Oregon

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: PTC
Consent Requirements: Yes

STATE RESOURCES

Medicaid Program: Oregon Medicaid
Administrator: Oregon Health Authority
Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center

Private Payer

Last updated 12/12/2024

Definitions

“Telemedicine” means the mode of delivering health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a patient’s health care.

“Audio only” means the use of audio telephone technology, permitting real-time communication between a health care provider and a patient for the purpose of diagnosis, consultation or treatment. “Audio only” does not include:

The use of facsimile, electronic mail or text messages.
The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OR Revised Statutes Ch. 743A.058. (Accessed Dec. 2024).

Treatment of Diabetes

“Telemedical” means delivered through a two-way electronic communication, including but not limited to video, audio, Voice over Internet Protocol or transmission of telemetry, that allows a health professional to interact with a patient, a parent or guardian of a patient or another health professional on a patient’s behalf, who is at an originating site.

SOURCE: OR Revised Statutes Sec. 743A.185(1)(c). (Accessed Dec. 2024).

Worker’s Compensation

“Telehealth” means providing healthcare remotely by means of telecommunications technology, including but not limited to telemedicine and telephonic or online digital services.

“Telemedicine” means synchronous medical services provided via a real-time interactive audio and video telecommunications system between a patient at an originating site and a provider at a distant site.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Dec. 2024).

Last updated 12/12/2024

Parity

SERVICE PARITY

A health benefit plan and a dental-only plan must provide coverage of a health service that is provided using telemedicine if:

The plan provides coverage of the health service when provided in person by a health professional;
The health service is medically necessary;
The health service is determined to be safely and effectively provided using telemedicine according to generally accepted health care practices and standards; and
The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of protected health information.

Plans may not:

Distinguish between originating sites that are rural and urban in providing coverage.

The coverage under subsection (2) of this section is subject to:

The terms and conditions of the health benefit plan or dental-only plan; and
Subject to subsection (8) of this section, the reimbursement specified in the contract between the plan and the health professional.

A health benefit plan and dental-only plan must pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Dec. 2024).

Treatment of Diabetes

A health benefit plan must provide coverage of a telemedical health service provided in connection with the treatment of diabetes if:

The plan provides coverage of the health service when provided in-person by the health professional;
The service is medically necessary;
The telemedical health service relates to a specific patient; and
One of the participants in the telemedical health service is a representative of an academic health center.

A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in person.

SOURCE: OR Revised Statutes Sec. 743A.185. (Accessed Dec. 2024).

Worker’s Compensation

All services must be appropriate, and the form of communication must be appropriate for the service provided.

Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2024.

Equipment or supplies at the distant site are not separately payable.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Dec. 2024).

PAYMENT PARITY

Paragraph (a) of this subsection does not prohibit the use of value-based payment methods, including capitated, bundled, risk-based or other value-based payment methods, and does not require that any value-based payment method reimburse telemedicine health services based on an equivalent fee-for-service rate.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Dec. 2024).

Worker’s Compensation

Insurers must pay distant site providers at the non-facility rate.

Equipment or supplies at the distant site are not separately payable.

The payment amount for code Q3014 is $35.70 per unit or the provider’s usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.

Professional fees of supporting providers at the originating site are not separately payable.

Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Dec. 2024).

Last updated 12/12/2024

Requirements

A health benefit plan and a dental-only plan must provide coverage of a health service that is provided using telemedicine if:

The plan provides coverage of the health service when provided in person by a health professional;
The health service is medically necessary;
The health service is determined to be safely and effectively provided using telemedicine according to generally accepted health care practices and standards; and
The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of protected health information.

Permissible telemedicine applications and technologies include:

Landlines, wireless communications, the Internet and telephone networks; and
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices.

During a state of emergency, a health benefit plan or dental-only plan shall provide coverage of a telemedicine service delivered to an enrollee residing in the geographic area specified in the declaration of the state of emergency, if the telemedicine service is delivered using any commonly available technology, regardless of whether the technology meets all standards required by state and federal laws governing the privacy and security of protected health information.

A health benefit plan and a dental-only plan may not:

Distinguish between rural and urban originating sites in providing coverage or restrict originating sites that qualify for reimbursement.
Restrict a health care provider to delivering services only in person or only via telemedicine.
Use telemedicine health care providers to meet network adequacy standards under ORS 743B.505 (Provider networks).
Require an enrollee to have an established patient-provider relationship with a provider to receive telemedicine health services from the provider or require an enrollee to consent to telemedicine services in person.
Impose additional certification, location or training requirements for telemedicine providers or restrict the scope of services that may be provided using telemedicine to less than a provider’s permissible scope of practice.
Impose more restrictive requirements for telemedicine applications and technologies than those specified above.
Impose on telemedicine health services different annual dollar maximums or prior authorization requirements than the annual dollar maximums and prior authorization requirements imposed on the services if provided in person.
Require a medical assistant or other health professional to be present with an enrollee at the originating site.
Deny an enrollee the choice to receive a health service in person or via telemedicine.
Reimburse an out-of-network provider at a rate for telemedicine health services that is different than the reimbursement paid to the out-of-network provider for health services delivered in person.
Restrict a provider from providing telemedicine services across state lines if the services are within the provider’s scope of practice and:
- The provider has an established practice within this state;
- The provider’s employer operates health clinics or licensed health care facilities in this state;
- The provider has an established relationship with the patient; or
- The patient was referred to the provider by the patient’s primary care or specialty provider located in this state.
- Prevent a provider from prescribing, dispensing or administering drugs or medical supplies or otherwise providing treatment recommendations to an enrollee after having performed an appropriate examination of the enrollee in person, through telemedicine or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.
Establish standards for determining medical necessity for services delivered using telemedicine that are higher than standards for determining medical necessity for services delivered in person.

A health benefit plan and a dental-only plan shall:

Work with contracted providers to ensure meaningful access to telemedicine services by assessing an enrollee’s capacity to use telemedicine technologies that comply with accessibility standards, including alternate formats, and providing the optimal quality of care for the enrollee given the enrollee’s capacity;
Ensure access to auxiliary aids and services to ensure that telemedicine services accommodate the needs of enrollees who have difficulty communicating due to a medical condition, who need an accommodation due to disability or advanced age or who have limited English proficiency;
Ensure access to telemedicine services for enrollees who have limited English proficiency or who are deaf or hard-of-hearing by providing interpreter services reimbursed at the same rate as interpreter services provided in person; and
Ensure that telemedicine services are culturally and linguistically appropriate and trauma-informed.

SOURCE: OR Revised Statutes Ch. 743A.058. (Accessed Dec. 2024).

Treatment of Diabetes

A health benefit plan must provide coverage of a telemedical health service provided in connection with the treatment of diabetes if:

The plan provides coverage of the health service when provided in person by the health professional;
The health service is medically necessary;
The telemedical health service relates to a specific patient; and
One of the participants in the telemedical health service is a representative of an academic health center.

A health benefit plan may not distinguish between rural and urban originating sites in providing coverage under subsection (2) of this section.

SOURCE: OR Revised Statutes Sec. 743A.185(1)(c). (Accessed Dec. 2024).

Worker’s Compensation

All services must be appropriate, and the form of communication must be appropriate for the service provided.

Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2024.

Distant site provider:

When billing for telemedicine services, the distant site provider must:

Use the place of service (POS) code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
Use modifier 95 to identify the service as a synchronous medical service rendered via a real-time interactive audio and video telecommunications system.

When billing for telehealth services other than telemedicine services, the distant site provider:

Must use the POS code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
May not use modifier 95.

Originating site billing:

When billing for telehealth services, the originating site may charge a facility fee using HCPCS code Q3014, if the site is:

The office of a physician or practitioner; or
A health care facility including but not limited to a hospital, rural health clinic, skilled nursing facility, or community mental health center.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Dec. 2024).

Medicaid

Last updated 12/12/2024

Consent Requirements

Prior to the delivery of services using a telemedicine or telehealth modality, a member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in a language that the member understands must be obtained by the health system, clinic, or provider and documented in the member’s health record. Consent must include an assessment of member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the member. Consent must be updated at least annually thereafter. For members and their families with LEP or hearing impairments, providers must use qualified or certified health care interpreters, when obtaining patient consent;

Consistent with ORS 109.640, provision of birth control information and services using a telemedicine or telehealth modality shall be provided to any person regardless of age without consent of parent or legal guardian;

Consistent with ORS 109.640, provision of any other medical or dental diagnosis and treatment using a telemedicine or telehealth modality shall be provided to any person 15 years of age or older without consent of parent or legal guardian;

See rule for additional requirements.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement. (Accessed Dec. 2024).

