Medicaid & Telemedicine Reimbursement

Medicaid reimbursement for telemedicine can vary widely from state-to-state.
Here’s a quick summary of the overall trends, and tips to navigate your own state’s Medicaid policies.

Almost all state Medicaid programs offer some sort of coverage for telemedicine, usually for live video. Some states reimburse for telemedicine with few restrictions, while others have more limited coverage.

A recent telemedicine policy report from the American Telemedicine Association (ATA) has an excellent, in-depth analysis of state Medicaid coverage for telemedicine.
Here are some of the key findings:

While the ATA report shows there’s still room for improvement, the nation is trending toward broader coverage for telemedicine.

As you’re researching your state Medical policies, also keep in mind that your state Medicaid handbook may not yet reflect the most recent policies passed. Some programs haven’t quite caught up yet to the flood of new telemedicine policy. That’s why it’s always best to contact your state Medicaid program and verify the telemedicine guidelines as you’re getting started.

Need some more help navigating your state Medicaid guidelines? No problem. Let’s drill down to the common requirements that many state Medicaid programs put on telemedicine coverage. Here’s a quick summary.

Patient Setting

Patient setting (also called “originating site”) means where the patient is at the time of the telemedicine service. Traditionally, an eligible patient setting for telemedicine was limited to specific kinds of health facilities, often located within a Health Professional Shortage Area (HPSA).

With telemedicine technology increasingly moving to flexible online and mobile solutions that let patients and providers videochat via cell phone, this requirement can really get in the way. Many patients look to telemedicine visits as a way to get quick medical care in their homes.

The good news is that many state Medicaid programs are moving away from this restriction. Currently, 24 states plus DC don’t have any restrictions on the patient location, and 25 states recognize the home as an eligible originating site.

Type of Telemedicine

There are many different types of telemedicine — the primary one is live video, followed by store-and-forward (saving and sending medical data), and remote patient monitoring (watching how a patient is doing from afar).

A majority of state Medicaid programs only cover live video telemedicine. Only Alabama, Alaska, Minnesota, Mississippi, Nebraska, and Texas cover remote patient monitoring and store-and-forward, in addition to live video.

Hopefully as these states start to show the powerful effects of alternative forms of telemedicine, other states will start to follow their lead.

Geography restrictions

In the past, many state Medicaid programs only covered telemedicine in cases where patients lived far away from health providers, in remote or rural areas. States would set a specific distance requirement or geographic area that a patient would need to meet to be eligible for telemedicine.

Luckily,most states are trending away from this type of restriction now. In fact, 82% of states offer state-wide telemedicine coverage and have no geographic limits.

Eligible Providers

While all states with telemedicine coverage let physicians practice telemedicine, state Medicaid programs often restrict what other healthcare providers can also do telemedicine.

Currently 15 states plus DC don’t have this restriction – meaning any healthcare provider is eligible! The rest of the states have a set list of eligible providers, and only 4 states limit coverage to physicians only.

Covered Health Services

The majority of states cover telemedicine for standard office visits, but only some have additional coverage for specialty services like echocardiograms, mental health counseling, telerehabilitation, or even ultrasounds.

Check your state’s policy to see what services are covered.

Increase practice revenue. Without the reimbursement headaches.

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