Page 2 ATA State Telehealth Policy Toolkit Coverage and Reimbursement

State Policy Toolkit
Improving Access to Covered Services for Telemedicine

Telemedicine (called telehealth in some states) has allowed states to implement innovative health policy reforms
that achieve significant cost savings and improve health outcomes. ATA has been instrumental in the
development and passage of these reforms, providing education, outreach and engagement for key stakeholders
at the state level. ATA is committed to establishing and promoting effective state policies and practices, to help
states—and their citizens—realize the full potential of telemedicine.

This toolkit is a resource for individuals looking to develop and/or influence telehealth policy at the state level.
It includes lists of suggested policy proposals, model telehealth legislation, talking points, and a guide for
promoting discussion and action for telehealth policy changes.

IMPORTANT FEATURES OF GOOD TELEHEALTH POLICY

No Artificial, Non-Medical Restrictions – States, like most payers, often impose a variety of restrictions on
telehealth. Examples of such obstructive policies include: geography/distance limitations, requirements for an
established patient-provider relationship or in-person exam, patient setting and provider-type restrictions, and
limits on applicable technology. These restrictions are often arbitrary and provide no consideration for
professional medical discretion, provider shortages or patient limitations. The primary goal of any responsible
telehealth policy should be to eliminate these unreasonable, unnecessary restrictions on the practice of
telemedicine.

State-wide Parity for Coverage – Telehealth-provided services should be covered to the same extent—and in a
similar manner—as in-person services. At the state level, the payment for telemedicine involves three major
payers: private insurance, Medicaid, and state employee coverage. Surprisingly, the most progress for parity is
with private insurance, with most states themselves missing the boat on telemedicine’s cost-savings. Notably 23
states require such parity and many have more than 10 years successful experience with this requirement.

Flexibility – Although telehealth is dynamic and evolving, state statutes are often static and can be inflexible.
Legislation should establish clear and basic priorities on which states can build future health policy
improvements. A state should regularly assess existing telehealth policies for improvements, and update those
policies when new clinically appropriate telehealth applications are developed.

OVERVIEW OF CURRENT TELEHEALTH COVERAGE AND REIMBURSEMENT

MEDICAID

All states allow reimbursement for physician services that do not require direct interactions with a patient, such
as for radiology or reading an EKG. Forty-eight states have some Medicaid coverage for other remote video or
store-and-forward services. The details of state Medicaid coverage vary widely and are seldom the same as in-
person coverage for a specific service.
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American Telemedicine Association
www.americantelemed.org