Prior to the delivery of services using a telemedicine or telehealth modality, a client or member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in the language that the client or member understands shall be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent shall include an assessment of client or member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the client or member. Consent shall be updated at least annually thereafter. For clients or members who experience LEP or hearing impairment clients, providers shall use qualified or certified health care interpreters when obtaining client or member consent;

Consistent with Oregon Revised Statute (ORS 109.640), provision of birth control information and services using a telemedicine or telehealth modality shall be provided to any person regardless of age without consent of parent or legal guardian;

Consistent with ORS 109.675, provision of outpatient diagnosis or treatment of a mental or emotional disorder or a chemical dependency using a telemedicine or telehealth modality shall be provided to any person 14 years of age or older without consent of parent or legal guardian;

Consistent with ORS 109.610, provision of diagnosis or treatment of certain sexually transmitted infections using a telemedicine or telehealth modality shall be provided to a person regardless of age without consent of parent or legal guardian;

See rule for additional requirements.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

Teledentistry

A member receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request.

The member’s chart Documentation shall reflect notification of the right to interactive communication with the distant site dentist.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

School Based Health Services

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

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;
The school medical provider meets the following privacy and security standards:
- 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:
  - 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.
  - The medically-qualified individual’s assessment of the child or young adult’s ability to access and participate in telemedicine or telehealth delivered services.
- Comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996; and
- Comply with the Authority’s Privacy and Confidentiality Rules in OAR Chapter 943, Division 14 except as noted in section (4) below.
  - 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 (see regulation for more).

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Dec. 2024).

Last updated 12/12/2024

Definitions

SOURCE: OR Statute 414.723, (Accessed Dec. 2024).

“Telemedicine” means the mode of delivering remote clinical health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a member’s healthcare.

“Telehealth” includes telemedicine and includes the use of electronic information and telecommunications technologies to support remote clinical healthcare, member and professional health-related education, public health, and health administration.

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include video conferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement & OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth & 410-120-0000, [slight variations exist between the definitions], (Accessed Dec. 2024).

Rules for RHCare Clinics, Certification Requirements for CCare Clinics, Certification Requirements for AbortionCare clinics

“Telehealth” means the provision of healthcare remotely by means of telecommunications technology.

SOURCE: OR Admin Code 333-004-3010, (Accessed Dec. 2024).

Behavioral Health Services

“Telehealth” means a technological solution that provides two-way, video-like communication on a secure line.

SOURCE: OAR 309-032-0860, Health Systems Division: Medical Assistance Programs, Behavioral Health Services. (Accessed Dec. 2024).

Telemedicine encompasses different types of programs, services, and delivery mechanisms for medically appropriate covered services within the recipient’s benefit package.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Dec. 2024).

“Virtual Visit” means a visit between a patient and an approved visitor using computerized or video monitors, or telephones.

SOURCE: OR OAR 309-106-0005, Health Systems Division: Behavioral Health Services, Chapter 309, Division 106 Visitation of Patients and Residents in State Institutions. (Accessed Dec. 2024).

Telehealth services include a variety of health services provided by synchronous or asynchronous electronic communications, including secure electronic health portal, audio, or audio and video and clinician-to-clinician virtual consultations.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2024 Prioritized List of Health Services, p. AD-2. (1/22/24). (Accessed Dec. 2024).

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

Live video, a two-way interaction between a patient and dentist using audiovisual technology;
Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time;
Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and
Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry, health care, public health practices, and education.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dc. 2024).

School Based Health Services

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include, but are not limited to, videoconferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.

“Telehealth” means the use of electronic information and telecommunications technologies, including telemedicine, to support remote clinical healthcare, client or member and professional health-related education, public health, and health administration.

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical Assistance Programs, School-Based Health Services. (Accessed Dec. 2024).

The Behavioral Health Loan Repayment Program and Behavioral Health Care Bonus and Housing Stipend Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 309-081-0010 and 309-083-0010, (Accessed Dec. 2024).

Health Care Provider Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 409-036-0010, (Accessed Dec. 2024).

Aging and People with Disabilities and Developmental Disabilities

“Technology and Telehealth” means electronic or virtual means or methods, including but not limited to computer technology, web or internet access, social media, videoconferencing or other technological means or methods to improve resident social isolation and allow for the provision of virtual health care.

SOURCE: OR OAR 411-062-0010, (Accessed Dec. 2024).

Assertive Community Treatment (ACT)

“Telehealth” means services that are delivered using secure HIPAA compliant audio and video communication. All allowable accommodations will be made for any individuals with any hearing, visual or physical impairments or disabilities who agree to utilize services in this manner. per OAR 410-120-1990 rule set.

“Telepsychiatry” means the application of telemedicine to the specialty field of psychiatry. The term describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing.

SOURCE: 309-019-0225, Oregon Health Authority, Health Systems Division: Behavioral Health Services, DACT Model (Accessed Dec. 2024).

Health Professional Student Clinical Training

“Telehealth” means the provision of health services where the patient and professional are not present in the same location but interact via technology.

SOURCE: 409-030-0110, Oregon Health Authority, Health Systems Division: Health Professional Student Clinical Training (Accessed Dec. 2024).

Last updated 12/12/2024

Email, Phone & Fax

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include the delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan and 410-120-1990 (Accessed Dec. 2024).

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions, (Accessed Dec. 2024).

“Audio only” does not include:

The use of facsimile, electronic mail or text messages.
The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (Duties of board) (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Ch. 414.723, (Accessed Dec. 2024).

Covered telephonic and online services include services related to evaluation, assessment and management as well as other technology-based services (CPT 98966-98968, 99441-99443, 99421-99423, 98970-98972, G2012, G2061-G2063, G2251-G2252).

Covered telephone and online services billed using these codes do not include either of the following:

Services related to a service performed and billed by the physician or qualified health professional within the previous seven days, regardless of whether it is the result of patient-initiated or physician-requested follow-up.
Services which result in the patient being seen within 24 hours or the next available appointment.

Covered interprofessional consultations include consultations delivered online, through electronic health records or by telephone (CPT 99446-99449, 99451-99452).

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Oct. 1, 2024 Prioritized List of Health Services, p. AD-3. (11/19/24). (Accessed Dec. 2024).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio, or member portal and may include transmission of data from remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions; OR OAR 410-120-1990 & OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Telehealth. [slight variations exist], (Accessed Dec. 2024).

Intent to Submit a State Plan Amendment:

The Authority reimbursement of patient to clinician telephonic and electronic services for established patients are based upon the maximum allowable fees are established using the CMS Resource Based Relative Value (RBRVS) methodology as published in the Federal Register annually with periodic updates, multiplied by the Oregon specific conversion factor. Oregon conversion factors as listed on Attachment 4.19-B, page 1 of this state plan.

Except as otherwise noted in the state plan, state developed fee schedule rates are the same for both governmental and private providers. The agency’s fee schedule rate was set as of 10/1/24 and is effective for services provided on or after that date. State-wide fee schedules are published on the agency’s web at https://www.oregon.gov/oha/HSD/OHP/Pages/Fee-Schedule.aspx

SOURCE: Oregon Health Authority, Public Notice, July 31, 2024, (Accessed Dec. 2024).

Behavioral Health

Patient consultations using telephone and online or electronic mail (e-mail) are covered when billed services comply with the practice guidelines set forth by the Health Evidence Review Commission and the applicable HERC-approved code requirements, delivered consistent with the HERC Evidence-Based Guidelines;

Behavioral health services specifically identified as allowable for telephonic delivery are listed on the Behavioral Health Fee schedule published by the Authority.

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Dec. 2024).

Teledentistry

Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry, health care, public health practices, and education.

Unless authorized in OAR 410-120-1200 Exclusions or OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered:

When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

School Based Health Services

For school-based telehealth service claims:

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

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Dec. 2024).

Indian Health Services

For the provision of services defined in Titles XIX and XXI and provided through an IHS or Tribal 638 facility, an “encounter” is defined as a face-to-face, telephone contact, or a prescription fill as defined in OAR 410-146-0085(8) between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (7) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management; OAR 410-146-0200, Tribal Pharmacy; and OAR 410-130-0190, Tobacco Cessation (OAR 410-120-1200). Except as set forth below, Providers may not make telephone contacts at the exclusion of face-to-face visits.

