Updated 50 State Telehealth Laws & Reimbursement Policies Report

Original Source: Center for Connected Health Policy

 

An updated Fall 2019 version of CCHP’s “State Telehealth Laws and Reimbursement Policies” Report is available today!  The Fall 2019 edition offers policymakers, health advocates and other interested health care professionals a detailed compendium of state telehealth laws, regulations and Medicaid policies.  The report also includes an executive summary, which summarizes CCHP’s findings along with an “At a Glance” Infographic and Chart that highlights key data points from the report.  CCHP’s online interactive map tool has also been updated with all of the newest information from this update.

FALL 2019 REPORT TAKEAWAYS

This round of updates to CCHP’s “State Telehealth Laws and Reimbursement Policies” revealed that States continue to refine and expand their telehealth reimbursement policies though they are not treated across the board in the same manner as in-person delivered services. Limitations in regards to reimbursable modality, services and location of the patient continue to be seen.  Although each state’s laws, regulations, and Medicaid program policies differ significantly, certain trends are evident. Live video Medicaid reimbursement, for example, continues to far exceed reimbursement for store-and-forward and remote patient monitoring (RPM).  Reimbursement for RPM and store-and-forward continue to be limited.

California made big changes to their Medicaid program (Medi-Cal) during this update. The most significant update is allowing the provider to decide what modality, live video or store-and-forward, can be used to deliver eligible services to a Medi-Cal enrollee. The provider can decide which modality to use if the service is covered by Medi-Cal and meets all other Medi-Cal guidelines and policies, can be appropriately delivered via telehealth, and meets procedural and definition components of the appropriate CPT or HCPCS code.  Additionally, electronic consultations (eConsult) was added as a subset of store-and-forward and reimbursement for one specific eConsult code is now allowed.  Finally, Medi-Cal has also explicitly listed the home as an originating site, even if there is not a provider physically with the patient at the time of the telehealth interaction.

Colorado also had some changes with the passage of a law requiring Medicaid reimburse telemedicine delivered services that would otherwise be eligible for reimbursement under the program.  Under the law, Medicaid is required to reimburse, at minimum, the same rate for telemedicine services as in-person services.

Allowing the home as an eligible originating site was one of the more common Medicaid policy changes during this Fall 2019 update.  Medicaid programs to explicitly add the home since Spring 2019 included CaliforniaKentuckyOhioNew Hampshire and Colorado.  Many of these states also explicitly added schools and/or federally qualified health centers and rural health centers to their eligible originating sites.

States that passed private payer laws included CaliforniaGeorgia and Florida although they took different approaches, with California and Georgia requiring payment parity, while Florida is allowing plans to negotiate with providers mutually acceptable payment rates.


KEY FINDINGS FOR THE FALL 2019 UPDATE INCLUDE:

  • Fifty states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service.
  • Fourteen states provide reimbursement for store-and-forward.  Four additional jurisdictions (HI, MS, NH, and NJ) have laws requiring Medicaid reimburse for store-and-forward but as of the creation of this edition, yet to have any official Medicaid policy indicating this is occurring.
  • Twenty-two state Medicaid programs provide reimbursement for remote patient monitoring (RPM).  As is the case for store-and-forward, two Medicaid programs (HI and NJ) have laws requiring Medicaid reimburse for RPM but at the time this report was written, did not have any official Medicaid policy.
  • Twenty-three states limit the type of facility that can serve as an originating site.
  • Thirty-four state Medicaid programs offer a transmission or facility fee when telehealth is used.
  • Forty states and DC currently have a law that governs private payer telehealth reimbursement policy.  Although Georgia passed a private payer law, it does not become effective until Jan. 1, 2020.