Tool: Telehealth Policy Finder
Explore telehealth-related laws and regulations from all 50 states and the District of Columbia, as well as at the federal level, with the Policy Finder tool from PHI’s Center for Connected Health Policy.
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Center for Connected Health Policy
Across the country, no two states are alike in how they define and regulate telehealth. To help policymakers, health advocates and other health care professionals understand the policies and trends throughout the nation, the Telehealth Policy Finder tool compiles telehealth-related laws and regulations across all 50 states and the District of Columbia, as well as at the federal level.
Explore the Policy Finder tool
Latest Policy Developments in CCHP’s Telehealth Policy Finder and Policy Trends Map (Updated 6/12/2024)
•Arizona: Added new regulations to implement the state’s statutory required telehealth provider registration for out-of-state providers. It also provides practice standards for them to follow, including consent and requirements around liability insurance. Arizona also joined the Counseling Compact through passage of SB 1173.
•Arkansas: The Arkansas Medicaid Program updated their Transportation Manual to explicitly allow telemedicine to be used for ambulance services. Specifically, it states that an ambulance service may triage and transport a beneficiary to an alternative destination or treat in place if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. The Arkansas Department of Health also revised their regulations to include telehealth practice standards for dietetics and speech language pathologists and audiologists.
•Georgia: In March, the Georgia Department of Health published a PowerPoint presentation to their website which indicates that telemedicine/telehealth practitioners are required to maintain professional liability insurance, including having a $1 million per occurrence and $3 million per aggregate in their policy. It also includes specific requirements for umbrella policies. Senate Bill 35 was also passed that amends Medicaid coverage requirements for continuous glucose monitoring.
•Maine: Passed LD 1956 which provides telehealth practice standards for optometrists, including that telehealth services are allowed as long as the licensee acts within the scope of practice of their license and standards of practice. Maine also joined the Physician Assistant Compact and Social Work Licensure Compact.
•Maryland: Passed House Bill 1078 which requires Medicaid to provide remote ultrasound procedures and remote fetal non stress tests in certain circumstances. House Bill 522/Senate Bill 492 was also passed which requires the State Department of Education and the Maryland Department of Health to jointly adopt guidelines for school health services regarding access to telehealth appointments. House Bill 1127/Senate Bill 950 was enacted to authorize the reimbursement of sexual assault forensic exams conducted through telehealth under certain circumstances, as well as requires a study on the feasibility of a telehealth program to conduct sexual assault forensic examinations. Additionally, two regulations were finalized. One regulation amends behavioral health crisis services regulations and references that mobile crisis follow-up outreach may be completed by means of telephone, telehealth or in person, and the second regulation relates to community based behavioral health services, and references the use of telehealth within mobile crisis teams.
•Michigan: Michigan Medicaid issued a new bulletin providing reimbursement clarification for out-of-state providers, including that they will reimburse out-of-state providers as long as they are enrolled in Michigan Medicaid and the patient is in the state where the provider is licensed. It also provides specific instructions for telemedicine providers licensed through the Interjurisdictional Telepsychology Compact. Additionally, the bulletin states that “virtual-only” providers not associated to a Michigan billing provider within the Community Health Automated Medicaid Processing System will be subject to out-of-state provider prior authorization requirements. See bulletin for additional billing instructions. Regulations governing telehealth practice for chiropractors were also adopted, including an informed consent requirement and practice standards.
•Missouri: Updated their telemedicine billing presentation to reflect continuation of telehealth after COVID-19, and provide billing clarifications, such as the correct place of service codes for health care providers delivering medical services and also those delivering behavioral health residential or inpatient services. It also clarifies the outpatient hospital facility fee and provides additional information for federally qualified health centers (FQHCs) and rural health clinics (RHCs). Specifically, it specifies the charges FQHCs can include on their cost report and which they cannot.
•Pennsylvania: Pennsylvania Medicaid updated their Federally Qualified Health Center/Rural Health Clinic Handbook, revising their definition for a FQHC/RHC encounter to include telehealth, telemedicine, or teledentistry between a beneficiary and the physician, dentist or licensed non-physician practitioner who exercises independent judgment in the provision of medically necessary health care services that are part of the FQHC’s/RHC’s approved scope of project.
•West Virginia: Passed Senate Bill 533 which requires that Medicaid and insurers that issue a policy on or after January 1, 2025, provide coverage for emergency medical services to (among other things) triage and transport a patient to an alternative destination within the state or treat in place if the ambulance service is coordinating the care of the patient through medical command or telehealth services. Senate Bill 300 was also passed which provides a definition of telehealth and allows for its use in the context of medication assisted treatment programs and treating patients with substance use disorder. Finally, House Bill 4110 was passed, which authorizes the West Virginia Board of Licensed Dietitians to promulgate a rule relating to telehealth practice, requirements and definitions. Additionally, a number of new regulations pertaining to telehealth were adopted including:
o A rule that establishes requirement for treatment of sexual assault victims at a health care facility, and addresses access to telehealth technology for teleSANE (sexual assault nurse examiners)
o A rule that establishes general standards and procedures for behavioral health services and support, including that a provider must have a policy regarding face to face or telemedicine availability of medical staff to directly observe the patient after hours.
o A rule establishing standards and procedures for licensure and regulation of medication assisted treatment (MAT) in office-based MAT programs, and includes that counseling sessions may be completed via telehealth.
o 4 professional boards adopted regulations addressing the use of telehealth within their profession, including: the Massage Therapy Licensure Board, the Board of Acupuncture, the Medical Imaging and Radiation Therapy Technology Board of Examiners and the Board of Licensed Dietitians. With the exception of the Dietitian regulations, the other board rules clarify that the professions are in-person and hands on, therefore those boards will not issue a license for the practice of telehealth in those particular professions.
