Medicaid & Medicare

Overview

Medicare and each Medicaid program are different in how they approach and reimburse telehealth delivered services. This section provides a brief overview of each program’s policies before jumping into the details.

Click the map to scroll down to the state

Federal

Last updated 10/10/2021

CMS reimburses for live video under certain circumstances and for …

CMS reimburses for live video under certain circumstances and for specific services when the patient is in a rural area and at a specified originating site with a few exceptions.  They also pay for traditional services delivered via store-and-forward in Alaska and Hawaii telehealth demonstration pilots.  Additionally, they also define communication technology-based services separately and provide reimbursement for those services when delivered via live video, asynchronously as well as remote physiologic monitoring depending on the applicable code’s description. However, as communication technology-based services are not considered “telehealth” by CMS, they are not under the same statutory restrictions telehealth-delivered services face.  More details are provided below.

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Alabama

Last updated 09/24/2021

Live video telemedicine services are covered for limited specialties and …

Live video telemedicine services are covered for limited specialties and under special circumstances.  Telephone consultations are not authorized.

SOURCE: AL Admin. Code r. 560-X-6-.14.  (Accessed Sept. 2021).

Alabama Medicaid reimburses for live video under some circumstances.  The Agency also covers an origination site fee.  For all telemedicine services, an appropriately trained staff member, or employees familiar with the patient’s treatment plan must be immediately available in-person to the patient.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (p. 28-17), April 2021. (Accessed Sept. 2021).

They make no reference to store-and-forward reimbursement, but the program reimburses for In-Home Monitoring through the Alabama Coordinated Health Network program for diabetes and Chronic Heart failure, although it’s not considered to fall under the telemedicine program.

SOURCE: AL Medicaid Management Information System Provider Manual, Primary Care Physician (p. 38).  April 2021. (Accessed Sept. 2021).

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Alaska

Last updated 10/14/2021

Alaska reimburses for Live Video, Store & Forward & Remote …

Alaska reimburses for Live Video, Store & Forward & Remote Patient Monitoring, although some restrictions apply.

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Arizona

Last updated 09/20/2021

AHCCCS covers all major forms of telehealth services. Asynchronous (also …

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Sept. 2021).

Arizona Health Care Cost Containment System (AHCCCS) covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS-registered providers. There are no geographic restrictions for Telehealth; services delivered via Telehealth are covered by AHCCCS in rural and urban regions. They reimburse for store-and-forward for specific specialties and for remote patient monitoring, although restrictions apply. Arizona’s Medicaid program uses an integrated managed care model with a fee-for-service delivery system for Alaska Native/American Indian populations and limited emergency services.

All services provided via telehealth must be medically necessary, non-experimental and cost-effective services.  Services are billed by the individual provider (located at the distant site).  Tele-presenter services are not billable.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-46 & 48), (07/12/2021); AHCCCS Medical Policy Manual Section 320-I Telehealth (07/12/21). p. 2.;  IHS/Tribal Provider Billing Manual (8/48 & 50),  .; AHCCCS, AHCCCS Fact Sheet: What is AHCCCS Managed Care? (n.d.) (Accessed Sept. 2021)

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Arkansas

Last updated 10/05/2021

Arkansas Medicaid reimburses for live video when the telemedicine service …

Arkansas Medicaid reimburses for live video when the telemedicine service is comparable to an in-person service.  Store-and-forward and remote patient monitoring is included in Medicaid’s definition of telemedicine, but there was no specific information found regarding reimbursement of the modalities.

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California

Last updated 08/28/2021

Medi-Cal allows providers to decide what modality, live video or …

Medi-Cal allows providers to decide what modality, live video or store-and-forward, will be used to deliver eligible services to a Medi-Cal enrollee as long as the service is covered by Medi-Cal and meets all other Medi-Cal guidelines, policies, can be properly provided via telehealth, and meets the procedural and definition components of the appropriate CPT or HCPCS code.  Additional requirements apply for specific programs (such as FQHCs/RHCS and Indian Health Services).  Medi-Cal also reimburses for one specific e-consult code.

