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Analysis: Many States Continue to Have Restrictive Telemedicine Policies

July 11, 2018
by Heather Landi
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The use of telemedicine is growing, and nearly all state Medicaid programs provide reimbursement for some telemedicine services, however, while state Medicaid programs are evolving to accelerate the adoption of telemedicine models, this evolution is occurring more quickly in some states than others, according to a recent analysis by healthcare advisory services firm Manatt Health.

State laws and Medicaid policies related to reimbursement, licensure and practice standards for telemedicine are rapidly evolving in response to the proliferation of technology and the growing evidence base demonstrating the impact of telemedicine on access, quality and cost of care. Some states have been proactive in encouraging the use of telemedicine as a means to enhance services in rural areas, increase access to care for members with complex conditions, and reduce costs associated with unnecessary emergency department visits, according to the Manatt Health report.

In light of the rapidly changing landscape, Manatt Health conducted a 50-state, and Washington, D.C., survey of state laws and Medicaid program policies related to telemedicine in the following key areas: practice standards and licensure; coverage and reimbursement; eligible patient settings; eligible provider types, eligible technologies, and service limitations.

Based on survey results, Manatt Health classified state telemedicine policies as “progressive,” “moderate,” or “restrictive” across each of these categories. In states categorized as “restrictive,” state law and Medicaid policy are restrictive and may inhibit the broad use of telemedicine, according to Manatt Health. Moderate states have moderately support the broad use of telemedicine and progressive states enable and incentivize expanded use of telemedicine.

The survey is intended to inform health systems and providers, state policy makers, and technology companies, regarding state-specific policies for providing health care services via telemedicine generally, and for Medicaid beneficiaries specifically. Survey results are current as of May 2018.

Manatt Health’s analysis found that 12 states are categorized as “restrictive” based on factors such as licensing protocol, Medicaid-eligible providers, Medicaid-eligible technologies and service limitations. Those states are Arkansas, Georgia, Massachusetts, Maryland, North Carolina, North Dakota, New Hampshire, Ohio, Pennsylvania, Rhode Island, South Carolina and Texas.

Twenty states were categorized as “progressive,” including Alaska, California, Colorado, Florida, New Jersey and New York. The remaining 18 states and also Washington, D.C. were classified as “moderate.”

Among the key findings in the study, 26 states provide reimbursement for telemedicine services delivered in a patient’s home.

Nearly all state Medicaid programs provide coverage and reimbursement for live video conferencing, but fewer states reimburse for telemedicine technologies beyond live video, such as store and forward, remote patient monitoring, or email and phone, the study found. Twenty-nine states are reimbursing for at least one method in addition to live video, sixteen states are reimbursing for three of the four different telemedicine technologies (most states do not reimburse for care provided via email and phone), and only one state, Colorado, reimburses for all four types of technologies.

Nine states require a provider to have an established relationship with a patient before they can connect and provide them with care via telemedicine, the study found. For example, in Mississippi, a “valid physician-patient relationship,” which includes a prior physical exam, must exist in order to provide care via telemedicine.

Nine states place limits on the frequency with which Medicaid patients can receive care via telemedicine within a given timeframe. For example, in Georgia, hospital services are limited to one telemedicine visit every three days, and nursing facilities are restricted to one telemedicine visit every thirty days.

The study also found that nine states place geographic restrictions on telemedicine encounters; their Medicaid policies limit reimbursement based on where a patient or originating site provider and the distant site provider are located. For example, in Indiana, the state only reimburses for telemedicine services when the hub and spoke sites are greater than twenty miles apart

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