New York Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

New York Medicaid offers live video reimbursement and some reimbursement for store-and-forward and home health services. The New York State Department of Health released a Medicaid telehealth expansion in 2019. The guidance states that other state offices will be updating guidances and regulation to reflect the changes made, however no other office has released updates at the time of this report.

“Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance.”

Live Video
Reimbursement policy applies to fee-for-service. Managed care plans may cover telemedicine at their own option and establish their own payment guidelines and structure.

Eligible Services/Specialties
FQHCs that have “opted into” Ambulatory Patient Groups (APGs) should follow the billing guidance outlined for sites billing under APGs.

Eligible Providers
Click for a list of eligible providers.

Eligible Sites
Click for a list of eligible sites.

Geographic Limits
No reference found.

Facility/Transmission Fee
Facility/transmission fees may be billed under certain circumstances.

NY Medicaid is authorized to establish fees to reimburse the cost of telehealth store-and-forward technology, per a State Plan Amendment submitted and approved by CMS. Store-and-forward technology may be utilized in the specialty areas of dermatology, ophthalmology and other disciplines, as determined by the Commissioner. Services must reduce the need for on-site or in-office visits.

Eligible Services/Specialties
For the home telehealth program, store-and-forward services may be reimbursed.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
NY Medicaid is authorized to establish fees to reimburse the cost of telehealth remote patient monitoring, per a State Plan Amendment submitted and approved by CMS.

NY will reimburse for remote patient monitoring for certain medical conditions.

Provider Limitations
No reference found.

Other Restrictions
Certain considerations apply to RPM.

No payment for telephone, e-mail, text messages, or facsimile transmissions.

Mental Health: Part of obtaining approval for telepsychiatry services is obtaining informed consent.

Out of State Providers
A distant site may be located within any of the fifty United States or United States’ territories where a telehealth provider is located when delivering health care services by means of telehealth.

NY Department of Health is encouraging Medicaid Managed Care (MMC) plans to allow for telehealth services. They are allowing MMC plans to request reimbursement of additional cost effective alternative telehealth services.