Half of US States Reimburse for 4 Common Forms of Virtual Care

October 27, 2023 - Though all 50 states and Washington, D.C., provide reimbursement for some form of live video-based telehealth within their Medicaid programs, only 25 provide Medicaid reimbursement for live video as well as store-and-forward telehealth, remote patient monitoring (RPM), and audio-only telehealth, a new report reveals.

Released by the Center for Connected Health Policy (CCHP), the Fall 2023 report details updates to telehealth policy since the Spring 2023 report. The report’s findings are based on information from CCHP’s online Policy Finder. State laws, state administrative codes, and Medicaid provider manuals are the primary resources for the Policy Finder.

While all states offer reimbursement for live video-based telehealth services, certain limitations exist. These include limitations related to the eligible services for reimbursement, the types of healthcare providers, and the patient's location.

Thirty-three state Medicaid programs reimburse for store-and-forward telehealth, which refers to sharing medical information with a healthcare practitioner via technology for evaluation or management. Since spring, Florida, Montana, North Dakota, South Carolina, and Utah have added reimbursement for store-and-forward telehealth.

The report notes that another five states have laws requiring Medicaid reimbursement for store-and-forward telehealth services, “but CCHP has not been able to locate any official Medicaid policy indicating that they are in fact reimbursing.” These states are Colorado, Connecticut, Mississippi, New Hampshire, and New Jersey.

With regard to RPM, 37 states have some form of reimbursement for these services in their Medicaid programs, up from 35 in the spring. Florida, Idaho, and Iowa are the latest to add reimbursement for RPM.

However, several states have restrictions in place for Medicaid reimbursement of RPM, including only offering reimbursement to home health agencies and restricting the clinical conditions that can be monitored.

Between the spring and fall, seven states added reimbursement for audio-only telehealth services to their Medicaid programs, bringing the total number of states allowing reimbursement for telephone-only care to 43 and Washington, D.C. The seven states are Alabama, Idaho, Kansas, Montana, Nebraska, Oklahoma, and Vermont.

Audio-only telehealth services have experienced a rapid reimbursement shift “from being often ineligible for reimbursement to becoming the second most commonly utilized telehealth modality eligible for Medicaid reimbursement in recent years, closely following live video services,” the report states.

A total of 25 states provide Medicaid reimbursement for all four forms of virtual care, including Alaska, Kentucky, Maine, Hawaii, Illinois, South Carolina, Texas, and Iowa.

Further, the CCHP report shows that states are creating alternatives to full licensure for out-of-state telehealth providers. Maryland, the District of Columbia, and Virginia, for example, entered into a licensing reciprocity agreement to expedite the licensure of physicians practicing within the three jurisdictions. There were also increases in participation in inter-state compacts, particularly the Professional Counseling Compact and the Interjurisdictional Psychology Compact.

Telehealth-based prescribing is another issue states are focused on, with several state bills addressing the remote prescribing of controlled substances. One example is a bill in Oklahoma that provides an exception for virtually prescribing controlled substances if they are Schedule III, IV, or V medications approved by the US Food and Drug Administration (FDA) for treating substance use disorder.

Remote prescribing of controlled substances via telehealth has also been an ongoing policy issue at the federal level.

Earlier this month, the Drug Enforcement Administration (DEA) agreed to extend flexibilities that allow providers to prescribe controlled medications, including Schedule II drugs like Adderall and Ritalin, via telehealth for new patients without a prior in-person exam through 2024.  

The agency extended the prescribing flexibilities following a two-day listening session, during which healthcare providers, telehealth companies, and other stakeholders made an impassioned plea to permanently allow the virtual prescription of controlled substances without an initial exam in person.