Telemedicine in Indiana: Law, Policies, Rules, and Regulations

Posted by Michael Hsu on 6/20/20 10:53 AM
Michael Hsu

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Telemedicine is a well-established practice in the State of Indiana. Since the enactment of the state’s telemedicine parity law in 2015, both providers and patients have embraced remote healthcare services. 

In the past five years, the state has been actively working on increasing access to remote healthcare services and has provided detailed legal guidelines for providers who wish to practice telemedicine in the Hoosier State.

Let’s take a look at Indiana’s telemedicine laws, policies, rules, and regulations, so you can get a better idea of whether you’re eligible to start offering telemedicine services to patients in the state. 

Telemedicine Definitions under Indiana State Law

The State of Indiana enacted it’s telemedicine parity law in 2015 and has since made significant progress in updating its telemedicine laws and policies to improve access to remote healthcare services and incentivize providers to embrace telemedicine.

 

The Indiana Code (IN Code, 27-8-34 & 27-13-1-34) defines “telemedicine services” as healthcare services delivered through interactive audio, video, and other electronic means of communication. 

According to IN Admin. Code, telemedicine services include:

  1. Medical examinations and consultations
  2. Behavioral health, including substance abuse evaluations and treatment

The initial definition of telemedicine in the State of Indiana highlights the fact that telemedicine does not include:

  1. A telephone transmitter for transtelephonic monitoring
  2. A telephone consultation or any other means of communication for the consultation between two providers

Apart from providing the early definition of telemedicine in Indiana, the state’s parity law set forth legal guidelines for the coverage of telemedicine services by private payers, which are still in effect. 

Under Indiana law, accident and sickness insurance policies and individual/group contracts must provide coverage for telemedicine services under the same criteria that are applicable to in-person medical care. 

Indiana’s parity law also states that private payers cannot enforce a dollar maximum for telemedicine services. The same applies to deductibles and coinsurance amounts that are less favorable for covered individuals than those applied to the same services that are delivered in-person.

What’s interesting to note is that Indiana’s telemedicine parity law explicitly excludes dental and vision insurance.

Expanding the Definition of Telemedicine

With the enactment of the telemedicine parity law, the Hoosier State started the Indiana Telemedicine Pilot Program. The success of the program prompted Indiana’s legislators to further define telemedicine under the law and provide legal guidelines for telemedicine practice standards.

In July 2016, Gov. Mike Pence signed a new bill into law — House Act No. 1263. The Bill added a new chapter in The Indiana Code, revising the old definition of telemedicine services and defining standards of care for practitioners in the state. The amended definition of telemedicine provided by the new Bill is currently in effect. 

The State of Indiana now defines telemedicine as the use of electronic communication and information technology for the delivery of healthcare services between a provider at a distant site and a patient at an originating site. 

Under the new definition, telemedicine in Indiana includes:

  1. Secure videoconferencing 
  2. Interactive audio-using store-and-forward technology
  3. Remote patient monitoring (RPM) technology

Whereas the state’s first take on telemedicine excluded RPM and provider-to-provider consultations, practice has shown that remote patient monitoring and store-and-forward technology are necessary modalities. Including these telemedicine modalities was a huge step forward that greatly facilitated the delivery of remote healthcare services in the Hoosier State. 

That said, the practice of telemedicine in Indiana is still limited to live, two-way, audio-video communication. 

House Act 1263 emphasizes that the following forms of communication are not considered telemedicine:

  • Audio only communication
  • Telephone consultations 
  • Electronic mail
  • Instant messaging conversations 
  • Facsimile communication
  • Internet questionnaires
  • Internet consultations

Who Can Practice Telemedicine in Indiana?

What’s curious about Indiana is that it slightly deviates from the general rule of thumb regarding telemedicine eligibility. Rather than providing an exhaustive list of eligible providers, the State of Indiana lists all of the services that are not reimbursable.

Under Indiana law (Section 405 IAC 5-38-4), eligible providers who can offer remote healthcare services regardless of the distance between them and the patient include:

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Community mental health centers
  • Critical access hospitals
  • Providers, determined by the office to be eligible, offering one of the covered telemedicine services

To get a better understanding of which medical professionals fall under “providers” as defined by the Indiana Administrative Code, we have to take a close look at the eligible services. 

Reimbursable CPT codes in Indiana include:

  • Office or other outpatient visits
  • Psychiatric diagnostic services
  • Psychotherapy
  • End-Stage Renal Disease (ESRD)

When it comes to ESRD, the Indiana Health Coverage Program (IHCP) requires at least one monthly in-person visit to examine the vascular access site.

Given that “office or other outpatient visits” is still a broad term, providers should consult the list of non-reimbursable telemedicine services before engaging in a virtual encounter with the patient. Any service not included in the IN Admin. Code is considered reimbursable.