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Colorado

Last updated 08/19/2021

Colorado Medicaid reimburses for live video for medical and mental …

Colorado Medicaid reimburses for live video for medical and mental health services.  They also provide reimbursement for remote patient monitoring for patients with certain chronic conditions.  Colorado Medicaid requires a member to be present and participating in a telemedicine service, excluding the possibility of utilizing store-and-forward, except in the case of teledentistry for an interim therapeutic restoration.

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Connecticut

Last updated 06/28/2021

CT passed a new temporary law, active until June 30, …

CT passed a new temporary law, active until June 30, 2023, that requires reimbursement of synchronous interactions, asynchronous store and forward transfers or remote patient monitoring, as well as audio-only if the provider is in-network under certain circumstances.  After the law expires the law will revert back to what is CT’s ‘permanent statute’ section, unless new legislation is passed before that time that further amends the law.

Based on a previous law and permanent statute, Connecticut Medicaid is also required to cover telemedicine services for categories of health care that the commissioner determines are appropriate, cost effective and likely to expand access to medically necessary services where there is a clinical need for those services to be provided by telehealth or for Medicaid recipients for whom accessing appropriate health care services poses an undue hardship.  The CT Medicaid Program manuals do not mention reimbursement for telemedicine but does indicate that while they do not provide reimbursement for behavioral health services provided electronically or over the phone, there is an exception for case management behavioral health services for clients age eighteen and under.  There is no reference to remote patient monitoring.

SOURCE:  HB 5596 (2021 Session), & CT Statute 17b-245e, (Accessed Jun. 2021).

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Delaware

Last updated 07/09/2021

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telemedicine …

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telemedicine services delivered via live video for certain providers and for patients at specific sites.  DMAP does not reimburse for store-and-forward and makes no reference to remote patent monitoring.

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District of Columbia

Last updated 08/19/2021

Medicaid shall cover and reimburse for healthcare services appropriately delivered …

Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.  Although this law was amended to expand reimbursement to store-and-forward and remote patient monitoring, it was not funded under an approved budget and financial plan and therefore did not go into effect.

Source: DC Code 31-3863. (Accessed Aug. 2021).

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Florida

Last updated 07/17/2021

FL Medicaid reimburses for real time interactive telemedicine according to …

FL Medicaid reimburses for real time interactive telemedicine according to administrative code, however there is no indication of reimbursement in any Medicaid Manual.  No reference was found in regards to reimbursement for store-and-forward or remote patient monitoring.

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Georgia

Last updated 09/30/2021

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward …

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.

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Hawaii

Last updated 09/28/2021

Hawaii Medicaid (Med-QUEST) reimburses for live video.  Although their statute …

Hawaii Medicaid (Med-QUEST) reimburses for live video.  Although their statute prohibits HI Medicaid from placing any restrictions on originating sites, regulations creating restrictions on the types or originating site eligible for reimbursement and their geographic location still exist in Hawaii Rules.  HI indicated in a memo that a state plan amendment was approved that allows for the changes in Hawaii Medicaid policy based on the statutory requirements, but it did not provide any specifics on removing the originating site or geographic restrictions currently present in HI rules.

Additionally, according to Hawaii’s statutory definition of telehealth, they should also be reimbursing for store-and-forward and remote patient monitoring, however CCHP has yet to find any documentation from Hawaii Medicaid that they are reimbursing for these modalities.

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Idaho

Last updated 10/04/2021

Idaho Medicaid reimburses for live video telehealth for certain providers …

Idaho Medicaid reimburses for live video telehealth for certain providers and for specific services.  There is no reference to store-and-forward or remote patient monitoring.

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Illinois

Last updated 08/26/2021

IL Medicaid reimburses for live video telemedicine and telepsychiatry services …

IL Medicaid reimburses for live video telemedicine and telepsychiatry services for specific providers.  A recent law change required them to expand reimbursement to other behavioral health professions beginning in Jan. 2019.  Although IL definitions of telemedicine and telehealth encompass store-and-forward there is no mention of store-and-forward reimbursement.  IL Medicaid will provide reimbursement for home uterine monitoring.

