Page 7 50 State Telemedicine Gaps Analysis Coverage and Reimbursement

50 State Telemedicine Gaps Analysis: Coverage & Reimbursement

Table 1
Composite Composite Composite Composite
State State State State
Grade Grade Grade Grade
AK B ID C MT B RI F
AL B IL C NC C SC B
AR C IN C ND B SD B
AZ B KS B NE B TN A
CA B KY B NH A TX B
CO B LA B NJ C UT B
CT F MA B NM A VA A
DC A MD B NV C VT B
DE B ME A NY B WA B
FL C MI B OH B WI C
GA B MN B OK C WV C
HI C MO B OR B WY B
IA C MS B PA B

When broken down by the 13 indicators, the state-by-state comparisons reveal even greater
disparities.

 Three additional states have enacted telemedicine parity laws since the release of the initial
report. Of the 24 states that have telemedicine parity laws for private insurance, only 16 of
them and D.C. scored the highest grades indicating policies that authorize state-wide
coverage, without any provider or technology restrictions (Figure 2). Colorado improved its
grade from a ‘B’ to ‘A’ because it removed the rural restrictions from its parity law. Over
half of the country, 27 states, ranked the lowest with failing scores for having either no parity
law in place or numerous artificial barriers to parity. Arkansas maintains a failing grade
because it places arbitrary limits in its parity law.

 Forty-eight state Medicaid programs have some type of coverage for telemedicine. Only four
states and D.C. scored the highest grades by offering more comprehensive coverage, with
few barriers for telemedicine-provided services (Figure 3). Maryland dropped from an ‘A’ to
‘B’ due to restrictions enforced in its regulations. Connecticut, Hawaii, Idaho, Rhode Island,
and West Virginia ranked the lowest with failing scores in this area. Iowa, Nevada and Utah
have improved their failing scores to ‘C’ by expanding coverage for telehealth under their
Medicaid plans.

 One area of improvement includes coverage and reimbursement for telemedicine under state
employee health plans. Twenty-four states have some type of coverage for telehealth under
one or more state employee health plan. Most states self-insure their plans and 58 percent of
the country is ranked the lowest with failing scores due to partial or no coverage of telehealth
(Figure 4).

Regarding Medicaid regulations, states are slowly moving away from the traditional hub-and-
spoke model and allowing a variety of technology applications. Twenty-four states and D.C. do
not specify a patient setting as a condition for payment of telemedicine (Figure 5). Aside from

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American Telemedicine Association
2015