The Center for Connected Health Policy’s latest report on state telehealth legislation and reimbursement finds little has changed in the connected health market in a year.

By Eric Wicklund

– Anyone looking for that fabled tipping point in telehealth reimbursement and adoption will have to wait a bit longer.

The latest edition of the Center for Connected Health Policy’s State Telehealth Laws and Reimbursement Policies Report finds little to celebrate among connected health enthusiasts, with states making minimal changes to their telemedicine guidelines and Medicaid policies over the past year.

The report, the 16th update since its first release in 2013, finds “very little movement” in the number of states reimbursing through Medicaid for live video, asynchronous (store-and-forward) telehealth or remote patient monitoring, with video-based virtual care still the most popular. What the report did find, though, is that states are tweaking their guidelines to either remove specific barriers or define specific places or uses for which telehealth and telemedicine is allowed and funded.

“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,” the report, prepared by CCHP Executive Director Mei Wa Kwong, JD, notes. “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.”

The upshot of this analysis is that states are moving slowly and gradually to embrace connected health. They’re working through the growing pains of a method of care delivery that hasn’t yet garnered widespread support among consumers, providers or the payer market – or a clear understand of value.

The point was made clear at last week’s Connected Health Conference in Boston, which featured a debate between Andrew Watson, MD, MLitt, FACS, Vice President of Clinical Information Technology Transformation at UPMC and President of the American Telemedicine Association, and Ateev Mehrotra, MD, MPH, an Associate Professor of Healthcare Policy and Medicine at Harvard Medical School, over whether telehealth’s costs outweigh the benefits.

Mehrotra, who has issued opinions in the past stating that telehealth hasn’t proven its value, continued that argument in Boston. He noted that some telehealth and telemedicine programs may be showing positive results, but the industry as a whole hasn’t reduced healthcare expenses or improved outcomes for a majority of Americans.

“Because a payer reimburses something doesn’t mean that it is cost-effective,” he added.

Watson countered that the industry “is on the learning curve right now,” and that providers are working to prove that these services are reducing healthcare waste and costs, improving workflows, boosting patient engagement and satisfaction and improving clinical outcomes.

“We’re starting to see the early (signs) of value,” he said.

That argument carries over to the CCHP report, which finds that states are placing value on specific telehealth and telemedicine services, and letting the market grow gradually.

According to the report:

  • 49 states and Washington DC reimburse for some form of live video in Medicaid fee-for-service, a number unchanged since CCHP’s spring report and up only one (Rhode Island) since the 2017 report.
  • 11 states provide reimbursement for store-and-forward a decrease of four this year. According to CCHP, four states previously listed as reimbursing for asynchronous telemedicine were removed from the list because they either reimburse only for teleradiology, which the organization doesn’t count in this survey, or the state’s Medicaid program isn’t clear on reimbursement.
  • 20 states provide reimbursement through Medicaid for remote patient monitoring (RPM), also unchanged this year. Expect that number to rise, though, as the Centers for Medicare & Medicaid Services moves forward with new reimbursement codes for RPM services.
  • 23 states strictly define where a telemedicine or telehealth program can originate – usually a healthcare facility. According to CCHP, some states have either removed originating site restrictions altogether or added new sites – 15 states and Washington DC now allow schools to be eligible originating sites, and 13 states are allowing the home to be an eligible originating site, although certain special conditions often apply. But overall, the number of states hasn’t changed this year.
  • 34 state Medicaid programs charge a transmission or facility fee when telehealth is used, up two states since the spring report.
  • 39 states and Washington DC have laws in place mandating some form of reimbursement through private payers, up one (Kansas) this year, with three of those states having laws that go into effect in 2019. This is a contentious issue, with payers in some states – notably Pennsylvania, Massachusetts and Florida – pushing back against payment parity with such force to scuttle proposed telehealth legislation.
  • Several states – Washington DC, New York, New Jersey and Hawaii, to name a few – “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.”

The CCHP report did note some movement in telehealth policy. The most common change implemented since the spring report was a requirement that providers get informed consent from the patient before using telehealth, with seven states adding that condition.

Along with the report, CCHP unveiled two interactive maps allowing users to track current state laws and policies and pending legislation.

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