When it comes to telehealth laws and reimbursement policies, legislators and policy makers across the country seem to be taking one step forward and then one step back, according to a new report from The Center for Connected Health Policy (CCHP).
While many states are beginning to expand telehealth reimbursement, others continue to restrict and place limitations on telehealth delivered services, according to the report.
CCHP, which is a program of the Public Health Institute, released its fourth annual State Telehealth Laws and Reimbursement Policies report as a summary guide to current Medicaid provider manuals, applicable state laws, and telehealth-related regulations for all 50 states, including the District of Columbia. The report captures the most recent policy language in each state as of March 2016. The report primarily addresses the individual state’s policies that govern telehealth use when seeking Medicaid coverage for service, however, the report authors also included a specific category that describes whether a state has established any specific policies that require private insurers to pay for telehealth services.
According to the report, states continue to pursue their own unique set of telehealth policies as more and more legislation is introduced each year. “Some states have incorporated policies into law, while others have addressed issues such as definition, reimbursement policies, licensure requirements, and other important issues in their Medicaid Program Guidelines,” the report authors state.
Currently, 47 states have some form of reimbursement for telehealth in their public program. And, in the 2016 legislative session, 44 states have introduced more than 150 telehealth-related pieces of legislation. “Many bills address different aspects of reimbursement in regards to both private payers and Medicaid, with some bills making changes to existing reimbursement laws. Many states have also proposed legislation that would adopt the Federation of State Medical Board’s model language for an Interstate Medical Licensure Compact,” the report authors wrote.
By examining the state-by-state policies, the CCHP report identified a number of trends, such as that live video Medicaid reimbursement continues to far exceed reimbursement for store-and-forward and remote patient monitoring.
“While there was an uptake in states reimbursing for store and forward and remote patient monitoring (RPM) between 2013 and 2015, in recent months that number has stagnated remaining the same since our last report was issued in July 2015,” the report authors wrote.
“Some states, however, are making progress just as others are pulling back,” the authors noted. For example, Washington’s Medicaid program, which previously did not cover store and forward, is now providing limited reimbursement for store and forward delivered services. On the flip side, Oklahoma’s Medicaid program has ceased its store and forward reimbursement. "These diverging policy directions are indicative of the capricious policies throughout the nation,” the report authors wrote.
Currently, and just as last year, 47 states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. The only states that don’t are the same states to have been found not to have any written definitive reimbursement policies—Massachusetts, Rhode Island and Utah. The number of states that reimburse for store and forward delivered services remains at nine. There has been no change since July 2015 in state Medicaid programs offering reimbursement for remote patient monitoring, continuing at 16 states. That’s an increase of six states since 2013.
Five state Medicaid programs, Alaska, Illinois, Minnesota, Mississippi and Washington, reimburse for all three—remote patient monitoring, live video in Medicaid fee-for-service and store and forward—with certain limitations. That represents an increase of only one from July 2015.
The report focused on 11 specific telehealth-related policy areas—definition of the term telehealth/telemedicine; reimbursement for live video; reimbursement for store-and-forward; reimbursement for remote patient monitoring (RPM); reimbursement for email/phone/fax; consent issues; location of service provided; reimbursement for transmission and/or facility fees; online prescribing; private payer laws and cross-state licensure.
According to the report, 30 states reimburse for transmission/facility fees. With regard to location of service provided, only 10 states currently have these types of restrictions, and the overall trend is to eliminate such limitations.
“A more common practice is for state Medicaid programs to limit the type of facility that may be an originating site, often excluding the home as a reimbursable site, impacting RPM as a result. Currently 23 states have a specific list of sites that can serve as an originating site for a telehealth encounter, with eight states adding eligible originating site lists to their policy since July 2015,” the report authors wrote.
Twenty-nine states include some sort of informed consent requirement in their statutes, administrative code and/or Medicaid policies. In nine states, state medical boards issue special licenses or certificates related to telehealth which could allow an out-of-state provider to render services via telemedicine in a state where they are not located, or allow a clinician to provide services via telehealth in a state if certain conditions are met.
Both Montana and Nevada dropped their telemedicine special license in the past year and adopted the Federation of State Medical Boards’ (FSMB) Interstate Medical Licensure Compact, along with 10 other states. The compact allows for an Interstate Commission to form an expedited licensure process for licensed physicians to apply for licenses in other states.
With regard to private payers, currently, 33 jurisdictions have laws that govern private payer telehealth reimbursement policies. But, not all these laws mandate reimbursement. “Additionally, some private payer laws require that reimbursement amount for a telehealth-delivered service be equal to the amount that would have been reimbursed, had the same service been delivered in-person; however, this is not always the case,” the report authors stated.
CCHP also has made the information available electronically in the form of an interactive map and search tool accessible on its website, cchpca.org.