- State lawmakers are coming around to the concept of allowing Medicaid members to access telehealth and telemedicine services from their own homes.
In its spring 2018 update of the State Telehealth Laws and Reimbursement Policies Report, the Center for Connected Health Policy reports that 10 states have amended their telehealth policies since August 2016 to specifically make the patient’s home an originating site for Medicaid-accepted telehealth and telemedicine programs. Those states are Delaware, Colorado, Maryland, Michigan, Minnesota, Missouri, New York, Texas, Washington and Wyoming.
Meanwhile, the report notes that six states have limited the geographic requirement altogether since 2013. And 16 states have added schools to the list of approved originating sites, though some are placing restrictions on those services.
According the CCHP’s sixth annual report, some 160 telehealth-related bills have been introduced during the 2018 legislative session in 44 states, continuing a digital health trend that saw more than 200 pieces of legislation introduced during the 2017 session. But not all of those bills are supportive of new healthcare services.
The expansion of connected care service to the home is one bright light in an otherwise unflattering landscape, according to CCHP officials. Their report notes that 23 states still limit reimbursement for telehealth to a specific list of facilities – a number that hasn’t changed since the CCHP’s fall 2017 update. And four states mandate that a provider and patient be separated by a certain distance.
Other common restrictions, the report says, include limiting reimbursement to specific specialties, specific services or CPT codes (such as office visits or inpatient consults) and certain healthcare providers, such as physicians or nurses.
The report makes clear once again that every state is taking a different approach to Medicaid and private payer reimbursement for telehealth and telemedicine, making it difficult for connected care programs to gain momentum and healthcare providers to establish multi-state services.
It also shines the spotlight on remote patient monitoring (RPM), considered one of the up-and-coming telemedicine services going forward. Some 20 states now reimburse for RPM services, the report says, down one state – Hawaii – from the fall 2017 report.
While RPM seems to be gaining traction, with the Centers for Medicare and Medicaid Services and the American Medical Association looking to improve Medicare reimbursement through more CPT codes at some time soon, state Medicaid programs still place a number of restrictions on the platform. The most common restrictions limit RPM to home health agencies, define what conditions can be monitored at home and limit the devices used and information gathered.
Some states haven’t clearly defined ho they reimburse for RPM. Hawaii, New York and New Jersey all require Medicaid to reimburse for the service, but there’s nothing on the books in any of the states that indicates the technology is being used or reimbursements are being made. And Kentucky has mandated an RPM pilot, though there’s no information on when or where that project will commence.
Finally, the report notes that some states reimburse for RPM when it’s delivered through different departments – such as South Dakota, where the technology is used by the Department of Aging Services.
Among other take-aways from the report:
- 49 states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service (up one state – Rhode Island - since the fall 2017 report);
- 15 states reimburse for asynchronous or store-and-forward services other than teleradiology (unchanged since fall 2017, though Georgia was added to the list and Hawaii was subtracted);
- 9 states reimburse for live video, store-and-forward and RPM;
- 32 states provide a transmission and/or facility fee (unchanged since fall 2017);
- 39 states or jurisdictions have guidelines in place for private payer reimbursement of telehealth (up two states – Iowa and Utah - from the fall 2017 report); and
- 31 states have a consent requirement in either Medicaid policy, law or regulation, an increase of one state.
In terms of telehealth licensure, the report finds that nine states – Alabama, Louisiana, Maine, Minnesota, New Mexico, Ohio, Oregon, Tennessee and Texas – issue specific licenses to use telehealth, while 22 states have joined the Federation of State Medical Boards’ Interstate Medical Licensure Compact, which offers an expedited process to applying for licenses to practice in member states. Three states, Tennessee, Montana and Nevada, dropped individual license requirements to join the compact (though Tennessee’s Osteopathic Board is still issuing telehealth licenses).
CCHP researchers also cited a few new trends in this year’s report.
In their telehealth legislation, Maryland lawmakers included a mandate in Medicaid reimbursement policy to make telehealth available to the hearing0-impaired, including adding providers fluent in American sign language to the list of eligible providers and creating an exception to include the home as an originating site for hearing-impaired patients.
“This is the first time CCHP has noted such an exception for this population and could start a trend to build into telehealth policies special exceptions and allowances for populations with very specific special needs,” the report noted.
On the other hand, Washington’s new regulations specify that if a store-and-forward telehealth visit leads to a face-to-face visit or a telemedicine consult within 60 days of the original visit, Medicaid won’t reimburse for the consult.
“This may indicate increased attention to ensuring telehealth services are resulting in either a replacement or a reduction of services (rather than extra services), as well as cost savings for the insurer,” the report says. “If the implementation of this policy proves successful, there may be other state Medicaid programs and insurers who follow suit with similar policies.”