Idaho Medicaid only reimburses for two-way live-video telemedicine services, and only one eligible provider may seek reimbursement for the same service that you receive on a single date of service. Private insurance companies may not and aren’t required to cover telemedicine services.
|Reimbursement for: Two-way live video between patient and provider. Remote monitoring and store-and-forward aren’t covered.
|Reimbursement for: Varies based on the insurance carrier.
|Idaho doesn’t currently have a private payer parity law and hasn’t proposed any parity-related legislation for several years.
Telehealth parity laws protect you from paying more for telemedicine compared to in-person services, meaning health insurance providers must charge the same out-of-pocket expenses for both types of services. Idaho doesn’t currently have any private payer parity laws, so private insurance carriers aren’t required to provide you with telehealth services or charge you equally for telehealth and in-person services.
Idaho Medicaid reimburses for two-way live video services you receive, but not remote patient monitoring or store-and-forward. However, if your telemedicine service is terminated early due to faulty equipment, it won’t reimburse. Idaho Medicaid also won’t cover telehealth services that can’t provide you with treatment that’s as effective as in-person services.
Idaho Medicaid allows you to receive telemedicine services from any place that normally provides medical service, but it doesn’t indicate whether there are any geographic limitations. Out-of-state providers must be licensed by the Idaho Board of Medicine, but Idaho is a member of the Interstate Medical Licensure Compact and Nurse Licensure Compact, so they may be eligible to provide you with telemedicine services through one of these compacts.
Eligible Health Care Providers
Most telehealth services with appropriate billing requirements are covered under Idaho Medicaid. However, telemedicine providers must send your primary care provider a summary of your visit, including any prescriptions and/or durable medical equipment provided, within three business days. Eligible telemedicine providers include:
Specific services covered include primary care, health and behavioral assessments/interventions, psychiatric crisis consultations, psychotherapy, pharmacological management, tobacco use cessation, and specialty services, such as speech, occupational, and physical therapy.
Providers who’ve already established a provider-patient relationship with you can prescribe prescription drugs via telehealth services, but only if it’s within their scope of practice and licensing. If they haven’t already established a relationship with you, the provider can take steps to establish one through telehealth. This requires a documented patient evaluation that adequately identifies any underlying conditions you have and establishes a diagnosis. Providers can’t prescribe you medications based solely on an online questionnaire, and they can’t prescribe controlled substances unless they are prescribed in compliance with Section 54 of the U.S. Controlled Substances Act, which deals with the practice of telemedicine.
Before signing up to see an online doctor, you should do some research to ensure you’ll receive quality care. You also want to make sure you won’t be overcharged for services you receive.
For more information about telehealth services in Idaho or to research any changes made in the state’s telehealth policies, explore these websites.