Tool: Telehealth Policy Finder

Across the country, no two states are alike in how they define and regulate telehealth. To help policymakers, health advocates and other health care professionals understand the policies and trends throughout the nation, the Telehealth Policy Finder tool compiles telehealth-related laws and regulations across all 50 states and the District of Columbia, as well as at the federal level.

Fall 2023 Updates

During their Fall review, CCHP noted that many state Medicaid programs moved to add a range of specific services as reimbursable when delivered via telehealth as well as additional provider types that can serve as distant site providers.  For instance, Nebraska Medicaid released guidance incorporating many PHE policies into their permanent reimbursement policies. This includes reimbursement for services such as health check services, mental health and substance use, physical and occupational therapy, physician services, speech pathology and audiology, visual care, and chiropractic services.  Moreover, various Medicaid programs have adopted strategies reminiscent of Medicare, detailing eligible telehealth service codes in a list for providers to reference, with some states identifying a subset of the codes as suitable for audio-only interactions. Likewise, many states have also now adopted the place of service (POS) code system previously introduced by Medicare, where POS 10 indicates services provided at a patient’s home and 02 indicates telehealth services provided at an originating site other than the patient’s home.

Just as in previous issues of this Summary Report, since the onset of the COVID-19 PHE, state Medicaid programs continue to expand their audio-only reimbursement policies.  However, the transition to permanent policy changes has typically been characterized by a more deliberate and cautious approach compared to the rapid implementation of temporary measures during the COVID-19 pandemic.  North Dakota’s General Information Provider Manual was updated, for instance, to provide for reimbursement of audio-only telephone evaluation and management (E/M) services, but only when initiated by an established patient or guardian of an established patient.  In June, Vermont Medicaid issued a Banner Notice related to their coverage of audio-only services, announcing that they will continue to allow audio-only services for a defined list of codes, which mirrors the Medicare list of codes.  In addition to audio-only telephone, a limited number of states are expanding into other modalities including store-and-forward and remote patient monitoring.  For example, Utah provides reimbursement for interprofessional internet assessment and management services for psychiatrists, which are listed as covered in their provider manual. Meanwhile, Texas passed HB 2727 which amends the statute related to its home telemonitoring services to modify the program to allow FQHCs and RHCs to be eligible providers.  It also adds end stage renal disease or a condition that requires renal dialysis treatment to the list of eligible conditions for remote telemonitoring services, among other changes.

Policies addressing requirements for provider enrollment, including rules around an in-state address, is the newest phenomenon in Medicaid telehealth policy.  Alabama’s Telemedicine Policy, for instance, now requires an in-state or qualifying bordering state site of practice address from which telemedicine services can be provided.  In some states, this has become such an issue that it necessitated legislation (for example, Indiana’s HB 1352), forbidding Medicaid programs from requiring an in-state address or provider’s presence for Medicaid enrollment.

Read the full Fall 2023 report, and explore the state summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting key findings.

Additional findings:

• Fifty States and Washington DC provide reimbursement for some form of LIVE VIDEO in Medicaid fee-for-service. Both the jurisdictions of Puerto Rico and Virgin Islands do not explicitly indicate they reimburse for live video in their permanent Medicaid policies.
• Thirty-three state Medicaid programs reimburse for STORE-AND-FORWARD. Florida, Montana, North Dakota, South Carolina and Utah are the states which added reimbursement for store and forward, although each in a limited capacity, and some only through specific communication technology-based service (CTBS) codes since the Spring update.
• Thirty-seven state Medicaid programs provide reimbursement for REMOTE PATIENT MONITORING (RPM). Three states, (Florida, Idaho, and Iowa) added reimbursement for RPM since Spring 2023.
• Forty-three states and DC Medicaid programs reimburse for AUDIO-ONLY telephone in some capacity; however, often with limitations. Seven states including Alabama, Idaho, Kansas, Montana, Nebraska, Oklahoma, and Vermont added reimbursement for audio-only telehealth in some capacity since Spring 2023.
• Twenty-five state Medicaid programs including Alaska, Arizona, California, Hawaii, Illinois, Iowa, Kentucky, Maine, Massachusetts, Maryland, Michigan, Minnesota, Missouri, New York, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin reimburse for ALL FOUR MODALITIES (live video, store-and-forward, remote patient monitoring and audio-only), although certain limitations may apply.
• Forty-three states, the District of Columbia and Virgin Islands have a PRIVATE PAYER LAW that addresses telehealth reimbursement. Not all of these laws require reimbursement or payment parity. Twenty-four states have explicit payment parity. No new states have added a private payer law since Spring 2023, though a few states have made modifications to private payer law requirements.
• Thirty-six states and DC explicitly allow FQHCs to serve as originating sites and thirty-seven states and DC explicitly allow FQHCs to serve as distant sites for telehealth. Meanwhile, twenty-five state Medicaid programs and DC explicitly clarify that FQHCs are eligible for the prospective payment system (PPS) rate when serving as distant sites.

Getting started with the Policy Finder

Launched in Spring 2021 by PHI’s Center for Connected Health Policy (CCHP), the Policy Finder tool is a searchable, easy-to-use database that is updated consistently throughout the year. Formerly known as the State Telehealth Laws and Reimbursement Report, the information from the online database can be exported for each state into a PDF document using the most current information available on CCHP’s website.

Use the Policy Finder tool to:

• Look up telehealth-related laws and regulations by topic, including COVID-19, Medicaid & Medicare, Private Payer and Professional Requirements
• Explore all current laws, temporary COVID-19 actions, and pending legislation in all 50 states and the District of Columbia, as well as at the federal level
• Compare the policy of any of the topic areas for any two states
• View color-coded maps recapping policy trends by state across topic areas, including Medicaid reimbursement for live video, store and forward and remote patient monitoring

The Policy Finder is designed to provide timely policy information that is easy for users to navigate and understand. Watch a quick tutorial to explore the tool, see how to use it and learn about its features:

Please note: this information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Originally published by Center for Connected Health Policy