Oregon Health Authority
Health Systems Division: Medical Assistance Programs - Chapter 410
Division 120
MEDICAL ASSISTANCE PROGRAMS
410-120-1990
Telehealth
(1) The following definitions apply to the Health System Division’s (Division) administrative rules applicable to the medical assistance program.
(2) “Asynchronous” means not simultaneous or concurrent in time. For the purpose of this general rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio without video, client or member portal and may include remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.
(3) “Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include health services that are normally delivered by audio telephone technology and normally not billed as separate services by a health care provider, such as the sharing of laboratory results.
(4) “Meaningful access” means client or member-centered access reflecting the following statute and standards:
(a) Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) including providing access to auxiliary aids and services as described in 45 CFR Part 92;
(b) National Culturally and Linguistically Appropriate Services (CLAS) Standards at
https://thinkculturalhealth.hhs.gov/clas/standards; and
(c) As applicable to the client or member, Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx;
(d) “Synchronous” means an interaction between a provider and a client or member that occurs at the same time using an interactive technology. This may include audio only, video only, or audio with video and may include remote monitoring.
(5) “Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include videoconferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.
(6) “Telehealth” includes telemedicine and also includes the use of electronic information and telecommunications technologies to support remote clinical healthcare, client or member and professional health-related education, public health, and health administration.
(7) “Telemedicine” means the mode of delivering remote clinical health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a client or member’s healthcare.
(8) “Trauma informed approach” means approach undertaken by providers and healthcare or human services programs, organizations, or systems in providing mental health and substance use disorders treatment where there is a recognition and understanding of the signs and symptoms of trauma in, and the intensity of such trauma on, individuals, families, and others involved within a program, organization, or system, and then considers those signs, symptoms, and their intensity and fully integrates that knowledge when implementing and providing potential paths for recovery from mental health or substance use disorders. The Trauma Informed Approach also means that providers and healthcare or human services programs, organizations, or systems actively resist re-traumatization of the individuals being served within their respective entities.
(9) “Trauma informed services” means those services provided using a trauma informed approach.
(10) Communications may be between providers, or between one or more providers and one or more clients or members, family members, caregivers and guardians.
(11) School-Based Health Services required by the Individuals Disabilities Education Act (IDEA), Section 504 Plan, under the Rehabilitation Act of 1973, or any other documented individualized health or behavioral health plan or as otherwise determined medically necessary provided in school programs and settings provided to eligible children in their education program settings by public education enrolled providers billing for these services to Medicaid are exempt from the following sections of this rule. See Chapter 410, Division 133 for School-Based Health Services Oregon Administrative Rules.
(12) Providers shall ensure Oregon Health Plan (OHP) clients or members are offered a choice of how services are received, including services offered using telemedicine or telehealth modalities and in-person services, except where the Authority issues explicit guidance during a declared state of emergency or if a facility has implemented its facility disaster plan.
(13) Providers unable to offer in-person services shall offer local provider options to a client or member when an in-person visit is clinically indicated or when the client or member requests in-person services. This may include but is not limited to care coordination or completing referral paperwork.
(14) Client or member choice and accommodation for telemedicine or telehealth shall encompass the following standards and services:
(a) Providers who offer telemedicine or telehealth delivered services shall offer meaningful access to services by completing a capacity assessment of the client or member in the use of specific approved methods of telemedicine or telehealth delivery that comply with accessibility standards including alternate formats, and provides the optimal quality of care for the client or member given considerations of client or member access to necessary devices, access to a private and safe location, adequate internet, digital literacy, cultural appropriateness of telemedicine or telehealth services, and other considerations of client or member readiness to use telemedicine or telehealth;
(b) Providers shall offer meaningful access to health care services for clients or members and their families who experience LEP or hearing impairment by working with qualified or certified health care interpreters, to provide language access services as described in Oregon Administrative Rule (OAR) 333-002-0040. These services shall not be significantly restricted, delayed, or inferior as compared to programs or activities provided to English proficient individuals;
(c) Providers shall collaborate with clients or members to identify and offer modalities for delivering health care services which best meets the needs of the member and considers the client or member’s choice and readiness for the modality of service selected;
(d) Providers shall offer telemedicine or telehealth services which are culturally and linguistically responsive as described in the relevant standards:
(A) National Culturally and Linguistically Appropriate Services (CLAS) Standards: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53;
(B) Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx .
(C) Trauma-informed approach to care.