Fall 2023 Updates
During their Fall review, CCHP noted that many state Medicaid programs moved to add a range of specific services as reimbursable when delivered via telehealth as well as additional provider types that can serve as distant site providers. For instance, Nebraska Medicaid released guidance incorporating many PHE policies into their permanent reimbursement policies. This includes reimbursement for services such as health check services, mental health and substance use, physical and occupational therapy, physician services, speech pathology and audiology, visual care, and chiropractic services. Moreover, various Medicaid programs have adopted strategies reminiscent of Medicare, detailing eligible telehealth service codes in a list for providers to reference, with some states identifying a subset of the codes as suitable for audio-only interactions. Likewise, many states have also now adopted the place of service (POS) code system previously introduced by Medicare, where POS 10 indicates services provided at a patient’s home and 02 indicates telehealth services provided at an originating site other than the patient’s home.
Just as in previous issues of this Summary Report, since the onset of the COVID-19 PHE, state Medicaid programs continue to expand their audio-only reimbursement policies. However, the transition to permanent policy changes has typically been characterized by a more deliberate and cautious approach compared to the rapid implementation of temporary measures during the COVID-19 pandemic. North Dakota’s General Information Provider Manual was updated, for instance, to provide for reimbursement of audio-only telephone evaluation and management (E/M) services, but only when initiated by an established patient or guardian of an established patient. In June, Vermont Medicaid issued a Banner Notice related to their coverage of audio-only services, announcing that they will continue to allow audio-only services for a defined list of codes, which mirrors the Medicare list of codes. In addition to audio-only telephone, a limited number of states are expanding into other modalities including store-and-forward and remote patient monitoring. For example, Utah provides reimbursement for interprofessional internet assessment and management services for psychiatrists, which are listed as covered in their provider manual. Meanwhile, Texas passed HB 2727 which amends the statute related to its home telemonitoring services to modify the program to allow FQHCs and RHCs to be eligible providers. It also adds end stage renal disease or a condition that requires renal dialysis treatment to the list of eligible conditions for remote telemonitoring services, among other changes.
Policies addressing requirements for provider enrollment, including rules around an in-state address, is the newest phenomenon in Medicaid telehealth policy. Alabama’s Telemedicine Policy, for instance, now requires an in-state or qualifying bordering state site of practice address from which telemedicine services can be provided. In some states, this has become such an issue that it necessitated legislation (for example, Indiana’s HB 1352), forbidding Medicaid programs from requiring an in-state address or provider’s presence for Medicaid enrollment.
Read the full Fall 2023 report, and explore the state summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting key findings.
Additional findings:
- 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 explicitly indicate they reimburse for live video in their permanent Medicaid policies.
- Thirty-three state Medicaid programs reimburse for STORE-AND-FORWARD. Florida, Montana, North Dakota, South Carolina and Utah are the states which added reimbursement for store and forward, although each in a limited capacity, and some only through specific communication technology-based service (CTBS) codes since the Spring update.
- Thirty-seven state Medicaid programs provide reimbursement for REMOTE PATIENT MONITORING (RPM). Three states, (Florida, Idaho, and Iowa) added reimbursement for RPM since Spring 2023.
- Forty-three states and DC Medicaid programs reimburse for AUDIO-ONLY telephone in some capacity; however, often with limitations. Seven states including Alabama, Idaho, Kansas, Montana, Nebraska, Oklahoma, and Vermont added reimbursement for audio-only telehealth in some capacity since Spring 2023.
- Twenty-five state Medicaid programs including Alaska, Arizona, California, Hawaii, Illinois, Iowa, Kentucky, Maine, Massachusetts, Maryland, Michigan, Minnesota, Missouri, New York, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin reimburse for ALL FOUR MODALITIES (live video, store-and-forward, remote patient monitoring and audio-only), although certain limitations may apply.
- Forty-three states, the District of Columbia and Virgin Islands have a PRIVATE PAYER LAW that addresses telehealth reimbursement. Not all of these laws require reimbursement or payment parity. Twenty-four states have explicit payment parity. No new states have added a private payer law since Spring 2023, though a few states have made modifications to private payer law requirements.
- Thirty-six states and DC explicitly allow FQHCs to serve as originating sites and thirty-seven states and DC explicitly allow FQHCs to serve as distant sites for telehealth. Meanwhile, twenty-five state Medicaid programs and DC explicitly clarify that FQHCs are eligible for the prospective payment system (PPS) rate when serving as distant sites.
Getting started with the Policy Finder
Launched in Spring 2021 by PHI’s Center for Connected Health Policy (CCHP), the Policy Finder tool is a searchable, easy-to-use database that is updated consistently throughout the year. Formerly known as the State Telehealth Laws and Reimbursement Report, the information from the online database can be exported for each state into a PDF document using the most current information available on CCHP’s website.
Use the Policy Finder tool to:
- Look up telehealth-related laws and regulations by topic, including COVID-19, Medicaid & Medicare, Private Payer and Professional Requirements
- Explore all current laws, temporary COVID-19 actions, and pending legislation in all 50 states and the District of Columbia, as well as at the federal level
- Compare the policy of any of the topic areas for any two states
- View color-coded maps recapping policy trends by state across topic areas, including Medicaid reimbursement for live video, store and forward and remote patient monitoring
The Policy Finder is designed to provide timely policy information that is easy for users to navigate and understand. Watch a quick tutorial to explore the tool, see how to use it and learn about its features:
Please note: this information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.
Originally published by Center for Connected Health Policy
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