Delaware

At A Glance

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MEDICAID REIMBURSEMENT

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: Yes
Audio Only: Yes

PRIVATE PAYER LAW

Law Exists: Yes
Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

Licensure Compacts: APRN, ASLP-IC, CC, EMS, IMLC, NLC, OTC, PA, PSY, PTC
Consent Requirements: Yes

STATE RESOURCES

Medicaid Program: Delaware Medical Assistance Program (DMAP)
Administrator: Delaware Health and Social Services Dept., Division of Medicaid & Medical Assistance (DMMA)
Regional Telehealth Resource Center: Mid-Atlantic Telehealth Resource Center

Private Payer

Last updated 07/26/2024

Definitions

“Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care provider consultation, patient and professional health-related education, public health, health administration, and other services as authorized in Chapter 60 of Title 24.

SOURCE: Title 18, Ch. 33, Sec. 3370(4); Title 18, Ch. 35 Sec. 3571R & DE Administrative Code Title 18: 1409(2). (Accessed Jul. 2024).

“Telemedicine” is a subset of telehealth which is the delivery of clinical health-care services and other services, as authorized in Chapter 60 of Title 24, by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health-care provider legally allowed to practice in the state and practicing within the health-care provider’s scope of practice as would be practiced in-person with a patient, while such patient is at an originating site and the health-care provider is at a distant site.

SOURCE: Title 18, Ch. 33, Sec. 3370; Title 18, Ch. 35 Sec. 3571R , & DE Administrative Code Title 18: 1409(2). (Accessed Jul. 2024).

Last updated 07/26/2024

Parity

SERVICE PARITY

A payer must reimburse the provider for the diagnosis, consultation, or treatment of the patient on the same basis as in-person services for telemedicine.

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Jul. 2024).

PAYMENT PARITY

An insurer, health service corporation, or health maintenance organization shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis and at least at the rate that the insurer, health service corporation, or health maintenance organization is responsible for coverage for the provision of the same service through in-person consultation or contact. Payment for telemedicine interactions shall include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health-care services.

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Jul. 2024).

Last updated 07/26/2024

Requirements

Private payers must provide coverage for the cost of health care services provided through telemedicine, and telehealth as directed through regulations by the Department. Insurers must pay for telemedicine services at least the same rate as in-person. Payment for telemedicine must include reasonable compensation to the originating or distant site for the transmission cost.

Private payers may not impose an annual or lifetime dollar maximum on coverage for telemedicine services other than what would apply in the aggregate to all items and services covered under the policy. Additionally, no copayment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services may be imposed unless equally imposed on all terms and services under the policy.

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Jul. 2024).

No insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; health service corporation providing individual or group accident and sickness subscription contracts; or managed care organization or health maintenance organization providing a health care plan for health care services shall impose any limitation on the ability of an insured to seek medical care through the use of telehealth service solely because the health care service is being provided through telehealth. Such prohibited limitations shall include, but not be limited to, preauthorization, medical necessity, homebound requirements, or requiring the use of technology permitting visual communication.

SOURCE: 18 DE Administrative Code 1409 (Accessed Jul. 2024).

No insurer may, in issuing or renewing an insurance policy to a health-care professional or health-care organization, increase the premium on such policy or take other adverse action against any health-care professional or health-care organization who performs or assists in the provision of reproductive health services, as that term is defined in § 1702 of Title 24, that is legal in this State to an individual who is from out of the state. This section applies to a policy that covers any medical professional who prescribes medication for the termination of human pregnancy to an out-of-state patient by means of telehealth.

SOURCE: DE Code Title 18, Chap. 25, Sec. 2535. (Accessed Jul. 2024).

Medicaid

Last updated 07/26/2024

Consent Requirements

Consent is required to assure that the patient is a willing participant in the telehealth delivered service and to assure that the recipient retains a voice in their treatment plan. The patient must be informed and given an opportunity to request an in-person assessment before receiving a telehealth assessment. This consent must be documented in the patient’s record and must identify that the covered medical service was delivered by telehealth.

Where a DMAP recipient is involuntarily detained or committed to a facility for care, obtaining member consent may be impracticable. In these instances, delivery of care via telehealth should continue to meet all other telehealth policy requirements and all normal DMAP criteria for member safeguards and confidentiality. Exceptions to consent end upon the discharge of the recipient from any facility where the individual was involuntarily detained

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.4.1, 16.4.3, pg. 75-76. (Accessed Jul. 2024).

Recipient must provide written consent to use telemedicine. It must be obtained by either the referring, consulting, or distant provider. An exception is made for involuntary detention and commitment. An exception applies when a DMAP recipient is detained or committed to a facility for care.

The client has the right to refuse these services at any time and must be made aware of any alternatives, including any delays in service, need to travel, or risks associated with not having services provided via telemedicine. The format used by the consulting provider to obtain written consent is left to the provider but must be maintained in the client’s records and must identify that the covered medical service was delivered by telemedicine.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10-13. (Accessed Jul. 2024).

Personal Assistance Services Agencies, Home Health Agencies and Aides

The consumer must consent to the use of telehealth.

SOURCE: 16 DE Admin. Code 3345, 3350, 3351. (Accessed Jul. 2024).

Last updated 07/26/2024

Definitions

Telehealth can be a cost-effective alternative to face-to-face in-person encounters under several circumstances, including where access to care is compromised due to the lack of available service providers in the patient’s geographical location. This definition is modeled on Medicare’s definition of telehealth services located at 42 CFR §410.78. Note that the Federal Medicaid statute (Title XIX of the Social Security Act) does not recognize telehealth as a distinct service.

For purposes of DMAP, telehealth means the use of information and communication technologies consisting of telephones, remote patient monitoring devices, or other electronic means to provide or support health care delivery. It occurs when the patient is at an originating site and the health care provider is at a distant site.

Telemedicine is a subset of telehealth that is the delivery of clinical health care and other services, as authorized under Delaware Medicaid, by means of real-time two-way electronic interactive telecommunications system between the patient at the originating site and the health care provider is at the distant site. Two-way electronic interactive communications systems include audio, visual, or other telecommunication or electronic communication, including the application of secure video conferencing or store and forward transfer technology. Telemedicine facilitates the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health.