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Indiana

Last updated 08/23/2021

Indiana Medicaid reimburses for live video telemedicine for certain services …

Indiana Medicaid reimburses for live video telemedicine for certain services and providers.  Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services.  Indiana Medicaid defines telehealth as including remote patient monitoring (RPM) services and reimburses home health agencies for RPM for patients with diabetes, congestive heart failure and COPD.

Changes that were made by recently passed Senate Bill 3 have not yet been transferred into the state’s Medicaid Telemedicine and Telehealth Reference Module, including prohibitions around restricting originating and distant sites.  However, Indiana Medicaid did announce changes to their policies in Bulletin 202142 and BT202145.  Both the Module and Bulletins are listed in the policy finder because both items are still publicly accessible on IN Medicaid’s website. However, it appears that the information in the Bulletins overrides the Module information in cases where it conflicts.

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Iowa

Last updated 10/11/2021

Iowa Medicaid pays for telehealth as long as it meets …

Iowa Medicaid pays for telehealth as long as it meets accepted health care practices and standards.  The Medicaid program does not have a definition for telehealth, and therefore it is unknown if the term encompasses store-and-forward or remote patient monitoring. Managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawki) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

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Kansas

Last updated 08/26/2021

Kansas Medicaid covers live video telemedicine for certain services.  Additionally, …

Kansas Medicaid covers live video telemedicine for certain services.  Additionally, they also cover remote patient monitoring that is in real-time through home health agencies and with prior authorization.

All insurers (including Medicaid) must cover medically necessary services, subject to the terms and conditions of the contract. Medicaid specifically must provide reimbursement for speech language pathology services and audiology services.

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Kentucky

Last updated 09/15/2021

The Medicaid program and managed care are required to reimburse …

The Medicaid program and managed care are required to reimburse for services delivered through telehealth.  The department is required to promulgate administrative regulations to establish requirements for telehealth coverage and reimbursement, which shall be equivalent to the coverage for the same service provided in person unless the telehealth provider and the Medicaid program or a Medicaid managed care organization contractually agree to a lower reimbursement rate for telehealth services, or the department establishes a different reimbursement rate.

Kentucky’s definition of telehealth includes synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters.  Store-and-forward is reimbursed by KY Medicaid under certain circumstances and remote patient monitoring is not considered an eligible telehealth service for reimbursement although included as part of KY’s glossary (see reference below).

Medicaid-participating practitioners and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services only when no other approved mode of delivering telehealth services is available.

 

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).

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Louisiana

Last updated 08/27/2021

Live video telemedicine is covered for distant site providers enrolled …

Live video telemedicine is covered for distant site providers enrolled in Louisiana Medicaid.  There is no reimbursement for the originating site.  Activity and sensor monitoring, health status monitoring and medication dispensing and monitoring are forms of remote patient monitoring that are covered by Louisiana Medicaid.  There is no reference to store-and-forward.

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Maine

Last updated 08/04/2021

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain …

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain conditions, and remote patient monitoring for patients with certain risk factors.  Although their definition of telehealth is broad enough to include of store-and-forward, there is no mention of store-and-forward reimbursement within their policies.

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Maryland

Last updated 08/31/2021

Maryland Medicaid covers live video telehealth conducted by specific providers …

Maryland Medicaid covers live video telehealth conducted by specific providers and in specific originating sites.  Recently passed legislation requires expanded coverage of asynchronous and remote patient monitoring modalities. Until June 30. 2023, the legislation also requires coverage of audio-only and telehealth reimbursement parity.

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Massachusetts

Last updated 09/01/2021

Massachusetts introduced major revisions to the state’s Medicaid telehealth policy …

Massachusetts introduced major revisions to the state’s Medicaid telehealth policy that took effect in January 2021 and established coverage for health care services, and parity for behavioral health services.  Massachusetts has also revised its definition of telehealth in statute. Even though the new definition of telehealth includes remote patient monitoring, there is not yet evidence that Medicaid is implementing RPM reimbursement at this time. Additionally, MA Medicaid Bulletins do not yet reflect the expansions to telehealth reimbursement made in law, with the latest one on permanent policy being dated January 2019. Based on official Massachusetts’s government public releases related to the new law, the MassHealth telehealth expansion of primary care and chronic disease management will expire in two years.

