NORTH CAROLINA
Although a parity bill had been presented to the North Carolina legislature this year, telemedicine remains an important resource that is still underutilized. On a bright note, however, that might be changing.
A new telepsychiatry program is in the process of ramping up to a statewide level after the pilot test for this program proved to be successful. Now there are many more hospitals and health care providers becoming wired for telehealth treatments like stroke care from a distance.
Ready to find out more about North Carolina’s telemedicine policy? Check out our state guide below!
Parity Law
North Carolina introduced a telemedicine parity law in April 2015, but has not passed it. Stay tuned and check this page for updates! And remember, many private payers still cover telemedicine even though there’s no legal requirement.
Type of Telemedicine Covered
North Carolina Medicaid will reimburse for live video medical services and telepsychiatry services.
Eligible Healthcare Providers
Specific providers are eligible to provide telehealthcare in North Carolina, including:
Physicians
Nurse practitioners
Nurse midwives
Physician’s assistants
Additionally, certain providers can perform telepsychiatry. They are:
Physicians
Advanced practice psychiatric nurse practitioners
Advanced practice psychiatric clinical nurse specialists
Licensed psychologists Ph.D. level
Licensed clinical social workers (LCSW)
Community diagnostic assessment agencies
Online Prescriptions
Prescribing for a patient not personally examined by telehealth provider may be suitable under certain circumstance that include: admission orders for a newly hospitalized patient, medication orders or prescriptions, including pain management, from a hospice physician for a patient admitted to a certified hospice program, prescribing for a patient of another licensee for whom the prescriber is taking call, continuing medication on a short-term basis for a new patient prior to the patient’s first appointment, an appropriate prescription in a telemedicine encounter where the threshold information to make an accurate diagnosis has been obtained, or prescribing an opiate antagonist to someone in a position to assist a person at risk of an opiate-related overdose.
Once again, the medical board states that prescribing online based on the use of Internet questionnaires is inappropriate and unprofessional.
Interstate Telemedicine Licensing
North Carolina requires telehealth providers obtain a full license specifically required for telemedicine in the state of North Carolina.
Provider-Patient Relationship
A doctor-patient relationship may be accomplished through telemedicine.
Restrictions on Locations
North Carolina Medicaid will not reimburse telehealth services if the recipient is located in a jail, detention center, or prison; the consulting provider is not a Medicaid-enrolled provider; or the consulting provider is not located in North Carolina or within the 40 miles radius.
Documenting Barriers to In-Person Care
Providers must obtain prior approval from NC Medicaid for all services delivered via telemedicine and telepsychiatry.
Additionally, in order to be reimbursed telehealth all services must be:
Medically necessary;
The procedure, product, or service is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs;
The procedure, product, or service can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide;
The procedure, product, or service is furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider.
Other Reimbursable Fees
Originating-site provider facility fees can be paid to eligible:
Physicians
Nurse practitioners
Nurse midwives
Advanced practice psychiatric nurse practitioners
Advanced practice psychiatric clinical nurse specialists
Licensed psychologists (Ph.D. level)
Licensed clinical social workers (LCSW)
Physician’s assistants
Hospitals (inpatient or outpatient)
Federally Qualified Health Centers
Rural Health Clinics
Local health departments
Local Management Entities
There are no facility fees for distant-site providers.
Reimbursement Rates
Good news! Telehealth reimbursement rates for a telemedicine service are the same as the comparable in-person medical service.
Other Restrictions
Providers must obtain prior approval from North Carolina Medicaid for all services delivered via telemedicine and telepsychiatry.
Providers must submit:
Prior approval request
All health records and any other records to document that the patient has met the specific criteria for telemedicine services
If the patient is under age 21, information supporting that all Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) criteria are met, and evidence-based literature supporting the request, if available.
Helpful Resources
Center for Connected Health Policy
The American Telemedicine Association State Policy Matrix
Mid-Atlantic Regional Telehealth Resource Center for North Carolina