Comiere Telehealth Reimbursement & Medicaid

The Center for Medicare and Medicaid Services (CMS)’s official policy on telehealth allows states to reimburse for telehealth under Medicaid as long as it meets federal standards for efficiency, economy, and quality of care.

The bad news is that this means there are 50 different Medicaid programs (plus DC and the US territories). Here is the complete list of state Medicaid policies on telehealth.

The good news is Comiere will help you make sense of them

Telemedicine State Coverage

The main category of telemedicine is live video, and most state Medicaid programs cover live video telemedicine only. The only states to cover remote patient monitoring and store-and-forward as well are Alabama, Alaska, Minnesota, Mississippi, Nebraska, and Texas.

As the awareness of the advantages of telemedicine grows, however, coverage of a wider variety of telehealth categories is likely to increase.

Eligible Originating Sites

The originating site is where the patient is located at the time they receive the telemedicine service. Until recently, eligible originating sites were restricted to certain health facilities, generally situated within a Health Professional Shortage Area (HPSA). Fortunately, some 24 states and Washington, D.C., place no restriction on originating sites, and 25 states consider the patient’s home as an authorized originating site.

Applicable Providers

All states that reimburse for telemedicine cover telehealth delivery by physicians, but many state Medicaid programs are strict about the other categories of healthcare provider allowed to deliver telemedicine. Fortunately, 15 states as well as Washington, D.C., put no restrictions on the healthcare providers who may deliver telemedicine, and just 4 states limit coverage to physicians only.

Geographical Limits

Traditionally, state Medicaid programs refused to cover telemedicine unless patients lived in remote locations, far from health providers. In these cases, patients had to fulfil distance requirements or live in specific geographic areas before they would be eligible for telemedicine. Thankfully, this is changing, and 82% of states now offer state-wide telemedicine coverage with no geographical restrictions.

Reimbursement for Telemedicine

When reimbursing for Medicaid-covered telemedicine services, states are encouraged to offer innovative payment methodologies. States may reimburse the health-care provider at the distant site and reimburse a facility fee to the originating site for example, or they may reimburse additional costs such as equipment or technical support.

Such extra costs may be included in the fee-for-service rates or reimbursed separately as an administrative cost. They must be linked to an eligible Medicaid service if they are separately billed and reimbursed.