Ineligible medical facilities and telemedicine services not reimbursed in Indiana include:

  • Ambulatory surgical centers
  • Outpatient surgical services
  • Home health agencies or services
  • Radiological services
  • Laboratory services
  • Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled
  • Anesthesia services or nurse anesthetist services
  • Audiological services
  • Chiropractic services
  • Care coordination services with the member not present
  • Durable medical equipment and home medical equipment providers
  • Optical or optometric services
  • Podiatric services
  • Physical therapy services
  • Transportation services
  • Services provided under a Medicaid home and community-based waiver
  • Provider to provider consultations

In simple terms, the limitations set forth by the IN Admin. Code imply that eligible telemedicine providers in the Hoosier State are:

  • Physicians
  • Physician assistants
  • Clinical nurse specialists
  • Nurse practitioners
  • Clinical psychologists
  • Clinical nurse specialists
  • Nurse-midwives
  • Home health agencies

Indiana Telemedicine Practice Standards

Providers offering telemedicine services in the State of Indiana will be held to the same standard of practice applicable to in-person medical encounters. Prior to offering telemedicine services, a provider must also determine whether it’s necessary for a medical professional to be physically present with the patient at the originating site. 

Establishing a Valid Physician-Patient Relationship

Providers in Indiana may establish a valid physician-patient relationship without an in-person examination. This allows healthcare providers to offer telemedicine services to both existing and new patients. 

In order for the relationship formed exclusively via telemedicine to be considered valid, the virtual examination of the patient must include:

  • Identifying the patient by acquiring their name and contact information. This includes obtaining a verbal statement or other data from the patient that would enable the provider to determine the patient’s location
  • Disclosing the provider’s name, credentials, and medical specialty
  • Obtaining informed patient consent
  • Obtaining the patient’s medical history and any other relevant medical information that might aid in the diagnosis
  • Discussing the diagnosis with the patient and the risk and benefits associated with various treatment options, and advising the patient to seek in-person medical care if the provider deems it necessary, given the patient’s medical condition 
  • Creating and maintaining the patient's medical record, as well as disclosing it to the patient's primary care provider, on request from and subject to the consent of the patient. 
  • Providing detailed instructions for appropriate follow-up care
  • Providing a detailed telemedicine visit summary to the patient, including information regarding the treatment and any prescription

Informed Patient Consent

IN Code states that providers may not be required to obtain additional written patient consent for the delivery of telemedicine services. This doesn’t mean that consent isn’t necessary — it simply allows for consent for telemedicine to be oral, written, or digital in nature. 

For remote patient monitoring, the originating site must obtain the patient’s consent, which must be maintained by both the originating and distant sites. 

In any case, providers must document the patient’s consent within their medical record.

Online Prescriptions

The State of Indiana is quite liberal when it comes to online prescriptions. While other states either outright prohibit the issuance of prescriptions based on telemedicine encounters or limit online prescriptions to non-controlled substances, Indiana allows for the prescription of non-controlled substances as well as non-opioid controlled substances. 

Of course, providers will first need to meet several conditions before issuing a prescription solely based on a telemedicine visit. 

These conditions include:

  • The provider must meet the applicable standard of care in the treatment of the patient
  • The prescription issued must be in the provider’s scope of practice
  • The prescription may not be an abortion-inducing drug
  • The prescription cannot be for an ophthalmic device — glasses, low-vision devices, or contact lenses

Telemedicine providers must also document the patient evaluation, including the examination on which the diagnosis is based, as well as identify any underlying conditions and contraindications to the recommended treatment, before issuing an online prescription.

Documenting Telemedicine Encounters

Under Indiana law, telemedicine practitioners must maintain detailed records of all telemedicine encounters, including the patient’s consent for telemedicine. Following each telemedicine visit, the provider must deliver a comprehensive visit summary to the patient.

This poses two challenges — you must find a solution that would enable you to share protected health information (PHI) with the patients in a secure, HIPAA compliant manner, as well as figure out how to efficiently maintain your electronic health record.

Curogram helps you solve both of these challenges. Our telemedicine platform is fully HIPAA compliant and comes with built-in safeguards that enable you to practice telemedicine in a secure and protected environment. 

Curogram integrates with over 700 EHRs, meaning you won’t have to manually enter the data into your electronic health record and waste valuable time on tedious administrative tasks. Curogram also enables you to quickly and easily share visit summaries with your patients in a secure environment.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

Cross-State Licensing

The State of Indiana isn’t a member of the Interstate Medical Licensure Compact, but it does offer providers located outside of Indiana to offer telemedicine services to patients in the state under certain conditions.

A medical professional located in another state may treat patients in Indiana via telemedicine, provided that they explicitly agree to be subject to the jurisdiction of the courts of law of Indiana and the state’s substantive and procedural laws. 

This includes filing a certification form that constitutes a voluntary waiver of any respective right to avail themselves of the jurisdiction or laws other than those in Indiana concerning the claim. The statute also states that telemedicine providers practicing predominantly in Indiana are not required to file for certification, but fails to define what “predominantly in Indiana” means. 

