Medicaid and Telehealth Program Policies by State

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The Center for Connected Health Policy updates its mandate regarding telehealth, Medicaid, health professional regulations, and private payers by individual states every six months. The reader can find all updates via the policy finder. A survey conducted from June to September 2021 focused on three primary areas: Medicaid reimbursement, remote patient monitoring, professional regulation, and private payer laws.

How States Vary Regarding Medicaid Expansion of Extensions

The survey findings indicated that each state varies regarding its extension policies. Many have seen expansions regarding their pandemic policies stretch primarily into the next few years; some states have made these expansions permanent. Some states have garnered expansions, while others have been less permissive. Find out more regarding specific states’ policies here. 

The Connection Between Medicaid Reimbursements & Telehealth Policies

Different states rendered new telehealth policies under Medicaid regarding how telehealth can be delivered, the professionals who can render telehealth services, and which settings fall under telehealth communication. Moreover, less than half of Medicaid programs are reimbursing for telehealth service delivery while simultaneously having strict reimbursement protocols established. 

Many states have also modified their legal definition of telemedicine and telehealth regarding private payer reimbursements. Words like “interactive” may have more restrictions put into place. However, the range of terminology also broadened to include live videos and more modes of communication. In addition, the standards of how providers can utilize telehealth have now tightened.

Medicaid Reimbursement Regarding Remote Patient Monitoring & More

Live video is the most effective reimbursed form of telehealth services offered. Although live videos are most accepted, there are some restrictions in Medicaid reimbursements, including the type of provider offering the service, the setting, and types of telehealth service, such as consultations or office visits. Store-and-forward services are generally reimbursed for real-time delivery only yet may still face some limitations. Store-and-forward is being initiated in various states via CPT and CTBS codes to fit the description to be eligible for reimbursement. 

Remote patient monitoring (RPM) garners forms of reimbursement in 29 out of 50 states. However, most states that extend RPM have many restrictions, including limitations on the information to be collected, the type of monitoring devices utilized, which types can monitor symptoms, and only offering reimbursement to home health agencies. Although there are many restrictions regarding Medicaid reimbursements, there have been some expansions regarding reimbursement eligibility for telephone, audio-only, and email telehealth services, mainly due to the pandemic.

As mentioned above, CTBS codes, which CMS established, are still widely employed by many states, including remote evaluation of pre-recorded information, virtual check-ins, remote physiological monitoring codes, and audio-only service codes. Much of Medicaid grants CTBS codes recognizable under telehealth but garner Medicare’s coding for reimbursement eligibility.

Eligible Providers, Geographic & Facility Originating Site Restrictions

The eligibility of providers is another factor regarding Medicaid reimbursement. Although the providers are generally more narrowly defined, a broadening trend has been seen since spring 2021 to include allied professionals such as occupational and physical therapists, Rural Health Centers (RHC), and Federally Qualified Health Centers (FQHCs). However, since FQHCs and RHCs are organizations instead of individual providers, they are often deemed less eligible. Psychologists and social workers have long since been eligible. Counselors and Marriage and Family Therapists have not.

Telehealth services are now more accepted under the Medicare program in rural areas, but it is now more common that Medicaid programs are limited regarding originating sites. Some of these sites can include the home and even schools. The pandemic is the most common reason for flexibility in sites approved to offer telehealth services. The reader should note that some limitations are still imposed on these sites. They often only include speech, occupational, mental health, and physical therapy services. Read the full report here.

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