CCHP’s annual survey and analysis of state telehealth laws and reimbursement policies shows that no two states approach telehealth in the same way.
Established by legislation in 1965, Medicaid is a medical assistance entitlement program for low-income families. Medicaid is America’s largest medical and health-related funding source for the poor. Though the program is jointly funded by federal and state governments, the federal government allows each state to set many features for their programs. States may reimburse for telehealth under Medicaid so long as the service satisfies federal requirements of efficiency, economy and quality of care. Extensive control is given to states to decide how to structure and administer their Medicaid telehealth policy. States are not required to submit a state plan amendment (SPA) when deciding to reimburse for services delivered via telehealth if they are reimbursed the same way/amount as services delivered via face-to-face. (https://www.medicaid.gov/medicaid/benefits/telemed/index.html).
Fifty States, Fifty Approaches
CCHP’s annual analysis of state telehealth Medicaid policies showed that although states occasionally use similar language in their policies, no two states are alike in how telehealth is actually defined and regulated. These differences create a confusing environment for those using telehealth, particularly health care systems that provide care in multiple states.
March 2017 Highlights
CCHP’s most recent fifty-state survey of state telehealth laws and Medicaid program policies was completed in March 2017 (released in April 2017). The full PDF report is available, as is an interactive map of existing and pending telehealth-related policies by state. Below are some key findings:
- 48 states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service. This has remained constant since CCHP’s August 2016 edition of this report.
- 13 states provide reimbursement for store-and-forward. 1 state, Nevada, has been added since August 2016.
- 22 state Medicaid programs provide reimbursement for remote patient monitoring (RPM). The 3 states that added RPM since August 2016 include Arizona, Nebraska and Virginia. Most states with RPM policies restrict reimbursement to home health agencies, and limit it to patients with specific clinical conditions.
- Although the practice of restricting reimbursable telehealth services to rural or underserved areas, as is done in the Medicare program, is decreasing, some states continue to maintain this policy. 6 states currently have some form of a geographic restriction.
- The practice of limiting the type of facility that can serve as an originating site decreased slightly since August 2016 to 23 states (down from 25).
- 31 state Medicaid programs offer a transmission or facility fee when telehealth is used. This number is up one since CCHP’s August 2016 update.
- The number of states with private payer laws has remained constant since August 2016, with 35 jurisdictions having laws addressing private payer reimbursement for telehealth.
Telehealth and Private Payers
Many private payer insurance plans do reimburse for telehealth-delivered services; however, federal law does not require these payers to provide coverage for any type of telehealth-delivered service. Some states have passed their own private payer laws, affecting private payer plans that operate in those states. Currently, thirty-four states and DC have some private payer-related reimbursement laws. Some states mandate some sort of reimbursement, while others mandate reimbursement at the same level as in-person care under certain conditions.
Regulations governing telehealth also vary across states, with limitations on cross-state licensing of health professionals being the most restrictive. Additionally, state health professional boards are releasing special telehealth standards for practitioners in their state.
Pending Telehealth Legislation
Each year, new federal and state legislation is introduced to address some of the barriers to telehealth use. On the state level, more than 150 telehealth-related bills were introduced in the 2016 legislative session, the majority of which addressed reimbursement in Medicaid programs and/or among private payers, established telehealth professional board standards, and addressed cross state licensing. Some legislation also sought to establish telehealth pilot programs to test the efficacy and/or cost effectiveness of telehealth in public programs. CCHP tracks pending legislation and regulation in the states on its Pending Legislation and Regulation page.
For further information, visit CCHP’s State Reimbursement map.