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Telemedicine Regulations in Georgia

Pioneering Telehealth

Georgia’s law requiring reimbursement from private payers for telemedicine visits went into effect way back in 2006, making it one of the first in the nation. Not only does the state support the use of telemedicine as a means of delivering healthcare, they do so enthusiastically. The state declared February 7, 2014, “Telehealth Day,” in honor of the work of the Georgia Partnership for Telehealth.

History of telemedicine regulations in Georgia

Georgia Telemedicine Act O.C.G.A. section 33-24-56.4 (2005)

Under the Georgia Telemedicine Act every health benefit policy as of July 1, 2005 includes payment for services that are covered under such health benefit policy and appropriately provided through telemedicine.

Georgia Composite Medical Board Regulation- Practice Through Electronic or Other Such Means (2014)

Practice Through Electronic or Other Such Means, is found under Georgia Comp. Rules and Regs. rule 360-3-.07and is intended to establish the minimum standards of practice while providing treatment and/or consultation recommendations through the use of telemedicine.

Getting Reimbursed for Telemedicine in Georgia

Private payer reimbursement for telemedicine in Georgia

 

Georgia is one of the states that paved the way for private payer reimbursement parity for telehealth. In 2005, they became one of the first to mandate reimbursement for this important method of patient care.

Definition

The law defines telemedicine services as, “The practice, by a duly licensed physician or other health care provider acting within the scope of such provider’s practice, of health care delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical visit with a patient.”

Exclusions

The law is clear that, “standard telephone, facsimile transmissions, unsecured electronic mail, or a combination thereof do not constitute telemedicine services.”

Policies Included

The law applies to any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed in this state, including, but not limited to, those contracts executed by the State of Georgia on behalf of state employees.

Parity

Insurers must reimburse treating providers for the diagnosis, consultation, or treatment of the insured delivered through telemedicine “on the same basis” that insurer is responsible for coverage for the provision of the same service through face-to-face contact.

Copayments and Maximums

The coverage required may be subject to all terms and conditions of the applicable health benefit plan.

Patient Site Requirements

The law explicitly states that, “It is the intent of the General Assembly to mitigate geographic discrimination in the delivery of health care,” thus there is no distinction between urban and rural patients related to reimbursement for telemedicine visits.

Georgia Department of Community Health (Medicaid)

Legacy Reimbursement Approach

Although the private payer reimbursement and the code of physicians in Georgia are progressive when it comes to telehealth, the Medicaid program is less so, reflecting the legacy approach taken by Medicare.

Hub-and-Spoke Model

The Georgia Department of Community Health reimburses approved health care providers for services delivered via telemedicine using a “hub-and-spoke” model. The “hub”, or “distant site”, is the location of the medical specialist, who provides consultation services to the “spoke”, or “originating site”, where both provider and participant (patient) are located. Communication between the originating and distant sites involves real-time interaction via a secure, two-way audio and video telecommunication system.

Practice Through Electronic or Other Such Means

Georgia Composite Medical Board

Georgia License Required

All treatments and consultations via telemedicine must be done by Georgia-licensed providers, which includes not only physicians, but also physician assistants (PAs) and advanced practice registered nurses (APRNs).

 

In-Person Examination

Prior to the telemedicine encounter, the telemedicine provider must have personally conducted an in-person examination of the patient unless one of three exceptions apply:

  • The telemedicine provider is able to examine the patient using technology and peripherals that are equal or superior to an in-person examination done by a provider within that provider’s standard of care; or
  • The telemedicine provider is providing care (conducting the telemedicine encounter) at the request of a physician, PA or APRN licensed in Georgia who has personally seen and examined the patient; or
  • The telemedicine provider is providing care (conducting the telemedicine encounter) at the request of a Public Health Nurse, a Public School Nurse, the Department of Family and Children’s Services, law enforcement, community mental health center or through an established child advocacy center for the protection or a minor, and the provider is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.

 

Records

The telemedicine provider must have the patient’s medical history available at the time of the consult. The provider must maintain patient records of the encounter and must document the evaluation and treatment. If there is a referring practitioner, the telemedicine provider must send a copy of this record to the referring practitioner.

 

Operational

The patient must receive the telemedicine provider’s credentials and emergency contact information. The patient must also receive clear instructions on follow-up in the event the patient needs emergency care related to the telemedicine treatment.

 

Annual In-Person Exam

The telemedicine provider must make “diligent efforts” to have the patient seen and examined in-person by a Georgia-licensed physician, PA or APRN at least once a year.

 

Standard of Care

The regulations defer to the existing standard of care expectations, and do not alter existing requirements on the practice of medicine or medical malpractice.

Frequently Asked Questions (FAQ)

In some cases. A prior in-person visit is required unless one or more of the following conditions are met:

  • You are able to examine the patient using technology and peripherals that are equal or superior to an in-person examination done within the standard of care
  • You are providing care at the request of a physician, PA or APRN licensed in Georgia who has personally seen and examined the patient
  • You are providing care at the request of a Public Health Nurse, a Public School Nurse, the Department of Family and Children’s Services, law enforcement, community mental health center or through an established child advocacy center for the protection of a minor, and you are able to examine the patient using technology and peripherals that are equal or superior to an examination done within the standard of care.

Generally yes, but physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult.

The Georgia medical board requires that providers make “diligent efforts” to have the patient seen and examined in-person by a Georgia-licensed physician, PA or APRN at least once a year.

Yes. As are the standards related to medical records documentation and confidentiality.

Unfortunately, not at this time. Georgia Medicare uses a hub and spoke model for telemedicine requiring that the patient be at an originating site in the presence of another care provider. This requirement does not apply to private payers, who are required to reimburse for telemedicine visits from anywhere.

Telehealth terms to know

Telemedicine

The practice of medicine from a distance in which intervention and treatment decisions and recommendations are based on clinical data, documents, and information transmitted through telecommunications systems.

Telepresence

The use of a set of technologies that allows individuals to feel as if they were present, to give the appearance of being present, or to have an effect at a place other than their true location. Telepresence generally means the use of means HD quality audio/video.

HIPPA Compliant Video

The Health Insurance Portability and Accountability Act (HIPAA) that was passed by Congress in 1996 requires certain protections for patient health information. These protections apply to electronically stored and transmitted patient records and encounters. HIPPA compliant video conferencing solutions must meet these standards for security and privacy.

Remote Monitoring

Type of ambulatory healthcare where patients use mobile medical devices to perform a routine test and send the test data to a healthcare professional in real-time. Remote monitoring includes devices such as glucose meters for patients with diabetes and heart or blood pressure monitors for patients receiving cardiac care.

Hub and Spoke

This model, used for Medicaid by Georgia, is designed to incorporate the services of a specialist via telemedicine with the patient and another provider participating together from the same location.

Store and Forward Technology

The transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site.

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