Telephone encounters must include all the same components of the service as if provided face-to-face.
During a state of emergency of an epidemic outbreak of an infectious disease impacting the safety of public health, in accordance with the Health Evidence Review Commission’s Prioritized List, guideline notes, and OAR 410-130-0610 (for dates of service on or before December 31, 2020) and OAR 410-120-1990 (for dates of service on or after January 1, 2021), telephonic evaluation management services, assessment and management services, and psychotherapy are appropriate to ensure access to care while avoiding and preventing unnecessary potential infectious exposure, and may be made in place of a face-to-face visit.

SOURCE: OR OAR 410-146-0085, Health Systems Division: Medical Assistance Programs American Indian/Alaska Native. (Accessed Dec. 2024).

Federally Qualified Health Center and Rural Health Clinics

For the provision of services defined in Titles XIX and XXI and provided through an FQHC or RHC, an “encounter” is defined as a face-to-face or telephone contact between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (4) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, a face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per OAR 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management (MCM) and 410-130-0190, Tobacco Cessation (see also OAR 410-120-1200). Except as set forth below, providers may not make telephone contacts at the exclusion of face-to-face visits.

Telephone encounters must include all the same components of the service as if provided face-to-face.
During a state of emergency of an epidemic outbreak of an infectious disease impacting the safety of public health, in accordance with the Health Evidence Review Commission’s Prioritized List, guideline notes, and OAR 410-130-0610 (for dates of service on or before December 31, 2020) and OAR 410-120-1990 (for dates of service on or after January 1, 2021), telephonic evaluation management services, assessment and management services, and psychotherapy are appropriate to ensure access to care while avoiding and preventing unnecessary potential infectious exposure, and may be made in place of a face-to-face visit.

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services. (Accessed Dec. 2024).

Last updated 12/12/2024

Live Video

POLICY

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute 414.723. (Accessed Dec. 2024).

“Synchronous” means an interaction between a provider and a member that occurs at the same time using an interactive technology. This may include audio only, video only, or audio and video and may include transmission of data from remote monitoring.

SOURCE: OAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

Communications may be between providers, or between one or more providers and one or more members, family members /caregivers /guardians.

SOURCE: OAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements, (Accessed Dec. 2024).

Patient consultations using videoconferencing, a synchronous (live two-way interactive) video transmission resulting in real time communication between a provider located in a distant site and the recipient being evaluated and located in an originating site, is covered when billed services comply with the billing requirements. See OAR for billing requirements.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Dec. 2024).

Coordinated Care Organizations (CCOs) shall provide reimbursement for telemedicine or telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) as defined in OAR 950-050-0010 for interpretation services provided using telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the CCOs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the CCO contract. Administrative rules and CCO Direct Agreements do not supersede any federal or state requirements with regard to the provision and coverage of health care interpreter services.

SOURCE: OAR 410-141-3566 . Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telemedicine and Telehealth Delivered Health Service and Reimbursement Requirements. (Accessed Dec. 2023).

The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided using telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).

Providers shall ensure Oregon Health Plan (OHP) clients or members are offered a choice of how services are received, including services offered using telemedicine or telehealth modalities and in-person services, except where the Authority issues explicit guidance during a declared state of emergency or if a facility has implemented its facility disaster plan.

Providers unable to offer in-person services shall offer local provider options to a client or member when an in-person visit is clinically indicated or when the client or member requests in-person services. This may include but is not limited to care coordination or completing referral paperwork.

SOURCE: OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

The Oregon Health Authority (OHA) will submit a Medicaid State Plan Amendment to the Centers for Medicare & Medicaid Services (CMS) to change from the flat telehealth rates used during the COVID-19 Public Health Emergency (PHE) to rates based on Relative Value Units (RVUs) multiplied by the Oregon conversion factor. See memo for a table that lists the current PHE rate and the proposed RVU-based rate for covered telehealth codes.

SOURCE: Oregon Health Authority, Notice of intent – OHA will amend the Medicaid State Plan to increase rates for telehealth services. Public Notice, May 18, 2023, (Accessed Dec. 2024).

ELIGIBLE SERVICES/SPECIALTIES

Providers billing for covered telemedicine or telehealth services are responsible for:

Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the member in connection with the telemedicine or telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act) except as noted in section (19) of this rule.
Obtaining and maintaining technology used in telemedicine or telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (A) except as noted in section (19) of this rule.
Developing and maintaining policies and procedures to prevent a breach in privacy or exposure of client or member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting as described in OAR 943-014-0440.
Maintaining clinical and financial documentation related to telemedicine or telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410.
Complying with all federal and state statutes as required in OAR 410-120-1380.

Providers shall develop and maintain care coordination policies and procedures to offer local provider options to clients or members when in-person services are clinically indicated or requested by the client or member and the provider does not offer these services.

The Authority shall only pay for telemedicine or telehealth services meeting all of the following requirements:

Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided using telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
When allowed by individual certification or licensing board’s scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
- When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
- For establishing a client or member-provider relationship.
All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02 when the client or member is located in a place other than their home. When the client or member is located in their home, the claim shall include Place of Service code 10.
All claim types except Dental services, shall include modifier 95 when the telemedicine or telehealth delivered service utilizes a real-time interactive audio and video telecommunication system. When provision of the same service utilizes a real-time interactive audio only, the claim should include modifier 93.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

Teledentistry

All billing requirements stated in this rule apply to all delivery modalities referenced in section (5) of this rule (live video, store and forward, remote patient monitoring and mobile communication devices).

As stated in ORS 679.543 and this rule, payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

The dentist who completes diagnosis and treatment planning and the oral evaluation also documents these services using the traditional CDT codes. This provider also reports the teledentistry event using D9995 or D9996 as appropriate. See the Dental Billing Instructions for details at: www.oregon.gov/oha/HSD/OHP/Pages/Policy-Dental.aspx;

The originating site may bill a CDT code only if a separately identifiable service is performed within the scope of practice of the practitioner providing the service. The service shall meet all criteria of the CDT code billed.

An assessment D0191 is a limited inspection performed to identify possible signs of oral or systemic disease, malformation or injury, and the potential need for referral for diagnosis and treatment. This code may be billed using the modality of teledentistry:

When D0191 is reported in conjunction with an oral evaluation (D0120-D0180) using teledentistry, D0191 shall be disallowed even if done by a different provider;
The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

Behavioral Health

For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health, (Accessed Dec. 2024).

Behavioral Health Resource Networks

A comprehensive BHRN must include at minimum the required services below to be funded by the OAC. These services may be provided by one or more entities who refer between and collaborate with each other. To be a BHRN, a BHRN must provide, and maintain sufficient capacity to provide, the following services and supports to individuals who use substances that cause harm or have a substance use disorder in the BHRN’s county or region:

Screening must be conducted by PSS, CRM, PWS or other addiction professional. Screening service must be available 24 hours a day, seven days a week, every calendar day of the year. Screening must be made available to each individual immediately upon first contact. At least one organization within each BHRN within each county or region must meet this requirement: …
- Services must be offered face-to-face or through telehealth. The modality must be based on the needs and preference of the individual as well as any safety concerns identified by the individual or the BHRN.

See rule for additional information.

SOURCE: OR OAR 944-001-0020, Oversights and Accountability Council, Behavioral Resource Networks, (Accessed Dec. 2024).

Behavioral Rehabilitation Services Program

To utilize telehealth for services required by the BRS program, the BRS contractor and BRS providers shall:

Comply with Telehealth for Behavioral Health requirements described in OAR 410-172-0850;
Comply with prioritized list of health services guidelines for telephone and e-mail consultation described in OAR 410-141-3830; and
Comply with agency specific BRSTelehealth program rules and policies.

The BRS contractor and BRS providers shall develop written telehealth policy that complies with section (4)(a)(A-C) of this rule. At minimum, the policy shall describe:

The circumstances the provider may provide BRS services via telehealth;
The telecommunication technologies the BRS contractor or BRS provider has implemented to deliver services via telehealth; and
The process to obtain an individual’s informed consent in accordance with ORS 107.154, 179.505, 179.507, 192.515, including a sample form.

The BRS contractor and BRS providers may utilize telehealth for services that require a face-to-face setting when there is a documented barrier to providing in-person services, as follows:

Services via telehealth shall be provided by a qualified program staff within their scope of position;
Service notes for phone, individual or group counseling shall follow the same criteria as face-to-face counseling and identify the session was conducted by telehealth and the reason for the use of telehealth; and
Individual or group counseling via telehealth shall meet HIPAA and 42 CFR Part 2 standards for privacy.

School Based Health Services

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

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;
The school medical provider meets the following privacy and security standards (see regulation)

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.

