State Telehealth Laws and Reimbursement Policies – Fall 2020

medicaid and telehealth

Updates to “State Telehealth Laws and Reimbursement Policies” revealed that Medicaid programs continue to refine their telehealth reimbursement policies.  During this update we saw the biggest change in covered modalities with store-and-forward reimbursement, which jumped from sixteen to eighteen state Medicaid programs providing reimbursement.  Surprisingly, two states (South Carolina and Washington) eliminated sections of their manuals that provided reimbursement for remote patient monitoring, decreasing the number of states by two.  

As mentioned above, most states have kept their COVID telehealth expansions siloed from their permanent telehealth policies.  However, a minority of states have made permanent changes to their telehealth policies and most were done through administrative actions and not legislatively. Examples of such expansions include expanding reimbursement for remote communication technology codes, such as the virtual check-in (G2012) and e-visits, which is communication through a patient portal.  Several states also clarified eligible originating sites to include the patient home, as well as schools.  The most common specialties that had expansions in covered services included behavioral health and substance use disorder services, teledentistry, school-based health services and speech therapy.  Allowing federally qualified health centers (FQHCs) and rural health clinics (RHCs) to qualify for reimbursement as a distant site was also a common policy change. 

Finally, although telephone has been allowed to deliver services in most states on a temporary basis to deliver healthcare due to the PHE, only a few states have taken the step to make it permanent but usually only for a narrow set of services.  For example, South Carolina allows for telephone service delivery, but only for dental services, Texas allows for it, but only for supportive encounters for behavioral health and case management, and Tennessee allows for it but only for ‘provider-based telemedicine’ which it strictly defines and specifies that it must be HIPAA compliant.  States such as Utah and New York took the approach of broadening their definition of telehealth to incorporate audio-only telephone, but did not explicitly require reimbursement for the modality.  Both Alabama and Alaska took the opposite step, by clarifying that service delivery via telephone is not allowed in their programs.

On the topic of private payer reimbursement, there was one state (West Virginia) to add a private payer law since Spring 2020, however a few other states amended their current private payer laws to be more expansive.  For example, Alaska, whose law was narrowly focused on mental health services previously, broadened the scope of their telehealth private payer law to apply to all covered services.  While both California and Washington have laws that require payers pay the same rate for telehealth delivered services as they do for in-person, they do not go into effect until Jan. 1, 2021.  

KEY FINDINGS FOR THE FALL 2020 UPDATE INCLUDE:

  • Fifty states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service.  
  • Eighteen states provide reimbursement for store-and-forward.  
  • Twenty-one state Medicaid programs provide reimbursement for remote patient monitoring (RPM).  
  • Sixteen states limit the type of facility that can serve as an originating site.  
  • Thirty-two state Medicaid programs offer a transmission or facility fee when telehealth is used. 
  • Forty-three states and DC currently have a law that governs private payer telehealth reimbursement policy.  
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