SOURCE: Massachusetts Office of Governor. (Accessed Sept. 2021). 

 

 

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Michigan

Last updated 09/01/2021

Michigan Medicaid reimburses for live video telemedicine for certain healthcare …

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals, for patients located at certain originating sites for specific services.  A new bulletin effective Aug. 1, 2021 Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional telephone/internet/electronic health record consultations and remote patient monitoring services under certain circumstances.

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Minnesota

Last updated 09/11/2021

Minnesota Medicaid provides reimbursement for live video and store-and-forward through …

Minnesota Medicaid provides reimbursement for live video and store-and-forward through their Medical Assistance (MA) program for certain providers when patients are located at specific originating sites.  Many of their individual programs have their own unique requirements for telemedicine reimbursement.  MA also now covers telemonitoring (Remote Physiological Monitoring Services). Under a new law, MA is covering audio-only through an expansion of emergency waivers until June 30, 2023.

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Mississippi

Last updated 08/13/2021

Mississippi Medicaid reimburses certain providers for live video telehealth when …

Mississippi Medicaid reimburses certain providers for live video telehealth when there is a telepresenter with the patient.  The requirement for a telepresenter is waived during a state of emergency when the patient’s residence is the originating site.  They also reimburse for store-and-forward teleradiology, and for remote patient monitoring for patients with certain chronic conditions.

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Missouri

Last updated 08/04/2021

Missouri Medicaid will reimburse for services delivered via live video.  …

Missouri Medicaid will reimburse for services delivered via live video.  They will also reimburse for some tele-dentistry asynchronous services and remote patient monitoring for specific conditions.

 

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Montana

Last updated 09/07/2021

Montana Medicaid reimburses for live video under some circumstances. There …

Montana Medicaid reimburses for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring based on the definition for telemedicine.

Telehealth services must be reimbursed at the same rate of payment as services delivered in person.

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Nebraska

Last updated 08/02/2021

Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient …

Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances. Reimbursement for store-and-forward is only specified for teleradiology.  Recent passage of LB 400 expands the Medicaid definition of telehealth to include audio-only in specific circumstances however no further information has been provided regarding reimbursement on a permanent basis.

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Nevada

Last updated 07/28/2021

Nevada’s state plan is required to entail reimbursement for telehealth …

Nevada’s state plan is required to entail reimbursement for telehealth and paid at the same rate, except for audio-only interaction.  Although the requirement is altered at various points after the state of emergency is terminated.

Nevada Medicaid and the Nevada Check Up (NCU) program reimburses for live video and store-and-forward services under specific conditions. There is no reimbursement for remote patient monitoring.

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New Hampshire

Last updated 07/26/2021

New Hampshire Medicaid follows the Center for Medicare and Medicaid …

New Hampshire Medicaid follows the Center for Medicare and Medicaid Services requirements and Federal regulations for the use of telehealth and telemedicine. Reimbursement is available for live video under some circumstances. New Hampshire statute has a definition for store-and-forward and remote patient monitoring, and states that the Medicaid program shall provide reimbursement for all modes of telehealth, including video and audio, audio-only, or other electronic media provided by medical providers to treat all members for all medically necessary services.  It states that primary care, remote patient monitoring and substance use disorder services shall only be covered in the event that the patient has already established care at an originating site via face-to-face in-person service, with a few exceptions.  Statute does not prohibit the Medicaid program from providing coverage for only those services that are medically necessary and subject to all other terms and conditions of the coverage.

SOURCE: NH Revised Statutes 167:4-d (Accessed Jul. 2021).

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New Jersey

Last updated 07/21/2021

New Jersey Medicaid reimburses for live video and remote patient …

New Jersey Medicaid reimburses for live video and remote patient monitoring under certain circumstances. Store-and-forward is not explicitly included in reimbursement; however, it could be covered within the definition of telemedicine. Individual Medicare managed care plans may have their own individual policies regarding telehealth and telemedicine.

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New Mexico

Last updated 07/19/2021

New Mexico Medicaid reimburses for live video telehealth at the …

New Mexico Medicaid reimburses for live video telehealth at the same rate as when services are provided in-person as well as store-and-forward.  There is no reference to remote patient monitoring.