For school-based telehealth service claims:

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

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:

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
The Authority may reimburse a SBHS delivered using a telehealth platform if:
- The telehealth service is medically necessary and appropriate;
- The delivery of the telehealth service reasonably approximates an in-person service; and
- 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).

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Dec. 2024).

Reproductive Health Access Program

Covered services provided by telehealth technology may be billed to the RH Program, as appropriate. The CVR must indicate that the visit was conducted via telehealth. All telehealth visits must adhere to applicable state and federal telehealth regulations.

SOURCE: OR OAR 333-004-3110, RH Access Fund Billing and Claims (Accessed Dec. 2024).

Linguistic and Cultural Access

CCOs shall ensure that providers offer meaningful access to telemedicine/telehealth services by completing a capacity assessment of members in the use of specific approved methods of telemedicine or telehealth delivery that comply with accessibility standards including alternate formats, and provides the optimal quality of care for the member given considerations of member access to necessary devices, access to a private and safe location, adequate internet, digital literacy, cultural appropriateness of telemedicine or telehealth services, and other considerations of member readiness to use telemedicine or telehealth;

CCOs shall ensure that providers offer meaningful access to health care services for members and their families who experience LEP or hearing impairments by working with qualified or certified health care interpreters to provide language access services as described in OAR 950-050-0040. Such services shall not be significantly restricted, delayed, or inferior as compared to programs or activities provided to English proficient individuals;

CCOs shall ensure that providers collaborate with members to identify modalities for delivering health care services which best meets the needs of the member and considers the member’s choice and readiness for the modality of service selected.

CCOs shall ensure that telemedicine or telehealth services provided are culturally and linguistically appropriate as described in the relevant standards:

National Culturally and Linguistically Appropriate Services (CLAS) Standards;
Tribal based practice standards;
Trauma-informed approach to care as defined in OAR 410-141-3500.

See full list of CCO requirements in regulation.

Newborn Nurse Home Visiting Service Requirements

If a family declines home visiting services in their home, an alternate location may be offered, and telemedicine services must be offered and delivered in accordance with ORS 743A.058. Declination of home visiting services in the home must be documented in the client’s medical record.

SOURCE: OAR 333-006-0120, Health Systems Division: Public Health Division, Universally Offered Newborn Nurse Home Program, (Accessed Dec. 2024).

Health benefit plans must reimburse at the case rate for newborn nurse home visiting services conducted via telemedicine pursuant to OAR 333-006-0120 and ORS 743A.058.

SOURCE: OAR 333-006-0190, Health Systems Division: Public Health Division, Universally Offered Newborn Nurse Home Program, (Accessed Dec. 2024).

1915(i) Home and Community Based Services State Plan Option

“Face-to-Face” means a personal interaction where both words can be heard and facial expressions can be seen, either in person or through telehealth services where there is a live streaming audio and video, if medically appropriate and necessary. Face-to-face could include communication methods such as telehealth/telemedicine, in lieu of in-person visits, in accordance with HIPAA, as directed by OHA and as chosen by the Individual. Medically appropriate and necessary accommodations shall be made for Individuals with disabilities including those with hearing or sight impairments. For telehealth the following conditions must be met:

The agent performing the assessment is independent and qualified as defined in 42 CFR 441.730 and meets the provider qualifications defined by the State, including any additional qualifications or training requirements for the operation of required information technology.
The Individual receives appropriate support during the assessment, including the use of any necessary on-site support-staff.
The Individual provides informed consent for this type of assessment.

Eligibility for 1915(i) HCBS is established through a diagnostic and face-to-face needs-based assessment by an external IQA who meets the requirements of a QMHP:

Telehealth is considered face-to-face and it is the Individuals choice to conduct the assessment in- person or via telehealth;
In-Person or telehealth options are based on the choice and preference of the Individual accessing HCBS;
Individuals who choose telehealth assessment options must schedule an in-person follow up meeting within ninety (90) days of the functional needs assessment.

See regulation for additional requirements.

SOURCE: OAR 410-173-0005 & 410-173-0010, Oregon Health Authority, Health Systems Division: Medical Assistance Programs, 1915(i) Home and Community Based Services State Plan Option (Accessed Dec. 2024).

Durable Medical Equipment

For initial ordering of DME items identified in section (9) of this rule, an in-person or telehealth face-to-face encounter that is related to the primary reason the client requires the medical equipment or supplies must occur no more than six months prior to the start of services.

Telehealth encounters used to satisfy the face-to-face encounter requirement for a DMEPOS item must meet the requirements outlined in the HERC Ancillary Guideline note A5.

SOURCE: 410-122-0090, Oregon Health Authority, Health Systems Division: Medical Assistance Programs, Durable Medical Equipment Program Rules (Accessed Dec. 2024).

Assertive Community Treatment (ACT)

Community-Based” means services and supports that must be provided in a participant’s home and/or surrounding community. This can include but not limited to virtual telehealth, or wherever within the community the participant feels most comfortable. This is person-centered and will be tailored to the participants discretion.

“Face to Face” means that a personal interaction where communication between at least two-person(s) can be had either in-person or virtually through telehealth services where there is a secured HIPAA approved live streaming audio and video per OAR 410-120-1990 rule set. Virtual Telehealth meetings for Face-to-Face fidelity measurement purposes will be a last resort option if in-person is not safely available or feasible.

SOURCE: 309-019-0225, Oregon Health Authority, Health Systems Division: Behavioral Health Services, DACT Model (Accessed Dec. 2024).

Behavioral Health Services – IPS

“Face to Face” means that a personal interaction where communication between at least two-person(s) can be had. This will include any interactions through telehealth services where there is secured Health Insurance Portability and Accountability (HIPAA) approved live streaming audio and video. Virtual Telehealth meetings for Face-to-Face fidelity measurement purposes will be a last resort option if in-person is not safely available or feasible.

SOURCE: 309-019-0270, Oregon Health Authority, Health Systems Division: Behavioral Health Services, (Accessed Dec. 2024).

Hospital Services

Caring contacts may be conducted in person, via telemedicine or by phone.

SOURCE: OAR 333-520-0070 Oregon Health Authority, Health Systems Division, Public Health Division, Emergency Department and Emergency Services. (Accessed Dec. 2024).

ELIGIBLE PROVIDERS

Providers who offer telemedicine or telehealth delivery of services shall meet the following requirements:

Shall hold an unencumbered Oregon license;
Shall be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per OAR 410-120-1260;
Shall provide services using telemedicine or telehealth that are within their respective certification or licensing board’s scope of practice and comply with telemedicine or telehealth requirements including, but not limited to:

- Documenting patient and provider agreement of consent to receive services;
- Allowed physical location of provider and patient;
- Establishing or maintaining an appropriate provider-patient relationship.
- Providers billing for covered telemedicine or telehealth services are responsible for:
  - Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the member in connection with the telemedicine or telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act) except as noted in section (19) of this rule.
  - Obtaining and maintaining technology used in telemedicine or telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (A) except as noted in section (19) of this rule.
  - Developing and maintaining policies and procedures to prevent a breach in privacy or exposure of client or member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting as described in OAR 943-014-0440.
  - Maintaining clinical and financial documentation related to telemedicine or telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410.
  - Complying with all federal and state statutes as required in OAR 410-120-1380.

The Authority shall only pay for telemedicine or telehealth services meeting all of the following requirements:

Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided using telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
When allowed by individual certification or licensing board’s scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
- When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
- For establishing a client or member-provider relationship.
All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02 when the client or member is located in a place other than their home. When the client or member is located in their home, the claim shall include Place of Service code 10.
All claim types except Dental services, shall include modifier 95 when the telemedicine or telehealth delivered service utilizes a real-time interactive audio and video telecommunication system. When provision of the same service utilizes a real-time interactive audio only, the claim should include modifier 93.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

“Meaningful access” means client or member-centered access reflecting the following statute and standards: Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) including providing access to auxiliary aids and services as described in 45 CFR Part 92;

National Culturally and Linguistically Appropriate Services (CLAS) Standards at https://thinkculturalhealth.hhs.gov/clas/standards; and
As applicable to the client or member, Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx;
“Synchronous” means an interaction between a provider and a client or member that occurs at the same time using an interactive technology. This may include audio only, video only, or audio with video and may include remote monitoring.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions & OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

Dentists providing Medicaid services shall be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and shall be enrolled as a Health Systems Division (Division) provider.

Providers billing covered teledentistry/telehealth services are responsible for complying with specific standards. See rule for teledentistry/telehealth services requirements for providers.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

See rule for requirements for providers billing behavioral health services.

SOURCE: OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health). (Accessed Dec. 2024).

