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Examining the State of Medicaid Telehealth Reimbursement

The Center for Connected Health Policy found that most of the US provides Medicaid telehealth reimbursement, with some notable variations.

State-by-state variations found in Medicaid telehealth reimbursement

Source: Thinkstock

- The majority of the United States offers Medicaid reimbursement for telehealth and related services, but reimbursement rules within each state can vary significantly, according to the Center for Connected Health Policy (CCHP).  

CCHP's Fifth Annual 50 State Telehealth Laws and Reimbursement Report focused on Medicaid fee-for-service policies and policy language in each state as of March 2017.

The report found that 48 states and the District of Columbia provide fee-for-service Medicaid reimbursement for some form of live video. Massachusetts and Rhode Island are the only two states without definitive reimbursement rules for their public insurance program.  

“No two states are alike in how telehealth is defined and regulated,” CCHP said. “While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist.”  

Key findings from the report include:

  • 34 states and D.C. have laws that govern private payer telehealth reimbursement policies
  • 31 states offer reimbursement for a transmission/facility fee
  • 23 states limit reimbursement to specified care facilities
  • 22 states specifically reimburse remote patient monitoring
  • 13 states reimburse for store-and-forward
  • 9 states in the US issue cross-state licensure or certificates for telehealth
  • 6 states have geographical limits for reimbursement

The findings reveal that while telehealth adoption rates across the country are increasing, it may be confusing for Medicaid beneficiaries and providers to use telehealth services.

Some states don’t even allow access to telehealth services unless a patient is located in a specified area. For example, New Hampshire only offers telehealth services to Medicaid beneficiaries within rural areas as defined by their Medicare guidelines.

States tend to alternate between using the terms “telehealth” and “telemedicine”according to the report, as defined by their laws. Generally, telehealth is a broader term while telemedicine focuses on specified clinical delivery.

When writing policy, states also sometimes use the “tele” prefix to identify more specific care delivery such as “telepsychiatry,” which is telemedicine specifically related to psychiatric services.

These differences in telehealth definitions within individual state policy can limit specialized telehealth services such as remote patient monitoring and store-and-forward services.

Even if a Medicaid provider operates in one of the 22 states that reimburses remote patient monitoring, they may have strict limitations on which of their services qualify for reimbursement.  

For example, Colorado providers can only receive fee-for-service reimbursement for remote patient monitoring if the patient’s condition includes congestive heart failure, COPD, asthma, or diabetes.

In California, one of 13 states that reimburses for store-and-forward telehealth, providers can only get reimbursed for teledermatology, teleophthalmology, and teledentistry.

“These differences are to be expected, given that each state defines its Medicaid policy parameters, but it also creates a confusing environment for telehealth participants to navigate, particularly when a health system or practitioner provides health care services in multiple states,” CCHP said.

CCHP added that over 200 pieces of telehealth-related legislation were introduced in the 2017 legislative period, where bills focused on changing existing reimbursement laws, developing telehealth licensure boards, and allowing telehealth to count towards network adequacy requirements for Medicaid and the private sector.

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