Interactive Communication is defined as telehealth delivered using multimedia communication technology that permits 2-way, real-time, interactive communications between a health care provider at a distant site and the patient at the originating site.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 01/12/24. Ch. 16 Telemedicine, 16.1 & 16.2 (Accessed Jul. 2024).

“Telemedicine is the use of medical or behavioral health information exchanged from one site to another via an electronic interactive telecommunications system to improve a patient’s health. Telemedicine services are provided with specialized equipment at each site including real-time streaming via the use of:

Video Camera
Audio Equipment
Monitor
The telecommunications must permit real-time encryption of the interactive audio and video exchanges with the consulting provider.”

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 14, 2016. Sec. 1.8. (Accessed Jul. 2024).

Personal Assistance Services Agencies, Home Health Agencies and Aides

“Telehealth Mechanism” means the use of information exchange from 1 site to another via an electronic interactive telecommunication system. Telehealth is provided with specialized equipment at each site including real-time streaming via the use of video streaming and audio equipment. The telecommunications must permit real-time encryption of the interactive audio and video exchanges with the personal assistance services agency.

SOURCE: 16 DE Admin. Code 3345, 3350, 3351. (Accessed Jul. 2024).

Last updated 07/26/2024

Email, Phone & Fax

Telephones are an acceptable mode to deliver telehealth if the following conditions are met:

It is determined that Interactive Telehealth Services are unavailable, and
Telephonic Services are medically appropriate for the underlying covered service.

When billing the DMAP for telephonic services that have been determined to be an acceptable mode to deliver telehealth, per 16.5.3, but that do not meet the full requirements of an E/M CPT® code, the provider must use the appropriate CPT® procedure codes under Telephone Services (Non-Face-to-Face Services) or Telephone Services (Non-Face-to-Face Nonphysician Services).

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.5.3.2, 16.6.5.2.3.4, pg. 76, 80. (Accessed Jul. 2024).

Chart reviews, electronic mail messages, facsimile transmissions, or internet services for online medical evaluations are not considered telehealth.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.3, pg. 79, (Accessed Jul. 2024).

Adult Behavioral Health

Telephone calls, internet services for online medical evaluations, electronic mail messages or facsimile transmissions between a health care practitioner and a patient or a consultation between two health care practitioners are non-covered services.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement Provider Specific Policy Manual (12/1/16), 1.8, p. 14. (Accessed Jul. 2024).

Last updated 07/26/2024

Live Video

POLICY

DMAP covers medically necessary telehealth services and procedures covered under the Title XIX State Plan. Qualifying practitioner services include any covered State Plan service that would typically be provided to an eligible individual in an inperson setting by an enrolled practitioner. Telehealth is not limited based on the diagnosed medical condition of the eligible recipient. All telehealth services must be furnished within the limits of provider program policies and within the scope and practice of the referring provider’s and distant telehealth practitioner’s professional standards as described and outlined in DMAP Provider Manuals. The service provided by the consulting/rendering provider or distant telehealth practitioner must be a service covered by DMAP. If a service is not covered in a face-to-face setting, it is not covered if provided through telehealth. A service provided through telehealth is subject to the same program restrictions, limitations, and coverage exist for the service when not provided through telehealth.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.6.2, pg. 78. (Accessed Jul. 2024).

DMAP will reimburse up to three (3) different consulting/distant telehealth practitioners for separately identifiable telehealth services provided to a member per date of service.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.6.3, pg. 79; Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 14. (Accessed Jul. 2024).

The same procedure codes and rates apply as for services delivered in person (enrolled providers will bill Usual and Customary). Practitioners should use 02 Modifier as Place of Service for all telehealth charges. When billing the DMAP, the provider must use the appropriate CPT® procedure codes.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.6.2, 16.6.5.2.1-3, pg. 78-80. (Accessed Jul. 2024).

The GT modifier (which indicates the service occurred via interactive audio and video telecommunication system) can be used for Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program in Group Physical Therapy treatment utilizing code 97150 + the GT modifier.

SOURCE: DE Medical Assistance Program. School Based Health Services Specific Policy Manual, pg. 53 & 57 (4/1/16). (Accessed Jul. 2024).

The referring provider is not required to be present at the originating site, however the recipient of the services must be present. The Distant Site provider must be located within the continental United States.

Reimbursement to the referring provider will only occur when providing a separately identifiable covered service.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.5.1, 16.3.4, & 16.6.2, pg. 75-78. & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 12. (Accessed Jul. 2024).

Except for instances listed in 24 Del.C. Chapter 60, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth but must meet the requirements of Del.C. 24 §6003.

The provision of services through telehealth must include accommodations, including interpreter and audio-visual modification, where required under the ADA, to ensure effective communication.

The distant site provider or other coverage must be available for appropriate followup care with the patient.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.4.1-2, 16.5.2, pg. 75-76 (Accessed Jul. 2024).

ELIGIBLE SERVICES/SPECIALTIES

The service must be medically necessary, written in the patient’s treatment plan and, follow generally accepted standards of care. The service provided by the distant provider must be a service covered by DMAP.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.4.1, 16.6.2, pg. 75, 78 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 12. (Accessed Jul. 2024).

Interactive audio and video telecommunications can be used for group physical therapy in the Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program for group physical therapy treatment.

SOURCE: DE Medical Assistance Program. School Based Health Services Specific Policy Manual, pg. 53 & 57 (4/1/16). (Accessed Jul. 2024).

Tele-Dentistry

Synchronous real-time tele-dentistry services must be provided in accordance with the recommendations provided by the American Dental Association. The evaluation is limited to a specific oral health problem or complaint.

SOURCE: DE Medical Assistance Program. Adult Dental Program Services Provider Specific Manual. 7/21/23. Sec. 4.2. p. 7-8 (Accessed Jul. 2024).

Adult Behavioral Health Service

Rate Methodologies for the CPT codes under the telemedicine section of the State Plan for Adult Behavioral Health Services are paid at a lower rate and provided in the manual.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 14 (Accessed Jul. 2024).

