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State Coverage for Telehealth Services

State Coverage for Telehealth Services

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The rural health care workforce is stretched to its limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to these areas, the need outpaces the supply in many communities. Also, many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient.

For states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations or examinations between provider and patient. Telehealth is defined as “the use of technology to deliver health care, health information or health education at a distance.” The two types of telehealth applications are real-time communication and store-and-forward. Real-time communication allows patients to connect with providers via video conference, telephone or a home health monitoring device, while store-and-forward refers to transmission of data, images, sound or video from one care site to another for evaluation.

The most common path being taken by states is to cover telehealth services in the Medicaid program. In fact, 43 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services. Another avenue is for states to require private insurance plans to cover telehealth services. Nineteen states and the District of Columbia now require private insurance plans in the state to cover telehealth services. Arizona will join this list in January 2015.

 

States with Coverage for Telehealth Services

States with Coverage for Telehealth Services

 
State Medicaid Reimbursement for Telehealth? Private Insurance Reimbursement Required for Telehealth? Relevant State Statutes/Code
Alabama Yes.

All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients.

State Link
No. Ala. Admin. Code r. 560-X-6-.14
Alaska Yes.

The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients as provided in AS 47.07.

State Link
No. Alaska Admin. Code tit. 7, § 110.620
Arizona Yes.

Arizona Health Care Cost Containment System (AHCCCS) covers medically necessary services provided via telemedicine.

State Link
Yes. (Beginning January 1, 2015)
 
All contracts issued, delivered or renewed on or after January 1, 2015 must provide coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in‑person consultation between the subscriber and a health care provider and provided to a subscriber receiving the service in a rural region of this state.
Ariz. Rev. Stat. Ann. §36-3601 et seq.

Ariz. Rev. Stat. Ann. § 20-841.09
Arkansas Yes.

Arkansas Medicaid covers Federally Qualified Health Center (FQHC) encounters and two ancillary services (fetal echography and echocardiography) as "telemedicine" services.

Arkansas Medicaid defines telemedicine services as medical services performed as electronic transactions in real time.  In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time. 

State Link
No.  
California Yes.

No health care service plan shall require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan, and between the health care service plan and its participating providers or provider groups.
No. Cal. Business and Professions Code §2290.5

Cal. Health and Safety Code §1374.13
Colorado Yes.

In-person contact between a health care or mental health care provider and a patient shall not be required under the state's medical assistance program for health care or mental health care services delivered through telemedicine that are otherwise eligible for reimbursement under the program.
Yes. Colo. Rev. Stat. §10-16-102 

Colo. Rev. Stat. §10-16-123 

Colo. Rev. Stat. §25.5-5-320
Connecticut Yes.

Beginning Jan. 1, 2013, the Commissioner of Social Services may establish a demonstration project to offer telemedicine as a Medicaid-covered service at federally-qualified community health centers. Under the demonstration project, in-person contact between a health care provider and a patient shall not be required for health care services delivered by telemedicine that otherwise would be eligible for reimbursement under the state Medicaid plan program, to the extent permitted by federal law and where deemed clinically appropriate.

 
No. Conn. Gen. Stat. P.A. §12-109
Delaware Yes.

The Delaware Medical Assistance Program will reimburse for telemedicine-delivered services provided to Delaware Medicaid clients in order to improve access to behavioral health services and general health care services, including medical subspecialties not widely available in the state.

State Link
No.  
Florida Yes.

Under Florida’s 1915 (b) Managed Care Waiver, telemedicine is provided but limited to certain state plan covered services, and is only provided to Medicaid eligible children enrolled in the Children’s Medical Services Network (CMS) who reside in underserved areas of the state. Eligible providers include those CMS Network approved providers currently allowed to provide consultative and office visits within their licensed scope of practice. The services delivered to recipients via telemedicine are reimbursed to eligible providers on a fee-for-service basis, at the same rate as the Medicaid allowed fee for the service provided in a traditional face-to-face manner. Medicaid will not pay for the purchase or installation of the equipment, or for any technical support required for telemedicine. A State Plan amendment has been finalized allowing telemedicine as a modality for other services.
No.  
Georgia Yes.

Every health benefit policy that is issued, amended, or renewed shall include payment for services that are covered under such health benefit policy and are appropriately provided through telemedicine in accordance with Code Section 43-34-31 and generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. The coverage required in this Code section may be subject to all terms and conditions of the applicable health benefit plan.
Yes. Ga. Code Ann., § 33-24-56.4
Hawaii Yes.

No accident and health or sickness insurance plan that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. The coverage required in this section may be subject to all terms and conditions of the plan agreed upon among the enrollee or subscriber, the insurer, and the provider.

