A state-by-state survey of Medicaid programs finds that most support real-time audio-visual telemedicine and telehealth, but there’s far less support for programs that offer remote patient monitoring and store-and-forward services.

By Eric Wicklund

– Roughly 40 percent of the nation’s Medicaid programs are taking a progressive approach to telehealth and telemedicine reimbursement, according to a new analysis. At the same time, about 20 percent of state programs are classified as restrictive.

The results are part of a state-by-state analysis by the Manatt legal and consulting firm. And it indicates a slow slide toward acceptance of connected care technologies like virtual visits, store-and-forward services and remote patient monitoring.

“A growing body of evidence suggests that telemedicine will be critical to delivering healthcare in the future, and state Medicaid policies are evolving – in some states more quickly than others – to accelerate adoption of telemedicine models,” the report, written by Manatt Health executives Jared Augenstein, Jacqueline D. Marks and Randi Seigel, states. “As technology advances and the evidence base for telemedicine expands, state policy will continue to evolve to integrate telemedicine into payment and delivery reforms that support overarching program objectives related to access, quality and cost of care.”

This report follows by two months a similar study conducted by the Connected Health Policy. Like this report, CCHP’s spring 2018 update of the State Telehealth Laws and Reimbursement Policies Report found some advances in how states are embracing telehealth and telemedicine, but many more setbacks and barriers.

It also continues to shine the spotlight on state Medicaid programs at a time when Congress is looking to address the nation’s ongoing opioid abuse epidemic. Many lawmakers and healthcare providers see telehealth and telemedicine as an avenue toward improved substance abuse treatments, and are looking at using Medicare to fund and expand those platforms.

The Manatt study focuses on five key considerations for telehealth and telemedicine in Medicaid:

Designating the patient’s home as an acceptable location for telehealth. Some 26 states provide Medicaid reimbursement for telehealth and telemedicine delivered to the patient in his or her home – meaning half the nation doesn’t allow patients to receive care at home.

“The home is a critical access point for telemedicine services,” the study notes. “It enables patients in rural areas to connect with their providers, and enables health systems to increase clinic capacity by conducting many types of routine follow-up or other visits remotely.”

Reimbursement for various virtual care modalities. Almost every state provides Medicaid coverage for real-time audio-visual telemedicine, but few state programs support other methods of delivering healthcare, such as asynchronous or store-and-forward telemedicine, remote patient monitoring or services delivered by phone or e-mail.

According to the report, 29 states reimburse for at least one modality beyond live video, while 16 cover three of the four services listed (most prohibit phone-, fax- or e-mail-based services, saying it isn’t enough to establish the doctor-patient relationship). Only one state, Colorado, reimburses for all the services listed above.

Establishing the physician-patient relationship. Nine states require that the physician and patient have an established relationship before the two can connect via telehealth or telemedicine; this sometimes means the patient has to visit the doctor for an in-person meeting. Mobile health advocates say this unfairly burdens underserved patients and those in remote and rural areas where access to healthcare is limited.

“Medicaid policies that require such a relationship claim to protect patients but also inhibit new market entrants that offer urgent and primary care services from serving the Medicaid market,” the report points out.

Limiting use. Nine states limit how often a Medicaid patient can access care through telehealth or telemedicine. In Georgia, for instance, hospital services are restricted to once every three days, while nursing facilities can only use the technology on a specific patient once every 30 days. Advocates say this limitation restricts care coordination and management, particularly for patients with chronic conditions.

Setting geographic barriers. Nine states place restrictions on where the provider and patient must be located to use telemedicine or telehealth, setting definitions for the originating site and/or the distant site. In Indiana, for instance, those two sites have to be at least 20 miles apart for Medicaid to reimburse for those services.

Using those criteria, the report then ranked each state’s Medicaid policies on telemedicine, classifying the state as either progressive, moderate or restrictive.

In all, 12 states were rated as restrictive, meaning they “may inhibit the broad use of telemedicine”: Arkansas, Georgia, Massachusetts, Maryland, North Carolina, North Dakota, New Hampshire, Ohio, Pennsylvania, Rhode Island, South Carolina and Texas.

Another 20 states were rated as progressive, meaning they “enable and incentivize broad use of telemedicine”: Alaska, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Maine, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, Nevada, New York, Utah, Vermont and Washington.

The other 18 states and the District of Colombia were rated as moderate, meaning they “are mixed and/or moderately support the broad use of telemedicine.”

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