North Dakota Telehealth Policy
North Dakota does not currently have an active PHE.
North Dakota is an expansion state with full coverage parity & full Medicaid parity.
ND Medicaid allows telehealth for any Medicaid-eligible provider.
Originating site facility fees (Q3014) are paid to hospitals, offices, and skilled nursing facilities.
Non-covered Medicaid services include: Group therapies, Targeted Case Management for high-risk pregnant women and infants or for individuals in need of long-term care services
Medicaid pays FQHCs a PPS or APM rate and covers RPM services only for home health telemonitoring.
North Dakota participates in the following interstate licensure compacts: Medical, APRN, eRN, PT, and EMS
RECIPROCITY: The board of physicians/PAs may allow a licensee from another state to practice in North Dakota
TELEHEALTH DEFINITION: “The use of interactive audio-video equipment to link practitioners and patients at different sites.”
SERVICE PARITY: “An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.”
PAYMENT PARITY: “Payment or reimbursement of expenses for covered health services delivered by means of telehealth under this section may be established through negotiations conducted by the insurer with the health services providers in the same manner as the insurer with the health services providers in the same manner as the insurer establishes payment or reimbursement of expenses for covered health services that are delivered by in-person means.”
NON-COVERED SERVICES: Therapies provided in a group setting, Store and Forward, Targeted Case Management for High Risk Pregnant Women and Infants, Targeted Case Management for Individuals in need of Long-Term Care Services
ORIGINATING SITES eligible for a facility fee: Service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility.
ELIGIBLE PROVIDERS: Licensed professionals enrolled with ND Medicaid acting within the scope of practice per their licensure.
REMOTE MONITORING: Reimbursed only in certain cases of Home Health Telemonitoring
Telemonitoring is not allowed for the initial Home Health evaluation visit or for the discharge visit. Limited to no more than forty percent (40%) of the total visits during each certification period.
E-VISITS: Not covered by Medicaid
Payment to FQHCs for covered services furnished to ND Medicaid members is made by means of an all-inclusive rate for each encounter. Each encounter includes covered services and supplies. Telemedicine services are billing using Modifier GT & 95, revenue code 0780, HCPCS Q3014, and POS code 02.
Payment made to only to the provider at distant site
Payment made to originating site as a facility fee
No payment for additional technology support personnel
NO reimbursement for store-and-forward
Synchronous teledentistry reimbursable “when applicable”
IHS and Tribal 638 Facilities:
Telemedicine services are reimbursed at all-inclusive rate regardless of whether the originating site is outside the physical facility/clinic
Coverage/payment is on the same basis as face-to-face contact
*Signed by the Governor May 7, 2021* Audio-only telehealth may be used for e-visits (“A face-to-face digital communication initiated by a patient to a provider through the provider’s online patient portal”) and virtual check-ins (“A brief communication via telephone or other telecommunications device to decide whether an office visit or other telecommunications device to decide whether an office visit or other service is needed”) (private payer law).
TELEHEALTH DEFINITION: The use of interactive audio, video, or other telecommunications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site and that is delivered over a secure connection that complies with the requirements of state and federal laws; Includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real time or through the use of store-and-forward technology; Does not include the use of electronic mail, facsimile transmissions, or audio-only telephone unless for the purpose of e-visits (face-to-face digital communication initiated by a patient to a provider through the provider's online patient portal) or a virtual check-in (a brief communication via telephone or other telecommunications device to decide whether an office visit or other service is needed)
SERVICE PARITY: Insurers may not offer policies unless the policy “ provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.”
PAYMENT PARITY: Payment/reimbursement for a telehealth service must be established “in the same way” as it would be for the same in-person, through negotiations with health care provider
ELIGIBLE PROVIDERS: “includes an individual licensed under chapter 43-05 (podiatrists), 43-06 (chiropractors) 43-12.1 as a registered nurse or as an advanced practice registered nurse, 43-13 (optometrists), 43-15 (pharmacists), 43-17 (physicians/physician assistants), 43-26.1 (PT), 43-28 (dentists), 43-32 (psychologists), 43-37 (audiology/SLP), 43-40 (OT), 43-41 (social worker), 43-42 (respiratory care practitioners), 43-44 (dieticians/nutritionists), 43-45 (addiction counselors), 43-47 (counselors), 43-58 (clinical laboratory personnel), or 43-60 (genetic counselors).”
