Policy trend maps

Much of CCHP’s work is dedicated to identifying and tracking how different definitions of telehealth influence policy across the US. This is a snapshot of some of our findings. Please note: there are nuances in many of the policies. To fully understand a specific policy and all its intricacies, the full language of it must be read.

Live Video Medicaid Reimbursement

Fifty states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. Both the jurisdictions of Puerto Rico and Virgin Islands do not indicate they reimbursement for live video in their Medicaid programs. The most predominantly reimbursed form of telehealth is live video, with every state offering some type of live video reimbursement in their Medicaid program. However, what and how it is reimbursed varies widely with some Medicaid programs limiting the types of reimbursable services and placing additional requirements and restrictions such as provider type and originating site stipulations. Map based on research conducted between July 2022 and early September 2022.

No live video reimbursement
Live video reimbursement

Store and Forward Medicaid Reimbursement

Twenty-five state Medicaid programs reimburse for store-and-forward. However, two states (NC, OH) solely reimburse store-and-forward as a part of Communications Technology Based Services (CTBS), which is limited to specific codes and reimbursement amounts. This number does not include states that only reimburse for teleradiology. Of those states that do reimburse for store and forward services, some have limitations on what qualifies for reimbursement. The states that only allow store-and-forward reimbursement through CTBS are identified with the color purple in the map. Map based on research conducted between July 2022 and early September 2022.

No reimbursement for Store and Forward
Reimbursement for Store and Forward
Store and Forward only reimbursed through CTBS

Remote Patient Monitoring Medicaid Reimbursement

Thirty-four state Medicaid programs provide reimbursement for RPM. Hawaii, Kentucky, Massachusetts, and West Virginia are the states to add RPM since Spring 2022. Many of the states that offer RPM reimbursement also have a multitude of restrictions associated with its use. The most common of these restrictions include only offering reimbursement to home health agencies, restricting the clinical conditions for which symptoms can be monitored, and limiting the type of monitoring device and information that can be collected. States that only allow remote patient monitoring through CTBS are identified with the color orange in the map. Map based on research conducted between July 2022 and early September 2022.

No reimbursement for Remote Patient Monitoring
Remote Patient Monitoring only reimbursed through CTBS
Reimbursement for Remote Patient Monitoring

Telephone Medicaid Reimbursement

Thirty-four states and DC Medicaid programs reimburse for audio-only telephone in some capacity; however, often with limitations. Audio-only was the modality that again (similar to the Spring 2022 edition) had the largest increase in states reimbursing for it, increasing by five since Spring 2022. Sometimes they only reimburse specific specialties such as mental health, or for specific services such as case management. Map based on research conducted between July 2022 and early September 2022.

No reimbursement for telephone
Reimbursement for telephone
Telephone only reimbursed through CTBS

Facility Originating Site Restrictions

Restricting reimbursable telehealth services to only rural or underserved areas is decreasing, but it’s still fairly common for state Medicaid programs to limit the type of facility that may be an originating site, which can either include or exclude the home or school as a reimbursable site. Currently, 17 states and DC have a specific list of sites that can serve as the originating site for a telehealth encounter. Map based on research conducted between July 2022 and early September 2022.

 

No specific originating site list or restriction
Has a billable originating site list or restriction

Transmission & Facility Fees

Thirty-seven states will reimburse either a transmission, facility fee, or both. Of these, the facility fee is the most common. Policies often stipulate a specific list of facilities eligible to receive the facility fee. Map based on research conducted between July 2022 and early September 2022.

Does not reimburse
Transmission / facility fee reimbursed

Private Payer Laws

Telehealth private payer laws is one of the areas of telehealth policy that has seen the most growth since our first report in 2012. Forty-three states, the District of Columbia and Virgin Islands have a private payer law that addresses telehealth reimbursement. Additionally, twenty-four of these states have an explicit requirement for payment parity within the law. States with payment parity are identified in the map with the color green. Map based on research conducted between July 2022 and early September 2022.

Private payer law does not exist
Payment Parity
Private payer law exists

Consent Requirements

Forty-five states, the District of Columbia and Puerto Rico include some sort of informed consent requirement in their statutes, administrative code, and/or Medicaid policies. This requirement can sometimes apply to the Medicaid program, a specific specialty or all telehealth encounters that occur in the state, depending on how and where the policy is written. In Medicare this requirement is exclusive to communication technology-based service (CTBS) codes where the patient needs to be made aware of any cost sharing responsibility. Map based on research conducted between July 2022 and early September 2022.

No Requirement for a Telehealth Specific Consent
Requirement for Telehealth Specific Consent