N.Y. Comp. Codes R. & Regs. tit. 14 § 596.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 596.7 - Reimbursement for Telehealth Services

(a) The licensed, designated, or authorized provider of service where the recipient is admitted is authorized to bill Medicaid for telehealth services.

(b) Under the Medicaid program, telehealth services are covered when medically necessary and under the following circumstances:

(1) the person receiving services is located at the originating/spoke site;

(2) the telehealth practitioner is located at the distant/hub site and is employed by or contracted with a program licensed or designated by the Office;

(3) the person or collateral receiving services is present during the encounter;

(4) the request for telehealth services and the rationale for the request are documented in the individual's clinical record;

(5) the clinical record includes documentation that the encounter occurred; and

(6) the telehealth practitioner at the distant/hub site is:

(i) authorized in New York State;

(ii) practicing within his/her scope of specialty practice; and

(iii) if the originating/spoke site is a hospital, credentialed and privileged at the originating/spoke site facility.

(c) Audio-only or audio-video communication is covered by Medicaid and the Child Health Insurance Plan to the extent consistent with regulations promulgated by the New York State Commissioner of Health pursuant to Section 2999-cc of the Public Health Law.

(d) The following interactions do not constitute reimbursable telehealth services;

(1) e-mail messages;

(2) text messages; or

(3) facsimile transmission.

(e) Reimbursement for services provided via telehealth must be in accordance with the rates and fees established by the Office and approved by the Director of the Budget. Such rates or fees shall be the same for identical procedures provided by practitioners in-person, in the same location as the recipient unless otherwise established by the Office.

(f) If a telehealth service is undeliverable due to a failure of transmission or other technical difficulty, reimbursement shall not be provided.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 596.7

Adopted New York State Register August 31, 2016/Volume XXXVIII, Issue 35, eff. 8/31/2016

Amended New York State Register July 3, 2019/Volume XLI, Issue 27, eff. 7/3/2019

Amended New York State Register September 28, 2022/Volume XLIV, Issue 39, eff. 9/13/2022