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Medicaid reimbursement for telemedicine

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When it comes to Medicaid reimbursement for telemedicine, the U.S. truly has 50 states and 50 unique policies. This page provides an overview of state-by-state Medicaid reimbursement legislation.

An overview of Medicaid reimbursement for telehealth

  • 48 state Medicaid programs reimburse for some form of live video
  • 19 state Medicaid programs offer reimbursement for remote patient monitoring
  • 7 state Medicaid programs (Alaska, Hawaii, Illinois, Minnesota, Mississippi, Missouri, and Washington) reimburse for all three
  • 30 states will reimburse either a transmission, facility fee, or both
  • 12 state Medicaid programs offer some reimbursement for store-and-forward, not counting states that only reimbursed for tele-radiology

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Medicaid Reimbursement Regulations

Synchronous video reimbursement

With the exception of Massachusetts and Rhode Island, every state offers some type of live video reimbursement in their Medicaid program. However, each state may restrict reimbursement based on the following:

  • Medical specialty type
  • Type of service provided
  • Location of the patient (referred to as the originating site)
  • Location of the provider (referred to as the distant site)

 

Store-and-forward reimbursement

In many states, “telemedicine” and/or “telehealth” is defined as occurring in real time, therefore excluding store-and-forward as falling under the definition of telemedicine and telehealth. Currently 12 states reimburse for store-and-forward. However, even within these states, Medicaid programs further limit reimbursement based on factors like services provided and medical specialty type. The following states offer some form of reimbursement for store-and-forward:

  • Alaska
  • Arizona
  • Connecticut
  • California
  • Hawaii
  • Illinois
  • Minnesota
  • Mississipi
  • Missouri
  • New Mexico
  • Virginia
  • Washington

 

Remote patient monitoring (RPM) reimbursement

19 states have some form of RPM reimbursement in their Medicaid program. Similarly to video and store-and-forward reimbursement, state Medicaid programs have restrictions on the reimbursement qualifications of RPM. The following states offer some form of reimbursement for remote patient monitoring:

  • Alabama
  • Alaska
  • Colorado
  • Hawaii
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Minnesota
  • Mississippi
  • Missouri
  • New York
  • South Carolina
  • Texas
  • Utah
  • Vermont
  • Washington

In addition to state Medicaid programs, Pennsylvania and South Dakota offer RPM reimbursement through the Department of Aging.

 

Email, phone and fax

Currently, no Medicaid programs offer reimbursement for delivering care through email, phone and fax.

 

Transmission/Facility Fee

30 state Medicaid programs will reimburse the facility fee, transmission fee or both. The transmission fee refers to any cost incurred by the originating site to provide video and/or audio communication on the patient’s end. The facility fee refers to any cost incurred by the distant site to provide video and/or audio communication on the physician’s end.

 

Location requirements for reimbursement

While Medicare restricts the geographic location of patients receiving telehealth care to rural or underserved areas, state Medicaid programs typically just limit the type of facility at which a patient may receive care. For example, many Medicaid programs exclude telemedicine care delivered to a patient in his/her home. Another common practice is to require a licensed healthcare provider to be located at the originating site with the patient.

 

Informed consent

29 states require either written or verbal consent from patients before practitioners may provide care to them. Sometimes, this applies to state Medicaid programs, and sometimes it does not.

Medicaid telemedicine definitions

Telehealth

The federal Health Resources and Services Administration (HRSA) defines telehealth as:
“The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”

Telemedicine

48 states and the District of Columbia have a definition for telemedicine in law, regulation, or their Medicaid program. The definition may or may not include store-and-forward services.

Store-and-forward

Many states haven’t defined store-and-forward. For those who have, it typically refers to the asynchronous process of transmitting medical information electronically.

Originating site

As previously mentioned, the originating site refers to the site at which the patient is receiving care.

Distant site

The distant site always refers to the medical site at which a practitioner is delivering telemedicine care.

Remote patient monitoring

RPM refers to the use of technical equipment to collect medical and other health data from patients. Information is then delivered electronically to a practitioner at a distant site for review.

mHealth

Mobile health involves transmitting patient health information using smartphones or tablets. It typically requires downloading some form of software and is currently not reimbursable in any state.

Cross-state licensing

Certain states have cross-state licensing laws that allow providers in neighboring states to provide care to patients without being fully licensed.

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