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:
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 15 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:
20 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:
In addition to state Medicaid programs, South Dakota offers RPM reimbursement through the Department of Aging.
Currently, no Medicaid programs offer reimbursement for delivering care through email, phone and fax.
32 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.
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.
31 jurisdictions 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.
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.”
49 states and the District of Columbia have a definition for telemedicine in law, regulation, or their Medicaid program. Meanwhile, 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.” The definition may or may not include store-and-forward services.
Many states haven’t defined store-and-forward. For those who have, it typically refers to the asynchronous process of transmitting medical information electronically.
As previously mentioned, the originating site refers to the site at which the patient is receiving care.
The distant site always refers to the medical site at which a practitioner is delivering telemedicine care.
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.
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.
Certain states have cross-state licensing laws that allow providers in neighboring states to provide care to patients without being fully licensed.