Telehealth Landscape Overview 50 States + DC

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 to navigate, particularly when a health system or practitioner provides health care services in multiple states. In most cases, states have moved away from duplicating Medicare’s restrictive telehealth policy, with some reimbursing a wide range of practitioners and services, with little to no restrictions.

One of the most common trends with live video reimbursement was the addition of eligible services to the list of telehealth eligible services, with applied behavioral analysis being the most common service addition mentioned in Medicaid manuals.

Additionally, in the wake of the COVID-19 pandemic, some states do seem to be adopting the Center for Medicare and Medicaid Services (CMS) communication technology-based services (CTBS) codes, including the virtual check-in and remote evaluation of prerecorded information, audio-only service codes and remote physiologic monitoring. All fifty states and the District of Columbia have a definition in law, regulation, or their Medicaid program for telehealth, telemedicine, or both.

Additionally, because of the allowance in most states to utilize telephone as a form of telehealth during COVID-19, some states are taking steps to broaden its permanent definitions of telehealth or telemedicine by removing the explicit exclusion of telephone or including audio-only services within the definition itself. One of the states with the most significant changes to their telehealth policy was Massachusetts which passed a comprehensive telehealth law to require reimbursement for both Medicaid and private payers if the services are covered in-person and it is appropriately delivered through telehealth. The law contained some unique elements including specifying that the rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same services delivered by other telehealth modalities. It also provided payment parity for in-network providers of behavioral health services delivered via interactive audio-video technology or audio-only telephone only.

Additional findings include:

  • 50 states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service.
  • 22 state Medicaid programs reimburse for store-and-forward. However, three states (NC, OH, VT) solely reimburse store-and-forward asa part of CTBS, which is limited to specific codes and reimbursement amounts. Additionally, three  jurisdictions (MS, NH, and NJ) have laws requiring Medicaid reimburse for store-and-forward but as of this time, have yet to have anyofficial Medicaid policy indicating this is occurring. 
  • 26 state Medicaid programs provide reimbursement for RPM. As is the case for store and-forward, two Medicaid programs (HI and NJ) have laws requiring Medicaid reimburse for RPM but at the time this response was written, did not have any official Medicaid policy. Additionally, one state (Ohio) only reimburses the remote physiologic monitoring codes CMS does.
  • 14 state Medicaid programs (Alaska, Arizona, Colorado, Maryland, Maine, Minnesota, Missouri, North Carolina, New York, Ohio, Oregon,Texas, Vermont and Virginia) reimburse for all three, although certain limitations apply.
  • 43 states and the District of Columbia have laws that govern private payer reimbursement of telehealth. Some laws require reimbursement be equal to in-person coverage, however most only require parity in covered services, not reimbursement amount. Not all laws mandate reimbursement coverage parity, and very few have explicit payment parity
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