Medicaid and private insurance companies must reimburse at the same amounts when you receive behavioral health and medical exams via telemedicine services as when you receive the same services in-person. However, Medicaid has some limitations on store-and-forward practices.
|Reimbursement for: Live video and remote patient monitoring. Store-and-forward isn’t reimbursed but can still be used to facilitate other reimbursable services.||Reimbursement for: All telemedicine services that meet the same clinical criteria as care provided in person.||Telemedicine services must have equally favorable dollar limits, deductibles, and coinsurance as comparable health care services provided in person.|
Indiana’s parity laws ensure you get equally reimbursed for telemedicine services, and these services meet the same clinical criteria and level of care as you’d get during in-person treatment. Indiana Medicaid, called the Indiana Health Coverage Programs, covers telemedicine services provided by live-video and remote patient monitoring. Payment for these services is equal to the current fee schedule amount, but reimbursements are only made when you, as the patient, are physically present and participating in the telemedicine session. You can receive a variety of medical exams and consultations and behavioral health, including substance abuse evaluations and treatment from providers paid through private insurance.
Through Indiana Medicaid, you can receive an array of telemedicine services, including psychotherapy, heart monitoring, speech therapy, alcohol and/or substance abuse, and new/established patient office visits, among others. Medicaid also will reimburse providers for end-stage renal disease services if you complete at least one monthly ESRD-related visit in a traditional clinical setting. With prior authorization, home health providers are reimbursed for remote patient monitoring if you’re being treated for COPD, congestive heart failure, or diabetes and have had two or more emergency room visits or inpatient hospital stays in the past year. If you’re receiving ongoing telemedicine services for any reason, you must have a traditional clinical evaluation performed by a physician at least once per year.
Eligible Health Care Providers
Medicaid reimburses telemedicine services you receive, regardless of the distance between you and these health care providers:
Indiana isn’t currently part of the Interstate Medical Licensure Compact. Still, providers outside the state may treat patients via telemedicine if they certify they’ll comply with Indiana courts and Indiana’s Substantive and Procedural Laws. These providers can include:
Indiana’s online prescribing laws prevent providers from issuing prescriptions through telemedicine unless they have established a provider-patient relationship. However, this doesn’t require the provider to see you in person. Providers can do this by collecting your medical history and other information to establish a diagnosis, discussing this diagnosis with you, creating and maintaining an appropriate patient record, and issuing instructions for follow-up care. Providers must also inform your primary care doctor of any prescriptions written and provide you with a telemedicine summary that includes information about the prescription. Providers can prescribe controlled substances to you without a previous examination if the medication isn’t an opioid. However, they can prescribe partial agonist opioids used to treat/manage opioid dependence.
If you’re looking for a new telemedicine provider, your health insurance company can help you find doctors who provide virtual medical visits. You can also do some searching on your own, while keeping some key points in mind to ensure you get the right care at the right price.
Indiana has made some major changes in its telemedicine policy in recent years, and updates to these policies are frequent. Keep up with these changes by visiting these websites.