Durable Medical Equipment

The face-to-face encounter may occur through telehealth; as implemented by DMAP. In addition, the face-to-face encounter occurred through telehealth may be performed by any of the practitioners described above with the exception of certified nurse-midwives.

SOURCE: DE Medical Assistance Program, Durable Medical Equipment Provider Specific Manual, 3.1.6, p. 20 (Feb. 26, 2024). (Accessed Jul. 2024).

Personal Assistance Services Agencies, Home Health Agencies and Aides

Follow-up visits, patient reassessments, and supervisory visits are authorized to be completed by telehealth mechanism.

SOURCE: 16 DE Admin. Code 3345, 3350, 3351. (Accessed Jul. 2024).

ELIGIBLE PROVIDERS

In order to provide telehealth under DMAP, providers at both the originating and distant site must be enrolled with DMAP and must meet all requirements for their discipline as specified in the Delaware Code and the Medicaid State Plan. For services delivered through telehealth technology to be covered, referring providers and distant telehealth practitioners (including out-of-region practitioners) must:

Act within their scope of practice;
Be licensed to provide telehealth services for which they bill DMAP in Delaware, or the State in which the provider is located if allowed under Delaware State law to provide telehealth services without a Delaware license through the Interstate Medical Licensure Compact or otherwise;
Be in good standing in all states in which provider is licensed;
Not be the subject of an administrative complaint or under investigation by another state’s licensing authority or board;
Be enrolled with DMAP; and
Have provider billing numbers (NPI and Taxonomy).

Distant telehealth practitioners may also need to enroll with the Department of Services for Children, Youth and their Families (DSCYF), Division of Prevention and Behavioral Health Services (DPBHS), and Division of Substance Abuse and Mental Health (DSAMH) as appropriate to provide and be reimbursed for behavioral health services.

The distant telehealth practitioner must be located within the continental United States. As required by §6505 of the Affordable Care Act, DMAP will not make any payments for items or services provided under the State Plan or under a waiver to any financial institution or entity located outside of the United States.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.3, pg. 74-75. (Accessed Jul. 2024).

To receive payment for services delivered through telemedicine technology from DMAP or MCOs, healthcare practitioners must:

Act within their scope of practice;
Be licensed (in Delaware, or the State in which the provider is located if exempted under Delaware State law to provide telemedicine services without a Delaware (license) for the service for which they bill DMAP;
Be enrolled with DMAP/MCOs;
Be located within the continental United States;
Be credentialed by DMMA-contracted MCOs, when needed;
Submit a DMMA Disclosure Form.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 11 (Accessed Jul. 2024).

Eligible distant site providers include:

Inpatient/outpatient hospitals (including ER)
Physicians (or PAs under the physician’s supervision)
Certified Nurse Practitioners
Nurse Midwives
Licensed Psychologists
Licensed Clinical Social Workers
Licensed Professional Counselors of Mental Health
Speech Language Therapists
Audiologists
Other providers as approved by the DMAP

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 12 (Accessed Jul. 2024).

ELIGIBLE SITES

Originating Site refers to where the patient is located at the time health care services are provided to the patient by means of telehealth. An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present, and telehealth can be effectively utilized.

Distant Site refers to the site at which a health care practitioner, legally allowed to practice in the state of Delaware or the state in which the provider is located if allowed under Delaware State law to provide telehealth services without a Delaware license through the Interstate Medical Licensure Compact or otherwise, is located while providing health care services by means of telehealth.

All telehealth sites, both originating and distant sites, must have a written procedure detailing a contingency plan for when a failure or interoperability of the transmission or other technical difficulties render the service undeliverable. Telehealth services are not billable to DMAP or MCOs when technical difficulties preclude the delivery of part or all of the telehealth session.

The referring provider’s medical records must document all components of the services being billed. All distant telehealth practitioners are required to develop and maintain written documentation in the form of evaluations and progress notes, the same as if the documentation had originated during an in-person visit or consultation, including the mode of communication (telehealth). Distant telehealth practitioners may opt to use electronic medical records in place of paper-based written records.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.2.5-6, 16.5.3.7, 16.5.4.1-2, pg. 73-74, 77. (Accessed Jul. 2024).

An originating site refers to the facility in which the Medicaid patient is located at the time the telemedicine service is being furnished. An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized.

Medical Facility Sites:

Outpatient Hospitals
Inpatient Hospitals
Federally Qualified Health Centers
Rural Health Centers
Renal Dialysis Centers
Skilled Nursing Facilities
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Intermediate Care Facilities/Institutions for Mental Diseases (ICF/IMDs)
Outpatient Mental Health/Substance Abuse Centers/Clinics
Community Mental Health Centers/Clinics
Public Health Clinics
PACE Centers
Assisted Living Facilities
School-Based Wellness Centers
Patient’s Home (must comply with HIPAA, privacy, secure communications, etc., and does not warrant an originating site fee)
Other Sites as approved by the DMAP

Medical Professional Sites:

Physicians (or Physicians Assistants under the supervision of a physician)
Certified Nurse Practitioners
Medical and Behavioral Health Therapists

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1. 8. pg. 11 & 12 (Accessed Jul. 2024).

GEOGRAPHIC LIMITS

There are no geographical limitations within Delaware regarding the location of an originating site provider.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 12. (Accessed Jul. 2024).

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.3.4 pg. 75. (Accessed Jul. 2024).

FACILITY/TRANSMISSION FEE

DMAP reimburses the originating site fee for telehealth services per completed transmission to licensed practitioners that are enrolled in DMAP. A facility fee for the originating site is covered, unless the originating site is the patient’s home. Although a home can be considered an originating site, it is not eligible for reimbursement of the originating site fee.

DMAP will reimburse the originating site fee for up to three (3) different originating site providers for separately identifiable telehealth services provided to a member per date of service. Each originating site provider will only be reimbursed one (1) originating site fee per member per day. DMAP will not reimburse the referring provider at the originating site on the same date of service unless the referring provider is billing for a separate identifiable covered service. Medical records must document that all components of the service being billed were provided to the recipient.

Practitioners should use HCPCS Level II procedure code Q3014 when billing for the facility fee.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.6.2-3, 16.6.5.1.1, pg. 79. (Accessed Jul. 2024).