School Based Health Services

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

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;
The school medical provider meets the following privacy and security standards (see regulation)

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.

For school-based telehealth service claims:

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

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Dec. 2024).

CCOs shall ensure that member choice and accommodation for telemedicine or telehealth shall encompass the following standards and services:

CCOs shall ensure that providers unable to offer in-person services have access to the CCO Provider Directory.
CCOs shall ensure that providers unable to offer in-person services inform the CCO upon referring a member to another provider in accordance with the requirements set forth in OAR 410-120-1990 so the CCO can provide any care coordination services necessary to support the member in accessing care.
CCOs shall ensure that providers offer meaningful access to telemedicine/telehealth services by completing a capacity assessment of members in the use of specific approved methods of telemedicine or telehealth delivery that comply with accessibility standards including alternate formats, and provides the optimal quality of care for the member given considerations of member access to necessary devices, access to a private and safe location, adequate internet, digital literacy, cultural appropriateness of telemedicine or telehealth services, and other considerations of member readiness to use telemedicine or telehealth;
CCOs shall ensure that providers offer meaningful access to health care services for members and their families who experience LEP or hearing impairments by working with qualified or certified health care interpreters to provide language access services as described in OAR 333-002-0040. Such services shall not be significantly restricted, delayed, or inferior as compared to programs or activities provided to English proficient individuals;
CCOs shall ensure that providers collaborate with members to identify modalities for delivering health care services which best meets the needs of the member and considers the member’s choice and readiness for the modality of service selected.

…

CCOs shall provide reimbursement for telemedicine or telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) as defined in OAR 950-050-0010 for interpretation services provided using telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the CCOs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the CCO contract. Administrative rules and CCO Direct Agreements do not supersede any federal or state requirements with regard to the provision and coverage of health care interpreter services.

SOURCE: OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telemedicine and Telehealth Delivered Health Service and Reimbursement Requirements. (Accessed Dec. 2024).

Dental Care Benefits for Pregnant Individuals

Pregnant members shall be seen, treated in person or via teledentistry for an OHP-covered service within the following time frames:

For emergency dental care: within 24 hours;
For urgent dental care: within one week.
For routine dental care: within four weeks, unless there is a documented special clinical reason that would make access longer than four weeks appropriate;
For initial dental screening or examination: four weeks.

Additional Dental Services are available to pregnant members if authorized as medically/Dentally Necessary due to the pregnancy. See regulation for more details.

SOURCE: OAR 410-123-1510, Health Systems Division: Medical Assistance Programs, Dental/Denturist Services. (Accessed Dec. 2024).

Behavioral Health Treatment Intake, Assessment and Service Planning

All providers shall develop and implement written service delivery policies and specific procedures for office- based, community-based and telehealth services and supports compliant with these rules, to be made available to individuals and family members upon request (see rule for minimum requirements).

SOURCE: OAR 309-019-0110, Health Systems Division: Medical Assistance Programs, Outpatient Behavioral Health Services. (Accessed Dec. 2024).

ELIGIBLE SITES

There is no limitation on the location of the client or member;

Providers may be located in any location where privacy can be ensured;

Persons providing interpretive services and supports shall be in any location where member privacy and confidentiality can be ensured.

[slight variation between sections cited below.]

The Authority shall only pay for telemedicine or telehealth services meeting all of the following requirements:

Services provided shall be medically and clinically appropriate for covered conditions within the Health Evidence Review Commission’s (HERC) prioritized list and in compliance with relevant guideline notes;
The Authority shall provide reimbursement for telemedicine or telehealth services at the same reimbursement rate as if it were provided in person. As a condition of reimbursement, providers shall agree to reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided using telemedicine or telehealth at the same rate as if interpretation services were provided in-person, per OARs 410-141-3515(12) and 410-141-3860(12).
When allowed by individual certification or licensing board’s scope of practice standards, telemedicine or telehealth delivered services for covered conditions are covered:
- When an established relationship exists between a provider and client or member defined as a client or member who has received in-person professional services from the physician or other qualified health care professional within the same practice within the past three years; and
- For establishing a client or member-provider relationship.
All physical and behavioral telemedicine or telehealth, and oral teledentristy services except School Based Health Services (SBHS) shall include Place of Service code 02 when the client or member is located in a place other than their home. When the client or member is located in their home, the claim shall include Place of Service code 10.
All claim types except Dental services, shall include modifier 95 when the telemedicine or telehealth delivered service utilizes a real-time interactive audio and video telecommunication system. When provision of the same service utilizes a real-time interactive audio only, the claim should include modifier 93.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

The authority shall include the costs of telemedicine services in its rate assumptions for payments made to clinics or other providers on a prepaid capitated basis.

SOURCE: OR Statute Ch. 414.723, (Accessed Dec. 2024).

School-Based Health Services required by the Individuals Disabilities Education Act (IDEA), Section 504 Plan, under the Rehabilitation Act of 1973, or any other documented individualized health or behavioral health plan or as otherwise determined medically necessary provided in school programs and settings provided to eligible children in their education program settings by public education enrolled providers billing for these services to Medicaid are exempt from the following sections of this rule. See Chapter 410, Division 133 for School-Based Health Services Oregon Administrative Rules.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

GEOGRAPHIC LIMITS

Medical Assistance Benefits: Out of State Services

The division may not provide any payments for items or services to any financial institution or entity located outside of the United States pursuant to 1902(a)(80) of the Social Security Act.

This provision also prohibits payments to telemedicine providers and pharmacies located outside of the United States.

SOURCE: OR OAR 410-120-1180 Health Systems Division: Medical Assistance Programs Chapter 10. (Accessed Dec. 2024).

FACILITY/TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Oct. 1, 2024 Prioritized List of Health Services, p. AD-2. (11/19/24). (Accessed Dec. 2024).

Costs for telehealth technologies used to provide SBHS are included in the cost for each service discipline and are not billed separately.

SOURCE: OR OAR 410-133-0245 Health Systems Division: Medical Assistance Program – Chapter 410. (Accessed Dec. 2024).

Last updated 12/12/2024

Miscellaneous

CCOs shall ensure that network providers offering telemedicine or telehealth services, must meet the following requirements:

Provide services using telehealth that are within their respective certification or licensing board’s scope of practice and comply with telemedicine or telehealth requirements including but not limited to:
- Documenting patient and provider agreement of consent to receive services;
- Allowed physical locations of provider and patient;
- Establishing or maintaining an appropriate provider-patient relationship.
Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the member in connection with the telemedicine or telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act)) except as noted in section (11) of this rule;
Obtaining and maintaining technology used in telemedicine/telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (b) except as noted in section (11) of this rule;
Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting as described in OAR 943-014-0440;
Maintaining clinical and financial documentation related to telemedicine or telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410;
Complying with all federal and state statutes as required in OAR 410-120-1380.

Providers must also ensure services are within their respective certification or licensing board’s scope of practice and comply with telehealth requirements. See rules for details.

SOURCE: OAR 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement Requirements. (Accessed Dec. 2024).

Teledentistry

Providers billing for covered teledentistry/telehealth services are responsible for the following:

Complying with Health Insurance Portability and Accountability Act (HIPAA) and Oregon Health Authority (Authority) Confidentiality and Privacy Rules and security protections for the patient in connection with the telemedicine communication and related records. See OAR 410-120-1990;
Obtaining and maintaining technology used in the telehealth communication that is compliant with privacy and security standards in HIPAA and Department Privacy and Confidentiality Rules described in subsection (5)(b)(A) of this rule;
Ensuring policies and procedures are in place to prevent a breach in privacy or exposure of member health information or records (whether oral or recorded in any form or medium) to unauthorized individuals;
Maintaining clinical and financial Documentation related to telehealth services as required in OARs 410-120-1360 and 410-120-1990.

The member’s chart Documentation shall reflect notification of the right to interactive communication with the distant site dentist;

A member may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

Network Adequacy

MCEs shall have an access plan that establishes a protocol for monitoring and ensuring access, outlines how provider capacity is determined, and establishes procedures for monthly monitoring of capacity and access and for improving access and managing access in times of reduced participating provider capacity. The access plan and associated monitoring protocol shall address the following: …

The availability of telemedicine within the MCE’s contracted provider network.

SOURCE: OAR 410-141-3515 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Network Adequacy. (Accessed Dec. 2024).

