Page 8 50 State Telemedicine Gaps Analysis Coverage and Reimbursement

50 State Telemedicine Gaps Analysis: Coverage & Reimbursement

this, 25 states recognize the home as an originating site, while 16 states recognize schools and/or
school-based health centers as an originating site (Figures 6-7).

Alaska has the highest ranking for Medicaid operations because its program covers telemedicine
when providers use interactive audio-video, store-and-forward, remote patient monitoring, e-
mail, fax, or audio conferencing for some services (Figure 8). South Dakota had dropped to a
‘B’ because it no longer covers telemedicine when some modalities are used. Almost half of the
country ranks the lowest with failing scores either because they only cover synchronous only or
provide no coverage for telemedicine at all. Idaho, Missouri, North Carolina and South Carolina
prohibit the use of “cell phone video” to facilitate a telemedicine encounter.

There is a national trend to allow state-wide Medicaid coverage of telemedicine instead of
focusing solely on rural areas or designated mileage requirements (Figure 9).

States are also increasingly using telemedicine to fill provider shortage gaps and ensure access to
specialty care. Fifteen states and D.C. do not specify the type of healthcare provider allowed to
provide telemedicine as a condition of payment (Figure 10). While 19 states ranked the lowest
with failing scores for authorizing less than nine health provider types. Florida, Idaho, and
Montana ranked the lowest with coverage for physicians only.

Overall, coverage of specialty services for telemedicine under Medicaid is a checkered board and
no two states are alike.

 Ten states and D.C. rank the highest for coverage of telemedicine-provided physician
services and most states cover an office visit or consultations, with ultrasounds and
echocardiograms being the least covered telemedicine-provided services (Figure 11).

 For mental and behavioral health services, generally mental health assessments, individual
therapy, psychiatric diagnostic interview exam, and medication management are the most
covered via telemedicine. Eight states and D.C. rank the highest for coverage of mental and
behavioral health services (Figure 12). The lowest ranking states for all Medicaid services,
scoring an ‘F’, are Connecticut and Rhode Island which have no coverage for telemedicine
under their Medicaid plans.

 Although state policies vary in scope and application, more four states have expanded
coverage to include telerehabilitation. Fourteen states are known to reimburse for
telerehabilitative services in their Medicaid plans. Of those, eight states rank the highest with
telemedicine coverage for therapy services (Figure 13).

 Alaska is the only state with the highest ranking for telemedicine provided services under the
home health benefit (Figure 14). Seventy-two percent of the country ranked the lowest with
failing scores due to a lack of telemedicine services covered under the home health benefit.

Finally, twenty-seven states have unique patient informed consent requirements for telemedicine
encounters (Figure 15). Twenty-eight states and D.C. do not require a telepresenter during the
encounter or on the premises (Figure 16).

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American Telemedicine Association
2015