ARIZONA TELEMEDICINE LAW
A leading center of innovation in the United States, Arizona is on the fast track for improving telemedicine coverage. The Arizona Telemedicine Program at the University of Arizona regularly meets with Arizona legislators to report on enhancements and innovation in telemedicine and discuss potential changes to the state laws.
Arizona is unique in having passed a partial telemedicine parity law. In other words, the state requires private payers to reimburse for telemedicine, but only for ‘rural’ areas and specific health care services.
Ready to find out more about Arizona’s telemedicine policy? Keep on reading.
Parity Law
Arizona has a partial telemedicine parity law. The law requires reimbursement through private payers, but only for certain health services delivered to patients in rural areas of Arizona. The law specifically defines a “rural” area as a region or city located in a county of less than nine hundred thousand people.
Many private payers will still cover telemedicine outside rural areas. Check with your commercial payers on their policy for telemedicine services.
Type of Telemedicine Covered
Arizona Medicaid covers live video, store-and-forward, and home health monitoring telemedicine.
Covered Health Services
Arizona Medicaid (AHCCCS) will reimburse for medically necessary services provided via live video, including:
Cardiology
Dermatology
Endocrinology
Hematology/oncology
Home Health
Infectious diseases
Neurology
Obstetrics/gynecology
Oncology/radiation
Ophthalmology
Orthopedics
Pain clinic
Pathology
Pediatrics and pediatric sub-specialties
Radiology
Rheumatology
Surgery follow-up and consults
Arizona Medicaid also covers the following behavioral health services:
Diagnostic consultation and evaluation
Psychotropic medication adjustment and monitoring
Individual and family counseling
Case management
See the Arizona Medicaid Telemedicine Handbook for more information.
Eligible Healthcare Providers
Not all healthcare providers can do telemedicine under Arizona Medicaid. Here’s the list of the eligible providers:
Physician
Registered nurse practitioner
Physician assistant
Certified nurse midwife
Clinical psychologist
Licensed clinical social worker
Licensed marriage and family therapist
Licensed professional counselor
Providers also must be licensed in Arizona and currently enrolled in the Arizona Medicaid program
Online Prescriptions
Arizona does not allow physicians to prescribe patients controlled substances and dangerous drugs based only on a virtual telemedicine visit. Physicians are prohibited from issuing a prescription to patients without having a physical or mental health status examination to establish a provider-patient relationship.
Informed Patient Consent
Arizona requires providers to get a patient’s oral or written consent before a telemedicine visit. Oral consent should be documented on the patient’s medical record. Read our article on informed patient consent to learn more.
Cross-State Telemedicine Licensing
Currently, Arizona does not allow out-of-state providers to treat Arizona patients via telemedicine.
Restrictions on Locations
According to Arizona’s parity law, private payers are required to provide coverage when the originating site (where the patient is) is located in a rural region, defined as an area or city with a population of less than nine hundred thousand persons.
· Under Medicaid, the provider must be delivering telemedicine at one of the following locations:
· IHS clinic
· Tribally-governed 638 facility
· Urban clinic for Native Americans
· Office of a physician or other practitioner
· Hospital
· Federally qualified health center (FQHC)
Reimbursement Rates
Terrific News! On January 1st, 2015 Arizona Medicaid started reimbursing for telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.