State Telehealth Laws and Reimbursement Program Policies
The updated Spring 2018 version of “State Telehealth Laws and Reimbursement Policies” from PHI's Center for Connected Health Policy (CCHP) offers policymakers, health advocates, and other interested health care professionals the most current summary guide of telehealth-related policies, laws, and regulations for all 50 states and the District of Columbia.
This round of updates revealed very little movement in terms of the number of states reimbursing for live video, store and forward and remote patient monitoring. Live video reimbursement continues to far exceed reimbursement for store-and-forward and remote patient monitoring delivered services. However, states are generally taking steps to revise details within their telehealth reimbursement policies, often expanding reimbursement to additional provider types and/or originating sites and eliminating barriers. For example, Vermont which previously had restrictions on provider types, eliminated the restriction, now only requiring providers be enrolled in Medicaid. Maine is another state that eased requirements related to its reimbursement of telemonitoring. Other states are adding additional specialties, for example teledentistry has become increasingly popular, with 10 state Medicaid programs reimbursing for it in some capacity. Expanding to different originating sites is also a frequent policy change with 15 states and DC now allowing schools to be eligible originating sites, and 10 states allowing the home to be an eligible originating site, although certain special conditions often apply. Some states (i.e. NY, NJ and HI) have passed wide ranging laws requiring telehealth reimbursement in their Medicaid program in recent years, but the programs have yet to respond with official regulation or documentation in their provider manuals indicating they are actively reimbursing services via telehealth.
In addition to the findings noted in the various sections above, CCHP took note of two changes in both Maryland and Washington that were noteworthy. Maryland made certain revisions to their Medicaid telehealth reimbursement policy targeted at making telehealth accessible to the hearing impaired, including making fluent American sign-language providers eligible for telehealth reimbursement and allowing the home to be an eligible originating site for the hearing impaired. This could start a trend to build into telehealth policies special exceptions and allowances for populations with very specific special needs. Washington revised their store-and-forward reimbursement policy, indicating that the agency will not pay for a store-and-forward if it results in a face-to-face visit within 60 days. This may indicate increased attention on ensuring telehealth services are resulting in either a replacement or reduction of services (rather than extra services), as well as cost savings for the insurer. If the implementation of this policy proves successful, there may be other state Medicaid programs and insurers who follow suit with similar policies.
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SPRING 2018 highlights
- 49 states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service. This has increased by one (RI) since CCHP’s Fall 2017 edition of this report.
- 15 states provide reimbursement for store-and-forward. This number remained the same since Fall 2017. While Georgia was added to the list, as they now provide reimbursement for some store-and-forward, Hawaii was removed from the list because CCHP could not locate any official Medicaid policy that indicates they are actively reimbursing for store-and-forward.
- 20 state Medicaid programs provide reimbursement for remote patient monitoring (RPM). This number has decreased by one since Fall 2017 because CCHP could not locate any official Medicaid policy indicating that Hawaii is actively providing reimbursement for RPM. No new states were added.
- 23 states limit the type of facility that can serve as an originating site. This number has remained steady since Fall 2017.
- 32 state Medicaid programs offer a transmission or facility fee when telehealth is used. This number has not changed since CCHP’s Fall 2017 update.
- 38 states and DC currently have a law that governs private payer telehealth reimbursement policy. This is an increase of two (Iowa and Utah) since Fall 2017, although both laws don’t go into effect until Jan. 1, 2019.