A facility fee is covered for originating sites.

Facility fees for the distant site are not covered.

Only one facility fee is permitted per date, per member.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 11. (Accessed Jul. 2024).

Last updated 07/26/2024

Miscellaneous

In the absence of a proper provider-patient relationship, providers are prohibited from issuing prescriptions solely in response to an internet questionnaire, an internet consult, or a telephone consult.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.5.5 p. 77. (Accessed Jul. 2024).

Provider manual lays out three different models for prescribing:

First Model: The distant telehealth practitioner consults with the referring healthcare provider (if present during the telehealth session or by other means) about appropriate medications. The referring provider then executes the prescription locally for the patient.
Second Model: The distant telehealth practitioner works with a referring provider at the originating site to provide front line care, including writing prescriptions. This method is common at mental health centers. The originating site medical professional must be available on site to write the prescription exactly as described by the distant telehealth practitioner.
Third Model: The distant telehealth practitioner directly prescribes and sends/calls-in the initial prescription or refill to the patient’s pharmacy.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual,1/12/24. Sec. 16.5.5 p. 77 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 13. (Accessed Jul. 2024).

The preferred order of prescribing medications is:

Secure e-prescribe
Fax
Phone
Hard Copy – If a hard copy of a prescription is required, it can be written and sent via delivery service to the referring site for the consumer to pick-up a couple of days after the appointment.

Procedures for Stimulants, Narcotics, and Refills: The distant telehealth practitioner writing the prescription should be available to manage emergencies or any prescription gaps between appointments. The originating site must be able to connect with the distant telehealth practitioner outside of “telehealth transmission hours”.

Procedures for access to care between telehealth visits, including emergency and urgent care: Patients should contact the referring provider or specialist as appropriate.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.5.6 p. 77-78. (Accessed Jul. 2024).

For stimulants, narcotics and refills, hard copy prescriptions can be written and sent via delivery service to the referring site for the consumer to pick up a couple days after the appointment (see manual for more details).

SOURCE: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8, p. 13. (Accessed Jul. 2024).

Telehealth provider responsibilities include:

Verify member eligibility for telehealth services. The service must be medically necessary, written in the patient’s treatment plan, and follow generally accepted standards of care.
Except for instances listed in 24 Del.C. Chapter 60, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth but must meet the requirements of Del.C. 24 §6003.
Consent is required to assure that the patient is a willing participant in the telehealth delivered service and to assure that the recipient retains a voice in their treatment plan.
The patient must be informed and given an opportunity to request an in-person assessment before receiving a telehealth assessment. This consent must be documented in the patient’s record and must identify that the covered medical service was delivered by telehealth.
The recipient must be able to adequately communicate, either directly or through a representative, with the originating and distant site practitioners.
Comply with Americans with Disabilities Act (ADA) communications regulations, including language translation / interpretation accommodations.
The provision of services through telehealth must include accommodations, including interpreter and audio-visual modification, where required under the ADA, to ensure effective communication.

Telehealth operational requirements include:

The distant telehealth practitioner cannot be a self-referring practitioner.
The distant site provider or other coverage must be available for appropriate followup care with the patient.
All telehealth services must comply with HIPAA patient privacy and confidentiality regulations at the site where the patient is located, the site where the distant telehealth practitioner is located, and in the transmission process.
All telehealth services must be performed on dedicated secure transmission linkages that meet the minimum federal and state requirements, including but not limited to 45 CFR, Parts 160 and 164 (HIPAA Security Rules). All confidentiality requirements that apply to written medical records will apply to services delivered by telehealth, including the actual transmission of health care data and any other electronic information and records.
Secure video-conferencing via personal computers, tablets, or other mobile devices may be considered to meet the requirements of telehealth where it can be demonstrated that the use of the devices and the patient setting comply with this DMAP telehealth policy.
Services provided via communications equipment which do not meet this definition, are non-secure, and are non-HIPAA compliant are not covered.
All telehealth sites, both originating and distant sites, must have a written procedure detailing a contingency plan for when a failure or interoperability of the transmission or other technical difficulties render the service undeliverable. Telehealth services are not billable to DMAP or MCOs when technical difficulties preclude the delivery of part or all of the telehealth session.

Documentation Requirements:

Originating / Referring Providers – The referring provider’s medical records must document all components of the services being billed.
Distant Site – All distant telehealth practitioners are required to develop and maintain written documentation in the form of evaluations and progress notes, the same as if the documentation had originated during an in-person visit or consultation, including the mode of communication (telehealth). Distant telehealth practitioners may opt to use electronic medical records in place of paper-based written records.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.4-5 p. 75-77. (Accessed Jul. 2024).

Services billed which indicate telehealth as the mode of service delivery but are not substantiated by either the claim form or written medical records are subject to disallowances in the course of an audit.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Sec. 16.6.2, p. 79. (Accessed Jul. 2024).

Confidentiality, privacy and electronic security standards for telemedicine as well as a contingency plan required of telemedicine sites are listed in the DE Behavioral Health Service Certification and Reimbursement manual.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10. (Accessed Jul. 2024).

The face-to-face encounter for home health services used to evaluate a patient’s condition and recertify services may take place via telehealth.

SOURCE: DE Medical Assistance Program. Home Health Provider Specific Manual, 2/15/20. Sec. 5.2.8, p. 18. (Accessed Jul. 2024).

Last updated 07/26/2024

Out of State Providers

A distant site provider is a health care practitioner, legally allowed to practice in the state of Delaware or the state in which the provider is located if allowed under Delaware State law to provide telehealth services without a Delaware license through the Interstate Medical Licensure Compact or otherwise.

Act within their scope of practice;
Be licensed to provide telehealth services for which they bill DMAP in Delaware, or the State in which the provider is located if allowed under Delaware State law to provide telehealth services without a Delaware license through the Interstate Medical Licensure Compact or otherwise;
Be in good standing in all states in which provider is licensed;
Not be the subject of an administrative complaint or under investigation by another state’s licensing authority or board;
Be enrolled with DMAP; and • Have provider billing numbers (NPI and Taxonomy).

