1. Presented by Marti Coté, R.N. and Tiffany Lewis 6-18-6-19-12 1DHCFP

2.  Telehealth is the use of a telecommunications system to substitute for an in-person encounter.  In order to be reimbursed by Nevada Medicaid, an interactive audio and video telecommunications system must be used that permits real-time communication between the provider at the distant site and the recipient at the originating site 6-18-6-19-12 2DHCFP

3. DHCFP will reimburse for telehealth services with the following site guidelines:  Originating site must be located in either a rural Health Professional Shortage Area (HPSA), or in a county that is not included in a Metropolitan Statistical Area (MSA)  Distant site provider is located at the time the service is provided via a telecommunication system 6-18-6-19-12 3DHCFP

4. The originating sites authorized by law are:  Offices of physician or practitioners;  Hospitals;  Critical Access Hospitals (CAH);  Rural Health Clinics (RHC);  Federally Qualified Health Centers (FQHC);  Hospital-based or CAH-based Renal Dialysis Centers (including satellites)  Skilled Nursing Facilities (SNF)  Community Mental Health Centers (CMHC) 6-18-6-19-12 4DHCFP

5. Practitioners at the distant site who may furnish and receive reimbursement for telehealth services are:  Physicians;  Nurse practitioners (NP);  Physician assistants (PA):  Nurse midwives  Clinical psychologists (CP)  Clinical social workers (CSW) 6-18-6-19-12 5DHCFP

6.  asynchronous telecommunications  single media format Telehealth communications do NOT include the following without visualization of the patient:  telephone calls  images transmitted via fax  text messages (electronic mail) 6-18-6-19-12 6DHCFP

7.  Skype  Face Time  AT&T connect  Logitech  IP phones 6-18-6-19-12 7DHCFP

8.  Office or other outpatients visits  Subsequent hospital care; 1 every 3 days  Nursing Facility care services; 1 every 30 days  Inpatient consultations  Individual psychotherapy  Pharmacologic management  Diabetes Self-Management Training, individual and group  Smoking cessation services  ESRD-related services For more information, refer to CMS Fact Sheet at www.cms.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf 6-18-6-19-12 8DHCFP

9.  The exam of the patient is under control of the distant provider.  A Tele-presenter is not required as condition of payment, unless medically necessary as determined by distant site provider.  No Prior Authorization is required. 6-18-6-19-12 9DHCFP

10.  CP and CSW cannot bill for psychotherapy services that include medical evaluation and management services.  For ESRD-related services, at least one “hands-on” visit must be furnished each month to examine the vascular access site.  DSMT must include at least 1 hour “in- person” of the 10-hour benefit in the year following the initial DMST. 6-18-6-19-12 10DHCFP

11. 6-18-6-19-12 11DHCFP

12. 6-18-6-19-12 12DHCFP