Page 5 State Telehealth Laws and Reimbursement Policies A Comprehensive Scan of the 50 States and District of Columbia

Key Findings

No two states are alike in how telehealth is defined and regulated. While there are some similarities in
language, perhaps indicating states may have utilized existing verbiage from other states, noticeable
differences exist. These differences are to be expected, given that each state defines its Medicaid policy
parameters, but it also creates a confusing environment for telehealth participants, particularly when a
health system provides health care services in multiple states. In some cases, states have duplicated the
policies governing telehealth in Medicare, while others have developed their own policies for their
Medicaid program.

Below are summarized key findings in each category area contained in the report.

Definitions
States alternate between using the term “telemedicine” or “telehealth”. In some states both terms are
explicitly defined in law and/or policy and regulations. In some cases, “telehealth” is used to reflect a
broader definition, while “telemedicine” is used mainly to define the delivery of medical services.
Additionally, some states put specific restrictions within the definition, such as excluding email, phone,
and/or fax from the definition. Forty-eight states and the District of Columbia have a definition in law,
regulation, or their Medicaid program for telehealth, telemedicine, or both. Two states, Rhode Island and
New Jersey, still lack a legal definition for both terms.

Medicaid Reimbursement
Forty-six states have some form of reimbursement for telehealth in their public program. The four states
that we determined did not have any written definitive reimbursement policies are:

1
• Iowa
• Massachusetts
• New Hampshire
• Rhode Island

The District of Columbia’s Medicaid manual currently does not indicate reimbursement for telehealth;
however, a law that recently went into effect in 2014 requires DC Medicaid to cover services delivered via
live video.

It should be noted that New Hampshire and Massachusetts employ managed care plans in their Medicaid
program. We did not examine whether the participating managed care plans provided any form of
telehealth reimbursement.

Live Video
The most predominantly reimbursed form of telehealth is live video, with every state offering some type of
live video reimbursement in their Medicaid program (except for the four states listed above). However,
what and how it is reimbursed varies widely. The spectrum ranges from a Medicaid program in a state like

1 A letter from the Department of Human Services addressed to the Elderly Waiver Interim Committee
and posted on the Iowa legislature’s website indicates that Iowa Medicaid will pay for otherwise covered
medical services if rendered via telemedicine, and if the standard in the medical community would
support rendering those services via telemedicine. CCHP reached out to Iowa Medicaid staff, who
confirmed this practice in Iowa Medicaid, stating that a service rendered via telemedicine must meet the
general provisions for Medicaid covered services outlined in 441 Iowa Administrative Code 79.9(2).
However, Iowa Medicaid has not published an official telehealth policy. Without an official outlined policy
available, CCHP has classified Iowa as not having a reimbursement policy for telehealth.