New Jersey State Telehealth Laws on Medicaid and Private Insurers


How does NJ state medicaid program reimburse mental health services delivered via telehealth? What are the state laws on private insurer’s coverage of telehealth? To answer such questions, the Center for Connected Health Policy compiles a collection of relevant New Jersey state laws.

GenPsych PC is now offering telepsychiatry service! Telepsychiatry is an innovative practice in healthcare that applies telemedicine to the field of psychiatry. It generally refers to the delivery of psychiatric assessment and care including medication management via telecommunications technology such as videoconferencing. Click HERE to learn more.

New Jersey Medicaid Telehealth Reimbursement

Live Video

NJ Medicaid must provide coverage and payment for telemedicine or telehealth delivered services on the same basis as when the services are delivered through in-person contact and consultation in NJ.  The reimbursement rate may not exceed the rate of in-person contact. Reimbursement is provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner, as appropriate.

NJ Medicaid and NJ FamilyCare programs may limit coverage to services that are delivered by participating health care providers, but may not charge a deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

Eligible psychiatric services – Telepsychiatry may be utilized by mental health clinics and/or hospital providers of outpatient mental health services to meet their physician related requirements including but not limited to intake evaluations, periodic psychiatric evaluations, medication management and/or psychotherapy sessions for clients of any age.

Store and Forward

Healthcare providers using engaging in telehealth services may use asynchronous store-and-forward technology for the transmission of medical information. Providers may use interactive, real-time, two- way audio in combination with asynchronous store-and-forward technology if they determine that they are able to meet the accepted standard of care provided in a face-to-face visit.

Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Store-and-forward is not explicitly included, but could fit into these definitions.

Remote Patient Monitoring

Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Remote patient monitoring is included within definition of telehealth.

Email/Phone/Fax

Telemedicine does not include the use, in isolation, of audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission.

New Jersey Private Payer Laws

A carrier that offers a health benefits plan shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation.

Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.

A carrier may limit coverage to services that are delivered by health care providers in the health benefits plan’s network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

Reimbursement must be made for health care services delivered through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate for in-person contact.

A health care plan may limit coverage to services that are delivered by health care providers in a plan’s network, but may not charge any deductible, copayment, or coinsurance for a health care service in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

Source consulted: Center for Connected Health Policy (www.cchpca.org).

GenPsych PC is now offering telepsychiatry service! Telepsychiatry is an innovative practice in healthcare that applies telemedicine to the field of psychiatry. It generally refers to the delivery of psychiatric assessment and care including medication management via telecommunications technology such as videoconferencing. Click HERE to learn more.

23 views
ABOUT

Founded in 2005, GenPsych is New Jersey’s premier mental health and substance abuse treatment provider. We treat mental health illness, drug & alcohol addiction and eating disorders. GenPsych is dedicated to helping our clients regain their emotional and physical health in a safe, supportive environment.

CONTACT US
ACCREDITED BY THE JOINT COMMISSION

© 2020 by Genpsych. Website Design by JKI Marketing