A new provider bulletin has been added and is now available at http://dhhs.ne.gov/Pages/Medicaid-Provider-Bulletins.aspx

• Provider Bulletin 23-38: Guidance on Telehealth after December 31, 2023

*Signed by the Governor April 21, 2021* Telehealth includes audio-only for the delivery of behavioral health services for an established patient (applies to Medicaid and private payers). 

*Signed by the Governor April 21, 2021* The originating site is any location where the patient is located (applies to Medicaid and private payers).

*Signed by the Governor April 21, 2021* Consent for telehealth services can be given verbally during the initial telehealth consultation, provided a signed statement is collected within ten days (applies to Medicaid and private payers).

TELEHEALTH DEFINITION: “The use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care provider in the diagnosis or treatment of a patient”

SERVICE PARITY: Insurers cannot exclude services from coverage solely because they are delivered via telehealth

PAYMENT PARITY: Telehealth is covered by and reimbursed under Medicaid fee-for-service, and its reimbursement is, at a minimum, the same rate as comparable in-person services.

PREREQUISITES TO TELEHEALTH: Patients must give written consent before an initial telehealth consultation

REMOTE MONITORING: Reimbursable when the services are from the originating site, the client is cognitively capable of operating the equipment or has an able person to assist, the originating site has space for program equipment/transmission capability, and the provider keeps record of the medical necessity of the service/patient data (paid per diem)

ORIGINATING SITES: A location where the patient’s “right for confidential and private services is protected.” The originating site fee is paid to the Medicaid-enrolled facility hosting the client for telehealth at a rate set forth in the Medicaid fee schedule. All Medicaid-enrolled facilities hosting the client for telehealth are eligible for a facility fee.

FQHCs and RHCs: 

• PROSPECTIVE PAYMENT SYSTEM (PPS) REIMBURSEMENT STRUCTURE
• Payment for telehealth services will be the Medicaid rate for the comparable in-person service. FQHC core services provided via telehealth technologies are not covered under the encounter rate.
• Telehealth transmission costs will be the lower of: 1) The provider’s submitted charge; or 2) The maximum allowable amount

OTHER NE MEDICAID POLICIES:

A patient’s home may constitute an originating site

In-person contact between a health care practitioner and patient is not required under Nebraska’s Medical Assistance Program

Medicaid managed care contracts include coverage of telehealth-delivered services

Out of state telehealth is covered if it otherwise meets regulatory requirements for services provided outside Nebraska AND either the patient or provider is within Nebraska

Medicaid will cover telehealth and transmission costs when the technology meets industry standards and is HIPAA compliant

For Medicaid home & community based waiver services for individuals with developmental disabilities:

• Observations can be done in person or via telehealth

Providing behavioral health services to children via telehealth:

• A trained staff member must be immediately available to a child receiving telehealth behavioral health service.

*Signed by the Governor April 21, 2021* Telehealth includes audio-only for the delivery of behavioral health services for an established patient (applies to Medicaid and private payers). 

*Signed by the Governor April 21, 2021* The originating site is any location where the patient is located (applies to Medicaid and private payers).

*Signed by the Governor April 21, 2021* Consent for telehealth services can be given verbally during the initial telehealth consultation, provided a signed statement is collected within ten days (applies to Medicaid and private payers).

*Signed by the Governor April 21, 2021* Insurers cannot place greater financial burden on beneficiaries for accessing mental health treatment via telehealth. Insurers must reimburse mental health telehealth at at least the same rate as in-person mental health treatment.

TELEHEALTH DEFINITION: “The use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care provider in the diagnosis or treatment of a patient.” Services may originate from the patient’s home.

SERVICE PARITY: Insurers cannot exclude services from coverage solely because they are delivered via telehealth.

EXPIRED: Temporary COVID-19 Policies (NE Commercial Payers)

EXPIRED JUNE 30: The requirement for written consentfrom patients before initiating telehealth is suspended. Insurers cannot deny claims for telehealth service based solely on lack of a signed written agreement.

*Signed by the Governor & effective May 25, 2021* COVID-19 liability act (protecting providers from lawsuit due to understaffing/COVID-related issues).

Physician-patient relationship may be established via telemedicine

Prescribing allowable via telehealth within provider’s scope of practice

Anyone practicing medicine and surgery in Nebraska and not specially falling under the exception described in Neb. Rev. Stat. §38-2025 must be licensed in Nebraska as either a physician or as an osteopathic physician and surgeon.

• Practitioners falling under the exception include physicians from other states who provide occasional consultation services to physicians in Nebraska, physicians from other states who occasionally order diagnostic or therapeutic services for patients in Nebraska, and physicians from other states who are occasionally granted temporary hospital privileges in Nebraska

Nebraska Professional Licensure Compacts

Interstate Medical Licensure Compact

*Signed by the Governor & effective May 25, 2021* COVID-19 liability act (protecting providers from lawsuit due to understaffing/COVID-related issues).

Anyone practicing medicine and surgery in Nebraska and not specially falling under the exception described in Neb. Rev. Stat. §38-2025 must be licensed in Nebraska as either a physician or as an osteopathic physician and surgeon.

• Practitioners falling under the exception include physicians from other states who provide occasional consultation services to physicians in Nebraska, physicians from other states who occasionally order diagnostic or therapeutic services for patients in Nebraska, and physicians from other states who are occasionally granted temporary hospital privileges in Nebraska

*Signed by the Governor & effective May 25, 2021* COVID-19 liability act (protecting providers from lawsuit due to understaffing/COVID-related issues).

*Signed by the Governor April 21, 2021* Telehealth includes audio-only for the delivery of behavioral health services for an established patient (applies to Medicaid and private payers).

*Signed by the Governor April 21, 2021* Insurers cannot place greater financial burden on beneficiaries for accessing mental health treatment via telehealth. Insurers must reimburse mental health telehealth at at least the same rate as in-person mental health treatment.

Anyone practicing medicine and surgery in Nebraska and not specially falling under the exception described in Neb. Rev. Stat. §38-2025 must be licensed in Nebraska as either a physician or as an osteopathic physician and surgeon.

• Practitioners falling under the exception include physicians from other states who provide occasional consultation services to physicians in Nebraska, physicians from other states who occasionally order diagnostic or therapeutic services for patients in Nebraska, and physicians from other states who are occasionally granted temporary hospital privileges in Nebraska

Private insurers required to provide coverage for asynchronous review by a dermatologist by way of telehealth.