One additional requirement is that providers must renew their certifications at the same time they renew their license.

The bottom line is that, although medical professionals outside of the state can offer telemedicine services to patients in Indiana, the process is a bit convoluted and represents an unnecessary administrative burden. 

That said, Indiana hasn’t proposed any laws to join the Interstate Medical Licensure Compact, which would facilitate interstate telemedicine licensing, and there are no signs that this would change in the near future.

Remote Patient Monitoring

We must dedicate a separate section to remote patient monitoring (RPM), given the fact that this practice in Indiana is subject to slightly different rules and regulations than live video telemedicine.

Remote patient monitoring in Indiana is only reimbursable under specific conditions. This telemedicine modality is only limited to patients receiving services from a home health agency. 

The reading of transmitted health information must be performed by a registered nurse, upon a written request by the patient’s physician. The treating physician must certify the need for home health services and confirm that they’ve had an in-person encounter with the patient, prior to sending the RPM request.

In addition, RPM services can only be provided to patients who have had an emergency room visit and inpatient hospital stay within the previous 12 months and have one of the following conditions:

  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Diabetes

The provider must obtain consent from the originating site — the medical facility at which the patient had received in-person medical care, and both sites must keep and maintain a record of the consent. 

Every patient receiving ongoing telemedicine services must attend an in-person clinical evaluation by a licensed physician at least once a year.

Indiana Medicaid Program

Indiana Medicaid reimburses for a wide range of telemedicine services delivered through interactive, live, two-way video communication. 

While Indiana state law doesn’t make the distinction between telemedicine and telehealth, the state’s Medicaid program defines them as separate terms. 

Telemedicine is considered the use of secure videoconferencing to render remote medical examinations and other healthcare services to patients at a distance. 

Telehealth services are defined as the remote monitoring of clinical data through equipment located in the Medicaid member’s home. 

In most other states, the main difference between the two terms is that telemedicine refers to examination, diagnosis, and treatment, while telehealth pertains to consultations. The situation in Indiana is a bit different — telemedicine encompasses both remote examinations and consultations, while telehealth is equivalent to remote patient monitoring. 

One thing to note is that Medicaid’s definitions of telemedicine and telehealth do not include store-and-forward technology. This means that store-and-forward can still be used to facilitate the provisioning of telemedicine services, but isn’t separately reimbursable. 

Regarding reimbursable services and eligible providers, the same policies apply to telemedicine services delivered to Medicaid members and other patients (see section “Who can practice telemedicine in Indiana?” above). 

Have a Successful Telemedicine Start in Indiana with Curogram

Curogram is an ideal solution for healthcare providers looking to embrace telemedicine in Indiana. 

With Curogram, you can set up your virtual clinic and start providing remote medical care to patients, in under 48 hours! Our platform is fully HIPAA compliant and incorporates the latest encryption standards, allowing you to practice telemedicine in a secure, protected environment. 

We took care of all the technical details for you — from built-in HIPAA safeguards and automatic data backup to secure file sharing and EHR integration. You won’t have to spend weeks and hundreds of dollars looking for an IT professional and consulting a lawyer to ensure your solution has the necessary capabilities and complies with all the laws, rules, and regulations. 

Curogram simplifies telemedicine and streamlines doctor-patient communication. Our platform allows you to see patients online, send automated appointment reminders, and share sensitive medical information in a safe environment — all from a single dashboard.

The best part about Curogram is that it mimics your in-person workflows, making it easy for your doctors and medical staff to transition to an online environment. Your patients will love it too — they’ll receive an SMS with a link to join the online appointment and can simply respond to the message if they have any inquiries or want to reschedule. Delivering remote medical care has never been easier!

A few reasons why you’ll love Curogram

Smart appointment reminders

Curogram enables you to create templated appointment reminders that the platform will automatically send to patients before the scheduled visits. With this simple yet essential feature, you’ll reduce no-shows by 75%! 

EHR integration

Say goodbye to menial administrative tasks! Curogram supports full EHR integration — all the relevant medical data is automatically updated in your electronic health record. This frees up a ton of time, meaning your doctors can admit more patients daily, ultimately increasing the revenue of your practice. 

Automated patient intake forms

Figuring out that the patient’s condition requires in-person medical care in the middle of an online appointment is awkward. You’d have to refuse the patient that already dedicated their time to the visit, and you won’t be able to bill them. 

Curogram sends out automated electronic patient intake forms a few days in advance of the appointments. You’ll have all the necessary medical information in advance, making patient onboarding easier and more efficient, and can advise an in-person visit if you deem it necessary.

Virtual waiting rooms

Curogram mimics your in-person workflows, allowing your doctors and medical staff to transition to an online working environment with ease. 

Our waiting room management tools facilitate patient onboarding, allow the staff to efficiently handle patient check-in and check-out, and make it easy for doctors to go in and out of video visits. 

If you want to explore all of Curogram’s features and test out the platform — click here and start your free 14-day trial!

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine

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