Page 28 50 State Telemedicine Gaps Analysis Coverage and Reimbursement

50 State Telemedicine Gaps Analysis: Coverage & Reimbursement

devising, adapting and advancing long-term optimal health delivery. MCOs experimenting with
innovative delivery models including medical homes and dual-eligible coordination have
incorporated telemedicine as a feature of these models especially because it helps to reduce costs
related to emergency room use and hospital admissions.

Twenty-four states authorize telemedicine-provided services under their Medicaid managed care
plans. Most notably, Massachusetts and New Hampshire offer coverage under select managed
care plans but not under FFS.

The federal Affordable Care Act (ACA) offers states new financing and flexibility to expand
their Medicaid programs, as well as to integrate Medicare and Medicaid coverage for dually
eligible beneficiaries (“duals”). Georgia, New York and Virginia are the only states that extend
coverage of telemedicine-provided services to their dual eligible population through the Centers
for Medicare and Medicaid Services (CMS) Capitated Financial Alignment Model for Medicare-
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Medicaid Enrollees.

The ACA also includes a health home option to better coordinate primary, acute, behavioral, and
long-term and social service needs for high-need, high-cost beneficiaries. The chronic
conditions include mental health, substance use disorder, asthma, diabetes, heart disease,
overweight (body mass index over 25), and other conditions that CMS may specify.

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Fifteen states have approved health home state plan amendments (SPAs) from CMS. Alabama,
Iowa, Maine, New York, Ohio, and West Virginia are the only states that have incorporated
some form of telemedicine into their approved health home proposals.

Medicaid plans have several options to cover remote patient monitoring, usually under a federal
waiver such as the Home and Community-based Services (HCBS) under Social Security Act
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section 1915(c). States may apply for this waiver to provide long-term care services in home
and community settings rather than institutional settings. Kansas, Pennsylvania, and South
Carolina are the only states that have used their waivers to provide telemedicine to beneficiaries
in the home, specifically for the use of home remote patient monitoring.

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American Telemedicine Association
2015