OTHER:
Insurance carriers cannot subject telehealth coverage to cost-sharing
Insurance carriers cannot impose specific requirements on technology used to deliver telehealth services
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
TELEMEDICINE DEFINITION: “The practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. The term includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.”
Providers may prescribe via telemedicine within their scope of practice
Opioids may ONLY be prescribed through telemedicine if done so as a federal Food and Drug Administration approved medication assisted treatment for opioid use disorder.
Practitioners must be licensed in ND to practice telemedicine
Physician supervision for PAs must be ND licensed but do not need to be physically located in ND
A licensee (Physician or Physician Assistant) “shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient.”
Before initially diagnosing/treating a patient, an examination must be performed, which can be done via telemedicine
“In-person medical evaluation” may include one of the following … “The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.”
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
A Physician Assistant practicing telemedicine from another state is subject to the rules regarding physician supervision, expect supervision may be by a ND physician who is not physically located in ND
Physician Assistants can prescribe medications via telemedicine within their scope of practice
Opioids may ONLY be prescribed through telemedicine if done so as a federal Food and Drug Administration approved medication assisted treatment for opioid use disorder.
A licensee (Physician or Physician Assistant) “shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient.”
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
According to the Board Statement on Telepsychology in North Dakota: “There is no special licensure status or credential within North Dakota for the practice of telepsychology. As a result, a psychologist licensed in North Dakota may be permitted to provide telepsychology services to recipients located either inside or outside North Dakota. When doing so, the psychologist must comply with the laws and regulations of a) North Dakota, including NDCC 43-32 and 43-51, b) the jurisdiction in which the psychologist is located, and c) the jurisdiction in which the recipient is located.”
North Dakota administrative code does not specifically condone or condemn telehealth for licensed counselors or psychologists
*Effective January 1, 2020 (retroactive)* COVID-19 liability protection for health care providers.
*Published April 1, 2021* DENTISTRY: The State Board of Dental Examiners is creating new regulations surrounding transparency in providing teledentistry.
*Signed by the Governor April 16, 2021* NUTRITION/DIETETICS: Updated standards of practice for telehealth nutrition/dietetics.
*New update as of April 2021* CHIROPRACTICS: Define telehealth for chiropractic services (“the use of electronic communications to provide and deliver chiropractic-related information and chiropractic services, including chiropractic-related information and services, over any distance. Telehealth encompasses chiropractic care and chiropractic promotion activities, including education, advice, reminders, interventions, and the monitoring of interventions”).
*Signed by the Governor April 19, 2021* DENTISTRY: Updated standards of practice for teledentistry.
Physical Therapists can use telehealth for providing services legally or professionally authorized. Patient consent must be obtained prior to each consultation.
All ND DHS temporary policies expire with the end of the national PHE
Telephone services & therapy provided in a group setting
Telehealth services can be audio-only
Reimbursement/coding guidelines for FQHCs/RHCs
Screenings for the “Right Track” program within the Developmental Disabilities Division can be done via phone or secure videoconferencing
No penalties for using non HIPAA-compliant technology;
COVERED SERVICES: Patient contact with dentist who provides the problem focused evaluation using audio and visual means;
NON-COVERED SERVICES: screening code D0190, dental case management (D9992), examinations via email (not audio/visual), patient contact with dentist via audio only, virtual check-in
In clarification of HB1465 and to align with CMS guidance, North Dakota issued bulletin 2021-1 to expand telehealth:
Insurers must start or continue to provide covered services via telehealth for: office visits, PT/OT/ST plan evaluation, behavioral health/SUD treatment, diabetes education, nutritional counseling
Insurance carriers must cover virtual check-ins and e-visits for established patients
PARTNER TELEHEALTH RESOURCE CENTERS
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant numbers U1UTH42525 and G01RH32157. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.