Page 23 Telehealth and Remote Patient Monitoring RPM for Long Termand Post Acute Care A Primer and Provider Selection Guide 2013

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(e.g., remote rural sites). bursement policies, so payment for telehealth may
require prior approval. Likewise, different states
CMS requires that reimbursement for Medicaid- have various standards by which their Medicaid
covered services, including those with telehealth programs will reimburse for telehealth expenses.
applications, must also satisfy federal requirements As with Medicaid, regulations for telehealth reim-
of efficiency, economy, and quality of care. With bursement by private insurers are set by the states.
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this in mind, states are encouraged to use the flex- Nineteen states have enacted parity laws requiring
ibility inherent in federal law to create innovative that services provided via telehealth must be re-
payment methodologies for services that incorpo- imbursed if the same service would be reimbursed
rate telehealth technology. when provided in person. These states include:

For example, states covering medical services utiliz- Arizona, California, Colorado, Georgia, Hawaii,
ing telehealth may reimburse both the provider at Kentucky, Louisiana, Maine, Maryland, Michigan,
the distant site from which the services are pro- Mississippi, Missouri, Montana, New Hampshire,
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vided for the consultation as well as the provider at Oklahoma, Oregon, Texas, Vermont and Virginia.
the originating site where the patient received the Some insurance programs cover specific telehealth
telehealth services for the office visit. States also services, e.g., behavioral health. Even in the absence
have the flexibility to reimburse any additional cost of a definitive policy, some insurers and Medicaid
(i.e. technical support, line-charges, depreciation agencies will reimburse for telehealth services as
on equipment, etc.) associated with the delivery of long as the rationale for using telehealth is justified
a covered service by electronic means as long as the to the agency’s satisfaction. State waivers or spe-
payment is consistent with the requirements of ef- cial programs offering remote diagnostics, remote
ficiency, economy, and quality of care. These add-on monitoring for specific disease entities or for
costs can be incorporated into the fee-for-service particular populations, allow for additional cover-
rates or separately reimbursed as an administrative age of telehealth services. A few states simply pay
cost by the state. If they are separately billed and claims regardless of whether the encounter was in
reimbursed, the costs must be linked to a covered person or via telehealth. The introduction of man-
Medicaid service. For specific information about aged care, within Medicaid and the private sector,
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Medicaid coverage of telehealth in each state, please has complicated telehealth reimbursement policies
see: http://ctel.org/expertise/reimbursement/medic- since a number of state programs acknowledge us-
aid-reimbursement/. ing telehealth within managed care but do not keep

specific telehealth utilization data. In many cases,

6.3 Private Health Insurance Coverage state Medicaid managed care and fee-for-service are
separate programs with separate guidelines.
There is no single widely-accepted standard for pri-
vate insurance coverage of telehealth services. Some
insurance companies value the benefits of tele-
health and will reimburse a wide variety of services.
Others have yet to develop comprehensive reim-

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