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.2.6 & 16.3 pg. 74-75. (Accessed Jul. 2024).

The distant site provider must be located within the continental US and enrolled in the DE Medicaid program or in a DE Medicaid Managed Care Organization to be reimbursed for services.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement Provider Policy Manual (Dec. 14, 2016), p. 11. (Accessed Jul. 2024).

Last updated 07/26/2024

Overview

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telehealth services, including any covered State Plan service that would typically be provided to an eligible individual in an in-person setting by an enrolled practitioner. Consistent with January 2024 updates to its Practitioner Provider Manual, in addition to live video coverage, DMAP now reimburses certain store-and-forward and telephonic services, as well as remote physiologic monitoring.

Last updated 07/26/2024

Remote Patient Monitoring

POLICY

Telehealth remote patient monitoring (RPM) services use electronic information and communication technologies to collect personal health information and medical data from a patient at an originating site and share with the distant site provider. The information is transmitted synchronously or asynchronously to the distant site provider for use in treatment and management of unstable/uncontrolled medical conditions that require frequent monitoring. The purpose of providing RPM services is to assist in the effective monitoring and management of patients whose medical needs can be appropriately and cost-effectively met through the use of RPM.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.2.9, pg. 74. (Accessed Jul. 2024).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

When billing the DMAP for RPM services, the provider must use the appropriate CPT® procedure codes under Digitally Stored Data Services/Remote Physiologic Monitoring.

When billing the DMAP for Remote Physiologic Monitoring services, the provider must use the appropriate CPT® procedure codes under Remote Physiologic Monitoring Treatment Management Services.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.5.2.3.2-3, pg. 80. (Accessed Jul. 2024).

OTHER RESTRICTIONS

Before RPM services can be provided, the distant telehealth practitioner must ensure that:

The recipient is cognitively and physically capable of operating the RPM equipment or that the recipient has a caregiver willing and able to assist with the equipment;
The recipient’s residence is suitable for RPM Services; and
The recipient or caregiver, as appropriate, receives education and training on the use, maintenance, and safety of the RPM equipment.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.2.9, pg. 74. (Accessed Jul. 2024).

Last updated 07/26/2024

Store and Forward

POLICY

Telehealth store-and-forward (S&F) technology is the asynchronous, secure electronic transmission of a patient’s health information provided through the transference of text, digital images, sounds, previously recorded video, or responses to a survey from one location to another to allow a consulting distant telehealth practitioner the ability to obtain the information, analyze it, and report back to the referring provider.

Reimbursement for telehealth S&F services will be provided for Medicaid patients with conditions or clinical circumstances where the provision of S&F services can appropriately reduce the need for in-person visits.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.2.8, pg. 74. (Accessed Jul. 2024).

The Behavioral Health manual still states that asynchronous or “store-and-forward” applications do not meet the DMAP definition of telemedicine.

SOURCE: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10 (Accessed Jul. 2024).

ELIGIBLE SERVICES/SPECIALTIES

When billing the DMAP for S&F services, the provider must use the appropriate CPT® procedure codes under Interprofessional Telephone/Internet/Electronic Health Record Consultations.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.5.2.3.1, pg. 80. (Accessed Jul. 2024).

Chart reviews, electronic mail messages, facsimile transmissions, or internet services for online medical evaluations are not considered telehealth.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.3, pg. 79. (Accessed Jul. 2024).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 07/26/2024

Consent Requirements

Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies is required to establish a health-care provider-patient relationship, among other things.

Informed consent must be obtained to establish a physician-patient relationship over telehealth.

SOURCE: Title 24, Ch. 60, Sec. 6003(a)(3). (Accessed Jul. 2024).

Physical Therapists, Optometrists, Dentists, and Dietitians

Before services are provided through telehealth, the licensee shall obtain written, informed consent from the patient, or other appropriate person with authority to make health care treatment decisions for the patient. At minimum, the informed consent shall inform the patient and document acknowledgement of the risk and limitations of:

The use of electronic communications in the provision of care;
The potential breach of confidentiality, or inadvertent access, of protected health information using electronic communication in the provision of care; and
The potential disruption of electronic communication in the use of telehealth.

Physical therapist regulation only – for the purposes of this subsection, written consent includes an electronic signature.

SOURCE: 24 DE Administrative Code 2602. 14.2.2.1; 24 DAC 2100, 5; 24 DAC 1100; 24 DAC 3800. 9.2.2. (Accessed Jul. 2024).

Social Workers

Prior to delivery of services by telehealth, the licensee shall obtain written, informed consent from the client, or other appropriate person with authority to make health care decisions for the client, in language that is likely to be understood and is consistent with accepted professional and legal requirements. Where the licensee cannot obtain written informed consent at the outset of care due to emergency circumstances, the licensee shall obtain verbal informed consent to be followed by written informed consent as soon as reasonably possible. At minimum, the informed consent shall inform the client of:

The limitations and innovative nature of using telehealth in the provision of social work services;
Potential risks to confidentiality of information due to the use of telehealth;
Potential risks of sudden and unpredictable disruption of telehealth services and how an alternative means of re-establishing electronic or other connection will be used under such circumstances;
When and how the licensee will respond to routine electronic messages;
Under what circumstances the licensee and client will use alternative means of communications;
Who else may have access to communications between the client and the licensee;
Specific methods for ensuring that a client’s electronic communications are directed only to the licensee; and
How the licensee stores electronic communications exchanged with the client.

Upon initial and subsequent contacts with the client by telehealth, the licensee shall make reasonable efforts to verify the identity of the client.

Upon initial contact, the licensee shall: obtain alternative means of contacting the client; provide to the client alternative means of contacting the licensee; and establish a written agreement relative to the client’s access to face-to-face emergency services in the client’s geographical area, in instances such as, but not necessarily limited to, the client experiencing a suicidal or homicidal crisis.

The licensee shall document in the file or record which services were provided by telehealth.

SOURCE: 24 DAC 3900, 10. (Accessed Jul. 2024).

Pharmacist Patient Counseling Services

Before patient counseling services are provided through telehealth, the pharmacist, or a registered intern or pharmacy student working under the direct supervision of a pharmacist, shall obtain verbal informed consent from the patient, or other appropriate person with authority to make health care treatment decisions for the patient.

