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.
August 2016 Highlights
CCHP’s most recent fifty-state survey of state telehealth laws and Medicaid program policies was completed in August 2016. 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 state Medicaid programs and DC are now reimburseing for live video telehealth
- 12 state Medicaid programs offer some reimbursement for store-and-forward, not counting states that only reimbursed for tele-radiology
- 19 state Medicaid programs reimburse for remote patient monitoring
- 30 state Medicaid programs offer a transmission or facility fee when telehealth is used
- 29 states require a telehealth specific informed consent be obtained from the patient in their statute, administrative code and/or Medicaid policies
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.