“Meaningful access” means client or member-centered access reflecting the following statute and standards:

Pursuant to Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the corresponding Federal Regulation at 45 CFR Part 92 and The Americans with Disabilities Act (ADA), providers’ telemedicine or telehealth services shall accommodate the needs of individuals who have difficulty communicating due to a medical condition, who need accommodation due to a disability, advanced age or who have Limited English Proficiency (LEP) including providing access to auxiliary aids and services as described in 45 CFR Part 92;
National Culturally and Linguistically Appropriate Services (CLAS) Standards at https://thinkculturalhealth.hhs.gov/clas/standards; and
As applicable to the client or member, Tribal based practice standards: https://www.oregon.gov/OHA/HSD/AMH/Pages/EBP.aspx;

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions & 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, (Accessed Dec. 2024).

“Face to Face” means a personal interaction where both words can be heard and facial expressions can be seen in person or through telehealth services where there is a live streaming audio and video, if medically appropriate.

SOURCE: OAR 410-172-0600 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services. (Accessed Dec. 2024).

Medical Assistance Benefits: Out of State Services

The division may not provide any payments for items or services to any financial institution or entity located outside of the United States pursuant to 1902(a)(80) of the Social Security Act.

This provision also prohibits payments to telemedicine providers and pharmacies located outside of the United States.

SOURCE: OR OAR 410-120-1180 Health Systems Division: Medical Assistance Programs Chapter 10. (Accessed Dec. 2024).

Health Professional Student Clinical Training

“Patient” means an individual who is seeking care, guidance or treatment options at a clinical or other service location, or from a health professional or health-related professional as defined in these rules, via telehealth.

SOURCE: 409-030-0110, Oregon Health Authority, Health Systems Division: Health Professional Student Clinical Training (Accessed Dec. 2024).

Last updated 12/12/2024

Out of State Providers

A provider located in a state other than Oregon whose services are rendered in that state shall be licensed and otherwise certified by the proper agencies in the state of residence as qualified to render the services. Certain cities within 75 miles of the Oregon border may be closer for Oregon residents than major cities in Oregon, and therefore, these areas are considered contiguous areas, and providers are treated as providing in-state services.

Reimbursement and services outside the territorial limits of the United states:

For purposes of this provision, the United States includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa;
The division may not provide any payments for items or services to any financial institution or entity located outside of the United States pursuant to 1902(a)(80) of the Social Security Act.

This provision also prohibits payments to telemedicine providers and pharmacies located outside of the United States.

SOURCE: OAR 410-120-1180, (Accessed Dec. 2024).

The Authority may expand network capacity through remote care and telemedicine, or telehealth services provided across state lines.

SOURCE: OR OAR 410-120-1990 (Accessed Dec. 2024).

Last updated 12/12/2024

Overview

OR Health Authority covers telehealth and telemedicine services. The definitions of which encompass video conferencing, store-and-forward imaging, streaming media including services with information transmitted via landlines, and wireless communications, including the Internet and telephone networks. Services must be culturally and linguistically appropriate.

Last updated 12/12/2024

Remote Patient Monitoring

POLICY

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute 414.723. (Accessed Dec. 2024).

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to: …

Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this general rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio without video, client or member portal and may include remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions; OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan and 410-120-1990 [slight variations exist], (Accessed Dec. 2024).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Last updated 12/12/2024

Store and Forward

POLICY

Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Sec. 414.723, (Accessed Dec. 2024).

Clinician-to-Clinician Consultations (telephonic, online or using electronic health record)

Covered interprofessional consultations delivered online, through electronic health records or by telephone (CPT 99446-99449, 99451-99452).

Store and forward codes (HCPCS G2010, G2250) are only covered when billed concurrently with a code that includes medical decision making and communication with the patient (for example, HCPCS G2012).

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Oct. 1, 2024 Prioritized List of Health Services, p. AD-3. (11/19/24). (Accessed Dec. 2024).

Behavioral Health Services:

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: 410-172-0850 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Dec. 2024).

Teledentistry

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to: …

Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time.

When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

A member may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions; OAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements[slight variations exist] & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Dec. 2024).

ELIGIBLE SERVICES/SPECIALTIES

HERC prioritized list indicate interprofessional consultation codes through EHRs are reimbursable.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Oct. 1, 2024 Prioritized List of Health Services, p. AD-2. (11/19/24). (Accessed Dec. 2024).

Teledentistry

Teledentistry includes store and forward. See teledentistry section cited in previous section.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

Intent to Submit a State Plan Amendment:

SOURCE: Oregon Health Authority, Public Notice, July 31, 2024, (Accessed Dec. 2024).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Oct. 1, 2024 Prioritized List of Health Services, p. AD-2. (11/19/24). (Accessed Dec. 2024).

Professional Requirements

Last updated 12/12/2024

Cross State Licensing

A person may not engage in the practice of medicine across state lines, claim qualification to engage in the practice of medicine across state lines or use any title, word or abbreviation to indicate or to induce another to believe that the person is licensed to engage in the practice of medicine across state lines unless the person is licensed in accordance with ORS 677.139 (License to practice medicine across state lines).

ORS 677.135 (“Practice of medicine across state lines” defined for ORS 677.135 to 677.141) to 677.141 (Responsibilities) do not apply to a physician or physician assistant engaging in the practice of medicine across state lines in an emergency, as defined by rule of the Oregon Medical Board.

- Consults with another physician or physician assistant licensed to practice medicine in this state; and
- Does not undertake the primary responsibility for diagnosing or rendering treatment to a patient within this state.

ORS 677.135 (“Practice of medicine across state lines” defined for ORS 677.135 to 677.141) to 677.141 (Responsibilities) do not apply to a licensed physician or physician assistant located outside this state who has an established physician-patient relationship with a person who is in Oregon temporarily and who requires the direct medical treatment by that physician or physician assistant.

SOURCE: OR Revised Statutes Annotated Sec. 677.137 (Accessed Dec. 2024).

Upon application, the Oregon Medical Board may issue to an out-of-state physician or physician assistant a license for the practice of medicine across state lines if the physician or physician assistant holds a full, unrestricted license to practice medicine in any other state of the United States, has not been the recipient of a professional sanction by any other state of the United States and otherwise meets the standards for Oregon licensure under this chapter.

In the event that an out-of-state physician or physician assistant has been the recipient of a professional sanction by any other state of the United States, the board may issue a license for the practice of medicine across state lines if the board finds that the sanction does not indicate that the physician or physician assistant is a potential threat to the public interest, health, welfare and safety.

A physician or physician assistant shall apply on a form provided by the board, accompanied by nonrefundable fees for the application and the license in amounts determined by rule of the board. The board shall adopt necessary and proper rules to govern the renewal of licenses issued under this section.

A license for the practice of medicine across state lines is not a limited license for purposes of ORS 677.132 (Limited license).

A license for the practice of medicine across state lines does not permit a physician or physician assistant to practice medicine in this state except when engaging in the practice of medicine across state lines.

SOURCE: OR Revised Statutes Annotated Sec. 677.139. (Accessed Dec. 2024).

A telemedicine licensee is subject to all the provisions of the Medical Practice Act (ORS Chapter 677), and to all the administrative rules of the Oregon Medical Board.

A telemedicine licensee has the same duties and responsibilities and is subject to the same penalties and sanctions as any other physician or physician associate licensed under ORS Chapter 677, including but not limited to the following:

The telemedicine licensee must establish an appropriate provider-patient relationship;
The telemedicine licensee must make a judgment based on some type of objective criteria upon which to diagnose, treat, correct, or prescribe;
The telemedicine licensee must engage in all necessary practices that are in the best interest of the patient; and
The telemedicine licensee must provide for an acceptable continuity of care for patients, including follow-up care, information, and documentation of care provided to the patient or suitably identified care providers of the patient.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Dec. 2024).

“The practice of medicine across state lines” means:

The rendering directly to a person of a written or otherwise documented medical opinion concerning the diagnosis or treatment of that person located within Oregon for the purpose of patient care by a physician, physician assistant, or physician associate located outside Oregon as a result of the transmission of individual patient data by telemedicine as defined in Oregon Laws 2022, chapter 45, section 14, from within Oregon to that physician, the physician’s agent, physician assistant, or physician associate outside Oregon; or

The rendering of medical treatment directly to a person located within Oregon by a physician, physician assistant, or physician associate located outside Oregon as a result of the outward transmission of individual patient data by telemedicine as defined in Oregon Laws 2022, chapter 45, section 14, from within this state to that physician, the physician’s agent, a physician assistant, or physician associate outside the state.

SOURCE: OR Admin. Rules, 847-025-0010. (Accessed Dec. 2024).

