Page 3 ATA State Telehealth Policy Toolkit Coverage and Reimbursement

 48 states have some coverage for telemental health: Alabama, Alaska, Arizona, Arkansas, California,
Colorado, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas,
Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri,
Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North
Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah,
Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

 23 states have some form of coverage for home telehealth: Alabama, Alaska, Arizona, Colorado, Indiana,
Kansas, Kentucky, Massachusetts, Minnesota, Mississippi, Nebraska, New Mexico, New York, North
Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Vermont, Washington, and
Wisconsin.

 17 states are authorized to cover remote patient monitoring: Alabama, Alaska, Colorado, Indiana, Kansas,
Massachusetts, Minnesota, Mississippi, Nebraska, New York, North Dakota, Pennsylvania, South Carolina,
South Dakota, Texas, Vermont, and Washington.

 13 states are authorized to cover store-and-forward based services: Alaska, Arizona, California, Illinois,
Minnesota, Mississippi, Nebraska, New Mexico, Oklahoma, Oregon, Tennessee, Texas, and Virginia.

The variations in telehealth Medicaid policies relate to service coverage, payment methodology, distance
requirements, eligible patient populations and health care providers, authorized technologies, and patient
consent. Some states follow Medicare’s statutory and regulatory guidance on telehealth services when devising
their own state plans, which may result in the authorized coverage of only real-time audio-video interactions,
while excluding remote monitoring and store-and-forward transmissions, or coverage in only rural areas or
limited clinical settings. These policy decisions can also be driven by resistance to outside competition by
established providers, budget constraints, public health needs, available infrastructure, or provider readiness – or
simply tradition. Unfamiliarity of successful telehealth policy models and a poor understanding of how
telehealth can be integrated into existing health delivery systems have resulted in disparate coverage.

Telehealth coverage is not guaranteed to be applied to all services that are offered in-person. For example,
Idaho’s Medicaid program will only reimburse for a limited number of mental health services delivered via
telehealth. In 2013, Michigan rescinded their minimum distance requirements of 50 miles between an
originating (patient) and distant (provider) site to qualify for Medicaid reimbursement.

However, good state-practices also exist. New Mexico is one of few states that reimburses for telehealth-
provided services delivered in the home and school. California’s telehealth provisions are a good example of
concise policymaking that recognizes telehealth as a legitimate delivery method, and also omits artificial
barriers such as requiring in-person contact or limiting the type of setting for a telehealth encounter:

Section 14132.72 – Welfare and Institutions Code
(b) It is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by
which an individual may receive health care services from a health care provider without in-person
contact with the provider.
(c) In-person contact between a health care provider and a patient shall not be required under the
Medi-Cal program for services appropriately provided through telehealth, subject to reimbursement
policies adopted by the department to compensate a licensed health care provider who provides health
care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program.
Nothing in this section or the Telehealth Advancement Act of 2011 shall be construed to conflict with or
supersede the provisions of Section 14091.3 of this code or any other existing state laws or regulations
related to reimbursement for services provided by a noncontracted provider.

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American Telemedicine Association
www.americantelemed.org