SOURCE: 24 DAC 2500, 5.2. (Accessed Jul. 2024).

NOTE: DE Professional Boards have different and varying consent requirements. See Professional Board Standards section for references and additional Board telehealth practice requirements.

Last updated 07/26/2024

Cross State Licensing

A health-care provider licensed in a state that has not adopted an interstate compact applicable to the health-care provider may only provide telehealth under this chapter if the health-care provider obtains an interstate telehealth registration from the Division of Professional Regulation. A health-care provider is eligible for an interstate telehealth registration only if all of the following requirements are continuously met:

The health-care provider holds a valid, active license issued by another state’s licensing authority or board.
The health-care provider is licensed in good standing in all states in which the health-care provider is licensed.
The health-care provider is not the subject of an administrative complaint which is currently pending before another state’s licensing authority or board.
The health-care provider is not currently under investigation by another state’s licensing authority or board, or any authority in this State.

A health-care provider who obtains an interstate telehealth registration consents and agrees to be subject to all of the following:

The law of this State regarding the health-care provider’s profession in this State, including all provisions of Title 11, Title 16, and this title, and all regulations of this State.
The judicial system of this State, which includes consenting and agreeing to be subject to the personal jurisdiction of the courts of this State under Chapter 31 of Title 10.
All profession conduct rules and standards incorporated into the practice act for the health-care provider’s profession.
The jurisdiction of the applicable licensing board in this State, including the board’s complaint, investigation, and hearing process. Any discipline imposed by a licensing board in this State may be reported to the applicable National Practitioner Database, as well as to every jurisdiction in which the health-care provider holds a license.

SOURCE: Title 24, Ch. 60, Sec. 6002. (Accessed Jul. 2024).

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

SOURCE: Title 24, Ch. 60, Sec. 6005. (Accessed Jul. 2024).

Consulting Physician

Consultation may be done telephonically, electronically or in person. Consultation shall ordinarily consist of a history and physical examination, review of records and imaging pathology or similar studies. Consultation includes providing opinions and recommendations. An active Delaware certificate is required of any out of state physician who comes into Delaware to perform a consultation more than twelve (12) times per year. A physician who comes into Delaware to perform consultations must be actively licensed in another State or country on a full and unrestricted basis. Any consultations done for teaching and/or training purposes may include active participation in procedures and treatment, whether surgical or otherwise, provided a Delaware licensed physician remains responsible as the physician of record, and provided the patient is not charged a fee by the consultant.

SOURCE: DE Admin Code, Title 24, Sec. 1700, 6. (Accessed Jul. 2024).

Social Work Examiners Licensure Exemptions

General licensure requirements do not apply to an individual who meets any of the following criteria:

Is licensed in good standing to practice social work in another jurisdiction, provided that the individual has made prior written application to the Board to practice social work in this State and the Board has approved the application. An individual may practice social work, within the scope of practice designated by the individual’s license, in this State under this subsection for no more than 30 days per year. An individual who provides services under this subsection is deemed to have submitted to the Board’s jurisdiction and bound by the laws of this State.
Is certified or licensed in this State by any other law, and is engaged in and acting within the scope of the profession or occupation for which the individual is certified or licensed.
Is clergy of any denomination, when engaging in activities that are within the scope of the performance of that individual’s regular or specialized ministerial duties.
Performs assessments such as basic information collection, gathering of demographic data, and informal observations, screening, and referral to determine a client’s general eligibility for a program or service and a client’s functional status for the purpose of determining need for services unrelated to a behavioral health diagnosis or treatment plan.
Creates, develops, or implements a service plan unrelated to a behavioral health diagnosis or treatment plan. Service plans may include job training and employability, housing, general public assistance, in-home services and supports or home-delivered meals, de-escalation techniques, peer services, or skill development.
Participates as a member of a multi-disciplinary team to implement behavioral health services or a treatment plan in certain circumstances.
Individuals exempted under this paragraph (c)(1)f. do not engage in any of the following restricted practices:
- Diagnosis of mental, emotional, behavioral, addictive, and developmental disorders and disabilities.
- Client assessment and evaluation.
- Provision of psychotherapeutic treatment.
- Development and implementation of assessment-based treatment plans.

Nothing in this subsection may be construed as requiring a license for any particular activity or function solely because the activity or function is not listed in this subsection.

Social Worker Reciprocity

Upon payment of the required fee and submission and acceptance of a written application on forms that the Board provides, the Board shall grant a license to an applicant who has done all of the following:

Presented proof of a current, active license in good standing and with no disciplinary action taken against the applicant in another jurisdiction whose standards the Board has determined are substantially similar to those of this State.
Presented proof that, in any other jurisdiction in which the applicant is or was licensed, the applicant’s license is in good standing or the applicant is voluntarily no longer licensed.
Successfully passed an examination that the Board designated under § 3906(a)(3) of this title.
Provided the Board with a certified statement as to whether any outstanding or ongoing disciplinary actions or ethical violations are against the applicant, or whether the applicant has engaged in any of the acts or offenses that may be grounds for disciplinary action under this chapter. Applicants are deemed to consent to the release of information regarding disciplinary actions or ethical violations and waive all objections to the admissibility of the information as evidence at any hearing or other proceeding to which the applicant may be subject under this chapter.

An applicant who has a license in another jurisdiction that has less stringent requirements than those of this State may obtain a license under this section if the applicant can prove to the Board’s satisfaction that the applicant has worked in another jurisdiction in the field for which the applicant is seeking a license in this State for at least 5 years in the 7 years immediately preceding application in this State. The Board may determine whether the requirements of another jurisdiction are less stringent than those of this State.

SOURCE: Title 24, Chap. 39, Sec. 3903 & 3909. (Accessed Jul. 2024).

Under Social Worker administrative code telehealth requirements, it is stated that a Delaware license is required, however the requirement does not apply to an individual providing social work services pursuant to a Delaware interstate telehealth registration, pursuant to Chapter 60 of Title 24 of the Delaware Code.

SOURCE: 24 DAC 3900, 10. (Accessed Jul. 2024).