(15) Privacy and security standards for telemedicine or telehealth services shall be met by satisfying the following:
(a) Prior to the delivery of services using a telemedicine or telehealth modality, a client or member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in the language that the client or member understands shall be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent shall include an assessment of client or member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the client or member. Consent shall be updated at least annually thereafter. For clients or members who experience LEP or hearing impairment clients, providers shall use qualified or certified health care interpreters when obtaining client or member consent;
(b) Consistent with Oregon Revised Statute (ORS 109.640), provision of birth control information and services using a telemedicine or telehealth modality shall be provided to any person regardless of age without consent of parent or legal guardian;
(c) Consistent with ORS 109.640, provision of any other medical or dental diagnosis and treatment using a telemedicine or telehealth modality shall be provided to any person 15 years of age or older without consent of parent or legal guardian;
(d) Consistent with ORS 109.675, provision of outpatient diagnosis or treatment of a mental or emotional disorder or a chemical dependency using a telemedicine or telehealth modality shall be provided to any person 14 years of age or older without consent of parent or legal guardian;
(e) Consistent with ORS 109.610, provision of diagnosis or treatment of certain sexually transmitted infections using a telemedicine or telehealth modality shall be provided to a person regardless of age without consent of parent or legal guardian;
(f) Services provided using a telemedicine or telehealth platform shall comply with Health Insurance Portability and Accountability Act (HIPAA), https://aspe.hhs.gov/report/health-insurance-portability-and-accountabilityact-1996, and with the Authority’s Privacy and Confidentiality Rules (Chapter 943 Division 14) except as noted in section (19) below;
(g) There is no limitation on the location of the client or member;
(h) OHP enrolled providers may be located in any location where client or member privacy and confidentiality can be ensured;
(i) Persons providing interpretive services and supports shall be in a location where client or member privacy and confidentiality can be ensured
(16) Providers who offer telemedicine or telehealth delivery of services shall meet the following requirements:
(a) Shall hold an unencumbered Oregon license;
(b) Shall be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per OAR 410-120-1260;
(c) Shall provide services using telemedicine or telehealth that are within their respective certification or licensing board’s scope of practice and comply with telemedicine or telehealth requirements including, but not limited to:
(A) Documenting client or member and provider agreement of consent to receive services.
(B) Allowed physical locations of provider and client or member.
(C) Establishing or maintaining an appropriate provider-client or member relationship.
(d) Providers billing for covered telemedicine or telehealth services are responsible for:
(A) Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the member in connection with the telemedicine or telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act) except as noted in section (19) of this rule.
(B) Obtaining and maintaining technology used in telemedicine or telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (A) except as noted in section (19) of this rule.
(C) Developing and maintaining policies and procedures to prevent a breach in privacy or exposure of client or member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting as described in OAR 943-014-0440.
(D) Maintaining clinical and financial documentation related to telemedicine or telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410.
(E) Complying with all federal and state statutes as required in OAR 410-120-1380.
(17) Providers shall develop and maintain care coordination policies and procedures to offer local provider options to clients or members when in-person services are clinically indicated or requested by the client or member and the provider does not offer these services.
(18) The Authority shall only pay for telemedicine or telehealth services meeting all of the following requirements:
(a) Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
(b) The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided using telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
(c) When allowed by individual certification or licensing board’s scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
(A) When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
(B) For establishing a client or member-provider relationship.
(d) All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02 when the client or member is located in a place other than their home. When the client or member is located in their home, the claim shall include Place of Service code 10.
(e) All claim types except Dental services, shall include modifier 95 when the telemedicine or telehealth delivered service utilizes a real-time interactive audio and video telecommunication system. When provision of the same service utilizes a real-time interactive audio only, the claim should include modifier 93.
(19) In the event of a declared emergency or changes in federal requirements, the Authority may adopt flexibilities to remove administrative barriers and support telemedicine, or telehealth delivered services:
(a) The Authority shall follow guidance from the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) which may allow enforcement discretion related to privacy or security requirements.
(b) The Authority may expand network capacity through remote care and telemedicine, or telehealth services provided across state lines.
(c) The Authority may expand the definition of an established client or member-provider relationship beyond the standard of an in-person encounter every three (3) years.
Statutory/Other Authority: ORS 413.042 & ORS 413.032
Statutes/Other Implemented: ORS 414.025, 414.065 & 414.723
History:
DMAP 75-2023, amend filed 09/13/2023, effective 09/13/2023
DMAP 47-2023, minor correction filed 06/05/2023, effective 06/05/2023
DMAP 1-2022, amend filed 01/05/2022, effective 01/05/2022
DMAP 64-2020, adopt filed 12/18/2020, effective 01/01/2021