NEW YORK
New York has become the 22nd state to pass legislation requiring that telehealth visits be reimbursed at the same rate as in-person visits after a new law signed by New York Governor Andrew Cuomo, which goes into effect Jan. 1, 2016.
This new law also authorizes the New York Medicaid agency to increase coverage and reimbursement of telemedicine.
Ready to find out more about New York’s telemedicine policy? Check out our state guide below!
Parity Law
Yes! New York has a parity law. On December 29, 2014 New York passed telehealth parity laws requiring telemedicine coverage under private insurance and Medicaid. The act will take effect January 1st, 2016.
Type of Telemedicine Covered
Live Video: Reimbursement policy applies to fee-for-service. Managed care plans may cover telemedicine at their own option and establish their own payment guidelines and structure.
Remote Patient Monitoring: For the home telehealth program, store and forward services may be reimbursed under the new law going into effect Jan. 1, 2016.
Store and Forward: For the home telehealth program, store and forward services may be reimbursed under the new law going into effect Jan. 1, 2016.
Covered Health Services
A health plan shall not exclude from coverage services that are provided via telehealth if they would otherwise be covered under a policy.
Billing Codes
Don’t forget your GT modifier!
Providers should also use the GT modifier with the relevant code to note telemedicine.
Eligible Healthcare Providers
Physician specialists, including psychiatrists;
Certified Diabetes Educators (CDEs);
Certified Asthma Educators (CAEs or A-ECs)
Clinical Psychologists;
Dentists;
Psychiatric Nurse Practitioners;
Genetic Counselors;
· Licensed Clinical Social Workers (LCSW) and Licensed Master Social Workers (LMSW) only when employed by an Article 28 clinic.
LCSWs and LMSW can only provide services to Medicaid enrollees under age 21 and pregnant women up to 60 days post-partum.
For the Home Telehealth program, a telehealth provider is:
· Licensed physician
· Licensed physician assistant
· Licensed dentist
· Licensed nurse practitioner
· Licensed registered professional nurse
· Licensed podiatrist
· Licensed optometrist
· Licensed psychologist
· Licensed social worker
· Licensed speech language pathologist or audiologist
· Licensed midwife
· Certified diabetes educator
· Certified asthma educator
· Certified genetic counselor
· Hospital
· Home care services agency
· Hospice
· Or any other provider as determined by the Commissioner
Interstate Telemedicine Licensing
New York extends licensure reciprocity to bordering tri-states (New Jersey, Pennsylvania, Connecticut).
Restrictions on Locations
Eligible locations for conducting telemedicine include:
· Licensed health facilities in Articles 28 (hospitals) and 40 (hospice)
· A facility as defined in Section 1.03, subdivision six of the Mental Hygiene Law which includes and place in which services for the mentally disabled are provided and includes but is not limited to a psychiatric center, development center, institute, clinic, ward, institution or building
· Private physician’s offices located in New York
· When a patient is receiving health care services by means of remote patient monitoring, the patient’s place of residence located within the state of New York or other temporary location located within or outside the state of New York.
Other Reimbursable Fees
Transmission fee may be billed under certain circumstances.
Reimbursement Rates
Telehealth reimbursement rates for a telemedicine service are the same as the comparable in-person medical service.
Helpful Resources
Center for Connected Health Policy
The American Telemedicine Association State Policy Matrix