The latest report on state Medicaid coverage of telehealth by the Center for Connected Health Policy finds that video-based telemedicine is now covered in some form in all 50 states and the District of Columbia.

By Eric Wicklund

May 30, 2019 – Every state now offers Medicaid reimbursement for some real-time virtual visits, according to the latest analysis of state telehealth and telemedicine laws and reimbursement policies by the Center for Connected Health Policy.

The challenge, as always, lies in finding out what state covers what services, as well as when, where, how and why.

CCHP’s Spring 2019 report on connected care guidelines and coverage highlight the advances that are being made in telehealth and telemedicine adoption at the state level, while also pointing out that each state follows its own path. So while Massachusetts might be commended for allowing some Medicaid coverage for telemental health services – becoming the last state to cross the virtual visit threshold – the commonwealth is also far down on the list for telehealth-friendly policies.

“No two states are alike in how telehealth is defined and regulated,” the report, overseen by Executive Director Mei Wa Kwong, JD, notes. “While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist. These differences are to be expected, given that each state defines its Medicaid policy parameters, but it also creates a confusing environment for telehealth participants to navigate, particularly when a health system or practitioner provides health care services in multiple states.”

“In most cases, states have moved away from duplicating Medicare’s restrictive telehealth policy, with some reimbursing a wide range of practitioners and services, with little to no restrictions<’ it adds.

According to the CCHP, the most common action taken by states since the last report was issued in fall 2018 is to join the Interstate Medical Licensure Compact. The IMLC, which saw its membership jump from 15 to 29 states and the District of Columbia, creates a streamlined process for applying for a medical license in multiple states, thus enabling doctors to expand their reach through telemedicine and telehealth.

Aside from the expansion of video-based telemedicine coverage, the CCHP identified three other significant trends in its 420-page report:

  1. Eleven states now offer reimbursement for asynchronous (store-and-forward) telehealth, a platforms that’s growing in popularity in direct-to-consumer circles because it allows both the patient and provider to interact on their own schedules. In addition, Hawaii, Mississippi, New Jersey, New York and the District of Columbia have legislated Medicaid reimbursement for the service, but they haven’t yet crafted policies to enable it.
  2. Remote patient monitoring programs are now reimbursable through Medicaid in 21 states, reflecting a renewed interest in the care delivery platform in the wake of the Centers for Medicare & Medicaid Services’ inclusion of new CPT codes for RPM reimbursement in Medicare. In addition, Hawaii, New York, New Jersey and the District of Columbia have laws in place for RPM reimbursement but haven’t created Medicaid policy yet, Iowa will begin an RPM program for Medicaid managed care plans in July and Kentucky is reportedly launching an RPM pilot, though there has been no evidence on that happening yet.
  3. Just six states – Alaska, Arizona, Maryland, Minnesota, Virginia and Washington – reimburse through Medicaid for all three modalities.

Among other notable trends, according to the CCHP, are the inclusion of the home and schools as eligible originating sites for telehealth programs, and the identification of teledentistry and substance abuse disorder (SUD) services as specialty care services qualifying for Medicaid and/or private payer reimbursement.

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