In the spring of 2018, the Center for Connected Health Policy (CCHP) published its update of the State Telehealth Laws and Reimbursement Policies Report.  One of the most comprehensive reports available on the issues involved with U.S. telehealth reimbursement of all types, that report is divided into multiple sections to address a variety of issues. A few of those sections are summarized for you below.

Home-Based Care

The first of the CCHP’s report sections of potential interest is that 10 states have amended their telehealth policies since August 2016 to specifically make the patient’s home an originating site for Medicaid-accepted telehealth and telemedicine programs. Those states are Delaware, Colorado, Maryland, Michigan, Minnesota, Missouri, New York, Texas, Washington, and Wyoming. To be more specific, professionals such as social workers licensed in New York have been able to use telehealth strategies to serve Medicaid patients who are geographically located in their homes. Fees collected by social workers for such interventions have been far superior than clinicians may imagine.

Six states have eliminated geographic requirements since 2013. A total of 16 states have also added schools to their approved originating sites (where the client/patient is located). Some states, however, are placing an increasing number of restrictions on such services.

Overall Perspective on Telehealth Reimbursement for Home-Based Care

According to the CCHP’s 2018 report, 160 telehealth-related bills were introduced during the 2018 legislative session to increase telehealth reimbursement in 44 states. These numbers continue a growing technology-based health care trend that led to 200 pieces of legislation being introduced during the 2017 session. (Some of those bills were not supportive of new healthcare services.) CCHP officials also reported that 23 states still limit reimbursement for telehealth to a specific list of approved “distant” sites (where the clinician is located). That number hasn’t changed since the CCHP’s fall 2017 update.
Lastly, four states mandate that a clinician and his/her client/patient be separated by a certain number of miles, which precludes the delivery of care in some urban communities. While many telehealth reimbursement experts focus on the need for more practitioners to serve rural clients/patients, the truth is that many urban dwellers are also underserved, particularly in low-income communities.
Last but not least, many internet start-ups already deliver home-based care, but they do not receive reimbursement from insurance carriers. Rather, they directly collect their fees from patients or their families. As discussed in one of our webinars, such companies can be fraught with legal and ethical complications for the licensed professional.


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