Or. Admin. Code § 410-133-0070

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-133-0070 - Telehealth

(1) The Authority may reimburse school medical providers for covered School-Based Health Services (SBHS) delivered via telehealth that meet the following criteria:

(a) The covered telehealth service is provided to a child or young adult to the same extent that the service may be covered if it were provided in person;

(b) The school medical provider meets the following privacy and security standards:

(A) Prior to the delivery of the covered service using a telemedicine or telehealth modality, the medically-qualified individual obtains written, oral, or recorded consent for the child or young adult to receive services using a telemedicine or telehealth delivery method. The medically-qualified individual must document oral consent. Documented or recorded consent must include:

(i) That information regarding the service and delivery method was provided in the language that the child or young adult or the parent or legal guardian understands. Consent must also be in the understood language.

(ii) The medically-qualified individual's assessment of the child or young adult's ability to access and participate in telemedicine or telehealth delivered services.

(B) Comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996; and

(C) Comply with the Authority's Privacy and Confidentiality Rules in OAR Chapter 943, Division 14 except as noted in section (4) below.

(c) The medically-qualified individual may use synchronous audio and visual interactive technologies, including interactive audio/telephonic services provided to a child or young adult in a geographical area where synchronous audio and video is not available or consent for audio/video is refused for services provided to a child or young adult; and

(d) Document the medium used to provide the telehealth.

(2) The Authority shall provide reimbursement for a Medicaid-covered school-based telehealth service at the same reimbursement rate as if the service were provided in person.

(3) For school-based telehealth service claims:

(a) A service provided using synchronous audio and video must include modifier GT;

(b) A service provided using synchronous audio, without video, (e.g., telephone) must include modifier 93.

(4) In the event of a national or state declaration of emergency or in a prolonged school closure due to crisis, pandemic, or disaster, the Authority may modify the requirements for telehealth services to facilitate delivery of medically necessary service delivery. Modifications include, but are not limited to:

(a) Recognizing that exceptional circumstances may affect how all educational and related services and supports are provided, the Authority shall, to the extent possible based on the exceptional circumstance, follow guidance from the US Department of Health and Human Services (HHS), Office for Civil Rights (OCR), Office of Special Education Programs (OSEP) in the Department of Education, and Office of Special Education and Rehabilitative Services (OSERS) and may allow enforcement discretion related to encryption requirements; and

(b) The Authority may reimburse a SBHS delivered using a telehealth platform if:

(A) The telehealth service is medically necessary and appropriate;

(B) The delivery of the telehealth service reasonably approximates an in-person service; and

(C) Access to the telehealth service shall reduce barriers in the delivery of the health care service to accommodate the child or young adult's Individual Plan of Care (IPOC).

Or. Admin. Code § 410-133-0070

DMAP 121-2024, adopt filed 09/06/2024, effective 9/6/2024

Statutory/Other Authority: 413.042

Statutes/Other Implemented: 414.065