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New York

Last updated 07/15/2021

New York Medicaid offers live video reimbursement and some reimbursement …

New York Medicaid offers live video reimbursement and some reimbursement for store-and-forward and home health services. The New York State Department of Health released a Medicaid telehealth expansion in 2019 and the Office of Mental Health released telepsychiatry guidance in November 2019.

Additional guidance has been released since however they appear to be tied to the COVID-19 emergency and temporary.

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North Carolina

Last updated 07/12/2021

NC Medicaid reimburses for medically necessary telehealth services via live …

NC Medicaid reimburses for medically necessary telehealth services via live video, remote patient monitoring, audio-only and other virtual communications modalities outlined in its updated telehealth clinical coverage policies.

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North Dakota

Last updated 07/08/2021

North Dakota reimburses for live video telemedicine for most services, …

North Dakota reimburses for live video telemedicine for most services, with a few exceptions.  They do not provide reimbursement for store-and-forward and no reference was found for remote patient monitoring.

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Ohio

Last updated 07/06/2021

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward and remote …

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward and remote patient monitoring are only reimbursed for certain communication technology-based service codes.

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Oklahoma

Last updated 06/29/2021

SoonerCare reimburses for live video telehealth. Store-and-Forward and Remote Patient …

SoonerCare reimburses for live video telehealth. Store-and-Forward and Remote Patient Monitoring must be compensable by the Oklahoma Health Care Authority (OHCA) in order to be reimbursed.  Continuous glucose monitoring is reimbursed by Medicaid.

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Oregon

Last updated 06/30/2021

As of January 1, 2021, Oregon Health Authority covers medically …

As of January 1, 2021, Oregon Health Authority covers medically necessary and appropriate physical, behavioral and oral health services within Oregon Health Plan (OHP) covered benefit plans.  A recently passed piece of legislation also requires coverage of synchronous and asynchronous transmission using audio-only, video only, audio and video and transmission of data from remote monitoring devices in certain circumstances.

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Pennsylvania

Last updated 10/18/2021

Under newly revised bulletins from the Office of Mental Health …

Under newly revised bulletins from the Office of Mental Health and Substance Abuse Services and PA Medical Assistance, they now offer live video reimbursement to a wide range of licensed providers, and patient locations, and audio-only in situations when the beneficiary does not have video capability or an urgent medical situation.   PA Medicaid does not consider store-and-forward or remote patient monitoring to fall under the definition of telemedicine.

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Rhode Island

Last updated 06/25/2021

The Rhode Island Medical Assistance Program reimburses for some specific …

The Rhode Island Medical Assistance Program reimburses for some specific codes via live-video.  A newly passed law requires Medicaid provide coverage of telemedicine, which includes live video, store-and-forward and remote patient monitoring. CCHP has not located documentation from RI Medicaid that they are implementing the policy yet.

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South Carolina

Last updated 06/19/2021

South Carolina Medicaid reimburses for live video under certain circumstances. …

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward is not reimbursed as it does not meet established conditions for the use of telemedicine. South Carolina Medicaid reimburses for home health monitoring through the Home Aging Program for some conditions when a patient is eligible.

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South Dakota

Last updated 09/10/2021

South Dakota Medicaid provides reimbursement for live video services under …

South Dakota Medicaid provides reimbursement for live video services under some circumstances. Reimbursement is not provided for store-and-forward or remote patient monitoring services.

South Dakota recently discontinued coverage of telephonic and audio only services that were covered on a temporary basis. The department will be bringing forth an administrative rules package in the coming months that is intended to enable certain services to be provided via telephone or other audio-only modalities on a permanent basis.

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Tennessee

Last updated 06/14/2021

TennCare reimburses for live video only for crisis-related services. A …

TennCare reimburses for live video only for crisis-related services. A law requires reimbursement for additional telehealth services and provider-based telemedicine, which includes store-and-forward.  Remote patient monitoring may be offered by health insurance entities.

TennCare services are offered through managed care entities. Each MCO has its own telehealth policy. Coverage and reimbursement for live video and store-and-forward may vary between MCOs.

