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 late May to early September 2023.

No live video reimbursement

Live video reimbursement

Store and Forward Medicaid Reimbursement

Thirty-three state Medicaid programs reimburse for store-and-forward. 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 late May to early September 2023.

No reimbursement for Store and Forward

Reimbursement for Store and Forward

Store and Forward only reimbursed through CTBS

Remote Patient Monitoring Medicaid Reimbursement

Thirty-seven state Medicaid programs provide reimbursement for RPM. 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 late May and early September 2023.

No reimbursement for Remote Patient Monitoring

Remote Patient Monitoring only reimbursed through CTBS

Reimbursement for Remote Patient Monitoring

Telephone Medicaid Reimbursement

Forty-three states and DC Medicaid programs reimburse for audio-only telephone in some capacity; however, often with limitations. The number of states reimbursing audio-only has more than doubled since Spring 2021. Sometimes Medicaid programs only reimburse specific specialties such as mental health, or for specific services such as case management. Map based on research conducted between late May to early September 2023.

No reimbursement for telephone

Reimbursement for telephone

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 late May to early September 2023.

No specific originating site list or restriction

Has a billable originating site list or restriction

Transmission & Facility Fees

Thirty-five 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 early May and late September 2023.

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. Though no new states have added private payer laws since Fall 2022, a few states did make adjustments to their existing private payer laws. 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 late May and early September 2023.

Private payer law does not exist

Explicit payment parity for at least one specialty

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 late May to early September 2023.

No Requirement for a Telehealth Specific Consent

Requirement for Telehealth Specific Consent