Page 10 50 State Telemedicine Gaps Analysis Coverage and Reimbursement

50 State Telemedicine Gaps Analysis: Coverage & Reimbursement

Assessment Methods

Scoring

This report considers telemedicine coverage and reimbursement policies in each state based on
two categories:

 Health plan parity
 Medicaid conditions of payment.

These categories were measured using 13 indicators. The indicators were chosen based on the
most recent and generally accessible information assembled and published by state public
entities. Using this information, we took qualitative characteristics based on scope of service,
provider and patient eligibility, technology type, and arbitrary conditions of payment and
assigned them quantitative values. States were given a certain number of points for each
indicator depending on its effectiveness. The points were then used to rank and compare each
state by indicator. We used a four-graded system to rank and compare each state. This is based
off of the scores given to each state by indicator. Each of the two categories was broken down
into indicators – three indicators for health plan parity and 10 indicators for Medicaid conditions
of payment.

Each indicator was given a maximum number of points ranging from 1 to 35. The aggregate
score for each indicator was ranked on a scale of A through F based on the maximum number of
points.

The report also includes a category to capture innovative payment and service delivery models
implemented in each state. In addition to state supported networks in specialty care and
correctional health, the report identifies a few federally subsidized programs and waivers that
states can leverage to enhance access to health care services using telemedicine.

Limitations

Telemedicine policies in state health plans vary according to a number of factors – service
coverage, payment methodology, distance requirements, eligible patient populations and health
care providers, authorized technologies, and patient consent. These policy decisions can be
driven by many considerations, such as budget, public health and safety needs, available
infrastructure or provider readiness.

As such, the information in this report is a snapshot of information gathered through April 2015.
The report relies on dynamic policies from payment streams that are often dissimilar and
unaligned.

We analyzed both Medicaid fee-for-service (FFS) and managed care plans. Benefit coverage
under these plans vary by size and scope. We used physician, mental and behavioral health,
home health, and rehabilitation services as a benchmark for our analysis. Massachusetts and
New Hampshire do not cover telemedicine-provided services under their FFS plans but do have

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American Telemedicine Association
2015