There shall be no reimbursement for a telehealth consultation between health care providers unless a health care provider-patient relationship exists between the patient and one of the health care providers involved in the telehealth interaction.
Yes. Hawaii Rev. Stat. §431:10A-116.3

Hawaii Rev. Stat. §432:1-601.5

Hawaii Rev. Stat. §432D-23.5
Idaho No.

Idaho Medicaid reimburses for telepsychiatry only.

State Link
No.  
Illinois Yes.

Physicians, advanced practice nurses, podiatrists, FQHCs, Rural Health Clinics (RHCs) and Encounter Rate Clinics (ERCs) will be allowed to render telemedicine services. In addition, telepsychiatry will be covered, when the physician rendering the service has completed either a general psychiatric residency program or a child/adolescent psychiatric residency program.

State Link 1

State Link 2
No. Ill. Rev. Stat. ch. 225, §60/49.5
Indiana Yes.

Telemedicine services are covered by the Indiana Health Coverage Programs (IHCP).

State Link
No. Ind. Code §12-15-5-11


405 IAC 5-38
Iowa Yes.

Iowa Medicaid conducted a legislatively mandated telemedicine pilot study between 1997 -
2000. Based on the lack of definitive data at the end of the pilot, the Legislature
discontinued that pilot program. In the wake of the telemedicine pilot, Iowa Medicaid has
not provided payment for telemedicine components (e.g. costs associated with the hardware, software, line charges, or related components associated with telemedicine) that are associated with the provision of otherwise covered services. However, Iowa Medicaid will pay for otherwise covered medical services if rendered via telemedicine, if the standard in the medical community would support rendering those services via telemedicine.

State Link
No.  
Kansas Yes.

Office visits, individual psychotherapy, and pharmacological management services may be reimbursed when provided via telecommunication technology. The consulting or expert provider must bill the codes listed below using the GT modifier and will be reimbursed at the same rate as face-to-face services.

State Link
No. Kan. Stat. Ann. §66-2001
Kentucky Yes.

The Cabinet for Health and Family Services and any regional managed care partnership or other entity under contract with the cabinet for the administration or provision of the Medicaid program shall provide Medicaid reimbursement for a telehealth consultation that is provided by a Medicaid-participating practitioner who is licensed in Kentucky and that is provided in the telehealth network established in KRS 194A.125(3)(b).

State Link
Yes. Ky. Rev. Stat. §194A.125(3)(b)

Ky. Rev. Stat. §205.559
Louisiana

Yes.

The State of Louisiana requires all health plans to cover telemedicine services and reimburse at no less than 75% of the "reasonable and customary amount of payment, benefit, or reimbursement which that licensed physician receives for an intermediate office visit."

State Link

Yes. La. Rev. Stat. Ann. §22:1821 

La. Rev. Stat. Ann. §37:1276.1
Maine Yes.

A carrier offering a health plan in this State may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the covered person and a health care provider.
Yes. Me. Rev. Stat. Ann. tit. 24-A §4316
Maryland Yes.
 
Yes.

 
Md. Insurance Code Ann. § 15-139
 
Md Health-General Code Ann. § 15-105.2
Massachusetts No. Yes. 2012 Mass. Acts, Chap. 224
Michigan Yes.

The Michigan Department of Community Health currently covers telemedicine services.

State Link 1
Yes.



State Link 2
2012 Mich. Pub. Acts, Act 214

2012 Mich. Pub. Acts, Act 215
Minnesota Yes.

Medical assistance covers telemedicine consultations. Telemedicine consultations must be made via two-way, interactive video or store-and-forward technology. Store-and-forward technology includes telemedicine consultations that do not occur in real time via synchronous transmissions, and that do not require a face-to-face encounter with the patient for all or any part of any such telemedicine consultation.

State Link
No. Minn. Stat. §256B.0625
Mississippi Yes. Yes. Miss. Code Ann. §25-15-9

Miss. Code Ann. §73-25-34
Missouri Yes.

Telehealth may be utilized to service individuals who are qualified as MO HealthNet participants under Missouri law. Reimbursement for such services shall be made in the same way as reimbursement for in-person contacts.

State Link
Yes. Mo. Rev. Stat. §208.670
Montana Yes.

Coverage of telemedicine services is treated like all other services.

State Link
Yes. 2013 Mont. Laws, Chap. 164

Mont. Code Ann. §37-3-342 et seq.
Nebraska Yes.

In-person contact between a health care practitioner and a patient shall not be required under the medical assistance program.

State Link
No. Neb. Rev. Stat. §71-8501 et seq.
Nevada Yes.

The Division of Health Care Financing and Policy (DHCFP) reimburses for telehealth services. The originating site must be located in either: a rural Health Professional Shortage Area (HPSA) or a county that is not included in a Metropolitan Statistical Area (MSA).