A license to practice across state lines is not required of a physician, physician assistant, or physician associate:

Engaging in the practice of medicine across state lines in an emergency; or
Located outside this state who consults with another physician or physician associate licensed to practice medicine in this state, and who does not undertake the primary responsibility for diagnosing or rendering treatment to a patient in Oregon;
Located outside the state and who has an established provider-patient relationship with a patient who is in Oregon temporarily for the purpose of business, education, vacation, or work and who requires the direct medical treatment by that physician, physician assistant, or physician associate.
Located outside the state and who has an established provider-patient relationship with a patient located in Oregon who requires temporary or intermittent follow-up care.

A physician, physician assistant, or physician associate who is located outside this state and practices medicine as described in section (1) of this rule is subject to ORS chapter 677 and rules adopted pursuant to ORS chapter 677, including but not limited to the disciplinary authority of the Board, while or as a result of practicing medicine as described in section (1) of this rule.

SOURCE: OR Admin. Rules, 847-025-0020. (Accessed Dec. 2024).

A license for the practice of medicine across state lines does not permit a telemedicine licensee to practice medicine in the state of Oregon except when engaging in the practice of medicine across state lines.

A license to practice medicine across state lines is not a limited license per ORS 677.132 or ORS 677.535.

A telemedicine licensee must not:

Act as a dispensing physician as described in ORS 677.010(5) or dispensing physician associate as described in ORS 677.511;
Prescribe controlled substances for the management of chronic pain to a person located in Oregon;
Provide written documentation for purposes of ORS 475C.783;
Employ a physician associate as defined in ORS 677.495 to treat a person located within Oregon;
Assert a lien for services under ORS 87.555;
Act as a supervising physician of an Oregon-certified First Responder or Emergency Medical Technician as defined in ORS 682.245;
Be eligible for any tax credit provided by ORS 316.076;
Participate in the Rural Health Services Program under 442.550 to 442.570; or
Prescribe medication based only on a sale or form over the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in ORS 677.095 and 677.265 is met.

SOURCE: OR Admin. Rules, 847-025-0030. (Accessed Dec. 2024).

To qualify for a license to practice medicine across state lines:

An applicant must hold a full, unrestricted license to practice medicine in another state, must not have been the recipient of a previous disciplinary or other action by any other state or jurisdiction and must otherwise meet the standards of licensure under ORS chapter 677.
An applicant who meets the qualifications for a license to practice medicine across state lines with the exception of being the recipient of previous disciplinary or other action by another state or jurisdiction may be issued a license for the practice of medicine across state lines if the Board finds that the previous disciplinary or other action does not indicate that the applicant is a potential threat to the public interest, health, welfare and safety of the citizens of the state of Oregon.
An applicant does not qualify for a license to practice medicine across state lines if the applicant is the subject of a pending investigation by a state medical board or another state or federal agency.

SOURCE: OR Admin. Rules, 847-025-0040. (Accessed Dec. 2024).

Oregon medical board requires a ‘Telemedicine Active’ license to practice medicine across state lines.

SOURCE: OR Practice of Medicine Across State Lines (Telemedicine) Practice Description Form. Revised 6/2024, (Accessed Dec. 2024).

Do I need an Active Oregon license if I am an Out-of-State-Physician providing service for Oregon patients with no patient contact (i.e., Teleradiology, Telemedicine, Pathologist, Telemonitoring)?
See requirements below:

Pathology: NO
Teleradiology: NO
Telemedicine: YES
Telemonitoring: YES

SOURCE: OR Medical Board. Application Process. FAQs. (Accessed Dec. 2024).

An active or telehealth licensed doctor of optometry in Oregon who volunteers to provide professional services to a charitable nonprofit corporation may request the additional practice location license required for that location from the Board at no charge.

SOURCE: OR Admin Rules, 852-050-0021. (Accessed Dec. 2024).

Each active and telehealth licensee must notify the Board in writing of each place of practice before engaging in practice at that location. If the licensee is practicing in a mobile facility or with a portable unit, the licensee must report the Base of Operations and specific locations of such practice to the Board in compliance with this rule. Telehealth licensees must notify the Board of any distant site locations including websites, applications and other virtual sites or online platforms.

SOURCE: OR Admin Rules, 852-050-0016, (Accessed Dec. 2024).

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Dec. 2024).

Last updated 12/12/2024

Definitions

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, through the use of a variety of electronic and telecommunications technologies, to a patient at a remote location staffed by a pharmacy technician.

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The remote location at which a patient receives pharmacy services through the use of telepharmacy must be affiliated with the pharmacy where the pharmacist providing the pharmacy services through telepharmacy regularly engages in the practice of pharmacy.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

Regarding remote supervision of a pharmacy technician in order to facilitate the use of telepharmacy; and
Describing the pharmacy services that a pharmacist may provide through telepharmacy.

SOURCE: OR Revised Statutes 689.700, (Accessed Dec. 2024).

Health Care Provider Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin. Rules 409-036-0010. (Accessed Dec. 2024).

Community Treatment and Support Services

“Telehealth” means a technological solution that provides two-way, video-like communication on a secure line.

SOURCE: OR Admin. Rules. 309-032-0860. (Accessed Dec. 2024).

Health Planning

“Telemedicine” means the provision of health services to patients by physicians and health care practitioners from a distance using electronic communications.

SOURCE: OR Revised Statutes 442.015(26). (Accessed Dec. 2024).

Board of Chiropractic Examiners

“Telehealth” means a variety of methods, through the use of electronic and telecommunications technologies, for the distance delivery of health care services, including chiropractic services, excluding in-person services, and clinical information designed to improve the health status of a patient, and to enhance delivery of the health care services and clinical information.

SOURCE: OR Admin. Rules 811-015-0066. (Accessed Dec. 2024).

Physical Therapy

“Telehealth service” means a physical therapy intervention, including assessment or consultation, that can be safely and effectively provided using synchronous two-way interactive video conferencing, or asynchronous video communication, in accordance with generally accepted healthcare practices and standards. For purposes of these rules, “telehealth service” also means, or may be referred to, as “telepractice, teletherapy, or telerehab.”

SOURCE: OR Administrative Rule, Sec. 848-040-0100(13). (Accessed Dec. 2024).

Occupational Therapy

“Telehealth” is defined as the use of interactive audio and video, in real time telecommunication technology or store-and-forward technology, to deliver health care services when the occupational therapy practitioner and patient/client are not at the same physical location. Its uses include diagnosis, consultation, treatment, prevention, transfer of health or medical data, and continuing education.

SOURCE: OR Admin. Code 339-010-0006(1) (Accessed Dec 2024).

Teleoptometry

“Telehealth” means the use of electronic and telecommunications technologies, including remote patient monitoring devices and store and forward technology, to support delivery of optometric clinical health care services.

“Telehealth” does not include electronic mail communication, facsimile transmission or audio-only telephone communication between a licensed optometrist and a patient, or the use of an automated computer program or managed website to diagnose or treat ocular or refractive conditions.

“Telemedicine” means the delivery of optometric clinical health care services to a patient by a licensed optometrist through telehealth.

SOURCE: OR Revised Statutes 683.230. (Accessed Dec. 2024).

“Telehealth” is the electronic delivery of optometry care across state lines that complies with the requirements of ORS 683.010 through 683.990 and OAR Chapter 853. Telehealth may include phone applications, online systems, remote patient monitoring devices, 2 way audio, visual or other telecommunications or electronic communications.

SOURCE: OAR 852-001-0002. Board of Optometry, Procedural Rules, Definitions. (Accessed Dec. 2024).

As used in this section, “telemedicine” means the practice of medicine and provision of health care services to a patient by a physician or physician associate from a distance using electronic communications, including synchronous technologies to facilitate an exchange of information between a patient and physician or physician associate in real time or asynchronous technologies to facilitate an exchange of information between a patient and a physician or physician associate in other than real time.

SOURCE: OR Revised Statutes Chapter 677.494, (Accessed Dec. 2024).

Dentistry

“Teledentistry” is defined as the use of information technology and telecommunications to facilitate the providing of dental primary care, consultation, education, and public awareness in the same manner as telehealth and telemedicine.

SOURCE: OR Revised Statutes 818-001-0002(17). (Accessed Dec. 2024).

Last updated 12/12/2024

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Dec. 2024).

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

Last updated 12/12/2024

Miscellaneous

Telemonitoring Registration

Telemonitoring is the intraoperative monitoring of data collected during surgery and electronically transmitted to a physician who practices in a location outside of Oregon via a telemedicine link for the purpose of allowing the monitoring physician to notify the operating team of changes that may have a serious effect on the outcome or survival of the patient. The monitoring physician is in communication with the operation team through a technician in the operating room.