Optometrists

In order to practice telehealth in Delaware, optometrists must have an active Delaware license in good standing or have obtained an interstate telehealth registration in compliance with Title 24, Ch. 60. Optometrists understand that this rule does not provide them with authority to practice telehealth in service to clients located in any jurisdiction other than Delaware, and they must comply with laws, rules, or policies for the practice of telehealth set forth by other jurisdictional boards of optometry. Optometrists practicing telehealth shall comply with all of these rules of professional conduct and with requirements incurred in state and federal statutes relevant to the practice of optometry.

SOURCE: 24 DAC 2100, 5. (Accessed Jul. 2024).

Dentists

In order to deliver Telehealth services one must hold a current, valid license issued by the Board. Licensees understand that this rule does not provide licensees with authority to deliver Telehealth Services to anyone located in a jurisdiction other than Delaware, and licensees bear responsibility for complying with laws, rules, and/or policies for the delivery of Telehealth Services set forth by other jurisdictional regulatory boards.

SOURCE: 24 DAC 1100. (Accessed Jul. 2024).

Physical Therapy and Athletic Training

This chapter shall not prohibit a physical therapist or athletic trainer who resides and works outside the State of Delaware and is licensed in a jurisdiction of the United States or credentialed in another country or, in the case of an athletic trainer, is certified by the National Athletic Trainers Association, from rendering care, if that person by contract or employment is providing non-clinical physical therapy or athletic training to patients/clients affiliated with or employed by established athletic teams, athletic organizations, or performing arts companies temporarily practicing, competing, or performing in the jurisdiction for no more than 60 days in a calendar year. All visiting physical therapists or athletic trainers must abide by Delaware laws, rules, and regulations relating to physical therapy and athletic training.

SOURCE: Title 24, Chapter 26, Sec. 2605(e). (Accessed Aug. 2024).

Marriage and Family Therapist Reciprocity

Upon payment of the application fee and submission and acceptance of a written application on forms provided by the Board, the Board shall grant a license to each applicant who shall present proof of current licensure in good standing in another state, the District of Columbia or territory of the United States, whose standards for license are substantially similar to those of this State. A license in good standing is defined in § 3052(a)(4)-(8) of this title.

An applicant who is licensed in a jurisdiction whose standards are not substantially similar to those of this State but who has held a license in good standing for a minimum of 5 years in the jurisdiction from which the applicant is applying for reciprocal license, and who has taken and passed the AMFTRB National Examination or other MFT licensing exam acceptable to the Board may be licensed, provided the applicant meets all other qualifications for reciprocity.

SOURCE: Title 24, Chapter 30, Sec. 3054. (Accessed Aug. 2024).

Dietitian Reciprocity

Reciprocity will be provided for registered, certified or licensed dietitians or registered, certified or licensed nutritionists from other states provided that the standards for registration, certification and/or licensure in that state are reasonably equivalent to those set forth in § 3806 of this title. Reciprocity applicants must follow the rules and regulations for application established under § 3809 of this title.

SOURCE: Title 24, Chapter 38, Sec. 3807. (Accessed Aug. 2024).

Last updated 07/26/2024

Definitions

Applies to: Physicians, Podiatry, Optometry, Chiropractic, Dentistry, Nursing, Occupational Therapy, Mental Health, Chemical Dependency Professionals, Psychology, Dietetic and Nutrition Therapy, and Clinical Social Workers

“Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health-care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

“Telemedicine” means a form, or subset, of telehealth, which includes the delivery of clinical health-care services by means of real time 2-way audio (including audio-only conversations, if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection), visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health-care.

SOURCE: Title 24, Ch. 60, Sec. 6001(5) & (6). (Accessed Jul. 2024).

Physical Therapy

“Telehealth is the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including physical therapy and athletic training related information and services, over large and small distances. Telehealth encompasses a variety of healthcare and health promotion activities, including education, advice, reminders, interventions, and monitoring of intervention.”

SOURCE: 24 DE Administrative Code 2600(14). (Accessed Jul. 2024).

Social Workers

“Telehealth” means the practice of social work by distance communication technology, such as, but not necessarily limited to, telephone, email, Internet-based communications, and videoconferencing. The licensee shall use telehealth only where appropriate based on the licensee’s professional judgment.

SOURCE: 24 DAC 3900, 10. (Accessed Jul. 2024).

Optometrists

Telehealth is the use of electronic communications to provide and deliver a host of health-related information and health-care services, including optometry-related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities, including education, advice, reminders, interventions, and monitoring of interventions.

SOURCE: 24 DAC 2100, 5. (Accessed Jul. 2024).

Dentistry

Telehealth is the use of electronic communications to provide and deliver a host of health-related information and health-care services, including dentistry and dental hygiene-related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities, including education, advice, reminders, interventions, and monitoring of interventions.

SOURCE: 24 DAC 1100. (Accessed Jul. 2024).

Dietitians

Telehealth is the use of electronic communications to provide and deliver a host of health-related information and health-care services, including dietetics and nutrition-related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities, including education, advice, reminders, interventions, and monitoring of interventions.

SOURCE: 24 DAC 3800. 9.0. (Accessed Aug. 2024).

NOTE: DE Professional Boards have different definitions of telehealth/telepractice/telemedicine. See Professional Board Standards section for references.

Licensure Compact Definitions

OT Compact: “Telehealth” means the application of telecommunication technology to deliver occupational therapy services for assessment, intervention and/or consultation.

Counseling Compact: “Telehealth” means the application of telecommunication technology to deliver professional counseling services remotely to assess, diagnose, and treat behavioral health conditions.

ASLP-IC: “Telehealth” means the application of telecommunication, audio-visual, or other technology that meets the applicable standard of care to deliver audiology or speech-language pathology services at a distance for assessment, intervention and/or consultation.

SOURCE: : Title 24, Ch. 20A, Sec. 2003A (OT); Ch. 30A Section 3002A (Counseling); Title 24, Ch. 37A, Section 3703A (Audiology & Speech-Language Pathology). (Accessed Jul. 2024).

