TABLE OF CONTENTS
Medicaid and private insurers pay the same for mental and physical telehealth services as they do for face-to-face consultations, although Medicaid limits store-and-forward practices.
|Reimbursement for: Live video and remote patient monitoring. Store-and-forward excluded.||Reimbursement for: All telehealth services that provide the same level of care as an in-person visit.||Insurers cannot deny or restrict telehealth service coverage when appropriately performed and HIPAA compliant|
Colorado’s parity laws make sure you get reimbursed properly for telehealth services. The state’s guidelines require the service to meet the same level of care you would receive in a non-telehealth session. HIPAA compliant software and telephone systems are mandatory, although this can be waived during emergencies. Colorado Medicaid pays for live video and remote monitoring at the same level as face-to-face visits. Store-and-forward services are not covered due to Medicaid’s requirement that the member is present during the entire telehealth session.
Colorado is part of several compacts, ensuring out-of-state providers can treat residents, including the Interstate Medical Licensure Compact, the Interjurisdictional Psychology Compact, the Physical Therapy Compact, and the Nurses Licensure Compact. All telehealth services providers should be licensed in Colorado or another state that is a member of the relevant compact.
Eligible Health Care Providers
Private insurers in Colorado don’t limit the types of providers or services for telehealth as long as the service is equal to what you would receive during an in-person visit. Since Medicaid members must be present during telehealth visits, store-and-forward technology is prohibited except for therapeutic restoration in teledentistry. Colorado Medicaid pays the following providers of live telehealth care:
Home health and long-term care agencies can bill Medicaid for remote monitoring services.
Colorado law assumes that you have an ongoing relationship with your telehealth provider. This relationship doesn’t have to come from an in-person visit. Pharmacists are under an obligation to report or decline to fill any prescription that, in their opinion, didn’t come from a preexisting provider/client relationship. Colorado has stricter requirements for the dispensing of opiate antagonists and marijuana.
If your doctor provides telehealth services, then you may wish to continue with your primary care practitioner. However, if you’re searching for a new telehealth provider, you should perform due diligence to ensure you get the service you need at the expected price.
Telehealth is a new and evolving field. Keep up with laws regarding providers, insurance carriers, and Colorado Medicaid by visiting these websites.