The facility where the surgery is to be performed must be a licensed hospital or ambulatory surgical center licensed by the Department of Human Services, must grant medical staff membership and/or clinical privileges to the monitoring physician, and must request the Board grant Telemonitoring active status to the monitoring physician to perform intraoperative telemonitoring on patients during surgery.

(3) Physicians granted Telemonitoring active status must register and pay a biennial active registration fee.

(4) The physician with Telemonitoring active status desiring to have active status to practice in Oregon must submit the reactivation application and fee and satisfactorily complete the reactivation process before beginning active practice in Oregon.

SOURCE: OR Admin. Rules. 847-008-0023. (Accessed Dec. 2024).

Optometry

Telehealth optometrists are subject to all of the provisions of the Oregon optometry law and rules and must meet the same standard of care.

Telehealth prescriptions may only be issued on an initial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine services.

SOURCE: OAR 852-020-0050. (Accessed Dec. 2024).

Scope of School Psychologist

The School Psychologist and Professional School Psychologist License authorizes the holder to perform the following duties:

Provide telemental health supports and services for behavioral and mental health, as trained.

SOURCE: OAR 584-245-0200 Teacher Standards and Practices Commission, Personnel Service Licenses. (Accessed Dec. 2024).

Occupational Therapy Licensing Board Supervision

“Routine supervision” requires the supervisor to have direct contact in person at least every two weeks at the work site or via telehealth as defined in OAR 339-010-0006(9) with interim supervision occurring by other methods, such as telephone or written communication;

“General supervision” requires the supervisor to have at least monthly direct contact in person with the supervisee at the work site or via telehealth as defined in OAR 339-010-0006(9) with supervision available as needed by other methods.

SOURCE: OAR 339-010-0005. (Accessed Dec. 2024).

Supervision of Occupational Therapy Assistants under 339-010-0035 for routine and general supervision, can be done through telehealth, but cannot be done when close supervision as defined in 339-010-0005 is required. The same considerations in (7)(A) through (F) must be considered in determining whether telehealth should be used.

SOURCE: OAR 339-010-0006. (Accessed Dec. 2024).

Opioid Use Disorder Medication Grant Program

Moneys awarded to grant recipients under section 83 of this 2024 Act may be used to:

Provide medication, telemedicine or any other reasonable treatment to persons in custody with an opioid use disorder.

SOURCE: House Bill 4002 (2024 Session), (Accessed Dec. 2024).

The Broadband Advisory Council: One representative must represent telehealth.

SOURCE: House Bill 4040 (2024 Session), (Accessed Dec. 2024).

Continuing Education Requirements – Naturopaths

Professional Development: limited to (2) hours of general education annually, structured program for physicians and health care professionals with course curriculum that includes at least one of the following topic areas:

Best practices for ensuring patient confidentiality and public safety in the digital clinic environment, effective charting, records access and transparency, record management, incorporating telemedicine in primary care.

SOURCE: 850-040-0210. (Accessed Jul. 2024).

Last updated 12/12/2024

Online Prescribing

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

Regarding remote supervision of a pharmacy technician in order to facilitate the use of telepharmacy; and
Describing the pharmacy services that a pharmacist may provide through telepharmacy.

SOURCE: OR Revised Statutes 689.700, (Accessed Dec. 2024).

“Telepharmacy” means the delivery of pharmacy services by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician or Pharmacy Technician.

“Telepharmacy system” means a system of telecommunications technologies that enables monitoring, documenting, and recording of the delivery of pharmacy services at a remote location by an electronic method which must include the use of audio and video, still image capture, and store and forward.

See rule for telepharmacy regulations.

SOURCE: OAR 855-139-0005. (Accessed Dec. 2024).

Remote Dispensing Site Pharmacy

A location in Oregon where the practice of pharmacy occurs by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician must be registered by the board in Oregon as a Retail Drug Outlet RDSP.

SOURCE: OAR 855-139-0010. (Accessed Dec. 2024).

Non-Resident Affiliated Pharmacies

A non-resident pharmacy includes a RDSP Affiliated Pharmacy located outside of Oregon and providing pharmacy services through a telepharmacy system to a Retail Drug Outlet RDSP located in Oregon.

Each non-resident RDSP Affiliated Pharmacy must be registered with the Oregon Board of Pharmacy.

To qualify for registration under these rules, every non-resident RDSP Affiliated Pharmacy must be registered and in good standing with the Board of Pharmacy in the pharmacy’s state of residence.

Each out-of-state non-resident RDSP Affiliated Pharmacy must designate an Oregon licensed Pharmacist-in-Charge (PIC), who is responsible for all pharmacy services and to provide supervision and control of the RDSP. To qualify for this designation, the person must:

Hold a license to practice pharmacy in the resident state;
Be normally working for the RDSP Affiliated Pharmacy a minimum of 20 hours per week;
Annually complete a self-inspection using the board’s RDSP Self-Inspection Form prior to July 1; and
Provide the PIC self-inspection report as requested by the board.

Every non-resident RDSP Affiliated Pharmacy will have a Pharmacist-in-Charge (PIC) who is licensed in Oregon prior to initial registration of the RDSP.

The PIC must comply with the requirements of OAR 855-115-0210.

SOURCE: OAR 855-139-0030. (Accessed Dec. 2024).

The Oregon licensed Pharmacist-in-charge of the RDSP Affiliated Pharmacy is responsible for all operations at the RDSP including responsibility for the telepharmacy system and enforcing policies and procedures.

SOURCE: OAR 855-139-0050. (Accessed Dec. 2024).

Technology

A RDSP and its RDSP Affiliated Pharmacy must:

Utilize a shared telepharmacy system and have appropriate technology or interface to allow access to information required to process and fill a prescription drug order;
Use still image capture or store and forward for verification of prescriptions with a camera that is of sufficient quality and resolution so that the Oregon licensed Pharmacist from the RDSP Affiliated Pharmacy can visually identify each

Please see rule for additional requirements.

SOURCE: OAR 855-139-0205. (Accessed Dec. 2024).

Chiropractic Physician

The use of telehealth as described in subsection (2) of this section is not an expansion of the scope of practice of chiropractic physicians. The use of telehealth establishes a doctor-patient relationship.

SOURCE: OAR 811-015-0066. (Accessed Dec. 2024).

Rules for Practice Across State Lines

A telemedicine licensee is subject to all the provisions of the Medical Practice Act (ORS Chapter 677), and to all the administrative rules of the Oregon Medical Board.

The telemedicine licensee must establish an appropriate provider-patient relationship;
The telemedicine licensee must make a judgment based on some type of objective criteria upon which to diagnose, treat, correct, or prescribe;
The telemedicine licensee must engage in all necessary practices that are in the best interest of the patient; and
The telemedicine licensee must provide for an acceptable continuity of care for patients, including follow-up care, information, and documentation of care provided to the patient or suitably identified care providers of the patient.

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Dec. 2024).

Optometry

“Telehealth prescription” may only be issued on an intial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine.

Note: The word ‘initial’ seems to be misspelled in official regulation.

SOURCE: OAR 852-001-0002. (Accessed Dec. 2024).

A physician licensed under ORS 677.100 to 677.228, a physician associate licensed under ORS 677.505 to 677.525 or a physician or physician associate licensed under ORS 677.139 may use telemedicine to engage in the practice of medicine and provide health care services, including the establishment of a provider-patient relationship, the diagnosis or treatment of a medical condition or the prescription of drugs, to a patient physically located in this state. The physician or physician associate is not required to be physically located in this state when engaging in the practice of medicine and providing health care services through telemedicine.

The practice of medicine using telemedicine occurs where the patient is physically located.

SOURCE: OR Revised Statutes Chapter 677.494, (Accessed Dec. 2024).

A telemedicine licensee [physicians practicing medicine across state lines] must not:

Act as a dispensing physician as described in ORS 677.010(5) or dispensing physician associate as described in ORS 677.511;
Prescribe controlled substances for the management of chronic pain to a person located in Oregon;
Provide written documentation for purposes of ORS 475C.783;
Employ a physician associate as defined in ORS 677.495 to treat a person located within Oregon;
Assert a lien for services under ORS 87.555;
Act as a supervising physician of an Oregon-certified First Responder or Emergency Medical Technician as defined in ORS 682.245;
Be eligible for any tax credit provided by ORS 316.076;
Participate in the Rural Health Services Program under 442.550 to 442.570; or
Prescribe medication based only on a sale or form over the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in ORS 677.095 and 677.265 is met.

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Dec. 2024).

Last updated 12/12/2024