Last updated 07/26/2024

Licensure Compacts

Member of the Advanced Practice Registered Nurse (APRN) Compact.

SOURCE: APRN Compact Map. (Accessed Jul. 2024).

Member of Audiology and Speech-Language Pathology Interstate Compact.

SOURCE: ASLP Compact Map. (Accessed Jul. 2024).

Member of Multistate Professional Counselor Licensure Compact.

SOURCE: Counseling Compact Map. (Accessed Jul. 2024).

Member of Emergency Medical Services Compact.

SOURCE: Interstate Commission for EMS Personnel Practice, Member States, (Accessed Jul. 2024).

Member of Interstate Medical Licensure Compact (IMLC)

SOURCE: IMLC. (Accessed Jul. 2024).

Member of Nurse Licensure (NLC) Compact.

SOURCE: Nurse Licensure Compact. Current NLC States. (Accessed Jul. 2024)

Member of Occupational Therapy Licensure Compact.

SOURCE: OT Compact Map. (Accessed Jul. 2024).

Member of Physician Assistant Licensure Compact.

SOURCE: PA Compact Map. (Accessed Jul. 2024).

Member of Physical Therapy Licensure Compact.

SOURCE: PT Compact. Member States. (Accessed Jul. 2024).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Map. (Accessed Jul. 2024).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 07/26/2024

Miscellaneous

No Reference Found

Last updated 07/26/2024

Online Prescribing

Health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include all of the following:

Thorough verification and authentication of the location and, to the extent possible, identity of the patient.
Disclosure and validation of the provider’s identity and credentials.
Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies as required by paragraph (a)(5) of this section.
Establishment of a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identification of underlying conditions or contra-indications, or both, for treatment recommended or provided.
Discussion with the patient of any diagnosis and supporting evidence as well as risks and benefits of various treatment options.
The availability of a distant site provider or other coverage of the patient for appropriate follow-up care.
A written visit summary provided to the patient.

Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology. Telehealth and telemedicine services may be used to establish a provider-patient relationship only if the provider determines that the provider is able to meet the same standard of care as if the health-care services were being provided in-person.

Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings. In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

SOURCE: Title 24, Ch. 60, Sec. 6003 & 6005. (Accessed Jul. 2024).

Delaware Board of Medical Licensure has specific requirements for electronic prescribing.

SOURCE: DE Admin Code, Title 24, Sec. 1700(19). (Accessed Jul. 2024).

Consulting Physician

SOURCE: DE Admin Code, Title 24, Sec. 1700, 6. (Accessed Jul. 2024).

Pharmacists

Telehealth may be used for patient counseling only.

SOURCE: 24 DAC 2500, 5.2. (Accessed Jul. 2024).

Pharmacists practicing within or outside of the state are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to an Internet pharmacy through an Internet site or that the prescription was issued by a practitioner who does not have a patient-practitioner relationship with the Delaware patient.

SOURCE: DE Code, Title 16, Chapter 47, Sec. 4744(d)(1)(a-b). (Accessed Jul. 2024).

Optometrists

All initial evaluations shall be performed face to face and not through telehealth or internet unless another Delaware-licensed optometrist or ophthalmologist is present at the originating site with the patient at the time of the diagnosis, or the provider meets the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

SOURCE: 24 DAC 2100, 5. (Accessed Jul. 2024).

NOTE: DE Professional Boards have different and varying requirements related to establishing a patient-provider relationship. See Professional Board Standards section for references and additional Board telehealth practice requirements.

Last updated 07/26/2024

Professional Board Standards

Health-care providers licensed by the following professional boards are authorized to deliver health-care services by telehealth and telemedicine:

The Board of Podiatry created pursuant to Chapter 5 of this title.
The Board of Chiropractic created pursuant to Chapter 7 of this title.
The Board of Medical Practice created pursuant Chapter 17 of this title.
The State Board of Dentistry and Dental Hygiene created pursuant to Chapter 11 of this title.
The Delaware Board of Nursing created pursuant to Chapter 19 of this title.
The Board of Occupational Therapy Practice created pursuant to Chapter 20 of this title.
The Board of Examiners in Optometry created pursuant to Chapter 21 of this title.
The Board of Pharmacy created pursuant to Chapter 25 of this title.
The Board of Mental Health and Chemical Dependency Professionals created pursuant to Chapter 30 of this title.
The Board of Examiners of Psychologists created pursuant to Chapter 35 of this title.
The State Board of Dietetics/Nutrition created pursuant to Chapter 38 of this title.
The Board of Social Work Examiners created pursuant to Chapter 39 of this title.

A professional board may promulgate or revise regulations and establish or revise rules applicable to health-care providers under the professional Board’s jurisdiction in order to facilitate the provision of telehealth and telemedicine services.

Practice requirements:

A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least one of the following:

Provide an appropriate examination in-person.
Require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis.
Make a diagnosis using audio or visual communication.
Meet the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

After a health-care provider-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient by the same health-care provider need not satisfy the limitations of this section.

A health-care provider treating a patient through telemedicine and telehealth must maintain complete records of the patient’s care and follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

Telehealth and telemedicine services shall include, if required by the applicable professional board listed, use of the Delaware Health Information Network (DHIN) in connection with the practice.

Nothing in this section shall be construed to limit the practice of radiology or pathology.

SOURCE: DE Statute Title 24, Chap. 60, Sec. 6002 & 6004. (Accessed Jul. 2024)

Physical Therapists and Athletic Trainers

SOURCE: DE Statute Title 24, Chapter 26, Sec. 2600. (Accessed Jul. 2024).

Board of Clinical Social Work Examiners

SOURCE: 24 DE Statute Title 24, Chapter 39, 3920; 24 DAC 3900, 10 (Accessed Jul. 2024).

Board of Dentistry and Dental Hygiene

SOURCE: 24 DAC 1100 (Accessed Jul. 2024).

Board of Pharmacy

SOURCE: 24 DAC 2500 (Accessed Jul. 2024).

Board of Examiners in Optometry

SOURCE: 24 DAC 2100, 5. (Accessed Jul. 2024).

Board of Dietetics/Nutrition

SOURCE: 24 DAC 3800.9 (Accessed Aug. 2024).