State Link
No.  
New Hampshire No. Yes. N.H. Rev. Stat. §415-J:1 et seq.
New Jersey No. No.  
New Mexico Yes.

Because the use of telehealth improves access to quality health care and will generally benefit the citizens of New Mexico, health insurers, health maintenance organizations, managed care organizations and third-party payors offering services to the citizens of New Mexico are encouraged to use and provide coverage for telehealth within the scope of their plans or policies. The state's medical assistance program is also encouraged to include telehealth within the scope of its plan or policy.

State Link
Yes. N.M. Stat. Ann. §24-25-1 et seq.

2013 N.M. Laws, Chap. 105
New York Yes.

Medicaid currently covers medically necessary physician specialist consultations provided via telemedicine to patients in Article 28 emergency rooms, hospital outpatient departments and hospital inpatient settings.

State Link
No.  
North Carolina Yes.

The North Carolina Division of Medical Assistance covers telemedicine and telepsychiatry for patients over 21 years old.

State Link
No.  
North Dakota Yes.

North Dakota Medicaid covers certain telehealth services.

State Link
No,  
Ohio No.

The state Medicaid program will reimburse for speech therapy provided by speech-language pathologists through the Medicaid School Program (MSP).
 
State Link
No.  
Oklahoma Yes.

For services that a health care practitioner determines to be appropriately provided by means of telemedicine, health care service plans, disability insurer programs, workers' compensation programs, or state Medicaid managed care program contracts issued, amended, or renewed on or after January 1, 1998, shall not require person-to-person contact between a health care practitioner and a patient.
Yes. Okla. Stat. tit. 36, §6803
Oregon Yes. Yes. Oregon Administrative Rule 410-130-0610
Pennsylvania Yes.

The Department of Public Welfare’s Medical Assistance Program has been expanded to include additional specialty physicians who will be able to perform consultations and diagnose patients, recommend and monitor treatment, and even order tests or prescribe medication.

State Link
No.  
Rhode Island No. No.  
South Carolina Yes.

South Carolina Medicaid covers a variety of telehealth services.
No.  
South Dakota Yes.

Telemedicine services provided to eligible South Dakota Medical Assistance Program recipients are limited to consultation services; follow-up office visits for established patients, and pharmacological management services. Coverage of telemedicine consultations is treated like any other consultation service as defined in the Physician’s Current Procedural Terminology (CPT).

State Link
No.  
Tennessee No.

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) allows providers to be reimbursed for the use of telehealth systems in the provision of crisis services.

State Link
No.  
Texas Yes.

A health benefit plan may not exclude a telemedicine medical service or a telehealth service from coverage under the plan solely because the service is not provided through a face-to-face consultation.

State Link
Yes. Tex. Government Code Ann. §531.0216

Tex. Government Code Ann. §531.02173

Tex. Insurance Code Ann. §1455.004
Utah Yes.

Medically necessary diagnostic and therapeutic services, appropriate for the adequate diagnosis or treatment of some special health care needs children, are covered services.

State Link
No. Utah Code Ann. §26-18-13
Vermont Yes.

All health insurance plans in this state shall provide coverage for telemedicine services delivered to a patient in a health care facility to the same extent that the services would be covered if they were provided through in-person consultation.

"Health insurance plan" means any health insurance policy or health benefit plan offered by a health insurer, as defined in 18 V.S.A. § 9402, as well as Medicaid, the Vermont health access plan, and any other public health care assistance program offered or administered by the state or by any subdivision or instrumentality of the state.
Yes.

 
Vt. Stat. Ann. tit. 8, §4100k
Virginia Yes.

The Virginia Department of Medical Assistance Services (DMAS) reimburses for telemedicine services under limited circumstances.

State Link
Yes.

Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall provide coverage for the cost of such health care services provided through telemedicine services, as provided in this section.
VA Code Ann. §38.2-3418.16
Washington Yes.

Fee-for-service clients are eligible for medically necessary covered health care services delivered via telehealth.
No.  
West Virginia Yes.

Under two conditions:
  • The consultation must involve real time consultation as appropriate for the member‘s medical needs and as needed to provide information to and at the direction of the consulting physician.
  • Medicaid coverage of teleconsultations is limited to members in non-metropolitan statistical professional shortage areas as defined by CMS. The referring provider must be located in the non-metropolitan area.

State Link
No.  
Wisconsin Yes.

Reimbursement for these services is subject to the same restrictions as face-to-face contacts (e.g., POS, allowable providers, multiple service limitations, PA).

State Link
No.  
Wyoming Yes.

Each site will be able to bill for their own services as long as they are an
enrolled Medicaid provider (this includes out-of-state Medicaid providers).

State Link
No. Wash. Rev. Code §33-26-102
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