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Texas

Last updated 09/21/2021

Texas Medicaid reimburses for live video, and store-and-forward in some …

Texas Medicaid reimburses for live video, and store-and-forward in some circumstances. Home telemonitoring is reimbursable for some conditions when a provider is approved to deliver those services.

The Commission is required to develop and implement a system that ensures behavioral health services may be provided using an audio-only platforms.

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Utah

Last updated 06/09/2021

Utah Medicaid reimburses for medically necessary, non-experimental and cost-effective services …

Utah Medicaid reimburses for medically necessary, non-experimental and cost-effective services via live video telehealth, and does not reference store-and-forward modality in their policy.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, P. 48 (May 2021). (Accessed May 2021).

Home telemetry for outpatient long-term cardiac monitoring is allowable with prior authorization under certain conditions.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 22 (May 2021).  (Accessed May 2021).

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Vermont

Last updated 06/02/2021

Vermont Medicaid reimburses for live video under certain circumstances. Home …

Vermont Medicaid reimburses for live video under certain circumstances. Home health monitoring is considered a Medicaid benefit and is available under certain conditions.  An administrative rule indicates store-and-forward is reimbursed for teledermatology and teleophthalmology.  Additionally, audio-only telephone is also required to be reimbursed under certain circumstances.

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Virginia

Last updated 09/21/2021

Virginia Medicaid reimburses for live video, store-and-forward, and remote patient …

Virginia Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. Plans participating in the Medicare-Medicaid Demonstration Waiver are permitted to use store-and-forward and remote patient monitoring in rural and urban locations and to provide reimbursement for services.

VA Medicaid recently moved the telehealth-specific content they had in their individual provider manuals into a ‘telehealth supplement’.  Manuals that formerly included telehealth content now direct providers towards the telehealth supplement.  Provider manuals that incorporate the supplement include:

  • Addiction and Recovery Treatment Services (ARTS)
  • Mental Health Services
  • Early Intervention Services
  • Physician/Practitioner
  • Home Health
  • Psychiatric Services
  • Residential Treatment Services

See the Provider Manual home page to access all manuals.

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Washington

Last updated 09/07/2021

Washington Medicaid (Apple Health) reimburses for live video, limited store-and-forward, …

Washington Medicaid (Apple Health) reimburses for live video, limited store-and-forward, and remote patient monitoring under some circumstances.

Client must be present and participating in telemedicine visit.  Clients under the Family Planning Only – Pregnancy Related program, Family Planning Only program (formerly TAKE CHARGE), First Steps, and School Based Health Care Service program are eligible for telemedicine through fee-for-service.

MCO’s cover the delivery of care via telemedicine. Follow the MCO’s policy and billing requirements.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 91 (Jul. 2021); (Accessed Sept. 2021).

Telemedicine is covered by the Department.

SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed Sept. 2021).

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West Virginia

Last updated 09/13/2021

West Virginia Medicaid reimburses for live video under some circumstances. …

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is only made for real-time communications, therefore there is no reimbursement for store-and-forward or remote patient monitoring.

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Wisconsin

Last updated 09/07/2021

Newly passed statute requires Wisconsin’s Medicaid program to provide coverage …

Newly passed statute requires Wisconsin’s Medicaid program to provide coverage for Telehealth services, as defined under 42 USC 1395m (m) (4) (F), remote physiologic monitoring, remote evaluation of pre-recorded patient information, brief communication technology-based services, care management services delivered through telehealth and any other telehealth or communication technology-based services.

ForwardHealth currently allows for only certain covered services to be provided via telehealth via interactive telehealth, specifically excludes store-and-forward from coverage and does not mention remote patient monitoring.

ForwardHealth updated their policy in July 2021 to allow any provider to deliver telehealth services and increase the services that are reimbursable.

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Wyoming

Last updated 09/02/2021

Wyoming Medicaid reimburses for live video under some circumstances. There …

Wyoming Medicaid reimburses for live video under some circumstances. There is no reference to store-and-forward or remote patient monitoring reimbursement.

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Medicaid & Medicare

Overview

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