Editor’s Note: As the demand for telemedicine services continues to grow, states are implementing new policies related to the payment for, and provision of, care via telemedicine modalities for all patients. State Medicaid programs, other payers and health systems across the country are increasingly relying on telemedicine technologies to address healthcare challenges, such as provider shortages, system capacity and access to care. In a new article for Inside Medical Liability, summarized below, Manatt Health reviews the changing landscape of state telemedicine laws and policies.
Information in the article is based on Manatt Health’s survey across 50 states and Washington, DC, of state laws and Medicaid policies related to practice standards and licensure; Medicaid coverage and reimbursement; Medicaid-eligible patient settings; Medicaid-eligible provider settings; Medicaid-eligible technologies; Medicaid service limitations; and corporate practice of medicine.1
Manatt’s survey reveals that nearly all state Medicaid fee-for-service (FFS) programs provide reimbursement for some telemedicine services, generally expanding access to telemedicine for their Medicaid FFS beneficiaries. The survey also highlights that Medicaid FFS programs provide significantly more expansive coverage than what is available to Medicare beneficiaries. At this time,2 Medicare FFS provides telehealth coverage only for a very limited set of services that meet strict requirements related to the technology utilized, the originating site and the provider type.
In contrast, state Medicaid FFS programs offer comprehensive coverage of telemedicine, allowing a broad range of services, providers, locations and technologies that are eligible for reimbursement. Most states allow various types of providers to administer care via telemedicine, and few impose impactful restrictions on the types of services that can be provided through these modalities.
Key Barriers and Implications
Despite this notable progress, major barriers still exist in some states to the provision of telemedicine services for Medicaid FFS beneficiaries: (See Table 1 for definitions of key terms used in this section.)
States may implement restrictive policies for a variety of reasons—fear of overutilization leading to skyrocketing costs, new technology and risk. There is little evidence to date that validates those concerns. Conversely, health systems have indicated that telemedicine programs are delivering positive benefits, including increased clinic and in-patient capacity, reduced hospital readmissions, and improved patient satisfaction and quality of care.
Telemedicine will be central to the role of healthcare delivery in the future. Manatt predicts that over time, all payers will re-evaluate their telemedicine reimbursement policies and take proactive steps to reduce barriers to care and expand access to digitally enabled care.
Key Terms and Definitions
|Live Video Conferencing||Two-way, interactive audio-video conferencing between a patient at an originating site and a provider at a distant site.|
|Store and Forward||The electronic transmission of medical images, records or prerecorded videos through secure email transmission.|
|Remote Patient Monitoring||The ongoing collection and transmission of health data, from a patient in one location to a provider in a different location.|
|Hub Site/Remote Provider Site||Where the provider who is delivering care via a telemedicine modality is located.|
|Spoke Site/Originating Site||Where the patient or provider requesting telemedicine services from a remote provider is located.|
1. Unless otherwise noted, the scope of this survey and the findings included in this article are limited to Medicaid fee-for-service. This is a known limitation given that many states are transitioning large portions of their Medicaid populations into managed care plans.
2. The Proposed Rule Medicare Program: Revisions to Payment Policies Under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B, released on July 12, 2018, if adopted, substantially expands the reimbursement for certain technology-based services that fall outside of the statutory definition of telehealth.