Page 11 50 State Telemedicine Gaps Analysis Coverage and Reimbursement

50 State Telemedicine Gaps Analysis: Coverage & Reimbursement

some coverage under at least one of their managed care plans. As such, the analysis and scores
are reflective of the telemedicine offerings in each program, and not the Medicaid program itself,
regardless of size and scope.

We did not analyze Children’s Health Insurance Plans (CHIP) plans. We are aware that states
provide some coverage of telemedicine-provided services for CHIP beneficiaries. Additionally,
some states recognize schools and/or school-based health centers as originating sites, however
we did not separately score or rank school-based programs.

Other notable observations in our analysis include state Medicaid plans that do not cover therapy
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services (i.e. physical therapy, occupational therapy, and speech language pathology). States
with no coverage for these benefits were not applicable for scoring or ranking.

Additionally, some states policies can be conflicting. States like New York and Washington
have enacted laws requiring telemedicine parity in their Medicaid plans. However, regulations
and the Medicaid provider manuals do not reflect these policy changes. Also Missouri and
Oklahoma have policy proposals that would expand coverage under Medicaid but are awaiting
final approval. In those cases, the analysis and scores are reflective of the authorized regulations
and statutes enacted by law. Future reports will reflect changes in the law if applicable.

Also, this report is about what each state has “on paper”, not necessarily in service. Important
factors, such as the actual provision and utilization of telemedicine services and provider
collaboration to create service networks are beyond the scope of this report.

Indicators

Parity

A. Private Insurance

Full parity is classified as comparable coverage and reimbursement for telemedicine-provided
services to that of in-person services. Twenty-three states and the District of Columbia have
enacted full parity laws. Only Arizona has enacted a partial parity law that require coverage and
reimbursement, but limit coverage to a certain geographic area (e.g., rural) or a predefined list of
health care services. For this report’s purpose, we measured components of state policies that
enable or impede parity for telemedicine-provided services under private insurance health plans.

Scale – Private Insurance Parity
A 7 points
B 6 points
C 5 points
F ≤ 4 points

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American Telemedicine Association
2015