State Telehealth Laws and Reimbursement Policies Report: Fall 2018
The updated Fall 2018 version 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.
The Fall 2018 edition offers policymakers, health advocates and other interested health care professionals a freshly redesigned compendium of state telehealth laws, regulations and Medicaid policies. The new report features the same detailed telehealth policy information found in previous reports, but in a fresh new format with policies grouped into three primary categories; Medicaid Reimbursement, Private Payer Laws, and Professional Regulation.
This round of updates to CCHP’s “State Telehealth Laws and Reimbursement Policies” report revealed very little movement in terms of the number of states reimbursing in Medicaid for live video, store-and-forward and remote patient monitoring (RPM). Live video reimbursement continues to far exceed reimbursement for store-and-forward and RPM services in the Medicaid program. However, states are generally taking steps to revise details within their telehealth reimbursement policies, often expanding reimbursement to additional provider types and/or originating sites and eliminating barriers.
For example, Nevada clarified that services covered include physician office services, podiatry, community paramedicine services, and medical nutrition therapy and specified that Nevada Medicaid providers are eligible to deliver services via telehealth as long as it is within their scope of practice. Some states, such as Maine, have taken steps to clarify within their Medicaid policy that federally qualified health centers and rural health centers can serve as either an originating or distant site provider for purposes of telehealth reimbursement.
Expanding eligible originating site lists is also a frequent policy change with 15 states and DC specifically stating they are allowing schools to be eligible originating sites, and 13 states allowing the home to be an eligible originating site, although certain special conditions often apply. 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 or regulations indicating they are actively reimbursing services via telehealth.
In addition to the findings noted in the various sections above, CCHP took note that the most common policy change since Spring 2018 was the number of states with a requirement to obtain a patient’s informed consent, increasing by seven states. A common addition to Medicaid manual telehealth sections was the incorporation of specific documentation and/or confidentiality requirements for telehealth delivered services.
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Fall 2018 highlights
- 11 states provide reimbursement for store-and-forward. Four states that were previously on the list were removed, due to clarification that their store-and-forward reimbursement only includes teleradiology (which CCHP does not count) and/or lack of information indicating a Medicaid reimbursement law providing for store-and-forward reimbursement has been implemented by the state’s Medicaid program.
- 20 state Medicaid programs provide reimbursement for remote patient monitoring (RPM). This number has remained unchanged since Spring 2018.
- 23 states limit the type of facility that can serve as an originating site. While some states removed their list of eligible facilities, others added specific facility lists, resulting in this number remaining steady since Spring 2018.
- 34 state Medicaid programs offer a transmission or facility fee when telehealth is used.
- 39 states and DC currently have a law that governs private payer telehealth reimbursement policy. This is an increase of one (Kansas) since Spring 2018, although three state laws don’t go into effect until 2019.