process?
Claims for dually eligible individuals will follow the existing crossover process. The FQHC will bill Medicare first. A crossover claim will then be crossed over to Medicaid. Medicaid will pay the difference between the Medicare payment and the FQHC's PPS rate (4013).

• Telehealth Regulations
• Public Health Law

New York State Agencies: Telehealth Guidance

• Department of Financial Services (DFS)
  • Information for Insurers and Providers
  • Information for Consumers
• Office of Addiction Services and Supports (OASAS) - OASAS Laws, Regulations and Guidance (scroll to Legal section and search by keywords "telehealth" or "telepractice")
• Office of Children and Family Services (OCFS)
• Office of Mental Health (OMH)
• Office for People with Developmental Disabilities (OPWDD)

Additional Information

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