State Telehealth Laws and Reimbursement Program Policies
The updated fifth edition 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.
Although each state’s laws, regulations, and Medicaid program policies differ significantly, certain trends are evident when examining the various policies. For instance, live video Medicaid reimbursement continues to far exceed reimbursement for store-and-forward and remote patient monitoring. However, in recent years there has been a slight uptake in reimbursement for store-and-forward as well as remote patient monitoring. Other notable trends include eliminating restrictions for a patient to receive services in a rural area and incorporating the home and/or school as an eligible originating site. Additionally, states are beginning to move away from the GT modifier and are utilizing either the newly adopted CMS place of service code 02 or the 95 modifier adopted by the American Medical Association, or a combination of two or more.
For this update in particular, CCHP noted that some states are veering away from standard definitions. For example, Maryland now allows reimbursement of asynchronous dermatology, ophthalmology and radiology, but excludes these specialties from the definition of store and forward. Some states 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 actually reimbursing services via telehealth.
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november 2017 highlights
- Forty-eight states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service. This has remained constant since CCHP’s April 2017 edition of this report.
- Fifteen states provide reimbursement for store-and-forward. Two states, Maryland and Oklahoma, have been added since April 2017.
- Twenty-one state Medicaid programs provide reimbursement for remote patient monitoring (RPM). While one state (Oklahoma) added reimbursement for RPM since April 2017, CCHP removed two states from the list due to no evidence of Medicaid programs implementing previously passed laws that included RPM reimbursement, resulting in a net loss of one state.
- Twenty-three states limit the type of facility that can serve as an originating site. This number has remained steady since April 2017.
- Thirty-two state Medicaid programs offer a transmission or facility fee when telehealth is used. This number is up one since CCHP’s April 2017 update.
- Thirty-six states and DC currently have a law that governs private payer telehealth reimbursement policy. This is an increase of two (North Dakota and New Jersey) since April 2017.