Skip to main content

North Dakota

States

Click here to download the COVID-19 Virtual Visit & Reimbursement Guide for North Dakota

Medicaid Policies

TELEHEALTH DEFINITION: “The use of interactive audio-video equipment to link practitioners and patients at different sites.” Qualified services must maintain visual contact, be medically appropriate and necessary, and use HIPAA compliant technology

SERVICE PARITY: “An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.”

PAYMENT PARITY: “Payment or reimbursement of expenses for covered health services delivered by means of telehealth under this section may be established through negotiations conducted by the insurer with the health services providers in the same manner as the insurer with the health services providers in the same manner as the insurer establishes payment or reimbursement of expenses for covered health services that are delivered by in-person means.”

NON-COVERED SERVICES: Therapies provided in a group setting, Store and Forward, Targeted Case Management for High Risk Pregnant Women and Infants, Targeted Case Management for Individuals in need of Long-Term Care Services

REMOTE MONITORING: Reimbursed only in certain cases of Home Health Telemonitoring

  • Telemonitoring is not allowed for the initial Home Health evaluation visit or for the discharge visit. Limited to no more than forty percent (40%) of the total visits during each certification period.

FQHCs and RHCs: 

  • FEE FOR SERVICE REIMBURSEMENT STRUCTURE
  • Payment to FQHCs for covered services furnished to ND Medicaid members is made by means of an all-inclusive rate for each encounter. Each encounter includes covered services and supplies. Telemedicine services are billing using Modifier GT & 95, revenue code 0780, HCPCS Q3014, and POS code 02.

OTHER ND MEDICAID POLICIES:

  • Payment made to only to the provider at distant site
  • Payment made to originating site as a facility fee
  • No payment for additional technology support personnel
  • NO reimbursement for store-and-forward
  • Synchronous teledentistry reimbursable “when applicable”
  • IHS and Tribal 638 Facilities:
    • Telemedicine services are reimbursed at all-inclusive rate regardless of whether the originating site is outside the physical facility/clinic
    • Coverage/payment is on the same basis as face-to-face contact

Temporary COVID-19 Policies (ND Medcaid)

NEWLY ELIGIBLE SERVICES: Telephone services & therapy provided in a group setting (cannot be audio-only)

OTHER ND MEDICAID TEMPORARY POLICIES:

“Right Track” program within the Developmental Disabilities Division: screenings can be done via phone or secure videoconferencing

There will be no penalties for using non-HIPAA compliant technology

Services provided via telehealth must be eligible for reimbursement under North Dakota Medicaid

  • Contact can be audio-only (change from permanent policy)

No originating site fee may be billed if the originating site is the patient’s home

Teledentistry

  • No penalties for using non HIPAA-compliant technology
  • COVERED SERVICES: Patient contact with dentist who provides the problem focused evaluation using audio and visual means
  • NON-COVERED SERVICES: screening code D0190, dental case management (D9992), examinations via email (not audio/visual), patient contact with dentist via audio only, virtual check-in

FQHCs and RHCs temporary: 

  • FEE FOR SERVICE REIMBURSEMENT STRUCTURE
  • Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site.
  • When providing telemedicine services to patients located in their homes or another facility during the COVID-19 public health emergency, FQHCs and RHCs should continue to bill revenue codes 521, 524, 525, or 529 along with the CPT or HCPCS code for the service rendered appended with modifier GT or 95.
  • If a non-HIPAA compliant platform is used, or the service is being provided telephonically with audio only, condition code DR should be populated in field 18 of the UB04 or the electronic equivalent.
  • Still non-covered services include store and forward, virtual check-in, e-visits.


Commercial Payer Policies

TELEHEALTH DEFINITION: “the use of interactive audio, video, or other telecommunications technology… [and] the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real time or through the use of store-and-forward technology.” Telehealth does not include audio-only, email, or fax.

SERVICE PARITY: Insurers may not offer policies unless the policy “ provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means."

PAYMENT PARITY: Payment/reimbursement for a telehealth service must be established “in the same way” as it would be for the same in-person, through negotiations with health care provider

Temporary COVID-19 Policies (ND Commercial Payers)

WAIVED REQUIREMENTS:

  • “Secure connection” provision suspended
  • “Audio-only” provision (barring use of audio-only telehealth) suspended

NEWLY ELIGIBLE SERVICES:

OTHER TEMPORARY ND COMMERCIAL PAYER POLICIES:


Medical Board Policies

TELEMEDICINE DEFINITION: “The practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider.  The term includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.”

