Medicaid, Private Payers & Other Telehealth Policy Issues
The primary changes summarized by CCHP since the Spring 2021 update include differences in Medicaid reimbursement policy, private payer policies, and telehealth policies applying to provider groups.
Medicaid Telehealth Policy
Medicaid policies changed by CCHP include shifts that add to or clarify the nature of services that can be provided using telehealth, the types of providers that can deliver services and the setting or location of the client or patient during a telehealth session. Also, less than one-half of State Medicaid programs are permanently reimbursing for audio-only telehealth.
Private Payer Telehealth Policy
Changes to private payer policy include states making changes to their definition of telehealth or telemedicine. Those definitions have expanded to more than live video alone to include audio-only sessions in some states. As expected, policies have changed, as professional requirements for many providers groups have become more specific. While some states have applied new requirements for various healthcare services, some states have allowed for exceptions for licensees or providers with certificates to practice.
Other Telehealth Policy Issues
- Policy for fifty states and Washington, DC provide fee-for-service Medicaid reimbursement for some form of live video.
- Twenty-two states reimburse providers for store-and-forward
- Medicaid programs in 29 states reimburse for remote patient monitoring (RPM)
- Twenty-two states allow audio-only (i.e., telephone) reimbursement with limitations in most cases
- Fourteen states have restrictions on the type of setting that can be considered the originating site
- A total of 35 state Medicaid programs have a transmission or facility fee for the use of telehealth
- Forty-three states plus Washington, DC mandate private payer telehealth reimbursement.
CCHP Fall 2021 Summary Resources
The complete CCHP Fall 2021 analysis and summary of telehealth policies can be found here: State Telehealth Laws and Reimbursement Policies Report, Fall 2021. The previous PDF version of this report has been replaced with a digitized version, which allows for updated information to be posted by the CCHP staff as it is announced. This new functionality allows the user to have the most current information when they need it. It is dubbed the “Policy Finder” database tool and now covers changes that have taken place in state telehealth policy from June 2021 to September 2021. The report is also available in a summary chart, listing the important policies by state, along with an infographic.
See TBHI’s previous articles related to reimbursement for more information:
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