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

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 in February 2021.

No live video reimbursement
Live video reimbursement

Store and Forward Medicaid Reimbursement

Store-and-forward services are only defined and reimbursed by twenty-two Medicaid Programs. 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.  Some states have allowed for store-and-forward reimbursement as a result of reimbursement for communication technology-based services (CBTS), some of which include the store-and-forward modality in its description. These states are identified with the color purple in the map.  Map based on research conducted in February 2021.

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

Remote Patient Monitoring Medicaid Reimbursement

Twenty-six states have some form of reimbursement for RPM in their Medicaid programs. 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. One state (Ohio) has reimbursement only for specific remote physiologic monitoring codes modeled after CMS reimbursement.  Map based on research conducted in February 2021.

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

Telephone Medicaid Reimbursement

Fifteen state Medicaid programs now allow for telephone reimbursement in some ways. Sometimes they only reimburse specific specialties such as mental health, or for specific services such as case management. Medicare and three out of the fifteen states are counted as reimbursing for telephone as a result of reimbursement for a CTBS code that allows for audio-only interaction.  Map based on research conducted in February 2021.

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 often exclude the home as a reimbursable site. Currently, 17 jurisdictions have a specific list of sites that can serve as the originating site for a telehealth encounter.  Map based on research conducted in February 2021.

 

No specific originating site list
Has a billable originating site list

Transmission & Facility Fees

Thirty-four 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 in February 2021.

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. Currently, 43 states and DC have laws that govern private payer telehealth reimbursement policies.  Map based on research conducted in February 2021.

Private payer law does not exist
Private payer law exists

Consent Requirements

Forty-three jurisdictions 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 in February 2021.

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