PRESCRIBING:

  • Providers may prescribe via telemedicine within their scope of practice
  • Opioids may ONLY be prescribed through telemedicine if done so as a federal Food and Drug Administration approved medication assisted treatment for opioid use disorder.

Practitioners must be licensed in ND to practice telemedicine

  • Physician supervision for PAs must be ND licensed but do not need to be physically located in ND

A licensee (Physician or Physician Assistant) “shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient.”

Before initially diagnosing/treating a patient, an examination must be performed, which can be done via telemedicine

“In-person medical evaluation” may include one of the following … “The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.”

Telemedicine abortions are prohibited

North Dakota Professional Licensure Compacts

Interstate Medical Licensure Compact

Temporary COVID-19 Policies (ND Medical Board)

SUSPENDED REQUIREMENTS:

  • “Secured connection” provision (limiting types of technology able to be used in telemedicine)
  • “Audio only” provision (prohibiting audio-only telemedicine)

Licensing requirements suspended for: Nurse Practitioners, Pharmacists, Physicians and Surgeons (Ch 43-17, includes Physician Assistants), Psychologists, Occupational Therapists, Social workers, Respiratory care practitioners, Dieticians and Nutritionists, Addiction counselors, counselors, Clinical lab personnel, Marriage and family therapists, Integrative health care, Naturopaths, Medical imaging and radiation therapy, EMS 

  • Providers licensed in these professions in other states are able to provide health care and behavioral health services (including by means of telemedicine) for ND citizens


Mid-Level Providers

A Physician Assistant practicing telemedicine from another state is subject to the rules regarding physician supervision, expect supervision may be by a ND physician who is not physically located in ND

Physician Assistants can prescribe medications via telemedicine within their scope of practice

  • Opioids may ONLY be prescribed through telemedicine if done so as a federal Food and Drug Administration approved medication assisted treatment for opioid use disorder.

Nurse Practitioners have full independent practice authority & full independent prescriptive authority in North Dakota

A licensee (Physician or Physician Assistant) “shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient.”

Before initially diagnosing/treating a patient, an examination must be performed, which can be done via telemedicine

North Dakota Mid-Level Professional Licensure Compacts

Enhanced Nurse Licensure Compact

Advanced Practice Registered Nurse Compact

Temporary COVID-19 Policies (ND Mid-Levels)

SUSPENDED REQUIREMENTS:

  • “Secured connection” provision (limiting types of technology able to be used in telemedicine)
  • “Audio only” provision (prohibiting audio-only telemedicine)

Licensing requirements suspended for: Nurse Practitioners, Pharmacists, Physicians and Surgeons (Ch 43-17, includes Physician Assistants), Psychologists, Occupational Therapists, Social workers, Respiratory care practitioners, Dieticians and Nutritionists, Addiction counselors, counselors, Clinical lab personnel, Marriage and family therapists, Integrative health care, Naturopaths, Medical imaging and radiation therapy, EMS 

  • Providers licensed in these professions in other states are able to provide health care and behavioral health services (including by means of telemedicine) for ND citizens


Behavioral Health Providers

According to the Board Statement on Telepsychology in North Dakota: There is no special licensure status or credential within North Dakota for the practice of telepsychology. As a result, a psychologist licensed in North Dakota may be permitted to provide telepsychology services to recipients located either inside or outside North Dakota. When doing so, the psychologist must comply with the laws and regulations of a) North Dakota, including NDCC 43-32 and 43-51, b) the jurisdiction in which the psychologist is located, and c) the jurisdiction in which the recipient is located.

North Dakota Mental Health Professional Licensure Compacts

None 

Temporary COVID-19 Policies (ND Mental Health Providers)

SUSPENDED REQUIREMENTS:

  • “Secured connection” provision (limiting types of technology able to be used in telemedicine)
  • “Audio only” provision (prohibiting audio-only telemedicine)

Licensing requirements suspended for: Nurse Practitioners, Pharmacists, Physicians and Surgeons (Ch 43-17, includes Physician Assistants), Psychologists, Occupational Therapists, Social workers, Respiratory care practitioners, Dieticians and Nutritionists, Addiction counselors, Counselors, Clinical lab personnel, Marriage and family therapists, Integrative health care, Naturopaths, Medical imaging and radiation therapy, EMS 

  • Providers licensed in these professions in other states are able to provide health care and behavioral health services (including by means of telemedicine) for ND citizens
Close